Laparoscopic-assisted small bowel resection for treatment of adult small bowel intussusception: a case report

Abstract

Background: Intussuception is a rare cause of intestinal obstruction in adults. Diagnosis is often difficult due to the variable and sometimes episodic nature of symptoms. Surgery is the recommended treatment option in adults if the diagnosis is proven.

Case presentation: We present a case of a 33 year old Caucasian female admitted with a small bowel obstruction and no history of previous abdominal surgery. Patient did not improve with medical management consisting of bowel rest and nasogastric tube decompression. Surgery was consulted and patient was taken to the operating room for a laparoscopic-assisted small bowel resection for a small bowel intussusception caused by a submucosal fibroma.

Conclusion: Our case highlights the feasibility and potential benefits of laparoscopy in assisting the diagnosis and treatment of small bowel obstructions.

Figure 1

Computed tomography scan showing dilated loops of small bowel consistent with a possible small bowel obstruction with possible target sign in right lower quadrant raising the possibility of intussusception.

Figure 2

Laparoscopic view of right lower quadrant just proximal to ileocecal valve. Transition zone of small bowel obstruction is identified. Cause of obstruction is difficult to evaluate and we were unable to reduce laparoscopically.

Figure 3

Targeted infraumbilical incision has been made and small bowel and cecum brought out through the incision with clearly evident small bowel intussusception (ileo-ileal).

Figure 4

Postoperative picture showing small infraumbilical targeted incision and 3 additional laparoscopic port sites.