spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.5922/2223-2427-2024-9-2-7spractice-475Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯИнвагинация кишки, колоректальный рак и кишечный эндометриоз как сочетанная причина кишечной непроходимости: клинический случайIntestinal intussusception, colorectal cancer and intestinal endometriosis as a combined cause of intestinal obstruction: a case studyhttps://orcid.org/0000-0002-3790-5140ШалыгинА. Б.ShalyginA. B.

Антон Борисович Шалыгин, кандидат медицинских наук, заместитель директора по хирургии; доцент кафедры общей хирургии

119146, Москва, ул. Большая Пироговская, 19, стр. 1

109240, Москва, ул. Яузская, 11

Anton B. Shalygin, Deputy Head; Associate Professor of the Department of General Surgery

19/1 Bolshaya Pirogovskaya St., Moscow, 119146

11 Yauzskaya St., Moscow, 109240

dr.ashalygin@gmail.comhttps://orcid.org/0000-0002-9688-4079ЕмельяновА. Ю.EmelyanovA. Yu.

Андрей Юрьевич Емельянов, кандидат медицинских наук, доцент кафедры общей хирургии; заведующий хирургическим отделением

119146, Москва, ул. Большая Пироговская, 19, стр. 1

109240, Москва, ул. Яузская, 11

Andrey Yu. Emelyanov, Associate Professor, Department of General Surgery; Head of the Department of Surgery

19/1 Bolshaya Pirogovskaya St., Moscow, 119146

11 Yauzskaya St., Moscow, 109240

macmeln@mail.ruhttps://orcid.org/0000-0002-2563-5630ГиноянС. Л.GinoyanS. L.

Сероб Левонович Гиноян, врач-хирург

109240, Москва, ул. Яузская, 11

Serob L. Ginoyan, Surgeon

11 Yauzskaya St., Moscow, 109240

ginoyan.serob@gmail.comhttps://orcid.org/0000-0002-6482-1110СотниковаТ. Н.SotnikovaT. N.

Татьяна Николаевна Сотникова, заведующая патологоанатомическим отделением

109240, Москва, ул. Яузская, 11

Tatyana N. Sotnikova, Head of the Department of Pathology

11 Yauzskaya St., Moscow, 109240

docsotnikova@mail.ruhttps://orcid.org/0000-0002-3096-2070ГвоздевА. А.GvozdevA. A.

Алексей Александрович Гвоздев, заведующий эндоскопическим отделением

109240, Москва, ул. Яузская, 11

Alexey A. Gvozdev, Head of the Department of Endoscopy

11 Yauzskaya St., Moscow, 109240

gvozdev_alexey@mail.ruhttps://orcid.org/0000-0001-7458-991XПолушкинаТ. В.PolushkinaT. V.

Татьяна Валерьевна Полушкина, врач-патологоанатом

109240, Москва, ул. Яузская, 11

Tatyana V. Polushkina, Doctor,

11 Yauzskaya St., Moscow, 109240

peperonya1173@yandex.ruhttps://orcid.org/0000-0003-1733-267XЖуравлевК. Н.ZhuravlevK. N.

Кирилл Николаевич Журавлев, кандидат медицинских наук, заведующий отделением лучевых и функциональных исследований

109240, Москва, ул. Яузская, 11

Zhuravlev Kirill Nikolaevich, Radiologist, Head of Department of Radiology

11 Yauzskaya St., Moscow, 109240

kir232@mail.ruПервый московский государственный медицинский университет имени И. М. Сеченова (Сеченовский Университет); Городская клиническая больница имени И. В. ДавыдовскогоРоссияSechenov First Moscow State Medical University (Sechenov University); Davydovsky City Clinical HospitalRussian FederationГородская клиническая больница имени И. В. ДавыдовскогоРоссияDavydovsky City Clinical HospitalRussian Federation2024160720240297110Copyright © Шалыгин А.Б., Емельянов А.Ю., Гиноян С.Л., Сотникова Т.Н., Гвоздев А.А., Полушкина Т.В., Журавлев К.Н., 20242024Шалыгин А.Б., Емельянов А.Ю., Гиноян С.Л., Сотникова Т.Н., Гвоздев А.А., Полушкина Т.В., Журавлев К.Н.Shalygin A.B., Emelyanov A.Y., Ginoyan S.L., Sotnikova T.N., Gvozdev A.A., Polushkina T.V., Zhuravlev K.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.spractice.ru/jour/article/view/475

