Introduction and importance: Adult intussusception is a rare clinical entity, accounting for less than 5% of all cases and often associated with an underlying lesion. Inflammatory fibroid polyps (IFPs) are rare benign mesenchymal tumors that may act as a lead point for intussusception, most frequently in the small intestine. Herein, we report the case of a 52-year-old woman presenting with ileocecal intussusception secondary to an IFP. Case presentation: A 52-year-old woman presented with intermittent abdominal pain and symptoms of subacute obstruction. Imaging revealed an ileocolic intussusception due to a polypoid ileal lesion. Laparoscopic ileocecal resection was performed with primary ileocolic anastomosis. Histopathological analysis confirmed the lesion as an inflammatory fibroid lesion. The postoperative course was uneventful, corresponding to Clavien–Dindo Grade 0. The patient remained symptom-free at 6 months of follow-up. Clinical discussion: IFPs most often arise in the stomach and small intestine. In the small bowel, IFPs can serve as a lead point for intussusception, but ileocecal presentations remain uncommon. The laparoscopic approach is safe and provides excellent visualization and is associated with reduced pain and faster recovery. Complete resection of IFPs is curative with rare recurrence rates. Definitive diagnosis relies on histopathology and immunohistochemistry. Conclusion: This case highlights the diagnostic challenges of adult intussusception, particularly when imaging is inconclusive. IFPs should be considered as a differential diagnosis. Moreover, it underscores the importance of laparoscopic surgical management both for diagnostic and therapeutic purposes.

Background: Synchronous colon cancer is a rare case; the prognosis tends to be poor, making diagnosis and management a challenge, especially in remote areas such as Kaimana, West Papua, with limited resources. Case Report: A 58-year-old man came with complaints of constipation and vomiting accompanied by unexplained weight loss. The patient had a history of digestive disorders for 5 years and was accustomed to consuming energy drinks with high frequency. During exploratory laparotomy, a tumor was found in the transverse colon, and a stoma was installed. The results of the colonoscopy biopsy showed adenocarcinoma with moderate differentiation in the ascending and transverse colon. The patient was managed with right hemicolectomy and, extended and end-to-end ileocolic anastomosis. After treatment, the patient showed improvement, and complaints improved. Discussion: A Highlight from this case is that this case is a rare case where the surgical management of synchronous colorectal cancer cases must be careful because there is a possibility of missing other small tumors. Extended hemicolectomy is the right choice considering the number of tumors, location, and limited resources in the hospital, with a high probability of success, so that it can improve the patient’s prognosis. Conclusion: Early screening of gastrointestinal complaints and assessment of risk factors in patients will greatly help in establishing the diagnosis of colon cancer. Extended hemicolectomy is a good management option, especially in cases of low-grade synchronous tumors, especially in areas with limited resources.

BackgroundPreoperative mechanical bowel preparation (MBP) and oral antibiotics (OA) are widely used to decrease the risk of postoperative septic complications after colorectal resections. Unfortunately, it is not clear whether bowel preparation can lead to symptoms of small bowel obstruction, which might even increase the risk of postoperative morbidity.MethodsConsecutive Crohn’s disease patients undergoing bowel resections with formation of ileocolic or colocolic anastomosis were included in the present prospective observational study. Urgent surgery, surgery without preoperative MBP, colorectal cancer, and fecal diversion were exclusion criteria. A polyethylene glycol solution (2 L) was used for MBP. OA consisted of paramomycin and metronidazole taken at 7 p.m. and 11 p.m. at the evening before surgery. Occurrence of complications at the anastomotic site (leakage, peritonitis, abscess, or fistula in direct proximity to the anastomosis) was a primary outcome measure. Complications of MBP were recorded. Mechanical bowel preparation was defined as “incomplete” when patients took a lesser amount of MBP solution than scheduled.ResultsBetween 2016 and 2024, ileocolic or colorectal resections with formation of an anastomosis were performed in 284 patients with Crohn’s disease. Nausea, vomiting, or abdominal pain occurred during the MBP in 29% of patients (n = 78), leading to termination of intake in 53 patients (19%). Women (p < 0.001), patients hospitalized urgently because of acute abdominal pain (p = 0.008), patients presenting with severe anemia before surgery (p = 0.007), and patients scheduled for resections completed by ileocolic anastomosis as opposed to colocolic or colorectal anastomosis (p = 0.01) demonstrated a significantly increased risk of incomplete MBP. Thirty-two percent of patients demonstrated apparent dilatation of small bowel at the time of surgery. The incidence of anastomotic complications was 4% in patients who were able to complete MBP and 7.5% after an incomplete MBP (p = 0.27). There were no deaths. The conversion rate from laparoscopy to open surgery was increased in patients with small bowel dilatation (17% vs. 6%); however, the difference was not statistically significant (p = 0.13).ConclusionThere is a considerable incidence of obstructive symptoms after preoperative mechanical bowel preparation in Crohn’s disease patients. Nevertheless, an incomplete MBP is not associated with increased risk of intra- or postoperative complications and can be used safely in that particular population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00384-026-05084-z.

