Case Of Adult Intussusception Research Articles

065. Ileoileal Small Bowel Intussusception in Adult

Background: Intestinal Intussusception is invagination of a proximal segment of the gastrointestinal tract into the distal. In adults, ileoileal intussusception is a rare case and diagnostically challenging. We present four cases of ileoileal small bowel intussusception in adults. Case: a 19-year-old man with complaint of abdominal pain. An exploratory laparotomy was performed, an ileoileal invagination was found. Second case : a 29-year-old woman with complaint of not being able to defecate or flatus. An ileal dilatation up to 240 cm from the ligament of treitz and ileoileal invagination with an ileal tumor was found in exploratory laparotomy. Third case : a 51-year-old man with complaint of difficulty defecating since 1 day before admission. A 30 cm long ileoileal invagination and tumor in the invaginated ileum was found. Fourth case : a 77-year-old man with a difficulty in defecating. A dilatation of the bowel starting from jejunum-ileum and a 20 cm long invagination was found. Conclusion: Clinical presentation of bowel obstruction is helpful to diagnose adult ileoileal small bowel intussusception. The mainstay of treatment is surgical intervention.

A case of community-acquired Clostridioides difficile infection causing intussusception, severe pneumonia, and severe hypokalemia

BackgroundClostridioides difficile infection is associated with antibiotic use and manifests as diarrhea; however, emerging cases of fulminant diarrhea caused by binary toxin-producing C. difficile unrelated to prior antibiotic exposure have been reported. Although fulminant colitis caused by C. difficile has been documented, instances of intussusception remain scarce. Here, we present a case of adult intussusception with severe hypokalemia and pneumonia resulting from a community-acquired C. difficile infection in Japan.Case presentationAn 82-year-old male presented with dizziness, progressive weakness, and diarrhea. Initial vital signs indicated severe respiratory and circulatory distress, and laboratory findings revealed hypokalemia, pneumonia, and septic shock. Imaging confirmed intussusception of the ascending colon. Although colonoscopy suggested a potential tumor, no malignancy was found. The C. difficile rapid test result was positive, indicating community-acquired C. difficile infection. Treatment with vancomycin was initiated; however, intussusception relapsed. Surgical intervention was successful and led to clinical improvement.The patient's complex pathophysiology involved community-acquired C. difficile-induced severe diarrhea, hypokalemia, hypermetabolic alkalosis, and subsequent intussusception. Although adult intussusception is uncommon, this case was uniquely linked to binary toxin-producing C. difficile. The identified strain, SUH1, belonged to a novel sequence type (ST1105) and clade 3, suggesting a highly virulent clone. Resistome analysis aligned with phenotypic susceptibility to metronidazole and vancomycin, confirming their treatment efficacy.ConclusionThis case report highlights a binary toxin-producing C. difficile that caused intussusception. The consideration of community-acquired C. difficile in the differential diagnosis of severe enteritis is necessary, even in Japan.

Single-port laparoscopic surgery for cecum cancer with intussusception: a case report

BackgroundMost adult cases of intussusception are caused by colorectal cancer, and emergency surgery is performed when symptoms such as abdominal pain and vomiting are present. The patient must customarily undergo both bowel decompression and radical surgery for colorectal cancer at the same time, and laparotomy is generally the procedure of choice.Case presentationAn 86-year-old woman presented to our hospital with diarrhea and bloody stools. Preoperative examination revealed the presence of a cancerous tumor in the advanced part of the transverse colon and bowel intussusception. Radical surgery was successfully performed using the laparoscopic single-port technique through a small incision at the umbilical site to treat intussusception caused by cecum cancer.ConclusionsWith only one wound site at the umbilicus, this single-port laparoscopic approach is much less invasive than endoscopic surgery that requires four to five incision wounds to perform the procedure. Furthermore, the patient was discharged without major complications and this surgical technique could be of great benefit if established as a standard procedure in the future.

