Tip intussusception of unmatured end ileostomy causing bowel obstruction: A case report for a novel subtype of stoma outlet obstruction?

Abstract

Introduction and importance: Stoma has become a common surgical act and is commonly performed. One of type of stoma creation is unmatured end ileostomy. Our case showed a rare tip intussusception of unmatured end ileostomy causing bowel obstruction.

Case presentation: A 51-year-old Madurese male underwent a left hemicolectomy with end ileostomy Hartmann's procedure for total bowel obstruction due to caecal well differentiated adenocarcinoma (pT4aN0M0). One month post operative, the patient came to outpatient clinic for bowel obstruction for the last 3 days. Examination for the end ileostomy tip was reddish, swollen, irreducible, unretracted but shortened. A triple contrast abdominal Computed Tomography was ordered, and no narrowing proximal from the stoma outlet was found. Early stomal closure with exploratory laparotomy was performed.

Clinical discussion: Any post unmatured end ileostomy bowel obstruction with unretracted shortened ileostomy limb, lumen narrowing around the full thickness annular curling of the ileum, and edematous mucosa of the distal tip with no cause of obstruction found on contrast abdominal CT, tip intussusception of unmatured end ileostomy as the cause of stoma outlet obstruction should be suspected.

Conclusion: Tip intussusception of unmatured ileostomy is rare clinical entity should be known to surgeon and should be considered as a new subtype of stoma outlet obstruction.