A Case of Intussusception of the Ileum Prolapsed through the Ileostomy

Abstract

A 65-year-old man who had an ileostomy created following total removal of the large intestine for ulcerative colitis had been on ambulatory treatment with chemotherapy at our hospital for stage IV lung cancer with metastases to the brain, liver and bone. He was seen at our clinic because of abdominal pain and prolapse of the stoma lasting since he got up in the morning. From macroscopic and abdominal CT findings, we determined that reduction might be difficult because the prolapsed intestine was seriously edematous and showed strong ischemic change. Emergency operation was thus performed. Detailed observation under general anesthesia revealed telescoping of a segment of the ileum within a neighboring segment of the ileum which had prolapsed through the stoma. The telescoped ileum including the normal portion was drawn out outside of the body, the intussusception was reduced by hands, and then resection of the necrotized intestine followed by a new creation of ileostomy was performed.
Intussusception and prolapse of the ileum through the ileostomy is very rare and causes are still unknown. We consider that possible causes may include abnormal peristalsis which might occur due to spinal metastasis of lung cancer, in addition to increased abdominal pressure and creation of the ileostomy via the intraperitoneal route.