Giant lipoma of the colon presenting as a case of adult intussusception: A case series

Introduction and importanceLipoma of the intestine is one of the uncommon benign tumors of the alimentary tract first reported by Bauer in 1957. The peak incidence is usually seen between 50 and 60 years of age and more commonly in females. They are usually either asymptomatic or mildly symptomatic. The occurrence of symptoms is mostly related to the diameter of the lesion. Presentation of caseWe present a single center consecutive case of three patients who had giant colonic lipomas presented with colonic intussusception. Two of the cases presented for the first time with an emergency condition: acute intestinal obstruction. The mode of presentation, diagnosis, and management outcome of colonic lipoma was assessed. DiscussionSymptomatic lipoma may present with non-specific abdominal pain, change in bowel habits, intussusception, and hemorrhage. The clinical diagnosis is usually challenging, given the non-specificity of symptoms of the disease. Computed tomography is considered to be a diagnostic modality of choice in recognizing the presence of lipoma. However, a definitive diagnosis of lipoma is usually obtained after a histopathologic examination of the resected specimen. The management of colonic lipoma depends on the size of the lesion and the presence or absence of symptoms. ConclusionColonic lipoma is a rare benign tumor that occurs in the elderly, frequently misdiagnosed as a malignant tumor. Despite the rarity of the disease, lipoma should be considered in the differential diagnosis of large bowel tumors and adult intussusception.

Intussusception Secondary to Adenocarcinoma of the Colon

Intussusception in adults is a rare occurrence, accounting for approximately 1%–3% of bowel obstruction cases. Here, we present a case of colocolic intussusception of the sigmoid colon caused by adenocarcinoma. A 67-year-old male presented to the emergency department with abdominal pain and rectal bleeding. A computed tomography (CT) scan revealed intussusception involving the sigmoid colon and a potential mass. In the operating room, the patient underwent flexible sigmoidoscopy, followed by sigmoidectomy and end colostomy. Pathological examination of the resected specimen confirmed moderately differentiated adenocarcinoma of the sigmoid colon with negative margins, and two of the 54 lymph nodes were positive for metastasis. A repeat CT scan of the abdomen showed multiple sub-centimeter low-density hepatic lesions, and biopsy confirmed a metastatic lesion. The patient ultimately elected hospice care. In this report, we describe a rare case of sigmoid intussusception in an adult patient, review the relevant literature, and summarize the diagnostic and management approaches suitable for adult intussusception cases.

The Clinico-histopathological Spectrum of Tumors and Tumor-Like Lesions in Adult Intussusception.

Intussusception is an uncommon cause of intestinal obstruction in adults. The etiology of this disease differs from the children. Thus, its management depends on the possible etiology and is different from pediatric cases. We aimed to study the clinico-histopathological spectrum ofthe tumors and tumor-like lesions in the intussusception in adults. A retrospective review of the adult (> 18years) intussusception cases was performed. The clinical data and follow-up were obtained. The histopathology was reviewed along with the special stains and immunohistochemistry for ascertaining a histopathological diagnosis. Fifteen cases of adult intussusception were identified from 107 resected specimens of adult intestinal obstruction. The mean age was 44.5years with a male/female ratio of 1.1:1. A definitive pathology could be ascertained in 80% of the cases (n = 12/15). Eight cases had benign non-neoplastic etiology (53.3%) (33.3% tumor-like lesions) while seven cases (46.7%) had neoplastic etiology (20% benign neoplastic; 26.7% malignant neoplastic). All cases of colonic or enterocolic intussusceptions were associated with neoplasia whereas 90% of the enteric intussusceptions occurred due to benign non-neoplastic causes. CONCLUSIONS: Non-neoplastic causes are predominant in the enteric intussusceptions while neoplastic causes are more commonly associated with colonic or enterocolic intussusceptions. The post-operative histopathological examination concludes on the adequacy of the index surgery or the provision of further management if required.

