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World Journal of Colorectal Surgery

Volume 3, Issue 4 2013 Article 6

Case report: Intussusception of the colon


through a colostomy: A rare presentation of
colonic intussusception.
Dr. Nora Trabulsi∗ Dr. Awad Al-Qahtani†
Dr. Carol Ann Vasilevsky‡

∗ McGill
University, Montreal, Quebec, Canada, Nora.trabulsi@yahoo.ca
†McGill
University, Montreal, Quebec, Canada, dr aq1@yahoo.com
‡McGill University, Montreal, Quebec, Canada

c 2014 The Berkeley Electronic Press. All rights reserved.


Copyright §
Case report: Intussusception of the colon
through a colostomy: A rare presentation of
colonic intussusception.
Dr. Nora Trabulsi, Dr. Awad Al-Qahtani, and Dr. Carol Ann Vasilevsky

Abstract

Intussusception of the bowel through the ostomy is a rare complication of ostomies. We


only found few case reports in the literature, of which one was a reported case of large bowel
intussusception into a colostomy and 4 cases of small bowel intussusception into ileostomies. We
report a case of large bowel intussusception through a colostomy.

KEYWORDS: colostomy, Intussusception


Trabulsi et al.: Case report: Intussusception of the colon through a colostomy: A 1

Introduction
Intussusception of the bowel through a stoma is a rare complication of
ostomies. We found case reports in the literature, one of which was a
reported case of large bowel intussusception into a colostomy and four of
which were small bowel intussusception into ileostomies. We report a case
of colonic intussusception into a colostomy.

Case Report
A 78 year-old woman with a past medical history of hypertension,
spinal stenosis, and diverticulosis presented to the emergency department
with abdominal pain and fever. Her abdominal series demonstrated free
intraperitoneal air. The patient underwent emergent laparotomy and
Hartmann’s procedure for perforated sigmoid diverticulitis. Her
postoperative course was uncomplicated and she was discharged home.

Presentation
Two months later, the patient presented to the emergency department
with a one day history of abdominal pain, constipation, and stoma
discoloration. There was no history of nausea, vomiting, or abdominal
distention. She had not passed stool or gas through the stoma for one day.

Physical Exam
On physical examination, the patient was hemodynamically stable and
afebrile. Her abdominal examination revealed an edematous stoma with
discoloration of the distal segment, and bloody discharge was present in the
ostomy appliance. Her abdomen was not distended. It was soft with
diminished bowel sounds.

Radiologic Imaging
A CT scan of the abdomen performed the same day demonstrated
colo-colostomy intussusception with peristomal herniation of mesenteric fat
(Images 1-3).

Treatment
The patient underwent exploratory laparotomy and was found to have
colonic intussusception through the prolapsed stoma with vascular
compromise of the distal segment. The distal segment was edematous,
dusky, and had sloughed mucosa (Images 4, 5). Peristomal fat herniation

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2 World Journal of Colorectal Surgery Vol. 3, Iss. 4 [2014], Art. 6

was also present. The distal colostomy segment was resected and
reanastomosed to the rectal stump. Postoperatively, the patient recovered
well and was discharged home.

Pathology
Histopathological exam of the resected segment revealed
intussusception of large bowel into the stoma with hemorrhagic, ischemic
necrosis at the mucosa level and peristomal herniation with organizing fat
necrosis.

Discussion and Literature Review


Bowel intussusception through ostomies is a very rare complication.
There are only a few reported cases in the literature. There are four reported
cases of intussusception of small bowel through an ileostomy. Three of
which were reported in pregnant women in 1959, 1992, and 2005. All of
whom had ileostomy performed for inflammatory bowel disease1-3. This lead
to the postulation that the increase in intra-abdominal pressure associated
with pregnancy might have contributed to the intussusception.
The fourth case is reported in a 49 year-old man who underwent
laparotomy and diverting loop ileostomy for complicated diverticulitis with
recto-vesical fistula and pelvic inflammatory mass involving the sigmoid
colon and distal small bowel4.
With respect to colonic intussusception through a stoma, there is one
reported case of an irreducible prolapsed colostomy secondary to an
ileocecal intussusception in a 58 year-old man5.

Conclusion
Intussusception of the bowel into a stoma is very rare. There are only
a few reported cases. Cases should be treated promptly as there might be an
element of obstruction or ischemia. There are no definite risk factors
identified. However, the increased intra-abdominal pressure associated with
pregnancy corresponded to several cases.

References
1. Priest FO, Gilchrist RK, Long JS. Pregnancy in the patient with
ileostomy and colectomy. J AM Med Assoc. 1959; 169(3):213-215.
2. Adedeji O, McAdam WA. Intussusception in ileostomy in a pregnant
woman. Postgrad Med J. 1992; 68(795):67-68.

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Trabulsi et al.: Case report: Intussusception of the colon through a colostomy: A 3

3. Kwok H, Milsom P. Intussusception through an ileostomy. ANZ J


Surg. 2005; 75(3):180-181.
4. Chessin DB, Stern DR, Heimann TM. Intussusception of the small
intestine through an ileostomy: A rare cause of intestinal necrosis.
Medical Center NY: Surgical Rounds. Sept. 2006.
5. Keane RM, Whittaker MG. Irreducibility of prolapsed colostomy due
to ileocaecal intussusception. Ir Med J. 1985; 78(3):80-81.

Image 1

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4 World Journal of Colorectal Surgery Vol. 3, Iss. 4 [2014], Art. 6

Image 2

Image 3

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Trabulsi et al.: Case report: Intussusception of the colon through a colostomy: A 5

Image 4

Image 5

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