Intussusception in adults is rare usually occurs as a complication due to malignancy. I report a case of intussusception that could be because of multiple large lymph nodes (more than 2 cm) at the area of the ileum.
A 32-year young newly married female came with the chief complaint of not passing flatus and motion with severe pain abdomen and vomiting. No significant dietary habit changed, No family history of any disease, No medical history of any disease. She was presented in an emergency with acute abdomen.
Hematological analysis revealed white blood cell: 12,000/μ, hemoglobin: 9.3 g/dl, platelet count: 12.5 × 104, carcinoembryonic antigen: 3.3, and cancer antigen: 19.9–11.1.
Results were not significant.
Computed tomography revealed 13 cm ileo ascending intussusception with multiple enlarged lymph nodes at the ileum [Figure 1].
Laparoscopic right hemicolectomy was done with two 10 mm and two 5 mm ports. Ileo cecal area was found grossly edematous and adherent to the retroperitoneal area with multiple enlarged lymph nodes [Figure 2]. Gross dilatation of the ileum was noted which was edematous also. Lateral-to-medial mobilization of the ascending colon was performed and ileocecal area was separated from the retroperitoneum. Ileocolic artery and vein were clipped and divided. Mesentery was divided and duodenum was separated from the transverse colon. Ileum ascending colon and part of transverse colon were resected laparoscopically and side-to-side anastomosis done extra corporeal after 3 cm supraumbilical incision. The surgery was completed [Figures 3 and 4].
Histopathological examination showed gangrenous ileum inside the ascending colon; the patient was discharged on day 6 postoperative.
DISCUSSION AND CONCLUSION
Intussusception in adults is rare Almost 90% of adults are associated with specific etiology, in which 19-42% are caused by malignancy and 22%–41% are attributed to benign.
In the present case, the young newly married female diagnosed with 13 cm ileoascending intussusception, so decided to go with laparoscopic right hemicolectomy.
Although the whole of the terminal ileum was completely engulfed in ascending colon, Intussusception reduction attempt was failure so then decided to go for laparoscopic right hemicolectomy.
Contraction of the left side of the colon can be of short duration 4–6 cm/min lasting for 10 s and long duration 0.5–2 cm/min lasting for 1 min. However, contraction in the right-side colon differs from the left-side colon. Mass and vertical contraction 12 × 180 cm/min last for 1 min in the right-side colon.
Right-side colon contraction was 2–3 times stronger than the left side.
Mass peristalsis of the right colon happens without required physical stimulation.
Hence, it is relatively easy for intussusception to occur on the right side. In the present case, although it was very difficult to identify the cause, it may be possible because of multiple lymph nodes found in the ileum.
The peristalsis of the ileum is stronger than the colon.
Intussusception in adults is often caused by tumors and they are rarely caused by other factors. To the best of my knowledge, no studies have reported a case of 13 cm of ileo ascending intussusception as reported in the present case.
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1. Zubaidi A, Al-Saif F, Silverman R. Adult intussusception: A retrospective review Dis Colon Rectum. 2006;49:1546–51
2. Smith MA, Dent DM, Botha JB. Intussusception in adults S Afr J Surg. 1978;16:139–43
3. Stein JH. Internal Medicine, Stein 19985th St. Louis, Missouri Mosby Inc.:1976–80
4. Azar T, Berger DL. Adult intussusception Ann Surg. 1997;226:134–8
5. Masuda H, Hayashi S, Nakamura Y, Horiuchi H, Watanabe K, Hayashi I, et al Intussusception in adult Nihon Univ J Med. 1992;34:179–89