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Laparoscopic management of an octogenarian adult intussusception caused by an ileal lipoma suspected preoperatively: a case report.

Shimazaki J, Nakachi T, Tabuchi T, Suzuki S, Ubukata H, Tabuchi T - World J Surg Oncol (2015)

Bottom Line: Macroscopic examination of the excised specimen showed a pedunculated tumor measuring 4.0 × 3.5 × 1.9 cm with an uneven surface, yielding a histological diagnosis of lipoma.The patient had an uneventful recovery and was discharged on postoperative day 8.This successful case showed that laparoscopic surgery can be a useful, safe, and efficacious procedure for adult intussusception, even in octogenarians.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo Ami, Inashiki, Ibaraki, 300-0395, Japan. shima-j@tokyo-med.ac.jp.

ABSTRACT
Adult intussusception is rare and usually caused by a tumor acting as the lead point. Therefore, laparotomy should be considered for the treatment. Laparoscopic procedures for use in cases of adult intussusception have been recently reported; however, there is no consensus regarding the safety and efficacy. Here, we describe a successful case of laparoscopic management of an octogenarian adult intussusception caused by an ileal lipoma, which was preoperatively suspected. An 87-year-old male presented with progressive abdominal distention and vomiting. Contrast radiography of the small intestine showed an ileal tumor, and magnetic resonance imaging indicated a target-like mass, consistent with an ileal intussusception. The patient was suspected with an intussusception due to an ileal lipoma, and laparoscopic surgery was performed. An approximately 10-cm-long ileal intussusception with a preceding tumor was present, and partial resection of the ileum, including the tumor, was performed. Macroscopic examination of the excised specimen showed a pedunculated tumor measuring 4.0 × 3.5 × 1.9 cm with an uneven surface, yielding a histological diagnosis of lipoma. The patient had an uneventful recovery and was discharged on postoperative day 8. This successful case showed that laparoscopic surgery can be a useful, safe, and efficacious procedure for adult intussusception, even in octogenarians.

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Related in: MedlinePlus

An approximately 10-cm-long ileal intussusception with a preceding tumor. (A) Laparoscopic image. (B) Intussuscepted ileum delivered from the small laparotomy.
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Fig3: An approximately 10-cm-long ileal intussusception with a preceding tumor. (A) Laparoscopic image. (B) Intussuscepted ileum delivered from the small laparotomy.

Mentions: The patient was placed under general anesthesia in the supine position. A 12-mm cannula for a camera was inserted in the periumbilical region by the open technique, and 10 mmHg of abdominal pressure was established by carbon dioxide insufflation of the pneumoperitoneum. Using direct laparoscopic visualization, two 5-mm ports were created in the left upper and lower quadrant for the surgeon, and two 5-mm ports were created in the right middle quadrant and just above the pubic bone for the assistant. An approximately 10-cm-long ileal intussusception with a preceding tumor was identified 40 cm proximal to the neo-terminal ileum (Figure 3A). Manual repositioning under laparoscopy did not reduce intussusception. There were sparse adhesions between the intussuscepted ileum and the retroperitoneum, which were exfoliated with a harmonic scalpel. Once the entire intussuscepted ileum had been mobilized within the abdominal cavity, a 4-cm incision was made in the periumbilicus, through which the intussuscepted ileum was delivered (Figure 3B). Partial resection of the delivered ileum including the tumor and a functional end-to-end anastomosis were performed. There were no signs of lymphadenopathy, and the liver had an unremarkable surface. Surgical blood loss was 5 ml, and operating time was 115 min. The excised tumor measured 4.0 × 3.5 × 1.9 cm and had an uneven surface with mucosal erythema (Figure 4A). Ulcerative mucosal change caused by the intussusception was observed in the oral side of the ileum from the tumor. Sectioning of the tumor revealed a solid, yellowish tissue. Histological examination of the excised tumor showed mature fat cells in the submucosa to the muscularis propria of the ileum (Figure 4B). Thickened mucosa on the tumor showed abundant micro vessels and epithelial ductal hyperplasia; however, no tumor was observed in that location.Figure 3


Laparoscopic management of an octogenarian adult intussusception caused by an ileal lipoma suspected preoperatively: a case report.

