Sigmoidorectal intussusception of adenoma of sigmoid colon treated by laparoscopic anterior resection after sponge-on-the-stick-assisted manual reduction

We present herein a case report of sigmoidorectalintussusception as an unusual case of sigmoidadenomatous polyp.The patient was a 56-year-oldman who suffered from rectal bleeding for one day.He initially visited his general practitioner and wasdiagnosed as having an intraluminal mass of 15 cmfrom the anal verge.Several hours after admission toour coloproctology clinic,he suddenly presented withlower abdominal cramping pain with rectal bleedingduring his bowel preparation using polyethylene glycolelectrolyte solution.An emergency colonoscopy revealedthat the invaginated colon with polypoid mass wasprotruded to the lower rectum.Gastrograffin enemashowed that the invaginated bowel segment was 3 cmfrom the anal verge.CT scan showed the typical findingof intussusception.We performed laparoscopic anteriorresection and anastomosis after the sponge-on-the-stick-assisted manual reduction.The permanent pathologicfinding showed villotubular adenoma of the sigmoidcolon.     

Colocolic intussusception

Summary 1. Colocolic intussusception in the adult is almost always a complication of pre-existing colonic disease, usually carcinoma or polypoid tumor.2. The cupola- or meniscus-shaped deformity associated with a temporary or high-grade obstruction is the most reliable indication of colocolic intussuception. When such a deformity is encountered, the fluoroscopist should be immediately alerted to the possibility of an underlying tumor.3. The roentgenographic findings in 18 cases of colocolic intussusception are reviewed and suitably illustrated case material presented.4. Benign tumors were the cause of colocolic intussusception in 6 of the 18 cases in our series, indicating a good prognosis in a substantial percentage of cases with colocolic intussusception. Lipomas of the colon were present in 5 cases in this series. In the sixth case a benign adenoma was the underlying cause.     

Cholecystojejunostomy intussusception

Intermittent prolapse of a jejunal loop into the gallbladder lumen was observed following cholecystojejunostomy in a patient with advanced carcinoma of the pancreas. This unusual complication was documented by cholangiography and sonography.     

Primary appendiceal intussusception

Summary There have been 132 cases of primary appendiceal intussusception reported since it was first described by McKidd in 1859. Five of the 132 patients were asymptomatic, the diagnosis having been made at operation in patients with acute or recurrent right lower quadrant pain. The 2 cases presented here are unusual in that each patient had symptoms related to another primary disease. In addition, the first case was clearly demonstrated and diagnosed on barium enema examination, and the second case was listed in the differential diagnosis and confirmed at operation. The presence of PAI should be suspected when a cecal filling defect is noted on the same side as the ileocecal valve, especially if the appendix fills from the center of the defect or is nonvisualized.     

Lipoma induced jejunojejunal intussusception

Intussusception in adults is rare. The clinical picture of intussusception in adults is subtle and the diagnosis is, therefore, elusive. The presence of a structural abnormality in the great majority of the adult cases mandates high clinical suspicion. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity. The present report describes a case of jejunojejunal intussusception in an adult with a history of severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was suspected preoperatively but computed tomography scan could not rule out malignancy. Exploratory laparotomy revealed jejunojejunal intussusception secondary to a lipoma which was successfully treated with segmental intestinal resection.     

Enterocolic intussusception in adults

Summary and Conclusions Enterocolic intussusception in adults is discussed with regard to incidence, location, pathology, diagnosis, and management and is illustrated by the case reports of six varieties. It should be emphasized that intraluminal tumors are the most common cause of intussusception in adults and that most such tumors of the colon are malignant. Early diagnosis, therefore, is very important, and sigmoidoscopy followed by a bariumenema study should be done in every case. Because of the sporadic occurrence and bizarre clinical picture of adult enterocolic intussusception, the physician should consider intussusception whenever confronted with any patient with confusing abdominal symptoms. Most intussusceptions in adults are subacute or chronic and cause only partial obstruction of the intestine. Read at the Resident's Night meeting of the New York Society of Colon and Rectal Surgeons, New York, New York, March 11, 1971. Senior Resident, Department of Surgery. Attending and Chief Surgeon, Section of Colon and Rectal Surgery. Associate Attending Surgeon, Section of Colon and Rectal Surgery.