intestinal intussusception is relatively common in children , whereas in adults it is a rare clinical entity , which occurs most often secondary to a defined pathologic abnormality .
although surgical resection is recommended , there is still no consensus regarding optimal management of adult intussusception caused by intestinal cancer . considering the theoretical risk of perforation , which could cause seeding of tumor cells and the release of microorganisms into the intraabdominal cavity
however , less invasive management may be indicated and laparoscopy appears to be an attractive alternative to laparotomy for selected patients [ 5 , 6 ] .
we describe how we performed an emergency laparotomy for adult colonic intussusception caused by sigmoid colon cancer .
the successful reduction allowed us to treat the extensive intussusception with a more limited anterior resection instead of en bloc wide abdominoperineal resection .
a 47-year - old woman was admitted to our emergency department with sudden and severe abdominal cramping pain after suffering repeated episodes of colicky and intermittent abdominal pain for about 1 week . on physical examination ,
the results of laboratory investigations were normal including tumor markers of carcinoembryonic antigen and ca19 - 9 .
plain abdominal radiography showed a distended colon and digital rectal examination revealed a protuberant mass - like lesion with a smooth surface .
1 ) , sigmoid - rectum intusussception caused by sigmoid colon cancer was diagnosed . at surgery ,
the sigmoid colon was found to be intussuscepted into the rectum very close to the anus , making reduction difficult . after dividing the peritoneum ,
the surgeon inserted his hands below the peritoneal reflection along the rectum and pushed the intussusception back from the distal to the proximal rectum using a milking action ( fig .
the rectum was divided 5 cm from the peritoneal reflection using a stapler , and the sigmoid colon was divided 10 cm proximal from the intussusception .
we removed the intussuscepted part of the colon as well as the rectum , intermediate lymph nodes , and regional lymph nodes , and performed an anterior resection .
histological examination revealed well - differentiated adenocarcinoma with invasion of the muscularis propriae ( fig .
the lymph nodes were negative for cancer cells . at present , three year after surgery , she is free of symptoms and she has had an uneventful course .
intussusception is a major cause of intestinal obstruction in children , but it is relatively unusual in adults .
adult intussusception accounts for only 1% of all bowel obstructions , 5% of all intussusceptions , and 0.0003 - 0.020% of all hospital admissions .
few general surgeons encounter more than one or two adult patients with colon intussusception during their careers , and most cases are undiagnosed before laparotomy .
intussusception of the sigmoid colon is often misdiagnosed as a large polyp   or rectal prolapse .
however , a delay in diagnosis could result in death , so surgeons must be aware of the possibility of this type of intussusception if they find an unusual rectal tumor in a patient with intestinal obstruction .
our patient presented with sudden and severe abdominal pain , after a short history of repeated episodes of colicky and intermittent abdominal pain .
although abdominal pain is the most common symptom , colonic intussusception can also manifest as a variety of acute , intermittent or chronic symptoms , making its preoperative diagnosis difficult .
ultrasonography has been used to evaluate suspected intussusception   and findings include the target and doughnut signs on the transverse view and the pseudokidney sign on the longitudinal view .
the major limitation of ultrasonography in evaluating acute intestinal obstruction is the presence of air in the bowel , which results in poor transmission and difficulties in interpreting the image .
the characteristic ct findings of intussusception include an early target mass with enveloped , eccentrically located areas of low density .
the characteristic appearance of intussusception on barium enema is a cup - shaped filling defect with a spiral or coil - spring appearance .
the ct findings proved helpful in establishing the preoperative diagnosis in our patient . for patients with intussusception and an inflamed , ischemic or friable bowel wall ,
it is advisable not to attempt operative reduction , but to proceed with resection . given the likelihood of malignancy , most cases of colo - colonic intussusception should be resected en bloc without reduction , which should be avoided because it may result in the spread of malignant cells [ 2 , 4 ] .
even when a benign tumor is suspected before surgery , careful manipulation is mandatory to avoid perforating the strangulated bowel with poor stability . according to nagorney et al .
lynn and agrez reported a case of sigmoid colon intussusception in whom the rectum was opened circumferentially with diathermy at the point of the intussusception , and the intussuscepted sigmoid colon was delivered out of the rectum through the anus . however , this procedure would cause contamination of the abdominal cavity . in our case ,
the peritoneal incision was clean and allowed us to deliver the sigmoid colon out of the rectum , whereby abdominoperineal resection was avoided [ 3 , 4 ] .
laparoscopic surgery is now widely used for the resection of benign and malignant gastrointestinal tumors ; however , its application for intussusception is still controversial .
reported that a laparoscopic approach is safe and effective for most cases of small bowel obstruction and recommended its use as the first - line treatment .
chiu et al . described the successful laparoscopic resection of ileocolic intussusception caused by primary ileal lymphoma .
the usefulness of laparoscopic surgery in emergency situations , particularly for non - decompressed intestinal obstruction , remains controversial because adequate intraperitoneal visualization is almost impossible in such cases . in our case ,
the small and large bowel were so dilated that laparoscopic manipulation would have been difficult .
the choice of a laparoscopic or open approach depends on the clinical condition of the patient , the location and extent of the intussusception , the possibility of underlying disease , and whether the surgeon has sufficient laparoscopic expertise .
 adult intussusception is rare and most often associated with cancer . 
 we report a case of intussuscepted sigmoid colon into the rectum protruding from the anus of a 47-year - old woman . 
 the cause of the intussusception was sigmoid colon cancer . 
 we removed the intussuscepted part of the sigmoid colon as well as the rectum and regional lymph nodes . 
 the patient recovered uneventfully and there has been no evidence of recurrence of the cancer . 
Introduction
Case Report
Discussion