A 62-year-old man undergoes CT for colicky abdominal pain and vomiting. Imaging shows ileocolic intussusception with a 3 cm lobulated lead point mass and no evidence of bowel ischaemia. He is haemodynamically stable. What is the correct operative approach?
- A En bloc resection of the intussusceptum with the lead point, without prior reduction ✓
- B Air or saline enema reduction followed by laparoscopic biopsy of the lead point
- C Manual intraoperative reduction, then resection only if the mucosa appears viable
- D Laparoscopic reduction alone with annual surveillance colonoscopy
Correct answer: A. En bloc resection of the intussusceptum with the lead point, without prior reduction
Explanation
In adults, intussusception almost always has a pathological lead point, and in ileocolic or colonic cases this is frequently a malignancy. Attempted reduction, whether radiological or manual, risks tumour fragmentation, venous dissemination, and spillage, so standard surgical teaching mandates en bloc resection with appropriate lymphadenectomy without preliminary reduction. Reduction-first strategies are reserved for paediatric idiopathic intussusception and are explicitly contraindicated here.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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