В работе представлены данные об уникальном клиническом случае, где у пациентки имеются две опухоли — мезенхимального и эпителиального происхождения, а также очаг внематочного эндометриоза в пределах слепой кишки. Сочетание этих патологий привело к развитию толстокишечной инвагинации, осложненной толсто-тонкокишечной непроходимостью, вызванной липомой слепой кишки, в сочетании с колоректальным раком той же локализации с локальными очагами эндометриоза. Выполнено оперативное вмешательство в объеме лапароскопической резекции терминального отдела подвздошной кишки, слепой, восходящей, поперечной, нисходящей ободочной кишки с лимфодиссекцией Д2 и формированием лапароскопически-ассистированного илеосигмоанастомоза. Пациентка выписана в удовлетворительном состоянии на 7-е сутки. Данное клиническое наблюдение было представлено широкому вниманию как пример нетипичного течения редкого осложнения заболевания, которое привело к первоначально ошибочному диагнозу и необходимости обширной резекции кишки по поводу рака, выполненной по неотложным показаниям с адекватным объемом лимфодиссекции. Кроме того, внимания заслуживает длительное, не менее 1 месяца, существование инвагинации с благоприятным исходом лечения.

The paper describes a unique clinical case involving a patient with two tumours of mesenchymal and epithelial origin, along with ectopic endometriosis located within the cecum. This combination of pathologies resulted in colonic intussusception and subsequent colon-small intestine obstruction due to a cecal lipoma, compounded by colorectal cancer in the same area with local endometriosis foci. The surgical intervention involved laparoscopic resection of the terminal ileum, cecum, ascending, transverse, and descending colon, along with D2 lymphadenectomy and laparoscopically assisted ileosigmoid anastomosis. The patient was discharged in satisfactory condition on the 7th day post-surgery. This clinical observation garnered significant attention due to its atypical presentation of a rare complication, initially leading to a misdiagnosis and necessitating extensive intestinal resection for cancer under urgent circumstances with adequate lymph node dissection. Furthermore, the favourable treatment outcome despite the long-term presence of intussusception for at least one month underscores the noteworthy aspect of this case.

