Takahashi Naoki, Narita Kiyoshi, Sato Rie, Suzuki Hideo, Machishi Hideki, Okada Yoshikatsu
Department of Surgery, Kuwana East Medical Center, 3-11 Kotobukicho, Kuwana, Mie, 511-0061, Japan.
Int J Surg Case Rep. 2017;36:116-118. doi: 10.1016/j.ijscr.2017.05.010. Epub 2017 May 15.
Adult intussusception is a rare condition with a pathological lead point. Intraoperative reduction of adult intussusception can eliminate the need for extensive or invasive resection. We safely performed a manual laparoscopy-assisted intraoperative reduction that allowed functional preservation of tissue.
A 70-year-old woman with dull right lumbar pain at regular intervals and right lower quadrant abdominal tenderness was admitted to our hospital. The ileum exhibited enhanced wall thickening and invagination into the ascending colon on computed tomography. Emergency laparoscopic surgery was chosen to treat the ileocolic intussusception. First, the right colon was mobilized. Second, the ileocecal region was pulled through a 4-cm right pararectus incision. Third, the edge of the intussusceptum was gently manipulated back upstream without tearing. After reduction, a soft mass was recognized on palpation at the lead point, located 10cm proximal to the ileocecal valve. Ileocecal resection was performed, and a laterally spreading tumor was observed in the resected specimen. The histological diagnosis was high-grade tubular adenoma. The postoperative course was uneventful.
Adult intussusception has a pathological lead point, and curative treatment generally includes resection of the lesion. Complete or partial intraoperative reduction can avoid or shorten bowel resection and allow functional preservation of the tissue.
Manual laparoscopy-assisted intraoperative reduction with a minilaparotomy was safely performed, which eliminated the need for extensive or invasive resection.
成人肠套叠是一种罕见的伴有病理性引导点的疾病。成人肠套叠的术中复位可避免广泛或侵入性切除。我们安全地进行了手动腹腔镜辅助术中复位，从而实现了组织功能的保留。
一名70岁女性因间歇性右腰部钝痛和右下腹压痛入院。计算机断层扫描显示回肠壁增厚并套入升结肠。选择急诊腹腔镜手术治疗回结肠套叠。首先，游离右半结肠。其次，将回盲部经右腹直肌4厘米切口牵出。第三，轻柔地将套叠部的边缘向上游回纳，避免撕裂。复位后，在回盲瓣近端10厘米处的引导点触诊时可触及一个柔软肿物。进行了回盲部切除，在切除标本中观察到一个侧向扩散的肿瘤。组织学诊断为高级别管状腺瘤。术后过程顺利。
成人肠套叠有一个病理性引导点，根治性治疗通常包括病变切除。术中完全或部分复位可避免或缩短肠切除，并能保留组织功能。
安全地进行了手动腹腔镜辅助的小切口术中复位，避免了广泛或侵入性切除。
