2021 Volume 54 Issue 6 Pages 424-429
A male aged 70 was transported by ambulance with chief complaints of intestinal tract procidentia and proctodynia. Intestinal tract procidentia from the anus was observed and necrosis of a prolapsed intestinal tract was suspected. A CT scan showed that the sigmoid colon had reversed in the rectum lumen and intussuscepted, and its presenting part had prolapsed. Given the possibility of perforation, surgery was chosen without trying reduction. The sigmoid colon was dissected on the oral side of the intussusception by laparoscopy, the posterior rectal cavity was mobilized to the level of the levator ani, the reversed prolapsed intestinal tract was pulled out through the anus, the intestinal tract was dissected on the anal side, and the specimen was removed. A 0-I type tumor in the presenting part of the intussusception and perforation around the tumor were observed in the resected specimen. There are some reports of sigmoid colon cancer developing into a presenting part with intussusception and resulting in procidentia. However, in this case, the intestinal tract was incarcerated out of the anus, which suggested the possibility of perforation or malignancy. Therefore, laparoscopic surgery was performed for intestinal tract mobilization and dissection, without attempting reduction, followed by Hartmann’s surgery with transanal removal of the specimen.