инвагинация кишечникакишечная непроходимостьлипомаколоректальный ракэндометриозлапароскопическая резекцияintestinal intussusceptionintestinal obstructionlipomacolorectal cancerendometriosislaparoscopic resectionReferencesTascilar O, Cakmak GK, Gün BD, Uçan BH, Balbaloglu H, Cesur A, Emre AU, Comert M, Erdem LO, Aydemir S. Clinical evaluation of submucosal colonic lipomas: decision making. World J Gastroenterol. 2006 Aug 21;12(31):5075—7. https://doi.org/10.3748/wjg.v12.i31.5075Tascilar O, Cakmak GK, Gün BD, Uçan BH, Balbaloglu H, Cesur A, Emre AU, Comert M, Erdem LO, Aydemir S. Clinical evaluation of submucosal colonic lipomas: decision making. World J Gastroenterol. 2006 Aug 21;12(31):5075—7. https://doi.org/10.3748/wjg.v12.i31.5075Chung YF, Ho YH, Nyam DC, Leong AF, Seow-Choen F. Management of colonic lipomas. Aust N Z J Surg. 1998 Feb;68(2):133—5. https://doi.org/10.1111/j.1445-2197.1998.tb04723.xChung YF, Ho YH, Nyam DC, Leong AF, Seow-Choen F. Management of colonic lipomas. Aust N Z J Surg. 1998 Feb;68(2):133—5. https://doi.org/10.1111/j.1445-2197.1998.tb04723.xGordon RT, Beal JM. Lipoma of the colon. Arch Surg. 1978 Jul;113(7):897—9. https://doi.org/10.1001/archsurg.1978.01370190119026Gordon RT, Beal JM. Lipoma of the colon. Arch Surg. 1978 Jul;113(7):897—9. https://doi.org/10.1001/archsurg.1978.01370190119026Hancock BJ, Vajcner A. Lipomas of the colon: a clinicopathologic review. Can J Surg. 1988 May;31(3):178—81.Hancock BJ, Vajcner A. Lipomas of the colon: a clinicopathologic review. Can J Surg. 1988 May;31(3):178—81.Pattarajierapan S, Khomvilai S. Endoscopic submucosal dissection of a symptomatic giant colonic lipoma: technical tips for resection and specimen retrieval. VideoGI E. 2022 Mar 2;7(5):190—192. https://doi.org/10.1016/j.vgie.2022.01.012Pattarajierapan S, Khomvilai S. Endoscopic submucosal dissection of a symptomatic giant colonic lipoma: technical tips for resection and specimen retrieval. VideoGI E. 2022 Mar 2;7(5):190—192. https://doi.org/10.1016/j.vgie.2022.01.012Osera S, Shinohara T, Tomori A, Momoi T, Fukushima H, Hisa T, Shiozawa S. Successful endoscopic resection using a bipolar snare for an adenoma overlying a transverse colonic lipoma. Endoscopy. 2020 Oct;52(10):E372—E373. https://doi.org/10.1055/a-1134-4567Osera S, Shinohara T, Tomori A, Momoi T, Fukushima H, Hisa T, Shiozawa S. Successful endoscopic resection using a bipolar snare for an adenoma overlying a transverse colonic lipoma. Endoscopy. 2020 Oct;52(10):E372—E373. https://doi.org/10.1055/a-1134-4567Lancet F, Alberti LE, Alberti-Flor JJ. Diminutive colon polyp coexisting with a large lipoma: an endoscopic ‘rarity’. Can J Gastroenterol. 2004 Mar;18(3):178. https://doi.org/10.1155/2004/796896Lancet F, Alberti LE, Alberti-Flor JJ. Diminutive colon polyp coexisting with a large lipoma: an endoscopic ‘rarity’. Can J Gastroenterol. 2004 Mar;18(3):178. https://doi.org/10.1155/2004/796896Chu SJ, Kim JS, Kim BW. Tubular adenoma overlying a colonic lipoma resected by endoscopic resection with use of a detachable endoloop. Gastrointest Endosc. 2019 Apr;89(4):894—895. https://doi.org/10.1016/j.gie.2018.11.025Chu SJ, Kim JS, Kim BW. Tubular adenoma overlying a colonic lipoma resected by endoscopic resection with use of a detachable endoloop. Gastrointest Endosc. 2019 Apr;89(4):894—895. https://doi.org/10.1016/j.gie.2018.11.025Facanali CBG, Facanali Junior MR, Sobrado Junior CW, Safatle-Ribeiro AV. A Sessile Serrated Lesion Overlying a Submucosal Colonic Lipoma: An Endoscopic Rarity Identified Using Artificial Intelligence. Am J Case Rep. 2023 Aug 11;24:e940499. https://doi.org/10.12659/AJCR.940499Facanali CBG, Facanali Junior MR, Sobrado Junior CW, Safatle-Ribeiro AV. A Sessile Serrated Lesion Overlying a Submucosal Colonic Lipoma: An Endoscopic Rarity Identified Using Artificial Intelligence. Am J Case Rep. 2023 Aug 11;24:e940499. https://doi.org/10.12659/AJCR.940499Snover DC. Atypical lipomas of the colon. Report of two cases with pseudomalignant features. Dis Colon Rectum. 