Acute Obstructive Abdomen due to Intestinal Intussusception in an Adult due to Sigmoid Tumor - Case report

Summary Introduction: Intestinal intussusception (II) is an event considered rare, especially in adults, initially reported in 1674 by Barbette of Amsterdam and later better described by John Hunter in 1789. It is defined as a telescopic invagination of the intestinal loop into the adjacent lumen following. Clinically, the diagnosis is challenging considering the different pain syndromes abdominals. Prior knowledge of the most prevalent etiologies, especially in adults, is important for guide the appropriate technique for treatment. The recommendation in the medical literature is resection oncology, since the malignant tumor presents itself as a common etiological factor of invagination. If not performed as recommended, the prognosis may be changed and the patient, consequently, harmed. Case report: 44-year-old male patient, who had stopped eliminating feces and flatus for 05 days, abdominal distension and x-ray image demonstrating air-fluid level with probable point stop in descending colon. Performed with tomography which suggested intestinal intussusception in sigmoid region. Urgent surgical approach indicated for obstructive acute abdomen and the invaginating telescopic appearance of the sigmoid loop was confirmed, opting for rectosigmoidectomy oncology. The anatomopathological analysis confirmed the association with malignant neoplasm (adenocarcinoma) with classification pT2 pN1b with 02 affected lymph nodes out of 35 resected next to the piece. The patient was discharged in the third post-operative period with good acceptance of diet and functioning colostomy bag for feces and flatus, walking and denying pain associated with laboratory improvement. Discussion: II is more commonly reported in pediatric patients and is little explored within the scope of adult patients. It presents a prevalence of 1-5% of obstructive acute abdominal syndromes. Among abdominal surgical diseases in general, there is a prevalence of less than 1 case for each 1300, in children it is 1 in 20. Ninety percent of adults have an etiological factor defined, with neoplasia being the most prevalent. As in the literature and in the case in question, the suspected malignancy in II in adult patients was confirmed with pathology. In pediatric cases, simple reversal of intussusception and/or pexy is sufficient, however this maneuver in adult patients is not recommended. Although rare, due to etiological statistics eminently neoplastic, the possibility of a surgical approach with oncological resection may benefit the adult patient undergoing R0 surgery. Materials and methods: A literature review was carried out on intestinal intussusception in adults associated with an observational, retrospective and descriptive study using the medical records of the patient. The events were described chronologically, accompanied by the medical residency in General Surgery in a secondary hospital in greater São Paulo.