Basidiobolomycosis is a rare infection caused by the saprophytic fungus Basidiobolus ranarum of the Zygomycetes family. Gastrointestinal basidiobolomycosis (GIB) is a newly recognized emerging and rare form of the disease with 46 cases reported in adults by 2018. Tissue invasive gastrointestinal Cytomegalovirus (CMV) infection is rare with &lt;20% cases reported worldwide. Here we report a rare concurrence of colonic basidiobolomycosis and CMV colitis, which had not been entered in literature till date. A middle-aged man presented with pain abdomen for 1.5 month following blunt abdominal trauma. On examination mass per abdomen was palpated. Radiological investigations revealed a mass lesion with necrotic areas and air pockets in right hypochondriac region. Right hemicolectomy with ileo-colic anastomosis was performed. Histopathological evaluation confirmed diagnosis of Colonic basidiobolomycosis and cytomegalovirus colitis Co-infection. Accordingly, patient was put on antifungal and antiviral drugs and discharged after 21 days of treatment. The case is reported for its rarest occurrence.

Abstract Background Ileocecal resection with an ileocolic anastomosis is the most common surgical procedure for Crohn’s disease (CD).1 Today’s leading surgical techniques, the (Kono-S) side-to-side and side-to-end anastomosis, have introduced new anatomical locations.2 Furthermore, lesions at the ileal inlet, corresponding to the critical diameter proximal to the anastomotic line, have been suggested to be associated with a higher risk of postoperative recurrence.1-3 The aim of our study was to evaluate the risk of postoperative recurrence according to the anatomical location of the lesions. Methods We conducted a retrospective analysis of 85 patients with CD after ileocecal resection (47% male, median age 33 years). All patients underwent a video-recorded ileocolonoscopy within 14 months of resection, which were centrally scored by eight expert endoscopists with the updated Rutgeerts score (URS) and a granular score per anatomical location (anastomotic line, ileal blind loop, ileal body, ileal inlet and neo-terminal ileum). The development of clinical postoperative recurrence (cPOR) was assessed. cPOR was defined as presence of CD-related symptoms combined with at least one of the following: C-reactive protein &amp;gt;5 mg/L, faecal calprotectin &amp;gt;250 µg/g, endoscopic recurrence (Rutgeerts score of ≥ i2b), or radiological signs of neoterminal ileitis. Patients that underwent treatment optimization based on this index ileocolonoscopy were excluded. We used Cox regression models to assess the association between granular endoscopic scores and cPOR. Models were adjusted for either the dichotomised or categorised URS and for postoperative prophylactic therapy. Results The majority of patients (84%) underwent an ileocecal resection with isoperistaltic side-to-side anastomosis. The median (interquartile range, IQR) time from ileocolonic resection to first postoperative ileocolonoscopy was 6.21 (5.88-7.00) months. During a median follow-up of 6.15 (4.91-8.07) years, 47% of patients developed cPOR. Analysis of the granular endoscopic scoring revealed that presence of lesions at the ileal inlet was associated with an increased risk of cPOR. Statistically significant association were observed for the deep aphthoid lesions [hazard ratio 1.96 (95% confidence interval 1.02-3.77), p = 0.045], punctiform lesions [HR 1.96 (1.02-3.77), p = 0.045], deep ulcerations [HR 3.23 (1.33-7.83), p = 0.01] and large superficial ulcerations [HR 2.89 (1.12-7.39), p = 0.029]. In contrast, no significant associations were observed with lesions in other locations. (Table 1) Conclusion The significant association between ileal inlet lesions and cPOR underscores the importance of incorporating new anatomical locations into endoscopic scoring systems, supporting the broader application of the URS.

