title: Anal protrusion of an ileo-colic intussusception in an adult with persistent ascending and descending mesocolons: a case report.
abstract: BACKGROUND
  Intussusception is one of the less common causes of intestinal obstruction among adults. It is usually covert (concealed) in its clinical presentation. The ileo-colic type with accompanying anal protrusion is extremely rare. The case at hand is that of both an ileo-colic intussusception with anal protrusion, in the presence of a persistence of both the ascending and descending mesocolons; a case possibly yet to be documented in literature.
  
  
  METHODS
  A 32 year-old African-Ugandan woman presented with complaints of a mass protruding per anus for 2 weeks. It was reducible and associated with colicky abdominal pain, loose stools, and bloody-mucoid discharge per anus. She had previously had a one and a half month's history of abdominal pain; periodically continuous, while other times colicky in character. Examination and investigations revealed an intussusception with a partial intestinal obstruction. At laparotomy she was found to have an ileo-colic intussusception with a freely mobile colon throughout its length. There were persistent ascending and descending mesocolons, and absent hepatocolic and splenocolic ligaments. The intussusceptum was 'milked' but not completely reducible. A right hemicolectomy was done, with ileo-transverse colonic anastomosis. Histopathological examination revealed no preexisting pathologic lesion as a lead point.
  
  
  CONCLUSIONS
  The persistence of the ascending and descending mesocolons (azygosis) best explains the anal protrusion of an ileo-colic intussusception with partial obstruction. In this case zygosis (normal retroperitoneal ascending and descending colonic positioning) failed embryologically. This experience is particularly beneficial to general surgeons, radiologists, gastroenterologists, colorectal surgeons and pathologists.
authors: Colorectal Surgery Unit, Department of Surgery, School of Medicine, Makerere College of Health Sciences, Makerere University, P O Box 7072, Kampala, Uganda. petongom@yahoo.co.uk
authors: Peter A
authors: PA
authors: Ongom
authors: Robert L
authors: RL
authors: Lukande
authors: Josephat
authors: J
authors: Jombwe
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D003085:Colic / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D007443:Intussusception / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D007813:Laparotomy; D008646:Mesocolon / Q000473:pathology*
references: Am J Surg. 1997 Feb;173(2):88-94
references: 9074370
references: Am J Surg. 1989 Jul;158(1):25-8
references: 2662787
references: Ann Surg. 1997 Aug;226(2):134-8
references: 9296505
references: Cases J. 2008 Sep 30;1(1):198
references: 18826634
references: Aust N Z J Surg. 1976 Feb;46(1):57-63
references: 1064405
references: Vestn Khir Im I I Grek. 1968 Dec;101(12):108-9
references: 5720959
references: J Ayub Med Coll Abbottabad. 2006 Jul-Sep;18(3):3-6
references: 17348303
references: Br J Surg. 1972 Feb;59(2):149-51
references: 4606952
references: Endoscopy. 2011;43 Suppl 2 UCTN:E103-4
references: 21424996
references: AJR Am J Roentgenol. 2003 Apr;180(4):1003-6
references: 12646445
references: Indian J Gastroenterol. 2007 Jan-Feb;26(1):39-40
references: 17401238
references: Ann Trop Paediatr. 2008 Dec;28(4):287-92
references: 19021945
references: Int Surg. 2000 Jul-Sep;85(3):226-30
references: 11325000