Management of Adult Intussusception in the Recent Era of Advanced Laparoscopy and CT: A Case Report and Literature Review
EAES Academy. Salama M. 07/05/22; 362987; P030
Mr. Mohamed Salama
Contributions
Contributions
Abstract
Introduction:
Intussusception is a rare condition in adults that represent only 1% of all intestinal obstruction and 5% of all intussusception cases. Its presentation and clinical signs are often variable and nonspecific so the diagnosis is difficult.
The optimal management strategy for adult intussusception remains controversial as to whether it should be conservative vs operative (open vs lap). Surgical management continues to be the main stay treatment. There is no consensus on whether laparoscopy can be applied to adult intussusception with respect of safety and efficacy.
Case report
A 26 Year old lady presented with abdominal pain, altered bowels and weight loss for six months. She has a past medical history of sarcoidosis, cardiac disease, Type 1 Diabetes and had a normal OGD and colonoscopy. CT was highly suggestive of small bowel intussusception. A diagnosis of jejuno-jejunal intussusception was confirmed by laparoscopy. Neither ischaemic nor substantial inflammation was evident. Laparoscopic exploration of the entire bowel was done. A reduction of the intussusception was performed laparoscopically. The affected segment was exteriorised via the side of umbilical port and examined manually and there was no underlying pathology. The patient had an uneventful recovery and discharged the next day post-operatively.
Conclusion:
• Laparoscopic surgery for adult intussusception is currently feasible and safe with a few technical points that need consideration: the distended intussusception should be grasped as widely as possible to disperse the tearing force; two non traumatic bowel clamps should be used for bowel manipulation; if resistance is felt at any time during the traction, bowel reduction should not be continued and en block resection laparoscopically seems safe; if the intra-operative manipulation of the intussusception appears dangerous due to massively dilated bowel or reduced space, conversion to open surgery is indicated.
• The choice of laparoscopic or open surgery for intussusception depends on clinical condition of the patient, the location and extent of intussusception, the possibility of underlying disease and the availability of experienced surgeon.
Intussusception is a rare condition in adults that represent only 1% of all intestinal obstruction and 5% of all intussusception cases. Its presentation and clinical signs are often variable and nonspecific so the diagnosis is difficult.
The optimal management strategy for adult intussusception remains controversial as to whether it should be conservative vs operative (open vs lap). Surgical management continues to be the main stay treatment. There is no consensus on whether laparoscopy can be applied to adult intussusception with respect of safety and efficacy.
Case report
A 26 Year old lady presented with abdominal pain, altered bowels and weight loss for six months. She has a past medical history of sarcoidosis, cardiac disease, Type 1 Diabetes and had a normal OGD and colonoscopy. CT was highly suggestive of small bowel intussusception. A diagnosis of jejuno-jejunal intussusception was confirmed by laparoscopy. Neither ischaemic nor substantial inflammation was evident. Laparoscopic exploration of the entire bowel was done. A reduction of the intussusception was performed laparoscopically. The affected segment was exteriorised via the side of umbilical port and examined manually and there was no underlying pathology. The patient had an uneventful recovery and discharged the next day post-operatively.
Conclusion:
• Laparoscopic surgery for adult intussusception is currently feasible and safe with a few technical points that need consideration: the distended intussusception should be grasped as widely as possible to disperse the tearing force; two non traumatic bowel clamps should be used for bowel manipulation; if resistance is felt at any time during the traction, bowel reduction should not be continued and en block resection laparoscopically seems safe; if the intra-operative manipulation of the intussusception appears dangerous due to massively dilated bowel or reduced space, conversion to open surgery is indicated.
• The choice of laparoscopic or open surgery for intussusception depends on clinical condition of the patient, the location and extent of intussusception, the possibility of underlying disease and the availability of experienced surgeon.
Introduction:
Intussusception is a rare condition in adults that represent only 1% of all intestinal obstruction and 5% of all intussusception cases. Its presentation and clinical signs are often variable and nonspecific so the diagnosis is difficult.
The optimal management strategy for adult intussusception remains controversial as to whether it should be conservative vs operative (open vs lap). Surgical management continues to be the main stay treatment. There is no consensus on whether laparoscopy can be applied to adult intussusception with respect of safety and efficacy.
Case report
A 26 Year old lady presented with abdominal pain, altered bowels and weight loss for six months. She has a past medical history of sarcoidosis, cardiac disease, Type 1 Diabetes and had a normal OGD and colonoscopy. CT was highly suggestive of small bowel intussusception. A diagnosis of jejuno-jejunal intussusception was confirmed by laparoscopy. Neither ischaemic nor substantial inflammation was evident. Laparoscopic exploration of the entire bowel was done. A reduction of the intussusception was performed laparoscopically. The affected segment was exteriorised via the side of umbilical port and examined manually and there was no underlying pathology. The patient had an uneventful recovery and discharged the next day post-operatively.
Conclusion:
• Laparoscopic surgery for adult intussusception is currently feasible and safe with a few technical points that need consideration: the distended intussusception should be grasped as widely as possible to disperse the tearing force; two non traumatic bowel clamps should be used for bowel manipulation; if resistance is felt at any time during the traction, bowel reduction should not be continued and en block resection laparoscopically seems safe; if the intra-operative manipulation of the intussusception appears dangerous due to massively dilated bowel or reduced space, conversion to open surgery is indicated.
• The choice of laparoscopic or open surgery for intussusception depends on clinical condition of the patient, the location and extent of intussusception, the possibility of underlying disease and the availability of experienced surgeon.
Intussusception is a rare condition in adults that represent only 1% of all intestinal obstruction and 5% of all intussusception cases. Its presentation and clinical signs are often variable and nonspecific so the diagnosis is difficult.
The optimal management strategy for adult intussusception remains controversial as to whether it should be conservative vs operative (open vs lap). Surgical management continues to be the main stay treatment. There is no consensus on whether laparoscopy can be applied to adult intussusception with respect of safety and efficacy.
Case report
A 26 Year old lady presented with abdominal pain, altered bowels and weight loss for six months. She has a past medical history of sarcoidosis, cardiac disease, Type 1 Diabetes and had a normal OGD and colonoscopy. CT was highly suggestive of small bowel intussusception. A diagnosis of jejuno-jejunal intussusception was confirmed by laparoscopy. Neither ischaemic nor substantial inflammation was evident. Laparoscopic exploration of the entire bowel was done. A reduction of the intussusception was performed laparoscopically. The affected segment was exteriorised via the side of umbilical port and examined manually and there was no underlying pathology. The patient had an uneventful recovery and discharged the next day post-operatively.
Conclusion:
• Laparoscopic surgery for adult intussusception is currently feasible and safe with a few technical points that need consideration: the distended intussusception should be grasped as widely as possible to disperse the tearing force; two non traumatic bowel clamps should be used for bowel manipulation; if resistance is felt at any time during the traction, bowel reduction should not be continued and en block resection laparoscopically seems safe; if the intra-operative manipulation of the intussusception appears dangerous due to massively dilated bowel or reduced space, conversion to open surgery is indicated.
• The choice of laparoscopic or open surgery for intussusception depends on clinical condition of the patient, the location and extent of intussusception, the possibility of underlying disease and the availability of experienced surgeon.
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