Davey M G, Conlon E T, Forde G, Byrnes V M, Carroll P A
Department of Surgery, Galway University Hospitals, Galway, Ireland.
School of Medicine and Health Sciences, University College Dublin, Dublin 4, Ireland.
Surg Case Rep. 2020 Sep 29;6(1):234. doi: 10.1186/s40792-020-01017-2.
Intussusception in adult patients is uncommon and appendiceal lead points are particularly rare.
We present the case of a 42-year-old male with a history of ulcerative colitis, presenting with sudden onset abdominal pain and bloody diarrhoea. Endoscopy revealed grossly normal mucosa in the descending colon with a congested polypoid mass in the proximal transverse colon. Computed tomography revealed ileocecal intussusception at the hepatic flexure. A right hemicolectomy was performed, where a grossly dilated appendix was noted, resected and sent for histopathological evaluation. Results revealed low-grade appendiceal mucinous neoplasm. Post-operatively, the patient remained symptom free, however required reintroduction of biologic therapy due to relapse of his ulcerative colitis 12 weeks later.
This case depicts a rare acute surgical presentation and reminds physicians and surgeons of the importance of 'thinking outside the box' in clinical practice.
成人肠套叠并不常见，阑尾作为套叠起始点尤为罕见。
我们报告一例42岁男性，有溃疡性结肠炎病史，突发腹痛和血性腹泻。内镜检查显示降结肠黏膜大致正常，近端横结肠有一充血的息肉样肿物。计算机断层扫描显示肝曲处回盲部肠套叠。行右半结肠切除术，术中发现阑尾明显扩张，予以切除并送组织病理学评估。结果显示为低度阑尾黏液性肿瘤。术后患者症状消失，但12周后因溃疡性结肠炎复发需重新使用生物治疗。
本病例描述了一种罕见的急性外科表现，提醒医生和外科医生在临床实践中“跳出框框思考”的重要性。