Acute intussusception in adults; study of two observations at the Friendship Hospital Sino-Guinean in Kipe

Aim The study aim to make our contribution to the study of intussusception in adults, rare pathology in adults, acute intussusception also called (AII) refers to penetration of an intestinal segment into the underlying segment, by turning into a glove finger (invagination roll). The aim of this work is to report two cases of acute intussusception in adults in the surgical department of the Sino-Guinean friendship hospital in kipe. Republic of Guinea. Material and Method This is a prospective two-year study, running from October 1, 2018 to September 30, 2020 Inclusive. All patients admitted for operated for acute intestinal invagination, whose age is between 25 and 50 years were included in our study. The operative specimen was analyzed anatomo pathologically after fixation with 10 percent formalin. Clinical presentation It concerned a man and a woman, in both cases the localization was ileal. Treatment was surgical and consisted of ileal resection followed by end-to-end ileoileale anastomosis in two planes. The operative consequences were simple. Conclusion Acute intussusception in adults is rare, the symptoms are noisy.

A Rare Case of Idiopathic Adult Intussusception

Intussusception is rare in adults compared to children. Therefore, cases of adult intussusception are not well reported or easily recognized. Only 5% of all intussusception cases occur within the adult population and only 1% of all bowel obstruction pathology is due to the illness. They are most commonly found in male children, aged 6 months to 3 years old. Many childhood cases tend to be idiopathic, while in adult cases, malignant neoplasms are found to be the lead point at which the proximal segments get caught upon. Generalized abdomen pain is the most common symptom reported in adult due to peristalsis of the intestines occurring over the intussuscepted portion of the bowel. This case report focuses on a 34 year old female that presented with vague symptoms of nausea, vomiting, diarrhea, and abdominal pain. After obtaining extensive medical history, ruling out the common differentials, and obtaining imaging of the abdomen, idiopathic jejunal intussusception is found to be the diagnosis in this patient. The patient was treated conservatively with antibiotics and pain management. The intussusception self-resolved and the patient was discharged home.

A clinicopathologic study of intussusception in Nepalese adults

Introduction: Intussusception is rate in adults and is usually secondary to a definable pathology. This study was designed to review adult intussusception, including presentation, diagnosis, and pathology.
 Methods: A retrospective study of 18 cases of intussusception in individuals older than 18 years of age visiting the department of surgery of Civil Service Hospital from 2010 to 2018 was done.
 Results: There were 18 cases of adult intussusception. The mean age was 49.2 years (range 19-84 years). Abdominal pain and vomiting were the commonest symptoms. The median duration of presentation was 5 days (range 20 hours to 10 months). Three patients (16.6%) presented with generalized peritonitis. There were eight ileocolic, seven ileoileal, and three colocolic intussusceptions. Two patients (11.1%) settled spontaneously. Twelve out of the 18 patients (66.6%) had leading lesions. Benign pathologies were seen in seven cases (38.8%) and malignant in five patients (27.7%). All malignancies were in the large bowl
 Conclusions: Adult intussusception is a rare entity, nearly one-third of their causes are malignant. Surgery is the best recommended treatment, with or without a primary reduction of the intussusception; the latter can result in more limited bowel resection.

Ileal and Colic Lipoma: Rare Cases of Bowel Intussusception in Adults

Ileal and Colic Lipoma: Rare Cases of Bowel Intussusception in Adults

Telescoping intestines intussusception in adults

Introduction: Intussusception in adults is a rare entity. Being one of the most common causes of intestinal obstruction in children, it accounts for only 5% of all cases of intussusceptions and about 1%-5% of bowel obstruction in adults. A minority of cases are idiopathic, without a lead point lesion. Postoperative adhesions, meckel’s diverticulum, inflammatory bowel disease, benign and malignant tumors, metastatic neoplasms or even iatrogenic presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery account for the various causes of secondary intussusception in 70%-90% of cases. Computerized tomography (CT) is often considered as one of the most useful, sensitive imaging modality in the diagnosis of intussusception. AIM: To study and describe the different pathological causes, clinical features and management of intussusception in adults. Materials & methods: A retrospective study was conducted to evaluate the various causes of intussusception. All patients above the age of 18yrs presenting with a clinical diagnosis of intussusception, between Jan 2008 and June 2015 were included in the study. Results: There were 15 cases of adult intussusception. A male predominance was noted and the mean age was 41.7 years. Majority of the patients presented with abdominal pain, abdominal distension, nausea and vomiting. The commonest site of intussception was the ileo-colic junction (46.7%, 7cases). There were four jejuno-jejunal cases (26.7%) and two ileo-ileal cases (13.3%). There were also two other cases of colonic intussusception, not involving the ileo-colic junction (13.3%). Among the pathological causes of intussusception, four cases were secondary to diffuse large B cell lymphoma (DLBCL), four due to submucosal lipomas, two cases secondary to peutz jegher polyps, one case of carcinoid involving the appendix, three cases due to inflammatory causes and one being idiopathic. All cases were treated surgically. Conclusion: Malignant lesions account for majority of causes of adult intussusception involving the colon. Adult intussusception is a challenging condition for the surgeon and is very often a preoperative diagnostic problem when compared to that in children. Because of the high incidence of malignancy in colonic intussusceptions, a segmental bowel resection is generally undertaken.

