A rare cause of obstructive defecation: Ileo-colo-colonic in
Intussusception is the invagination of an intestinal segment to the continuing part of the intestine. Usually, it is a pediatric diagnosis due to benign pathologies. Intussusception as the most common cause of intestinal obstruction occurs most frequently in infants. However, less than 5% of the intussusception cases are seen in adults. One such case has been reported in the Turkish Journal of Surgery.

A 29-year-old woman with intermittent and colicky abdominal pain, constipation, and painful defecation, accompanied with distention and a sense of rectal fullness was hospitalized. Similar symptomatology was present for last three months. The patient was described fecal incontinence with a mass protruding from her anus during maximal discomfort. Physical examination revealed distended abdomen with mild tenderness.

Patulous anus with a bulky mass protruding through the rectum mimicking prolapse was detected on rectal examination. Coronal curved multiplanar reconstruction of contrast-enhanced computed tomography (CT) (Figure 1) showed bowel-within-bowel appearance of ileo-colo-colic intussusception elongated from the cecum to the splenic flexure. Surgical intervention had been decided and informed consent had been received.

At diagnostic laparoscopy, a dilated and partially invaginated bowel was observed. On conversion to laparotomy, ileo-colo-colic intussusception including terminal ileum and right, transverse, left, and sigmoid colon was determined. Subtotal colectomy had been initiated because all colonic segments invaginated each other down till recto-sigmoidal junction.

Subtotal colectomy with ileorectal anastomosis and posterior rectopexy was performed. Pathological examination revealed a benign cecal ulcer causing colo-colic intussusception. After an unremarkable postoperative course, she was doing well at the 13-month follow-up.

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