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| CASE REPORT |
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| Year : 2022 | Volume
: 5
| Issue : 2 | Page : 30-32 |
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Laparoscopic right hemicolectomy for 13 cm ileo ascending intussusception in a young female
Bijendra Kumar Sinha
Department of Minimal Access, Bariatric and GI Surgery, Neotia Hospital, Siliguri, West Bengal, India
| Date of Submission | 06-Jun-2021 |
| Date of Decision | 22-Jun-2021 |
| Date of Acceptance | 15-Oct-2021 |
| Date of Web Publication | 04-Jan-2023 |
Correspondence Address:
Dr. Bijendra Kumar Sinha
Department of Minimal Access, Bariatric and GI Surgery, Neotia Hospital, Siliguri, West Bengal
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijcs.ijcs_16_21
Intussusception is relatively common in children in comparison to adult. Only 1% of adult shows symptoms of bowel obstruction, in which most of the cases, malignancy is responsible. Herein, I present an extremely unusual case of intussusception that occurred in a young female who had gangrenous ileum inside the ascending colon with multiple enlarged lymph nodes around the terminal ileum. A 32-year-old female patient was diagnosed with the 13 cm ileo ascending intussusception with the complaint of not passing flatus and motion, severe pain abdomen, and vomiting for 3 days. Abdomen was distended. She had mild pain abdomen for 3 months. Computed tomography scan revealed 13 cm intussusception of ileo ascending. Laparoscopic right hemicolectomy was performed and revealed dense adhesion at the ileum and ascending region with gross dilatation of the ileum. No neoplastic lesions were observed in the resected tissue of the lead part of intussusception. The postoperative clinical course was favorable and the patient was discharged on day 6 after surgery. There are no reports of 13 cm intussusception as observed in the present case. Intussusception should thus be considered as one of the causes due to multiple lymph nodes in adults also.
Keywords: 13 cm ileo ascending intussusception, hemicolectomy, laparoscopic
How to cite this article:
Sinha BK. Laparoscopic right hemicolectomy for 13 cm ileo ascending intussusception in a young female. Indian J Colo-Rectal Surg 2022;5:30-2 |
| Introduction | |  |
Intussusception in adults is rare usually occurs as a complication due to malignancy. I report a case of intussusception that could be because of multiple large lymph nodes (more than 2 cm) at the area of the ileum.
| Case Report | | |
A 32-year young newly married female came with the chief complaint of not passing flatus and motion with severe pain abdomen and vomiting. No significant dietary habit changed, No family history of any disease, No medical history of any disease. She was presented in an emergency with acute abdomen.
Hematological analysis revealed white blood cell: 12,000/μ, hemoglobin: 9.3 g/dl, platelet count: 12.5 × 104, carcinoembryonic antigen: 3.3, and cancer antigen: 19.9–11.1.
Results were not significant.
Computed tomography revealed 13 cm ileo ascending intussusception with multiple enlarged lymph nodes at the ileum [Figure 1].
Laparoscopic right hemicolectomy was done with two 10 mm and two 5 mm ports. Ileo cecal area was found grossly edematous and adherent to the retroperitoneal area with multiple enlarged lymph nodes [Figure 2]. Gross dilatation of the ileum was noted which was edematous also. Lateral-to-medial mobilization of the ascending colon was performed and ileocecal area was separated from the retroperitoneum. Ileocolic artery and vein were clipped and divided. Mesentery was divided and duodenum was separated from the transverse colon. Ileum ascending colon and part of transverse colon were resected laparoscopically and side-to-side anastomosis done extra corporeal after 3 cm supraumbilical incision. The surgery was completed [Figure 3] and [Figure 4].
Histopathological examination showed gangrenous ileum inside the ascending colon; the patient was discharged on day 6 postoperative.
| Discussion and Conclusion | | |
Intussusception in adults is rare[1] Almost 90% of adults are associated with specific etiology, in which 19-42% are caused by malignancy and 22%–41% are attributed to benign.[2]
In the present case, the young newly married female diagnosed with 13 cm ileoascending intussusception, so decided to go with laparoscopic right hemicolectomy.
Although the whole of the terminal ileum was completely engulfed in ascending colon, Intussusception reduction attempt was failure so then decided to go for laparoscopic right hemicolectomy.
Contraction of the left side of the colon can be of short duration 4–6 cm/min lasting for 10 s and long duration 0.5–2 cm/min lasting for 1 min. However, contraction in the right-side colon differs from the left-side colon. Mass and vertical contraction 12 × 180 cm/min last for 1 min in the right-side colon.
Right-side colon contraction was 2–3 times stronger than the left side.
Mass peristalsis of the right colon happens without required physical stimulation.[3]
Hence, it is relatively easy for intussusception to occur on the right side. In the present case, although it was very difficult to identify the cause, it may be possible because of multiple lymph nodes found in the ileum.
The peristalsis of the ileum is stronger than the colon.[4]
Intussusception in adults is often caused by tumors and they are rarely caused by other factors.[5] To the best of my knowledge, no studies have reported a case of 13 cm of ileo ascending intussusception as reported in the present case.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Zubaidi A, Al-Saif F, Silverman R. Adult intussusception: A retrospective review. Dis Colon Rectum 2006;49:1546-51.  |
| 2. | Smith MA, Dent DM, Botha JB. Intussusception in adults. S Afr J Surg 1978;16:139-43. |
| 3. | Stein JH. Internal Medicine, Stein. 5 th ed. St. Louis, Missouri: Mosby Inc.; 1998. p. 1976-80. |
| 4. | Azar T, Berger DL. Adult intussusception. Ann Surg 1997;226:134-8. |
| 5. | Masuda H, Hayashi S, Nakamura Y, Horiuchi H, Watanabe K, Hayashi I, et al. Intussusception in adult. Nihon Univ J Med 1992;34:179-89. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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