Tianyi Frank-Leonel, Kadia Benjamin Momo, Dimala Christian Akem, Agbor Valirie Ndip
Kousseri Regional Hospital Annex, Kousseri, Extreme North region, Cameroon.
Foumbot District Hospital, Foumbot, Cameroon.
BMC Res Notes. 2017 Oct 30;10(1):521. doi: 10.1186/s13104-017-2838-8.
Transanal protrusion of intussusception is a complication of intussusception which involves the exteriorization of the apex of the intussusceptum through the anus. However, it is rarely reported and its confusion with rectal prolapse often leads to a diagnostic delay.
A 10-month-old female with no significant past history from a rural area in the Extreme North region of Cameroon was referred from a local health centre to our emergency deparment for an irreducible mass. It was reported that the child had spent 5 days at home on over-the-counter medication, then 3 days at a health centre where she was being treated for a respiratory tract infection and a rectal prolapse. On arrival at our hospital, she was conscious and moderately dehydrated. Cardiopulmonary examination revealed generalized coarse crackles over both lung fields. Her abdomen was tender, with a left upper quadrant mass, absent bowel sounds and a dark anal mass. In view of these, diagnoses of bronchopneumonia, intestinal obstruction and a probable rectal prolapse were made. An exploratory laparotomy was carried out after resuscitation with per-operative findings of a prolapsed ileo- colic intussusception and a necrosed intussusceptum. The necrosed portion was resected and an end-to-end ileo-transverse anastomosis was carried out. The immediate post- operative period was uneventful, but the patient died 3 days after the surgery, from an overwhelming sepsis.
Transanal protrusion of intussusception requires timely surgical intervention to prevent mortality. The similarity in presentation to rectal prolapse coupled with inadequate knowledge on the condition by primary healthcare personnel causes a delay in the diagnosis and an increased mortality. A high index of suspicion is essential for an early diagnosis and an improved referral system for timely and definitive treatment.
套叠经肛门突出是套叠的一种并发症，涉及套叠顶端经肛门向外翻出。然而，其报道较少，且与直肠脱垂相混淆常导致诊断延误。
一名来自喀麦隆极北地区农村、无重大既往病史的10个月大女性患儿，因不可回纳性肿物从当地卫生中心转诊至我院急诊科。据报道，该患儿在家自行服用非处方药5天，后在卫生中心治疗3天，期间接受呼吸道感染和直肠脱垂治疗。入院时，患儿意识清醒，有中度脱水。心肺检查显示双肺野有广泛的粗湿啰音。腹部压痛，左上腹可触及肿物，肠鸣音消失，肛门处有一暗红色肿物。鉴于此，诊断为支气管肺炎、肠梗阻及可能的直肠脱垂。复苏后行剖腹探查术，术中发现为回结肠套叠脱垂且套叠部分坏死。切除坏死部分并进行回肠-横结肠端端吻合术。术后即刻情况平稳，但患儿在术后3天因严重败血症死亡。
套叠经肛门突出需要及时手术干预以预防死亡。其临床表现与直肠脱垂相似，加上基层医护人员对此病认识不足，导致诊断延误及死亡率增加。高度怀疑指数对于早期诊断至关重要，同时需要改进转诊系统以实现及时、明确的治疗。
