Hayama Tamuro, Hashiguchi Yojiro, Ohno Kohei, Okada Yuka, Nemoto Kentaro, Yagi Takahiro, Tsukamoto Mitsuo, Fukushima Yoshihisa, Ozawa Tsuyoshi, Shimada Ryu, Okamoto Koichi, Tsuchiya Takeshi, Nozawa Keijiro, Matsuda Keiji
Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 183-8605, Japan.
Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
BMC Surg. 2019 Jul 2;19(1):74. doi: 10.1186/s12893-019-0539-z.
Intussusception is a relatively common condition seen in children. In comparison, adult intussusception is rare and usually occurs as a complication in patients with organic diseases. It is responsible for 1% of all bowel obstructions, in most of intussusceptions a malignant tumor is involved. Herein, we present an extremely unusual case of intussusception that occurred as a complication at the site of a functional end-to-end anastomosis.
A 57-year-old female patient was diagnosed with tumors in the ascending and descending colon and was referred to our department. Laparoscopic hemicolectomy and laparoscopic descending colectomy were performed. The mechanical intestinal obstruction occurred on the 9th day postoperatively, and computed tomography scan revealed intussusception at the site of the ileocolic anastomosis. Endoscopic reduction was attempted, but the procedure was challenging. Surgery was then performed and revealed that the site of ileocolic anastomosis firmly adhered to the side wall and right retroperitoneum. However, the intestine in the oral side of the anastomosis was not fixed. Examination of the anastomotic site revealed that the ileum had passed through the anastomosis and prolapsed into the transverse colon. The ileocolic anastomosis was resected. End-to-end anastomosis was performed, and surgery was then completed. No neoplastic lesions were observed in the resected tissue of the lead point of intussusception. The postoperative clinical course was favorable, and the patient was discharged on the 11th day after the second round of surgery.
There are no reports the anastomosis is involved as part of the intussception, as observed in the present case. Intussusception should thus be considered as one of the causes of postoperative mechanical intestinal obstruction.
肠套叠是儿童中较为常见的病症。相比之下，成人肠套叠较为罕见，通常作为器质性疾病患者的并发症出现。它占所有肠梗阻病例的1%，在大多数肠套叠病例中都涉及恶性肿瘤。在此，我们报告一例极为罕见的肠套叠病例，该病例作为功能性端端吻合部位的并发症出现。
一名57岁女性患者被诊断为升结肠和降结肠肿瘤，转诊至我科。进行了腹腔镜半结肠切除术和腹腔镜降结肠切除术。术后第9天发生机械性肠梗阻，计算机断层扫描显示回结肠吻合部位出现肠套叠。尝试进行内镜复位，但操作具有挑战性。随后进行手术，发现回结肠吻合部位牢固地附着于侧壁和右腹膜后。然而，吻合口近端的肠管未固定。检查吻合部位发现回肠穿过吻合口并脱垂至横结肠。切除回结肠吻合口。进行端端吻合，手术完成。在肠套叠套入点的切除组织中未观察到肿瘤性病变。术后临床过程顺利，患者在第二轮手术后第11天出院。
如本病例所示，尚无关于吻合口作为肠套叠一部分的报道。因此，肠套叠应被视为术后机械性肠梗阻的原因之一。
