Adult colo-colonic intussusception caused by congenital bands: A case report and literature review

Colocolic intussusception with intestinal obstruction in adults secondary to a colonic lipoma

We report the case of a woman in her early 60s, who presented with colocolic intussusception, leading to acute large bowel obstruction. The patient presented with colicky abdominal pain, diarrhoea mixed with blood and mucous and raised inflammatory markers. Abdominal examination revealed mild tenderness in the left lower abdomen. The CT scan reported colocolic intussusception extending from proximal to mid-sigmoid colon, with early ischaemic changes. The patient underwent laparoscopy-assisted sigmoid colectomy with an end colostomy and an uneventful postoperative recovery. Histopathological examination identified a benign colonic lipoma, with ischaemic and necrosed intussuscepted colonic segment. Intestinal intussusception is rare in adults and only accounts for 1% of the cases of intestinal obstruction in adults, mostly caused by a pathological lead point like colonic adenocarcinoma or a benign lipoma. Due to the potential risk of malignancy, radiological decompression is not advisable in adults, and en bloc resection of the intussuscepted segment is recommended.

Duodenal obstruction due to two congenital bands: a case report and literature review

Introduction

Anomalous congenital bands are a rare cause of intestinal obstruction, with only five previously reported cases involving duodenal obstruction. We present a fifth case of duodenal obstruction due to two congenital bands and provide a comprehensive literature review summarizing the clinical features of this condition.

Case report

An eight-year-old girl was admitted to our department with recurrent bilious vomiting and abdominal pain lasting six days. She had no significant past medical history, with no previous abdominal surgeries or trauma. Physical examination revealed abdominal tenderness and decreased bowel sounds. Contrast x-ray showed an obstructed passage of contrast through the third part of the duodenum. Abdominal ultrasound identified a strip-like hypoechoic structure compressing the third part of the duodenum. A diagnosis of duodenal obstruction was confirmed, and laparoscopic surgery combined with gastroduodenoscopy was performed. The procedure revealed two congenital bands adjacent to the duodenum: one extending from the duodenum to the transverse colon, and the other from the duodenum to the root of the mesentery. The bands were resected, and gastroduodenoscopy confirmed the resolution of the obstruction.

Discussion

We reviewed 93 cases of anomalous congenital bands, including the present one, comprising 33 adults and 60 children, with 71.0% of the cases involving males. Common symptoms included vomiting and abdominal pain, with physical examinations often showing tenderness and distension. Imaging techniques like plain x-ray, contrast x-ray, ultrasound, and computed tomography often indicated intestinal obstruction but were less effective in directly identifying congenital bands. All cases required abdominal surgery for diagnosis and treatment. Congenital bands were primarily found attached to the ileum or its mesentery and were resected in all cases, with a favorable postoperative prognosis. This case and the literature review provide valuable insights for clinical diagnosis and treatment.

Invaginación sigmoidea en un adulto. ¿Está indicada la reducción endoscópica preoperatoria?

Introducción. La invaginación intestinal o intususcepción es el deslizamiento de una parte del intestino dentro de otra adyacente. Es la causa más común de obstrucción intestinal en niños entre 3 meses y 6 años de edad, con una baja incidencia en adultos, correspondiente al 1 % del total de los cuadros obstructivos en el adulto. Su localización en colon es poco frecuente, pero conviene prestar especial atención por su asociación a lesiones malignas. Caso clínico. Varón de 39 años que acude a Urgencias con cuadro de obstrucción intestinal secundario a una invaginación en sigmoide. Se intenta reducción endoscópica, sin éxito, por lo que se indicó cirugía urgente, realizando sigmoidectomía y anastomosis colorrectal. El resultado anatomopatológico informó un adenoma de gran tamaño como causante de la invaginación. Conclusión. Existen controversias respecto al manejo endoscópico en invaginación intestinal en los adultos, especialmente en el colon, debido al elevado porcentaje de etiología tumoral maligna, recomendándose actualmente la resección en bloque sin reducción, para minimizar el riesgo de potencial siembra tumoral.