Laparoscopic Right Hemicolectomy With D2 Lymphadenectomy for Adult Ileocecal Intussusception Secondary to Cecal Adenocarcinoma: A Case Report

TL;DR

A 47-year-old woman with a cecal tumor causing intestinal blockage underwent successful laparoscopic surgery, showing this approach is safe for complex cases.

Contribution

Demonstrates laparoscopic right hemicolectomy with D2 lymphadenectomy as a viable surgical option for adult intussusception caused by cecal adenocarcinoma.

Findings

Laparoscopic surgery successfully treated intussusception caused by cecal adenocarcinoma.

D2 lymphadenectomy was safely performed with minimal postoperative complications.

The procedure allowed for temporary bowel diversion when needed.

Abstract

Adult ileocecal intussusception is an uncommon condition that often indicates an underlying malignancy. A 47-year-old woman presented with a three-month history of bowel habit changes, hematochezia, abdominal pain, and a palpable epigastric mass. Laboratory evaluation showed anemia (hemoglobin 8.9 g/dL), thrombocytosis (529,000/μL), and elevated carcinoembryonic antigen (5.78 ng/mL). Contrast-enhanced CT revealed ileocecal intussusception extending into the transverse colon with pericolic lymphadenopathy. Diagnostic laparoscopy identified a 4 × 4 cm cecal mass and approximately 10 cm of intussuscepted ileum. Given the high suspicion of malignancy, no reduction was attempted. A laparoscopic right hemicolectomy with D2-level lymphadenectomy was performed, including pericolic and intermediate lymph node dissection along the ileocolic, right colic, and right branch of the middle colic vessels with ligation at the superior mesenteric artery origin. An end ileostomy was created due to anemia, transient vasopressor use, and mild bowel edema. The postoperative course was uneventful, with early ambulation, oral tolerance, and discharge after 48 hours. This case highlights the importance of maintaining oncologic principles in adult intussusception and demonstrates that laparoscopic right hemicolectomy with D2 lymphadenectomy is a safe, effective, and adaptable approach, even when temporary diversion is required.

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