J Korean Surg Soc.  2012 Dec;83(6):397-402. 10.4174/jkss.2012.83.6.397.

Laparoscopic colectomy of colonic intussusceptions in adults

• Kim BS
• Kang KH
• Park HC
• Lee BH

• KMID: 1437542
• DOI: http://doi.org/10.4174/jkss.2012.83.6.397

Abstract

Adult intussusception is a rare entity. Most adult intussusceptions require surgical intervention because they have a high rate of pathologic leading point. Mandatory laparotomy and en bloc resection is recommended in colonic intussusceptions due to the possibility of malignancy. We report herein 3 cases of adult colonic intussusceptions. The intussusceptions were located in the sigmoid and rectum, which were managed by laparoscopic colectomy. Case 1 was managed by laparoscopic anterior resection and diverting ileostomy combined with perineal reduction. Perineal approach facilitated laparoscopic reduction. In case 2, intraoperative colonoscopy was performed to determine the distal resection margin. Intraoperative colonoscopy showed edematous bowel mucosa as well as leading point after reduction of intussusceptions. Case 3 showed asymptomatic transient rectorectal colonic intussusceptions.

Keyword

Adult; Intussusception; Colon; Laparoscopy

MeSH Terms

Adult
Colectomy
Colon
Colon, Sigmoid
Colonoscopy
Humans
Ileostomy
Intussusception
Laparoscopy
Laparotomy
Mucous Membrane
Rectum

Figure

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  Fig. 1 Flexible sigmoidoscopy showed the mass lesion 7 cm from the anal verge and the partial downward displacement of involved bowel.

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  Fig. 2 Computed tomography scans showed bowel-within-bowel mesenteric fat and vessel appearance (arrow) with wall thickening representing tumor (arrowhead).

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  Fig. 3 Computed tomography scans demonstrated enlargement of the colorectal wall and fat within the intussusceptum, and air within the intussuscipiens.

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  Fig. 4 Flexible sigmoidoscopy showed invaginated bowel with polypoid mass lesion about 10 cm from anal verge.

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  Fig. 5 Bowel mucosa after reduction of intussusception. Intraoperative colonoscopy showed polypoid mass about 17 cm from anal verge (arrow) and mucosal edema and congestion in intussuscipiens (arrowthead).

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  Fig. 6 Hemolock clip (arrow) and colonoscopic light (arrowhead) at distal portion of mass.

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  Fig. 7 Computed tomography scans demonstrated irregular enhancing wall thickening at upper rectum with rectorectal intussusception.

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