Adult intussusception with cecal adenocarcinoma: Successful treatment by laparoscopy-assisted surgery following preoperative reduction

A Rare Case of Cecal Adenocarcinoma Presenting as Intussusception

Colorectal cancer is widely recognized as one of the most common types of cancer worldwide. The management and outlook for colorectal cancer depend on its specific characteristics and how it presents clinically. Despite the identification of various risk factors and causes, cecal carcinoma, a type of colorectal cancer, is infrequent in Western populations under 50 years of age, and little research has been conducted on its epidemiology. Additionally, intussusception, a medical condition where one part of the intestine slides into another, is relatively rare among younger individuals. In this case report, we present a 36-year-old male who presented with abdominal pain. A physical exam revealed mild right-sided and peri-umbilical tenderness. A computed tomography scan of the abdomen and pelvis with contrast revealed long segment intussusception involving the terminal ileum and cecum. The patient underwent a reduction of intussusception and hemicolectomy. He was diagnosed with invasive cecal adenocarcinoma with metastasis to lymph nodes. He was started on chemotherapy and has been following as an oncology outpatient.

Cecal Adenoma Presenting as a Large Bowel Intussusception in an Adult

An adult intussusception is a relatively rare entity and is more commonly confined to the small bowel when it is found. The majority of the colonic intussusceptions in adults are caused by malignant neoplasms. Here we present the case of a 65-year-old female with a cecal adenoma as the lead point causing intussusception all the way to the splenic flexure. Controversy still exists regarding optimal treatment strategies, specifically the question of if it is safe or not to perform preoperative reduction prior to surgical resection in adult large bowel intussusceptions.

Potential Therapeutic Approaches for the Intussusception Through a Side-to-Side Jejunojejunal Anastomosis After Laparoscopic Gastrectomy

We reviewed our experience with the management of intussusception presenting as a complication of laparoscopic gastrectomy (LG) and studied the feasibility of a laparoscopic intervention to treat or prevent this condition. We retrospectively analyzed the data of 12 patients diagnosed with intussusception, following gastrectomy, from 2008 to 2017, including clinical manifestations, incidence, post-LG time-interval before diagnosis, and treatment. Totally, 12/2300 gastrectomy patients (0.52%) developed intussusception. All 12 had undergone laparoscopic distal gastrectomy for gastric cancer (12/1250, 0.96%) and presented with intussusception through a side-to-side jejunojejunal anastomosis. The mean latency period was 423.8 (range: 86 to 1500) days. Four patients underwent emergent laparoscopic reduction of the efferent loop without bowel resection, along with fixation of the reduced jejunum to the afferent loop and the small bowel mesentery, to prevent a recurrence. One patient required open surgery with manual reduction and segmental resection of the gangrenous small bowel portion. All operated patients recovered without any complications. Intussusception resolved spontaneously in the remaining 7/12 patients. We found that a laparoscopic approach can be used for preventing or managing post-LG intussusception. We found that recurrence can be prevented or treated by anchoring and fixing the (reduced) efferent loop to the afferent loop and the small bowel mesentery.

Synchronous ileal inflammatory fibroid polyp and Meckel's diverticulum found during laparoscopic surgery for adult intussusception

We present a rare case of synchronous ileal inflammatory fibroid polyp and Meckel’s diverticulum detected during laparoscopic surgery for adult intussusception. A 48-year-old woman presented with sudden onset of severe abdominal pain. Abdominal computed tomography revealed a segment of ileocecal intussusception. Thus, laparoscopic exploration was performed, which revealed an ileal mass with an outpouching closed luminal structure in the distal ileum. Two abnormal structures were resected via mini-laparotomy, and the patient was discharged without postoperative complications. Histopathological examination confirmed an ileal inflammatory fibroid polyp and Meckel’s diverticulum with ectopic pancreatic tissue.

Single-incision laparoscopic surgery for jejuno-jejunal intussusception caused by an angiolipomatous polyp in an adult: A case report

RATIONALE

Small bowel intussusception in adults is rare but is more likely to occur in the presence of a lead point. Surgical intervention is necessary in most cases, even if there is successful nonsurgical reduction of the intussusception.