Anastomotic recurrence after curative resection of colorectal cancer represents a rare but clinically significant phenomenon, occurring in approximately 2% of operated patients. We present a case report of a 61-year-old male patient who developed two successive anastomotic recurrences after right hemicolectomy with ileocolic anastomosis for mucinous adenocarcinoma. The patient initially underwent right hemicolectomy in 2016 for T4b, N2b, M0 mucinous adenocarcinoma with clear surgical margins. Following completion of adjuvant chemotherapy, the first anastomotic recurrence occurred in January 2019 (36 months postoperatively), treated by ileocolic resection with ileocolic anastomosis. The second recurrence occurred in March 2020 (14 months after the first recurrence), managed by total colectomy with ileorectal anastomosis. Pathological examination confirmed recurrence with characteristics similar to the primary tumor in both instances. At 3 months follow-up after the final intervention, no additional recurrence was observed. Repeated anastomotic recurrence represents a rare therapeutic challenge requiring intensive surveillance, a multidisciplinary approach, and escalating surgical management. Understanding pathophysiological mechanisms, including the role of the anastomotic microenvironment and tumor biology, is important for developing preventive strategies in highrisk patients.

Ileo-colic mechanical anastomosis in a newborn with disused microcolon

We report a rare and complex case of a 14 year old male presenting with delayed, complicated appendicitis and secondary mesenteric ischemia involving the terminal ileum and cecum.

Sclerosing encapsulating peritonitis (SEP), also called abdominal cocoon syndrome, is a rare cause of intestinal obstruction. In 1907, Owtschinnikow first termed it as peritonitis chronica fibrosa encapsulata. It can be either idiopathic or secondary. Secondary cocoon syndrome may be due to medications, infections such as tuberculosis (TB) in endemic regions, cirrhosis, peritoneal dialysis and gynaecological malignancies. A 37-year-old female diagnosed with abdominal TB, who had not complied with anti-tubercular therapy (ATT) for the last 5 years, presented with acute intestinal obstruction and a history of recurrent subacute intestinal obstruction. Computed tomography (CT) imaging of the abdomen showed dilated bowel loops with a transition point in the ileum, multiple large calcified mesenteric lymph nodes and ascites. Diagnostic laparoscopy revealed dense adhesions and a fibrocollagenous membrane encapsulating the intestine. It was converted to laparotomy, an abdominal cocoon was confirmed, and extensive adhesiolysis and ileocolic anastomosis were done. GeneXpert showed extensively drug-resistant tuberculosis (XDR-TB), and the patient was started on an XDR-TB regimen. Abdominal cocoon syndrome secondary to TB, presenting as intestinal obstruction, is a rare but serious complication that requires surgical intervention. This case further highlights the importance of adherence to medication and the consideration of resistant forms of TB, such as XDR-TB, in patients with non-compliance with treatment. Surgical management, along with appropriate modification of ATT based on drug-resistance profiling, for patient recovery is essential.

Despite advances in therapeutic strategies, postoperative recurrence (POR) of Crohn's disease (CD) remains common, underscoring the importance of vigilant and accurate surveillance. Colonoscopy is the gold standard to assess for POR, but it is invasive and can be poorly tolerated by patients. Intestinal ultrasound (IUS) has emerged as a reliable, noninvasive modality for monitoring CD at the point of care and has excellent accuracy for evaluation of POR. However, visualization of the ileocolic anastomosis with IUS can be challenging. This review provides practical guidance for identifying the ileocolic anastomosis and its key sonographic landmarks. It also outlines techniques for assessing the anastomosis with grayscale IUS and discusses strategies for integrating IUS into routine postoperative surveillance of CD.

