Treatment of postoperative jejunal intussusception in adult with oral gastrografin after laparoscopic low rectal resection. A case report. (2020)

• Record Type: Journal Article
• Authors: Romano, Mafalda; Tartaglia, Ernesto; Amodio, Ferdinando; Gragnaniello, Angelo; Bortone, Sara; Fabozzi, Massimiliano
• Is Part Of: International journal of surgery case reports. Volume 74(2020)
• Page Start: 120
• Page End: 123
• Publication Date: 2020
• Subjects: POD post-operative day -- BMI Body Mass Index -- CT computed tomography -- MRI magnetic resonance imaging -- RT+ CT chemoradiotherapy -- US abdominal ultrasonography -- os oral; Intussusception -- Postoperative bowel intussusception -- Intestinal obstruction -- Gastrografin -- Contrast material; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.08.005
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Intussusception is a rare cause of postoperative small bowel obstruction in adult and the treatment is still debated. Bowel Intussusception should be kept in mind in a post operative patient who develops obstructive symptoms. The time of diagnosis makes the difference between surgical treatment and others. Abdominal CT have a good accuracy in diagnosis. Surgery is necessary if peritoneal irritation is present. Otherwise, conservative treatment is considered. Abstract: Introduction: Postoperative intussusception is a rare cause of intestinal obstruction in adults. Intussusception refers to a condition in which a segment of the intestine invaginates into the lumen of an adjacent segment of the intestine. Presentation of case: We report a case of postoperative jejunojejunal intussusception in a 42-year-old male following a laparoscopic low anterior resection for rectal cancer. In post-operative day (POD) 2 the patient showed intermittent bowel obstruction and fever. Diagnosis was established with abdominal computed tomography (CT) and enteroclysis, which led to a spontaneous reduction of the invagination. Discussion: The incidence of intussusception in adults is rare condition. It represents less than 5% of all cases. In adults, transient asymptomatic enteric intussusception often resolves spontaneously without any treatment. When bowel obstruction is complete and persistent, surgery is need. Intussusception as cause of intestinal obstruction should be kept in mind in a post operative patient who develops obstructive symptoms. Early diagnosis makes the difference between surgical and others treatment. The pathogenesis and diagnosis of postoperative intussusception in the adult is discussed in the case report. Conclusion: The authors presented a rare cause of postoperative small bowel obstruction treated without surgery. The peculiarity of this case report is that the authors have successfully used, in an adult, conservative treatment with gastrografin, which is the treatment of choice used in children. The use of gastrografin was decisive and there were no recurrences in the follow up.