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Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Ileocecal colonic intussusception with adenocarcinoma: A rare case report and management strategy
Mohamed Ali Chaouch1, Wassim Touir1, Maissa Jellali1
1Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
Insights
Adult intussusception is rare, often caused by underlying conditions like cancer. This case highlights a 73-year-old female with ileocecal intussusception and adenocarcinoma, emphasizing early diagnosis and multidisciplinary care for better outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Radiology
Background:
- Intussusception is rare in adults, unlike in pediatric populations.
- Adult intussusception often presents with diverse symptoms and requires a thorough diagnostic workup.
- Identifying the underlying cause is critical for appropriate management.
Observation:
- A 73-year-old female presented with symptoms of intussusception.
- Multi-detector computed tomography (MDCT) revealed ileocecal intussusception with characteristic imaging findings.
- Pathological examination confirmed cecal adenocarcinoma as the lead point.
Findings:
- The patient underwent emergency laparoscopic right colectomy due to compromised blood supply.
- Postoperative complications, including an anastomotic leak, were managed effectively.
- The adenocarcinoma was staged as T3N1aM0, requiring adjuvant chemotherapy.
Implications:
- This case emphasizes the importance of early diagnosis and a multidisciplinary approach in managing adult intussusception.
- Prompt surgical intervention and meticulous postoperative care are crucial for favorable outcomes.
- Awareness of adenocarcinoma as a potential lead point in adult intussusception is vital.
Introduction And Importance:
Intussusception, a condition primarily seen in pediatric populations, involves the telescoping of one segment of the bowel into an adjacent section. In adults, intussusception is rare and presents unique diagnostic and management challenges. This case report highlights a 73-year-old female with ileocecal colonic intussusception complicated by an underlying adenocarcinoma, emphasizing the need for early diagnosis and a multidisciplinary approach.
Case Presentation:
A 73-year-old female with a history of hypertension and type 2 diabetes presented with right-sided abdominal pain, nausea, and vomiting. Physical examination revealed tenderness in the right upper quadrant, and no palpable mass or rectal bleeding. Lab results, including tumour markers, were normal. Multi-detector computed tomography (MDCT) identified ileocecal colonic intussusception with the "target sign" and low colonic wall enhancement. An emergency laparoscopic right colectomy was performed due to compromised blood supply. Postoperatively, an anastomotic leak was managed with antibiotics, bowel rest, and wound care. Pathological examination revealed cecal adenocarcinoma with one positive lymph node, staged as T3N1aM0, necessitating adjuvant chemotherapy.
Clinical Discussion:
Adult intussusception, a rare condition, often has an identifiable organic cause, with clinical symptoms ranging from acute to chronic or asymptomatic. Diagnostic imaging, such as MDCT, plays a crucial role in diagnosis and evaluation. Surgical management varies based on the nature and location of the lead point. In this case, the chronic symptoms, lymph node as the lead point, and low colonic wall enhancement warranted an urgent laparoscopic right colectomy with complete mesocolic excision.
Conclusion:
This case underscores the complexity of adult ileocecal colonic intussusception, especially when associated with adenocarcinoma. Timely diagnosis, multidisciplinary collaboration, and meticulous surgical intervention are essential. Effective management of postoperative complications, like the anastomotic leak, is crucial.
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