Ileocolic resections (ICRs) are the most common resections for Crohn's disease. Historical control groups have often been used for comparison when assessing postoperative recurrence, usually with temporal bias. This study aimed to (1) report contemporary rates of postoperative recurrence requiring repeat surgery (surgical recurrence at anastomosis [surgical recurrence at the ileocolic resection site (SR-ICR)] or surgical recurrence at any site) and the rates of endoscopic recurrence (ER) in the "biologic era"; and (2) determine risk factors for SR-ICR and ER. A retrospective multicenter study involving 12 tertiary Australian centers was performed. Patients (of any age) who had undergone an ICR for Crohn's disease between 2007 and 2023 were included. Cox proportional hazards modeling was used to evaluate clinicopathological risk factors for SR-ICR and ER (defined as Rutgeerts grade ≥i2b). Overall, 875 patients were included (mean 38.7 ± 15.1 years, 51% female). Median follow-up was 63.9 months. Rates of SR-ICR were 4.5% (95% confidence interval [CI], 2.8%-6.1%) and 12.8% (95% CI, 8.8%-16.5%) at 5 and 10 years, respectively. Rates of surgical recurrence at any site were 5.6% (95% CI, 3.8%-7.5%) and 15.1% (95% CI, 11.0%-19.1%) at 5 and 10 years, respectively. Early (within 12 months) ER occurred in 24.7%. On multivariable analysis, smoking (adjusted hazard ratio, 3.49; 95% CI, 1.93-6.29) was the only factor significantly associated with SR-ICR. Smoking, positive microscopic margins, and granulomas were associated with ER, and prophylactic therapy and younger age at diagnosis (<17 years) were protective. The rate of SR at the ileocolic anastomosis in this large Australian cohort was low, recorded to be 1 in 20 at 5 years. Smoking remains the strongest risk factor for both ER and SR. Histopathological factors influence ER and should be considered in future risk prediction models.

Obstructed colon cancer: Review and perspectives.

Anastomotic leak (AL) is the most severe complication after laparoscopic right colectomy (RC), with historical median rates around 8%. Whether intracorporeal ileocolic anastomosis (ICA) offers advantages over extracorporeal anastomosis (ECA) under standardized, purely laparoscopic conditions remains uncertain. We aimed to compare AL rates and short-term postoperative outcomes between ICA and ECA in laparoscopic RC for colon cancer. Prospective multicenter cohort (TREND-compliant) across 11 hospitals (January 2019-June 2022). Adults with non-metastatic right colon cancer undergoing elective laparoscopic RC were included. Exposure (ICA vs ECA) was determined by each hospital's routine practice. AL, per predefined clinical, radiologic, or endoscopic criteria. conversion to open surgery, length of stay (LOS), complications (Clavien-Dindo), surgical site infection (SSI), and a composite of severe complications (COSC). Analyses used the full cohort; propensity score matching (PSM) was prespecified as a sensitivity analysis. A total of 438 patients were analyzed: 225 ICA and 213 ECA. AL occurred in 3/225 (1.33%) after ICA and 3/213 (1.41%) after ECA (p = 1.00; risk difference - 0.08 percentage points; 95% CI - 2.1 to 2.3). Conversion was lower with ICA (2.2% vs 7.5%; p = 0.013), while LOS was shorter with ICA (median 4days; p < 0.001). There were no significant differences in severe morbidity (Clavien-Dindo ≥ III: 5.8% ICA vs 3.8% ECA; p = 0.375), SSI (incisional or organ/space), COSC (6.7% ICA vs 4.2% ECA; p = 0.298), reoperation, or mortality. Findings were consistent in PSM analyses (213:213). In this prospective multicenter laparoscopic cohort, both intracorporeal and extracorporeal anastomosis achieved anastomotic-leak rates below 2%, with no superiority of one technique over the other regarding leak or severe morbidity. ICA was associated with lower conversion and shorter hospital stay. These results confirm the overall safety and feasibility of both approaches in experienced centers. NCT03918369.

Application of a Right-Sided Colectomy Anastomotic Leak Score to a Multi-institutional Cohort.

