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RETROGRADE ILEO-ILEAL INTUSSUSCEPTION
P K Wagle*, Ashfaq Tapia**, R M Joshi***, S M Navadgi**
*Lecturer; **Registrar; ***Associate Professor, Department of Surgery, BYL Nair Charitable Hospital, Mumbai.
Retrograde ileo-ileal intussusception is a rare entity. We present here the case of a 26 year old male patient who presented with the features of intestinal obstruction. Patient underwent exploratory laparotomy and made an uneventful recovery.CASE REPORT
A 26 year old male was admitted with colicky pain in the abdomen of 2 days duration in the epigastric and umbilical region. The patient had multiple episodes of bilious vomiting and obstipation.
The patient had undergone exploratory laparotomy around one and a half months earlier for haemoperitoneum following blunt abdominal trauma and a splenectomy had been done then.
At admission the patient was afebrile and had distension of abdomen. The bowel sounds were sluggish. There was tenderness all over the abdomen but guarding, rigidity and rebound tenderness were absent. X-rays of the abdomen showed multiple air fluid levels and dilated small bowel loops in the left hypochondriac region suggestive of post-splenectomy adhesive obstruction. Sonography of the abdomen revealed multiple dilated small bowel loops.
The patient was managed conservatively for about 24 hours, but when he did not respond to the treatment and developed guarding, a decision to operate was taken. On exploration, the patient had massively dilated small bowel loops with a band found between a loop of ileum and the anterior abdominal wall which was divided. About 30 cm proximal to the ileo-caecal junction, an ileo-ileal intussusception was discovered. The distal ileum and large bowel were collapsed.
Since the intussusception could not be reduced, that portion of the ileum was resected and an ileo-ileal anastomosis was performed.
The specimen (Fig. 1) was cut open to reveal the intussusception to be retrograde where the distal ileum was found entering into the grossly hypertrophied and oedematous proximal ileal loop. There was marked inflammation but no evidence of gangrenous changes. There were dense adhesions present between the two loops of bowel which could not be separated. Histopathology showed moderate inflammation with no evidence of any malignancy. The patient recovered uneventfully and was discharged.
DISCUSSION
The term retrograde intussusception was first coined by John Hunter in 1789. Since then retrograde intussusceptions have been seldom reported.
This condition is usually seen at autopsy and after gastric resection surgery where retrograde jejuno-gastric intussusceptions have been described.[1] Deterling, et al[2] have also described retrograde intussusceptions with the common causes being the sudden withdrawal of the Miller Abbott tubes and following pelvic surgeries.
Mitra and Roth[3] have in 1983 reported a case very similar to the one described here. Like the case discussed here, they have been unable to determine the cause for the retrograde ileo-ileal intussusception.
REFERENCES1.Akehurst AC. Retrograde intussusception - A report of a case and review of 103 cases in the literature. BJS 1955; 43 : 207-13.
2.Deterling RA, O'Malley RD, Knox W. Intussusception in the adult with emphasis on the retrograde type. AMA Arch Surg 1953; 67 : 853-4.
3.Mitra A, Roth RN. Retrograde ileo-ileal intussusception. Postgrad Med J 1984; 60.
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