Successful treatment of adult cecorectal intussusception caused by cecum cancer with mobile cecum: a case report

Abstract

Background: Intussusception occurs when a segment of the bowel (the intussusceptum) telescopes into an adjacent segment (the intussuscipiens). Adult intussusception occurs rarely and often requires surgical resection for its treatment. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature.

Case presentation: A 71-year-old woman was transferred to our hospital for the treatment of upper abdominal pain. Physical examination, laboratory tests, and imaging inspections showed strangulated bowel obstruction induced by intussusception associated with the intra-rectal mass. We performed an emergency operation and treated the intussusception using a combined transabdominal and trans-anal approach. The intraoperative findings revealed bloody ascites and a potentially malignant tumor that had moved toward the anal side from peritoneal reflection. The tumor served as the lead point in the cecum with mobile cecum. After reducing the intussusception using the combined procedure, we removed the ileocecal portion. The intraoperative and histopathological findings suggested that cecum cancer with mobile cecum had caused the cecorectal intussusception. The patient had an uneventful postoperative course, except for postoperative pulmonary pneumonia.

Conclusion: To the best of our knowledge, this is the first reported case of adult cecorectal intussusception due to cecum cancer with mobile cecum successfully treated using the combined transabdominal and trans-anal approach. This combined procedure may be useful in treating the intussusception where the lead point is distal from the peritoneal reflection.

Keywords: Cecorectal intussusception; Combined transabdominal and trans-anal procedure; Mobile cecum.

Fig. 1

Abdominal computed tomography (CT) scout. Findings suggest intestinal dilation and intestinal gas-like obstruction on the right side and a paucity of gas in the middle to the left side

Fig. 2

Abdominal computed tomography (CT) images. a Sausage-shaped sign in the descending colon. b Enlargement of the colorectal wall, fat within the intussusception, and air within the intussuscipiens in the pelvis. c Mass in the rectum

Fig. 3

Combined transabdominal and trans-anal procedure. We pushed the mass, which is located distal of the peritoneal reflection, through the anus to the oral side. Subsequently, we used the Hutchinson maneuver

Fig. 4

Intraoperative view. Ascending colon and cecum are invaginated in the transverse colon with the mobile cecum. a Intraoperative photograph. b Schematic representation

Fig. 5

Resected specimen and histopathological images. a The tumor is reddish, round, elastic soft, granular surfaced, measuring 45 mm in length and 40 mm in width in the cecum. b The lesion is stained with hematoxylin and eosin (magnification: 200×)