1984 Jul;27(7):485—8. https://doi.org/10.1007/BF02555551Snover DC. Atypical lipomas of the colon. Report of two cases with pseudomalignant features. Dis Colon Rectum. 1984 Jul;27(7):485—8. https://doi.org/10.1007/BF02555551Virgilio E, Mercantini P, Cavallini M. Is endoscopic resection a correct treatment for atypical gastrointestinal lipomas? World J Clin Cases. 2016 Jan 16;4(1):30—2. https://doi.org/10.12998/wjcc.v4.i1.30Virgilio E, Mercantini P, Cavallini M. Is endoscopic resection a correct treatment for atypical gastrointestinal lipomas? World J Clin Cases. 2016 Jan 16;4(1):30—2. https://doi.org/10.12998/wjcc.v4.i1.30Palma R, Pontone S, Marino IR, Magliocca FM, Frattaroli S, Tonini V, D’Andrea V. Sheep in Wolf’s Clothing: Pedunculated Colonic Lipoma with Overlying Hyperplastic and Ulcerated Epithelium. Dig Dis Sci. 2020 Jul;65(7):1951—1953. https://doi.org/10.1007/s10620-020-06188-4Palma R, Pontone S, Marino IR, Magliocca FM, Frattaroli S, Tonini V, D’Andrea V. Sheep in Wolf’s Clothing: Pedunculated Colonic Lipoma with Overlying Hyperplastic and Ulcerated Epithelium. Dig Dis Sci. 2020 Jul;65(7):1951—1953. https://doi.org/10.1007/s10620-020-06188-4Radhi JM, Haig TH. Lipoma of the colon with overlying hyperplastic epithelium. Can J Gastroenterol. 1997 Nov-Dec;11(8):694—5. https://doi.org/10.1155/1997/547175Radhi JM, Haig TH. Lipoma of the colon with overlying hyperplastic epithelium. Can J Gastroenterol. 1997 Nov-Dec;11(8):694—5. https://doi.org/10.1155/1997/547175Vasiliadis K, Katsamakas M, Nikolaidou A, Christoforidis E, Tsalis K, Tsalikidis A. Submucosal lipoma of the ascending colon as a source of massive lower gastro-intestinal bleeding: a case report. Acta Chir Belg. 2008 May-Jun;108(3):356—9. https://doi.org/10.1080/00015458.2008.11680239Vasiliadis K, Katsamakas M, Nikolaidou A, Christoforidis E, Tsalis K, Tsalikidis A. Submucosal lipoma of the ascending colon as a source of massive lower gastro-intestinal bleeding: a case report. Acta Chir Belg. 2008 May-Jun;108(3):356—9. https://doi.org/10.1080/00015458.2008.11680239Adachi S, Hamano R, Shibata K, Yoshida S, Tateishi H, Kobayashi T, Hanada M. Colonic lipoma with florid vascular proliferation and nodule-aggregating appearance related to repeated intussusception. Pathol Int. 2005 Mar;55(3):160—4. https://doi.org/10.1111/j.1440-1827.2005.01803.xAdachi S, Hamano R, Shibata K, Yoshida S, Tateishi H, Kobayashi T, Hanada M. Colonic lipoma with florid vascular proliferation and nodule-aggregating appearance related to repeated intussusception. Pathol Int. 2005 Mar;55(3):160—4. https://doi.org/10.1111/j.1440-1827.2005.01803.xAl-Badawi IA, Abu-Zaid A, Alomar O, Alsabban M, Alsehaimi SO, Alqarni SMS, Alabdrabalamir SN, Baradwan S, Al Baalharith M, AlOdaini AA, Saleh SAK, Adly HM, Bukhari IA, Salem H. Association between Endometriosis and the Risk of Ovarian, Endometrial, Cervical, and Breast Cancer: A Population-Based Study from the U. S. National Inpatient Sample 2016—2019. Curr Oncol. 2024 Jan 13;31(1):472—481. https://doi.org/10.3390/curroncol31010032Al-Badawi IA, Abu-Zaid A, Alomar O, Alsabban M, Alsehaimi SO, Alqarni SMS, Alabdrabalamir SN, Baradwan S, Al Baalharith M, AlOdaini AA, Saleh SAK, Adly HM, Bukhari IA, Salem H. Association between Endometriosis and the Risk of Ovarian, Endometrial, Cervical, and Breast Cancer: A Population-Based Study from the U. S. National Inpatient Sample 2016—2019. Curr Oncol. 