Kamal Radin Hardika, Musthofa Kamal, Ramadhan Faldha R, Danardono Edwin, Thohari Fadia Hasna
Surgery Department, Faculty of Medicine Airlangga University/Dr. Soetomo General Hospital, Surabaya, Indonesia.
Digestive Surgery Division, Surgery Department, Faculty of Medicine Airlangga University/Dr. Soetomo General Hospital, Surabaya, Indonesia.
Int J Surg Case Rep. 2025 Feb;127:110854. doi: 10.1016/j.ijscr.2025.110854. Epub 2025 Jan 7.
Stoma has become a common surgical act and is commonly performed. One of type of stoma creation is unmatured end ileostomy. Our case showed a rare tip intussusception of unmatured end ileostomy causing bowel obstruction.
A 51-year-old Madurese male underwent a left hemicolectomy with end ileostomy Hartmann's procedure for total bowel obstruction due to caecal well differentiated adenocarcinoma (pT4aN0M0). One month post operative, the patient came to outpatient clinic for bowel obstruction for the last 3 days. Examination for the end ileostomy tip was reddish, swollen, irreducible, unretracted but shortened. A triple contrast abdominal Computed Tomography was ordered, and no narrowing proximal from the stoma outlet was found. Early stomal closure with exploratory laparotomy was performed.
Any post unmatured end ileostomy bowel obstruction with unretracted shortened ileostomy limb, lumen narrowing around the full thickness annular curling of the ileum, and edematous mucosa of the distal tip with no cause of obstruction found on contrast abdominal CT, tip intussusception of unmatured end ileostomy as the cause of stoma outlet obstruction should be suspected.
Tip intussusception of unmatured ileostomy is rare clinical entity should be known to surgeon and should be considered as a new subtype of stoma outlet obstruction.
造口术已成为一种常见的外科手术且普遍施行。未成熟端回肠造口术是造口创建的一种类型。我们的病例显示了未成熟端回肠造口术罕见的尖端套叠导致肠梗阻。
一名51岁的马都拉男性因盲肠高分化腺癌（pT4aN0M0）导致完全性肠梗阻，接受了左半结肠切除术及带有端回肠造口的哈特曼手术。术后一个月，患者因过去3天的肠梗阻前来门诊。对端回肠造口尖端的检查发现其发红、肿胀、无法回纳、未回缩但缩短。安排了腹部三联对比计算机断层扫描，未发现造口出口近端有狭窄。进行了早期造口关闭并探查性剖腹手术。
任何未成熟端回肠造口术后出现肠梗阻，伴有未回缩缩短的回肠造口肢体、回肠全层环形卷曲周围的管腔狭窄以及远端尖端黏膜水肿，且腹部对比CT未发现梗阻原因时，应怀疑未成熟端回肠造口尖端套叠是造口出口梗阻的原因。
未成熟回肠造口尖端套叠是一种罕见的临床情况，外科医生应了解，且应将其视为造口出口梗阻的一种新亚型。