Shimazaki J, Nakachi T, Tabuchi T, Suzuki S, Ubukata H, Tabuchi T - World J Surg Oncol (2015)

An approximately 10-cm-long ileal intussusception with a preceding tumor. (A) Laparoscopic image. (B) Intussuscepted ileum delivered from the small laparotomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4340886&req=5

Fig3: An approximately 10-cm-long ileal intussusception with a preceding tumor. (A) Laparoscopic image. (B) Intussuscepted ileum delivered from the small laparotomy.
Mentions: The patient was placed under general anesthesia in the supine position. A 12-mm cannula for a camera was inserted in the periumbilical region by the open technique, and 10 mmHg of abdominal pressure was established by carbon dioxide insufflation of the pneumoperitoneum. Using direct laparoscopic visualization, two 5-mm ports were created in the left upper and lower quadrant for the surgeon, and two 5-mm ports were created in the right middle quadrant and just above the pubic bone for the assistant. An approximately 10-cm-long ileal intussusception with a preceding tumor was identified 40 cm proximal to the neo-terminal ileum (Figure 3A). Manual repositioning under laparoscopy did not reduce intussusception. There were sparse adhesions between the intussuscepted ileum and the retroperitoneum, which were exfoliated with a harmonic scalpel. Once the entire intussuscepted ileum had been mobilized within the abdominal cavity, a 4-cm incision was made in the periumbilicus, through which the intussuscepted ileum was delivered (Figure 3B). Partial resection of the delivered ileum including the tumor and a functional end-to-end anastomosis were performed. There were no signs of lymphadenopathy, and the liver had an unremarkable surface. Surgical blood loss was 5 ml, and operating time was 115 min. The excised tumor measured 4.0 × 3.5 × 1.9 cm and had an uneven surface with mucosal erythema (Figure 4A). Ulcerative mucosal change caused by the intussusception was observed in the oral side of the ileum from the tumor. Sectioning of the tumor revealed a solid, yellowish tissue. Histological examination of the excised tumor showed mature fat cells in the submucosa to the muscularis propria of the ileum (Figure 4B). Thickened mucosa on the tumor showed abundant micro vessels and epithelial ductal hyperplasia; however, no tumor was observed in that location.Figure 3

Bottom Line: Macroscopic examination of the excised specimen showed a pedunculated tumor measuring 4.0 × 3.5 × 1.9 cm with an uneven surface, yielding a histological diagnosis of lipoma.The patient had an uneventful recovery and was discharged on postoperative day 8.This successful case showed that laparoscopic surgery can be a useful, safe, and efficacious procedure for adult intussusception, even in octogenarians.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo Ami, Inashiki, Ibaraki, 300-0395, Japan. shima-j@tokyo-med.ac.jp.

ABSTRACT
Adult intussusception is rare and usually caused by a tumor acting as the lead point. Therefore, laparotomy should be considered for the treatment. Laparoscopic procedures for use in cases of adult intussusception have been recently reported; however, there is no consensus regarding the safety and efficacy. Here, we describe a successful case of laparoscopic management of an octogenarian adult intussusception caused by an ileal lipoma, which was preoperatively suspected. An 87-year-old male presented with progressive abdominal distention and vomiting. Contrast radiography of the small intestine showed an ileal tumor, and magnetic resonance imaging indicated a target-like mass, consistent with an ileal intussusception. The patient was suspected with an intussusception due to an ileal lipoma, and laparoscopic surgery was performed. An approximately 10-cm-long ileal intussusception with a preceding tumor was present, and partial resection of the ileum, including the tumor, was performed. Macroscopic examination of the excised specimen showed a pedunculated tumor measuring 4.0 × 3.5 × 1.9 cm with an uneven surface, yielding a histological diagnosis of lipoma. The patient had an uneventful recovery and was discharged on postoperative day 8. This successful case showed that laparoscopic surgery can be a useful, safe, and efficacious procedure for adult intussusception, even in octogenarians.

Show MeSH
Related in: MedlinePlus