2024 Jan 13;31(1):472—481. https://doi.org/10.3390/curroncol31010032Higesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight JC, Missmer SA, Rahmioglu N, Zondervan KT, Becker CM. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update. 2019 Jul 1;25(4):486—503. https://doi.org/10.1093/humupd/dmz014Higesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight JC, Missmer SA, Rahmioglu N, Zondervan KT, Becker CM. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update. 2019 Jul 1;25(4):486—503. https://doi.org/10.1093/humupd/dmz014Lo HW, Weng SF, Chen HS, Tsai EM. Pelvic inflammatory disease is associated with ovarian cancer development in women with endometriosis: A cohort study in Taiwan. Int J Gynaecol Obstet. 2022 Jul;158(1):145—152. https://doi.org/10.1002/ijgo.13935Lo HW, Weng SF, Chen HS, Tsai EM. Pelvic inflammatory disease is associated with ovarian cancer development in women with endometriosis: A cohort study in Taiwan. Int J Gynaecol Obstet. 2022 Jul;158(1):145—152. https://doi.org/10.1002/ijgo.13935Murakami K, Kotani Y, Shiro R, Takaya H, Nakai H, Matsumura N. Endometriosis-associated ovarian cancer occurs early during follow-up of endometrial cysts. Int J Clin Oncol. 2020 Jan;25(1):51—58. https://doi.org/10.1007/s10147-019-01536-5Murakami K, Kotani Y, Shiro R, Takaya H, Nakai H, Matsumura N. Endometriosis-associated ovarian cancer occurs early during follow-up of endometrial cysts. Int J Clin Oncol. 2020 Jan;25(1):51—58. https://doi.org/10.1007/s10147-019-01536-5Anifantaki F, Boutas I, Kalampokas T, Kalampokas E, Sofoudis C, Salakos N. Association of endometriosis and breast cancer: mini review of the literature. Arch Gynecol Obstet. 2016 Jan;293(1):5—10. https://doi.org/10.1007/s00404-015-3809-8Anifantaki F, Boutas I, Kalampokas T, Kalampokas E, Sofoudis C, Salakos N. Association of endometriosis and breast cancer: mini review of the literature. Arch Gynecol Obstet. 2016 Jan;293(1):5—10. https://doi.org/10.1007/s00404-015-3809-8Mandai M, Osuga Y, Hirata T, Enomoto T, Nakai H, Honda R, Taniguchi F, Katabuchi H. Cancers associated with extraovarian endometriosis at less common/rare sites: A nationwide survey in Japan. J Obstet Gynaecol Res. 2020 Jun;46(6):917—923. https://doi.org/10.1111/jog.14244Mandai M, Osuga Y, Hirata T, Enomoto T, Nakai H, Honda R, Taniguchi F, Katabuchi H. Cancers associated with extraovarian endometriosis at less common/rare sites: A nationwide survey in Japan. J Obstet Gynaecol Res. 2020 Jun;46(6):917—923. https://doi.org/10.1111/jog.14244Razak S, Alam I, Afsar T, Abulmeaty MMA, Almajwal A, Jahan S. A Prospective Evaluation of Serum Vitamin D (1, 25(OH)2 D3) and Endogenous Sex Hormone Levels in Colorectal Cancer Patients. Front Oncol. 2019 Jun 4;9:468. https://doi.org/10.3389/fonc.2019.00468Razak S, Alam I, Afsar T, Abulmeaty MMA, Almajwal A, Jahan S. A Prospective Evaluation of Serum Vitamin D (1, 25(OH)2 D3) and Endogenous Sex Hormone Levels in Colorectal Cancer Patients. Front Oncol. 2019 Jun 4;9:468. https://doi.org/10.3389/fonc.2019.00468Teng SW, Horng HC, Ho CH, Yen MS, Chao HT, Wang PH; Taiwan Association of Gynecology Systematic Review Group. Women with endometriosis have higher comorbidities: Analysis of domestic data in Taiwan. J Chin Med Assoc. 2016 Nov;79(11):577—582. https://doi.org/10.1016/j.jcma.2016.04.006Teng SW, Horng HC, Ho CH, Yen MS, Chao HT, Wang PH; Taiwan Association of Gynecology Systematic Review Group. Women with endometriosis have higher comorbidities: Analysis of domestic data in Taiwan. J Chin Med Assoc. 2016 Nov;79(11):577—582. https://doi.org/10.1016/j.jcma.2016.04.006

The authors declare that there are no conflicts of interest present.