Background: Gastrointestinal surgery frequently necessitates bowel anastomosis, and the choice of technique significantly influences postoperative outcomes. Since Travers, Lembert, and Halsted established the early principles of intestinal suturing, anastomosis has emerged as a fundamental component of gastrointestinal surgery. To ensure anastomotic integrity and optimal patient recovery, meticulous surgical technique, precise tissue apposition, and gentle tissue handling are crucial. Both single-layer and double-layer anastomotic techniques are widely used, but there is ongoing debate about their comparative safety, efficiency, and effectiveness. Objective: To evaluate and compare operative time, postoperative complications, hospital stay, and short-term mortality between single-layer and double-layer ileocolic anastomoses in patients undergoing right hemicolectomy. Method: This is a single-center prospective hospital-based interventional double-blinded randomized controlled trial that included 46 patients undergoing right hemicolectomy at No. (1) Military Hospital (700 bedded) from 01/12/2022 to 31/05/2024 (total of 18 months). The patients were randomized into group A (single-layer anastomosis, n = 23) and group B (double-layer anastomosis, n = 23) using block randomization. Operative times, postoperative complications (anastomotic leak, surgical site infection), length of hospital stay, and 30-day mortality were recorded. Data was analyzed using Student’s t-test, with p&lt;0.05 considered statistically significant. Results: Among a total of 46 patients, 54.3% were male patients and 45.6% were female patients. Most patients in both groups were aged 41–60 years, while the fewest patients in Group A were over 80 years and in Group B were between 61 and 80 years. The mean operative time was significantly shorter in Group A (18.43 ± 2.68 minutes) compared to Group B (28.70 ± 2.55 minutes, p&lt;0.001). Disease profiles included carcinoma, tuberculosis, and perforation. Both groups demonstrated high success rates with comparable complication profiles. Anastomotic leaks occurred in 4% of Group A and 9% of Group B (NS). Surgical site infection was seen in 9% of both groups. There was no 30-day mortality. The mean duration of the postoperative hospital stay was 7.39 ± 0.50 days in group A and 7.61 ± 0.50 days in group B (p = 0.14). Conclusion: Both single-layer and double-layer anastomosis techniques are effective and safe for right hemicolectomy. The single-layer technique offers a significant reduction in operative time without increasing postoperative complications, suggesting it as a time-efficient alternative for bowel anastomosis.

Outcomes of Laparoscopic Right Hemicolectomy with Intra-corporeal versus Extracorporeal Ileocolic Anastomosis for the Treatment of Right-Sided Colonic Cancer

S4900 Novel Presentation of Extensive Gastric Oxyntic Metaplasia at the Ileocolic Anastomosis in a Crohn’s Disease Patient

Abstract Neonatal appendicitis (NA) is a rare entity, and resultant ileocecal (I-C) segment stricture is never reported before. It often poses a diagnostic dilemma. Diagnostic delays could lead to increased morbidity, such as perforation, peritonitis, sepsis, and intestinal obstruction. We report a case of NA causing intramural I-C stricture and resultant intestinal obstruction in a preterm infant. Progressive abdominal distension, feeding intolerance, and constipation were the triad of clinical presentations purporting an evolving obstructing-inflammatory response to a recent episode of appendicitis. Early laparotomy, resection of the I-C segment along with the diseased appendix, and ileocolic anastomosis resolved the child’s obstruction symptoms.

Not all cuts heal the same: elevated anastomotic leak rates after elective colectomy for inflammatory bowel disease and diverticulitis.

Abstract Aims Expected anastomotic leak rates in the context of general surgery vary depending on type of anastomosis, but generally range from 0.5-18% [1]. This audit aimed to assess anastomotic leak rate after abdominal surgery from an entirely emergency population in a specialised Surgical Unit at John Radcliffe Hospital, Oxford. Methods Anastomotic leak rates were audited based on M&amp;M data and patient records between 25/03/2024-02/01/2025. Data including patient demographics, type of join, length of stay, rate of leak/ return to theatre, and mortality were collected. The rate of stoma formation vs anastomosis was not assessed in this audit. Results Overall 78 cases (M=33, F=45) were analysed. Median age of patients was 67.5 years, mean ASA was 2. Leak and return to theatre rates were both determined to be 4% (n=3). Of the three recorded anastomotic leak cases, two were small bowel anastomoses, and one was ileocolic anastomosis. Mortality rate was 4% (n=3); one patient passed away due to other co-morbidities unrelated to the operation. Median length of stay was 10 days. Conclusions It is possible to have an acceptable rate of anastomotic leak in an emergency setting. To further this, it may be beneficial to audit the rates of stoma formation vs anastomosis in managing surgical emergency cases.