Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment. The intussusceptum refers to the proximal segment that invaginates into the distal segment, or the intussuscipiens (recipient segment). Intussusception, more common in the small bowel and rarely involving only the large bowel, has historically presented as small bowel obstruction, although there is an increasing appreciation of cases of transient, asymptomatic intussusception within the era of abdominal CT scans. The natural history of intussusception starts with a lead point, typically neoplastic (such as lymphadenopathy, polyp, or cancer), which acts as a focal area of traction that draws the proximal bowel within the peristalsing distal bowel. Symptoms occur due to continued peristaltic contractions of the intussuscepted segment against the obstruction. With continued invagination resulting in edema, eventually the vascular flow to the bowel becomes compromised, resulting in ischemia to the affected segment that, left untreated, can result in necrosis and perforation.In the pediatric population, ileocolic intussusception is the most common type. The etiology of intussusception in children is typically idiopathic, often influenced by anatomic or infectious factors (►Table 1). The diagnosis and management in this population generally starts with nonoperative reduction of the intussusceptum using air or contrast enemas.In the adult population, intussusception is frequently due to a pathologic lead point, which can be intraluminal, mural, or extramural. As opposed to the pediatric population, the treatment of intussusception causing obstruction in adults typically involves surgery, often with bowel resection. Keywords AbstractIntussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. Idiopathic ileocolic intussusception is the most common form in children and is typically managed with nonoperative reduction via pneumatic and/or hydrostatic enemas. In the adult population, intussusception is uncommon and occurs more often in the small intestine than in the colon. It is associated with lead point pathology in most symptomatic cases presenting as bowel obstruction. When lead point pathology is present in adult small bowel intussusception, it is usually benign, though when malignant it is most frequently due to diffuse metastatic disease, for example, melanoma. In contrast, adult ileocolic and colonic intussusception lead point pathology is most frequently primary adenocarcinoma when malignant. The diagnosis is typically made intraoperatively or by cross-sectional imaging. With increasingly frequent CT/MRI of the adult abdomen in the current era, transient and/or asymptomatic intussusceptions are increasingly found and may often be appropriately observed without intervention. When intervention in the adult population is warranted, usually oncologic bowel resection is performed due to the association with lead point pathology.

A number of procedures, including cholecystectomy, appendectomy, urologic procedures, adrenalectomy, and bariatric procedures, are currently being performed with this methodology. There is, as yet, no standard published technique for single-port access to the peritoneal cavity for SILS. We describe, herein, an access technique utilizing existing instrumentation including a Gelport and wound retractor that is reliable and easy. This technique has been used successfully at our institution for a number of single incision laparoscopic procedures.

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Laparoscopic hysteropexy is a safe and effective treatment. The 1- to 4-year outcome suggests high patient satisfaction and low rates of apical prolapse recurrence. Longer term follow-up and randomized controlled studies are required.