Combined Ileoileal and Ileocolic Intussusception Secondary to Inflammatory Fibroid Polyp in an Adult: A Case Report

Rare "ileum-ileum-colon type" adult intussusception caused by Meckel's diverticulum inversion: A case report

RATIONALE

Ileum-ileum-colon intussusception constitutes a small proportion of the classification of intussusception. Both adult intussusception and Meckel's diverticulum are rare clinical entities, with few reports documenting Meckel's diverticulum inversion leading to ileum-ileum-colon intussusception in adults.

PATIENT CONCERNS

A 33-year-old Chinese male presented with intermittent abdominal pain persisting for 1 month, that had intensified over the preceding day.

DIAGNOSES

Abdominal computed tomography revealed intussusception, suspected to be secondary to a small intestinal lipoma.

INTERVENTIONS

Emergency laparotomy was performed, during which the ileum, located approximately 70 cm from the ileocecal region, was found to be invaginated into the terminal ileum and subsequently into the ascending colon, reaching the hepatic flexure. An inverted Meckel's diverticulum was at the forefront of the intussusception. Surgical resection of the diverticulum, terminal ileum, and cecum was performed, followed by an end-to-side anastomosis of the ileum and colon.

OUTCOMES

The patient was discharged on postoperative day 7 without complications. During a 1-month follow-up, the patient reported no discomfort and exhibited normal bowel movements.

LESSONS

Adult intussusception of the "ileum-ileum-colon type" resulting from inverted Meckel's diverticulum is exceedingly rare and poses challenges for preoperative diagnosis. Prompt surgical intervention can lead to favorable outcomes in patients. During surgery, the initial step should involve attempting reduction of the intussusception while ensuring that the intestine is preserved as much as possible to maintain intestinal function.

Malignant Ileocolocolic Intussusception in a 19-Year-Old Male

Adult intussusception is an infrequent occurrence typically resulting from an identifiable lead point of a benign or malignant etiology. Here, we present a case of a 19-year-old male who presented to the emergency department with complaints of abdominal pain, intractable nausea, and fluctuations between bloody diarrhea and constipation. These symptoms had begun two months prior and had increased in severity, resulting in significant appetite changes. An abdominal and pelvic computed tomography scan without contrast was obtained, which showed evidence of intussusception of the ileocecum into the transverse colon with resultant small bowel obstruction. The patient underwent an exploratory laparotomy, which resulted in a partial ileocolectomy due to the presence of a 6.8 cm cecal mass with palpable mesenteric lymphadenopathy. The pathologic specimen was identified as Burkitt lymphoma based on a combination of histologic, immunohistochemical, and fluorescence in situ hybridization findings. Currently, the patient is undergoing three cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (R-CODOX-M/IVAC) per Magrath protocol for low-risk Burkitt lymphoma.

A feeding jejunostomy causing an intussusception – case report and literature review

Use of enteral nutrition has increased dramatically over the past two decades due to improved nutritional formulas, better quality feeding tubes and the ability to use less invasive endoscopic, fluoroscopic and laparoscopic techniques. Intussusception accounts for 1–5% of adult intestinal obstructions, with feeding tubes acting as a lead point in < 1% of cases. Since intussusception is rare, especially in adults, it is not always considered in the initial differential diagnosis of patients presenting with abdominal pain, nausea, vomiting or constipation. If left untreated, intussusception can eventually lead to bowel compromise, poor outcomes and even death. Therefore, prompt recognition and correction are necessary. We present a case of small bowel obstruction in an elderly male secondary to a tube-related intussusception. A review of the signs, symptoms and treatment recommendations is provided.

Intussusception Related to Small Intestinal Lipomas: A Case Report and Review of the Literature

INTRODUCTION

Adult intussusception is a rare disease that is difficult to diagnose and treat and is even rarer when it is caused by a lipoma of the small intestine. We reported a case of a small intestine lipoma combined with intussusception, which can guide people in future clinical work.

CASE PRESENTATION

A 51-year-old female was admitted to the hospital with "abdominal pain for 1 month." Enhanced computed tomography (CT) of the abdomen suggested a lipoma in the left lower quadrant and a proximal intussusception. After excluding surgical contraindications, laparoscopic exploration was performed on the second day of admission, which showed a small amount of ascites in the abdominal cavity, a small intestine-small intestine-type intussusception about 20 cm from the ileocecal area and about 140 cm from the ileocecal area, and a mass of about 2×4 cm that was palpable by laparoscopic intestinal forceps, which was protruded into the intestinal cavity with a soft texture and sound mobility. A 5 cm-long incision was made above the mass to dissect into the abdomen layer by layer, and the diseased intestine was dislodged outside the abdominal cavity with oval forceps. The intestine was reduced by hand and observed for half an hour after reduction, and the blood circulation and peristalsis of the intestine were observed to be still sound. The intestine was dissected at 2 cm from the upper and lower margins of the mass using linear anastomosis to operate small intestine side-to-side anastomosis. The intestine was opened concurrently and closed with a linear anastomosis, using 3-0 absorbable thread to reinforce anastomosis intermittently. The procedure went smoothly, and the patient was discharged on the 5th postoperative day.

CONCLUSION

A small intestinal lipoma combined with small intestinal intussusception is rare in clinical practice and needs to be diagnosed by asking history detailedly, physical examination, and relevant ancillary tests such as abdominal CT. Laparoscopic-assisted small incision surgery for adult intussusception combines the advantages of laparoscopic surgery and laparotomy, operating simply and easily.