Laparoscopic Treatment of Adult Sigmoidorectal Intussusception Caused by a Mucinous Adenocarcinoma of the Sigmoid Colon: A Case Report

다국어 초록 (Multilingual Abstract)

Intussusception is a rare cause of intestinal obstruction in adult patients, but is common in children. In fact, it accounts for an estimated 1% of all cases of bowel obstruction in adults, although adult intussusception of the large intestine is rare.
Sigmoidorectal intussusception, however, is a rare variety with few cases reported in the literature. A mucinous adenocarcinoma,a subtype of adenocarcinoma, is characterized by extracellular mucin production and accounts for between 5%and 15% of the neoplasms of the colon and rectum. Despite the general consensus supporting surgical resections for adult intussuceptions, controversy remains over whether intussuceptions should be reduced before resection. Most cases of colon intussusception should not be reduced before resection because they most likely represent a primary adenocarcinoma.
However, prior reduction followed by a resection can be considered for the sigmoidorectal intussusception to avoid inadvertent low rectal cancer sugery. We experienced one case of sigmoidorectal intussusception caused by a mucinous adenocarcinoma of the sigmoid colon in a 79-year-old woman. Abdominal computed tomography demonstrated a sigmoidorectal intussusception. After the end-to-end anastomosis-dilator-assisted reduction, the patient underwent a laparoscopic oncological anterior resection under the impression that a sigmoidorectal intussusception existed. We report a successful laparoscopic anterior resection in a patient with an intussusception caused by a sigmoid malignant tumor.

참고문헌 (Reference)

1 박영진, "성인에서 에스상 결장의 용종에 의해 발생한 에스상결장-직장-항문형의 장중첩증 1예" 대한대장항문학회 25 (25): 121-124, 2009

2 Boyle MJ, "Ultrasonic diagnosis of adult intussusception" 88 : 617-618, 1993

3 Begos DG, "The diagnosis and management of adult intussusception" 173 : 88-94, 1997

4 Lorigan JG, "The computed tomographic appearances and clinical significance of intussusception in adults with malignant neoplasms" 63 : 257-262, 1990

5 Kanemitsu Y, "Survival after curative resection for mucinous adenocarcinoma of the colorectum" 46 : 160-167, 2003

6 Nagorney DM, "Surgical management of intussusception in the adult" 193 : 230-236, 1981

7 Matsuda K, "Surgical management of adult sigmoid colon intussusception caused by a malignant tumor: report of a case" 33 : 768-771, 2003

8 Park KJ, "Sigmoidorectal intussusception of adenoma of sigmoid colon treated by laparoscopic anterior resection after sponge-on-the-stick-assisted manual reduction" 12 : 146-149, 2006

9 Chuang Ch, "Laparoscopic management of sigmoid colon intussusception caused by a malignant tumor: case report" 99 : 615-616, 2007

10 Dujardin M, "Inverted Meckel’s diverticulum as a leading point for ileoileal intussusception in an adult: case report" 27 : 563-565, 2002

11 Weilbaecher D, "Intussusception in adults: review of 160 cases" 121 : 531-535, 1971

12 Eisen LK, "Intussusception in adults: institutional review" 188 : 390-395, 1999

13 Dean DL, "Intussusception in adults" 73 : 6-11, 1975

14 Brayton D, "Intussusception in adults" 88 : 32-43, 1954

15 Du W, "Incidence and survival of mucinous adenocarcinoma of the colorectum: a population-based study from an Asian country" 47 : 78-85, 2004

16 Rosiere A, "Early diagnosis of adult intestinal intussusception at four different locations" 94 : 314-317, 1994

17 Matsuba Y, "Adult intussusception due to lymphangioma of the colon" 38 : 181-185, 2003

18 Warshauer DM, "Adult intussusception detected at CT or MR imaging: clinical-imaging correlation" 212 : 853-860, 1999

19 Azar T, "Adult intussusception" 226 : 134-138, 1997

20 Hutchinson J, "A successful case of abdominal section for intussusception" 7 : 195-198, 1873