Appendicular staple line serving as hypomochlion for ... · was in 1991.3 Since then, the use of...
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REFERENCES 1. Azar T. et al. Ann Surg 1997;226:134 2. Simper S. et al. Surg Obes Relat Dis 2007;3:446 3. Daniell J. et al. Obstet Gynecol 1991;78:721 4. Sohn M. et al. Chirurg 2014;85:46 Appendicular staple line serving as hypomochlion for intussusception Mickael Chevallay, Calin Stanescu, Ioanis Rotas, Markus Menth and Bernhard Egger Department of Surgery HFR Fribourg - Cantonal Hospital, CH-1708 Fribourg We present the case of a 22 year-old man who suffered from an ileocolic intussusception with the staple line after appendectomy serving as hypomochlion. METHODS DISCUSSION The two most used technique to secure the appendiceal stump are endoloop or endostapling. The first description of an appendectomy using a stapling device was in 1991.3 Since then, the use of linear staplers during laparoscopic appendectomy is a common and safe practice and may even reduce surgical site infections and intra abdominal abscess formation in severe appendicitis.4 However, such a staple line may also serve as a hypomochlion for an intussusception. When confronted with an adult patient presenting with bowel obstruction after appendectomy, this should raise concern, not only because of probable adhesions but also because of a probable intussusception due to a staple line on the caecum. RESULTS The patient presented to the emergency department with abdominal pain and bloody diarrhea for the last 24 hours. Patient’s history revealed a laparoscopic appendectomy using a linear stapler 6 years earlier. An abdominal CT scan demonstrated an ileocolic intussusception (Figure 1). An immediate colonoscopic attempt to reduce the intussusception failed. Even at laparoscopy it was not possible to reduce the invagination. After conversion to laparotomy a right hemicolectomy was performed. Histopathology (Figure 2) confirmed that the staple line with fibrous remodeling after appendectomy was serving as hypomochlion for the pathology. No signs of neoplastic tissue were found. The patient was discharged home 10 days later after an uneventful postoperative follow-up. BACKGROUND Intussusception is the telescoping of a proximal intestinal segment into the distal intestine provoking obstruction and ischemia. Adult intussusception is a rare entity, representing 5% of all cases. 1 The hypomochlion for this process has a peristaltic inactivity and is generally of neoplastic nature. The development and improvement of stapling devices have shortened operative time and improved perioperative safety. 2 However, the introduction of new surgical material as a non-absorbable staple line may also alter the intestinal peristalsis and may therefore serve as hypomochlion for an intussusception. Picture 1. Operative specimen of the right hemicolon. The distal part seems to have suffered most from ischemia Figure 1. Abdominal Ct-Scan with intra-venous and oral contrast showing the ileo-colic intussuseption
Transcript of Appendicular staple line serving as hypomochlion for ... · was in 1991.3 Since then, the use of...
REFERENCES
1. Azar T. et al. Ann Surg 1997;226:1342. Simper S. et al. Surg Obes Relat Dis 2007;3:4463. Daniell J. et al. Obstet Gynecol 1991;78:7214. Sohn M. et al. Chirurg 2014;85:46
Appendicular staple line serving as hypomochlion for intussusception
Mickael Chevallay, Calin Stanescu, Ioanis Rotas, Markus Menth and Bernhard Egger
Department of Surgery HFR Fribourg - Cantonal Hospital, CH-1708 Fribourg
We present the case of a 22 year-old man who sufferedfrom an ileocolic intussusception with the staple lineafter appendectomy serving as hypomochlion.
METHODS
DISCUSSION
The two most used technique to secure the appendicealstump are endoloop or endostapling. The firstdescription of an appendectomy using a stapling devicewas in 1991.3 Since then, the use of linear staplersduring laparoscopic appendectomy is a common andsafe practice and may even reduce surgical siteinfections and intra abdominal abscess formation insevere appendicitis.4 However, such a staple line mayalso serve as a hypomochlion for an intussusception.When confronted with an adult patient presenting withbowel obstruction after appendectomy, this should raiseconcern, not only because of probable adhesions butalso because of a probable intussusception due to astaple line on the caecum.
RESULTS
The patient presented to the emergency departmentwith abdominal pain and bloody diarrhea for the last 24hours. Patient’s history revealed a laparoscopicappendectomy using a linear stapler 6 years earlier. Anabdominal CT scan demonstrated an ileocolicintussusception (Figure 1). An immediate colonoscopicattempt to reduce the intussusception failed. Even atlaparoscopy it was not possible to reduce theinvagination. After conversion to laparotomy a righthemicolectomy was performed. Histopathology (Figure2) confirmed that the staple line with fibrous remodelingafter appendectomy was serving as hypomochlion forthe pathology. No signs of neoplastic tissue were found.The patient was discharged home 10 days later after anuneventful postoperative follow-up.
BACKGROUND
Intussusception is the telescoping of a proximalintestinal segment into the distal intestine provokingobstruction and ischemia. Adult intussusception is arare entity, representing 5% of all cases.1 Thehypomochlion for this process has a peristaltic inactivityand is generally of neoplastic nature. The developmentand improvement of stapling devices have shortenedoperative time and improved perioperative safety. 2
However, the introduction of new surgical material as anon-absorbable staple line may also alter the intestinalperistalsis and may therefore serve as hypomochlion foran intussusception.
Picture 1. Operative specimen of the right hemicolon. The distal part seems to have suffered most from ischemia
Figure 1. Abdominal Ct-Scan with intra-venousand oral contrast showing the ileo-colic intussuseption
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