Laparoscopic right hemicolectomy for ileocolic intussusception secondary to caecal neoplasm

Mucinous appendix intussusception: Case report

INTRODUCTION AND IMPORTANCE

Intussusception is an intestinal invagination of one bowel segment into another. It occurs mostly in children, but it can show in adults due to different etiologies. Appendiceal neoplasms are rare and can mimic an acute onset of appendicitis. Appendiceal mucinous neoplasm is one of the subtypes of appendiceal malignancies found in less than 1 % of appendectomies samples.

CASE PRESENTATION

We present the case of a 32-year-old woman with abdominal pain in the right upper quadrant, whose computed tomography revealed an ileocolic intussusception and a low-density tubular image in the distal loop. She underwent diagnostic laparoscopy and laparoscopic right colectomy. Biopsy results confirmed a LAMN with acute appendicitis and intussusception.

CLINICAL DISCUSSION

Appendiceal intussusception (AI) is associated with the alteration of peristalsis, in addition to multiple inflammatory conditions and diseases such as parasites, foreign bodies, Crohn's disease, and lymphoid hyperplasia. The pathophysiology of AI is not fully established, but the main appendicular alteration that has been associated with it is the presence of a tumor. AI lead points are typically pathological in 90 % of cases, 65 % of which are neoplastic in nature. Right hemicolectomy should be performed for tumors involving the periappendicular area or in those larger than 2 cm in size. Follow-up and surveillance colonoscopy is suggested.

CONCLUSION

Intussusception is a rare diagnosis in adults. However, malignancy should be suspected if identified.

Bleeding Edge Therapy: Ileocolic Intussusception Due to Ileocecal Valve Adenocarcinoma and Its Management in an Adult Patient-Case Report and Literature Review

Adenocarcinoma as the primary cause of bowel intussusception is uncommon. We describe the case of a 86-year-old patient admitted for ileocecal intussusception due to the presence of adenocarcinoma, located in the ileocecal valve and right colon. The etiologies of intussusception, its diagnosis, and conservative or surgical treatments are discussed, with attention placed on the indications for reduction of the invagination prior to surgical resection.

Manual laparoscopy-assisted intraoperative reduction for adult ileocolic intussusception with ileal adenoma: A case report

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Adult intussusception is a rare condition with a pathological lead point.

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Manual intraoperative reduction of adult intussusception is safe and can eliminate the need for extensive or invasive resection.

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Laparoscopy is a beneficial and minimally invasive technique for patients with intussusception.

Introduction

Adult intussusception is a rare condition with a pathological lead point. Intraoperative reduction of adult intussusception can eliminate the need for extensive or invasive resection. We safely performed a manual laparoscopy-assisted intraoperative reduction that allowed functional preservation of tissue.

Presentation of case

A 70-year-old woman with dull right lumbar pain at regular intervals and right lower quadrant abdominal tenderness was admitted to our hospital. The ileum exhibited enhanced wall thickening and invagination into the ascending colon on computed tomography. Emergency laparoscopic surgery was chosen to treat the ileocolic intussusception. First, the right colon was mobilized. Second, the ileocecal region was pulled through a 4-cm right pararectus incision. Third, the edge of the intussusceptum was gently manipulated back upstream without tearing. After reduction, a soft mass was recognized on palpation at the lead point, located 10 cm proximal to the ileocecal valve. Ileocecal resection was performed, and a laterally spreading tumor was observed in the resected specimen. The histological diagnosis was high-grade tubular adenoma. The postoperative course was uneventful.

Discussion

Adult intussusception has a pathological lead point, and curative treatment generally includes resection of the lesion. Complete or partial intraoperative reduction can avoid or shorten bowel resection and allow functional preservation of the tissue.

Conclusion

Manual laparoscopy-assisted intraoperative reduction with a minilaparotomy was safely performed, which eliminated the need for extensive or invasive resection.

Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception

BACKGROUND

Bowel intussusception represents an infrequent and challenging condition in adult patients. Preoperative diagnosis and treatment strategies often remain difficult especially in emergency patients. Primary reduction of intussusception before surgical resection is discussed controversially in adult patients and at the moment there is no consensus about the best treatment in literature.

CASE REPORT

We report the case of a 40-year-old male patient with a ten-day history of increasing colicky abdominal pain and constipation associated with nausea and vomiting. Clinical examination revealed acute abdomen with a palpable mass in the right upper abdomen. Ultrasonography and CT-scan showed typical signs of bowel intussusception. Emergency laparotomy and extended right hemicolectomy were performed. Histological examination detected an adenocarcinoma of the ileocecal valve as leading pathology.

CONCLUSIONS

In adults most cases of intussusception are caused by structural lesions. The high incidence of malignancies in adult patients, which require an optimal oncological treatment, should be the main reason for primary surgical resection without reduction.