Department of General Surgery, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel.
World J Emerg Surg. 2013 Sep 23;8(1):37. doi: 10.1186/1749-7922-8-37.
Intussusception is rarely encountered in adults, accounting for just 5% of all occurrences and 1% of bowel obstructions. In up to 90% of episodes of adult intussusceptions, operative intervention is required secondary to pathological lead points. Prior to the current report, only three cases of total ileocolic intussusception with rectal prolapse in adults have been described in the world literature, making it an important contribution to surgical knowledge. In addition to a discussion of disease etiology, this review outlines sound diagnostic and therapeutic principles in the successful management of this rare emergent surgical condition.
In this case report, we will present a rare case of total ileocolic intussusception with rectal prolapse in a 22 year-old female without antecedent history. She had both a lead point in the cecum, as well as a highly mobile, intraperitoneal colon. Lead points have been found in only half of the reported cases, including this one. In addition, colonic laxity may enable this phenomenon, being attributed to the loss of zygosis during the embryological period, in which there is persistence of the ascending and descending mesocolons and lack of apposition to the retroperitoneum. The diagnostic work-up, operative strategy and pathological findings are discussed. The three previous cases reported in the English-language medical literature were reviewed.
Adult intussusception, while uncommon, may be encountered in an acute surgical setting and optimal outcomes depend on a high index of suspicion and expeditious management. Embryological divergence may contribute to the even rarer variant of total ileocolic intussusception with rectal prolapse.
成人肠套叠很少见，仅占所有病例的 5%和肠梗阻的 1%。在多达 90%的成人肠套叠病例中，由于病理性的套叠起点，需要进行手术干预。在本报告之前，世界文献中仅描述了三例成人全回肠结肠套叠伴直肠脱垂，这对手术知识是一个重要贡献。除了讨论疾病病因外，本综述还概述了成功治疗这种罕见的紧急手术情况的合理诊断和治疗原则。
在本病例报告中，我们将介绍一例罕见的 22 岁女性全回肠结肠套叠伴直肠脱垂病例，无既往病史。她既有盲肠内的套叠起点，也有高度移动的腹腔内结肠。在报道的病例中，只有一半发现了套叠起点，包括这一例。此外，结肠松弛可能使这种现象成为可能，这归因于胚胎期的消失，在此期间，升结肠和降结肠系膜仍然存在，并且与腹膜后没有贴合。讨论了诊断性检查、手术策略和病理发现。回顾了英语医学文献中报道的前三例病例。
成人肠套叠虽然不常见，但可能在急性外科环境中遇到，最佳结果取决于高度怀疑和迅速管理。胚胎学分歧可能导致更罕见的全回肠结肠套叠伴直肠脱垂的变异。
