Robertson Cameron G, Due Steven L, Shimokawa Kontoku, Yeow Marina
Department of Surgery, Flinders Medial Centre, Flinders Drive, Bedford Park, South Australia 5042 Australia.
Int J Surg Case Rep. 2015;12:1-3. doi: 10.1016/j.ijscr.2015.05.010. Epub 2015 May 7.
Ileorectal intussusception is a rare condition in adults in which the distal ileum, caecum, variable lengths of ascending and transvers colon, and associated mesentery invaginate into the rectum.
We present the case of a 56 year old man who presented to our hospital for investigation of vague symptoms including small volumes of bright red rectal bleeding and colicky abdominal pain. He was found on CT scanning to have an extensive ileorectal intussusception and extensive liver metastasis. An emergency laparotomy was performed due to the concern of bowel ischaemia. No evidence of bowel ischaemia was found. The intussusceptum was carefully reduced and an extended right hemicolectomy with a primary anastomosis was performed. The patient recovered well and was discharged home six days post operatively.
Intussusceptions are rare in the adult population. They may not present with the classical triad of crampy abdominal pain, vomiting, and bloody stools and radiological imaging plays a key role in diagnosis. Intussusception in adults is usually secondary to malignancy and operative management needs to take into account the risk of upstaging the disease. In the face of pre-existing metastasis, preserving bowel length should be considered; however, there is no high level evidence to guide decision-making.
Intussusception is a diagnosis that needs to be considered in the adult population. Diagnosis largely depends on radiological imaging, especially CT scanning. The operative management is variable and should be determined on a case by case basis.
回直肠套叠在成年人中是一种罕见病症，其中远端回肠、盲肠、不同长度的升结肠和横结肠以及相关系膜套入直肠。
我们报告一例56岁男性患者，因出现包括少量鲜红色直肠出血和绞痛性腹痛等模糊症状前来我院就诊。CT扫描发现他患有广泛的回直肠套叠和广泛的肝转移。由于担心肠缺血，遂进行了急诊剖腹手术。未发现肠缺血迹象。小心地将套入部复位，并进行了扩大右半结肠切除术及一期吻合术。患者恢复良好，术后六天出院。
套叠在成人中罕见。它们可能不会表现出腹痛、呕吐和血便的典型三联征，影像学检查在诊断中起关键作用。成人套叠通常继发于恶性肿瘤，手术治疗需要考虑疾病分期升级的风险。面对已存在的转移，应考虑保留肠长度；然而，尚无高级别证据指导决策。
套叠是成人人群中需要考虑的一种诊断。诊断很大程度上依赖于影像学检查，尤其是CT扫描。手术治疗方式多样，应根据具体病例确定。