PATIENT CONCERNS

A 54-year-old woman who was transferred to our emergency room with complaints of intermittent cramping pain of 4 days' duration.

DIAGNOSIS

Abdominal contrast-enhanced computed tomography revealed a jejuno-jejunal intussusception due to an angiolipomatous polyp.

INTERVENTION

A single-incision laparoscopic surgery (SILS) was performed without the need for any additional incisions.

OUTCOMES

She was uneventfully discharged on postoperative day 4.

LESSONS

The SILS procedure with adequate preoperative diagnosis by CT, with or without US, can offer good clinical outcomes for small bowel intussusception. Even surgeons who have little experience with laparoscopic intestinal anastomosis can consider SILS to treat small bowel intussusception in adults.

Laparoscopic surgery for idiopathic adult intussusception successfully reduced by colonoscopy

Most cases of adult intussusception are caused by neoplastic lesions, and idiopathic adult intussusception is very rare. We present a case in which laparoscopic surgery was performed for idiopathic adult intussusception initially reduced by colonoscopy. A 53-year-old woman presented to the emergency department of our hospital with intermittent lower abdominal pain. Contrast-enhanced computed tomography and ultrasonography of the abdomen showed a concentric structure in the ascending colon. We diagnosed intussusception. Colonoscopy achieved successful reduction before surgery. Twelve days after this reduction, laparoscopic surgery was performed. Histopathological examination did not reveal any causative pathology; therefore, idiopathic adult intussusception was diagnosed. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. Preoperative colonoscopy should be utilized to diagnose the main lesion and may be useful for reducing adult intussusception. Laparoscopic surgery is both minimally invasive and safe and can be performed following endoscopic reduction.

Recurrent intestinal intussusception in an adult due to intestinal pseudopolyps not associated with inflammatory bowel disease: a case report

INTRODUCTION

Intestinal intussusception is very rare in adults and, unlike in children, it is due to an organic cause, mainly benign or malignant tumors, in 90 % of cases. Recurrent intussusception in an adult is even more exceptional, and in the case reported it was due to repeated occurrence of intestinal pseudopolyps, which is exceptional according to the literature. Preoperative diagnosis is difficult, and surgery is always indicated because a tumor is usually present. The surgical procedure may be controversial, as some would prefer desintussusception before resection, while others would advocate initial resection because of the risk of dissemination if a malignant lesion exists.

CASE PRESENTATION

We report the case of a 34-year-old Caucasian man who underwent emergency laparoscopic surgery for intestinal obstruction and was found to have a jejunal intussusception. Polyps or pseudopolyps, some of them large and causing the intussusception, were seen in the surgical specimen. Our patient had also undergone surgery for intussusception 10 years before, after which the pathological report also noted the presence of these formations.

CONCLUSIONS

Recurrent intussusception in adults due to the presence of intestinal pseudopolyps is exceptional and, to the best of our knowledge, this is the first such case reported.

Cecal adenocarcinoma presenting as colonic intussusception in adulthood

Intussusception occurs when a proximal segment of intestine invaginates into a distal segment. It is a common cause of intestinal obstruction in children but is infrequent in adults. A 77-year-old woman presented with a 1-month history of intermittent abdominal pain associated with nausea and distended abdomen. Imaging showed a complex elongated sausage-shaped mass in the transverse colon with no obstructive pattern or free air. Surgery confirmed colonic intussusception in addition to a palpable cecal mass requiring a right hemicolectomy. Histologic study demonstrated adenocarcinoma in situ within a tubulovillous adenoma. Surgical excision of the affected intestine is the recommended treatment of choice.

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.

Laparoscopic-assisted resection of jejunojejunal intussusception caused by a juvenile polyp in an adult

Most bowel intussusceptions in adults have a leading point. However, there have been few reports of jejunojejunal intussusception secondary to a solitary juvenile polyp in adult. We report herein the case of a 19-year-old female with a solitary juvenile polyp in the jejunum causing intussusception. Laparoscopic-assisted reduction and segmental resection of the jejunum were successfully done for the patient.