{
  "abstract": "A male in his 40s with a medical history of multiple sclerosis and a virgin abdomen presented to the hospital with a 1-month history of progressively worsening colicky abdominal pain with intermittent obstructive symptoms. He was tender in his right hemi-abdomen and had normal vitals and laboratory values. A CT scan obtained on presentation revealed evidence of a large ileocaecal intussusception due to a 3-cm ileocaecal lipoma ( figure 1), requiring an urgent robotic ileocaecal resection. In the operating room, it was noted that the intussusception could not be manually reduced, and the decision was made to transect the leading and trailing ends in situ. The afferent limb was first taken about 10 cm from the ileocaecal valve. However, when taking the efferent limb, proximal to the hepatic flexure, the robotic stapler failed to fire across the colon as the device registered colonic tissue that was too thick, mandating an even more distal transection point, past the hepatic flexure. On inspection of the specimen (online supplemental video 1), it was discovered that precisely 47 cm of small bowel had indeed invaginated into the ascending and transverse colon. The initial inability for the robotic stapler to fire across the colon was caused by the unexpected long length of intussusception of the small bowel, essentially attempting to transect through four layers of bowel wall instead of two. Importantly, clinicians must anticipate a lengthy invagination when stapling across bowel, especially when utilising a manual stapler without bowel-wall thickness feedback technology. The commonly used manually deployed EndoGIA stapler is not equipped with such sensing technology and failure to confirm a bowel thickness of only two layers can lead to the dreaded complication of stump or anastomotic leak. Our patient did well with primary anastomosis and was discharged home after appropriate monitoring.",
  "authors": [
    {
      "affiliations": [
        "Department of Surgery, Mount Sinai South Nassau, Oceanside, New York, USA"
      ],
      "name": "Jeffrey Baum"
    },
    {
      "affiliations": [
        "Department of Surgery, Mount Sinai South Nassau, Oceanside, New York, USA"
      ],
      "name": "Paige Varney"
    },
    {
      "affiliations": [
        "Department of Surgery, Mount Sinai South Nassau, Oceanside, New York, USA"
      ],
      "name": "Neema Patel"
    },
    {
      "affiliations": [
        "New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York, USA"
      ],
      "name": "Maria Chimarios"
    },
    {
      "affiliations": [
        "Department of Surgery, Mount Sinai South Nassau, Oceanside, New York, USA"
      ],
      "name": "Charles Thompson"
    }
  ],
  "title": "Massive bowel intussusception requiring right hemicolectomy",
  "uid": "89983b48-b749-5bf7-962c-29c976fb5114"
}