Late postoperative adult intussusception without tumor related cause: an alternative option in management

Abstract

Introduction and Aims: To present a case of late postoperative
bowel obstruction with uncommon etiology, that was
successfully reduced during endoscopy. Description of a
case: We report a case of a 63 year-old man presenting with
failure to pass flatus and stool for two days. The patient underwent
partial left hemicolectomy due to cancer of the sigmoid
colon 5 years ago and an emergency transverse colostomy
was performed 2 years ago due to bowel obstruction
(megacolon). Six months after colostomy, a diagnostic colonoscopy
was performed which revealed a fibrotic stenosis at
the site of anastomosis that was corrected performing balloon
dilatation. Restoration surgery with closure of colostomy
was decided since abdominal computed tomography
and laboratory tests confirmed the absence of cancer recurrence.
A preoperative control colonoscopy identified a
coil-spring polypoid mass with normal mucosa at the level
of anastomosis. There was no sign of ischemia and mucosal
fold intussusception was suspected. A reduction with balloon
dilatation was performed successfully during colonoscopy.
After reduction, the anastomosis was revealed with normal
appearance of mucosa and the bowel function was corrected.
Biopsies taken of the lead point of the obstructive mass
confirmed the presence of intestinal mucosa. Mucosal fold
intussusception is a rare cause of postoperative bowel obstruction
at the site of anastomosis. In these cases, endoscopic
balloon dilatation could be proved safe and efficient,
avoiding a potentially unnecessary bowel resection.
Key words: Adult intussusception, management