Adult Intussusception: Three Cases Reports and Review of the Literature.

Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, etiology, and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms and most cases are diagnosed at emergency laparotomy. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial, but there is a shift against this, especially in colonic cases. This paper presents the diagnosis and management of three cases of adult intussusception, in our hospital.

A Case of Adult Intussusception with Early Cancer in the Invaginated Cecal Segment Identified by Formalin Injected Fixation

A Case of Adult Intussusception with Early Cancer in the Invaginated Cecal Segment Identified by Formalin Injected Fixation

A Case of Adult Intussusception due to Ascending Colon Lymphangioma

A Case of Adult Intussusception due to Ascending Colon Lymphangioma

Adult Intussusception at a Tertiary Care Center: A Retrospective Study.

Background:In adults, the majority of cases of intussusception are due to malignancy.Aims:The aim of the study is to describe the pattern of intussusception in the adult population diagnosed and treated at a tertiary care center.Subjects and Methods:Study Design: This is a retrospective cross-sectional study based on chart review, and data collection was made from the computer database and inpatient case records. Study Setting: Adult intussusception cases diagnosed and treated at a tertiary care referral center in South India. All inpatient case sheets including investigations and histopathology information on the computer database of all patients diagnosed with intussusception in the period of August 2012 to July 2016 were retracted based on a pretested and standardized form. Demographic data and other baseline data were summarized with descriptive statistics. SPSS software was used for data analysis.Results:Of the 77 patients, 47 (61%) were male. The common presentations were abdominal pain (95%), vomiting (64%), and rectal bleeding (29%). Common examination findings were abdominal tenderness (45%), guarding (39%), and abdominal mass (38%). On ultrasonography, fifty (65%) patients had intussusception with ileocolic (25) as the most common type. Computed tomography abdomen was taken for 28 (36%) patients, in which 23 (82%) had intussusception with ileocolic (9) as the most common type. Surgery was done for 53 (69%) patients, and the most common procedure was right hemicolectomy (25) followed by resection and anastomosis of the small bowel (23). Intraoperatively, 42 (79%) patients had intussusception with ileocolic (23) as the most common type. Intraoperatively, 14 (26%) patients had a bowel gangrene. Biopsy-proven cause for intussusception was present in 46 patients, with malignancy (21) as the most common cause. The patients were on regular follow-up. Recurrence of intussusception occurred in six patients of the small bowel intussusception who had polyposis.Conclusions:Adult intussusception is often associated with malignancy. Hence, a formal resection without reduction is needed and surgery should be done following oncological principles.

2552 A Rare Case of Ileocecal Intussusception in a Young Adult

INTRODUCTION: Intussusception is a process in which a segment of bowel telescopes into the adjoining intestinal lumen. The pathophysiology is unclear but it is typically due to a pathologic lead point within the bowel, which is malignant in over 50% of cases. The clinical presentation of adult intussusception is non-specific, unlike the characteristic triad of abdominal pain, palpable abdominal mass, and bloody stool seen in pediatric patients. It is a rare cause of abdominal pain in adults, comprising only 5% of all intussusceptions. CASE DESCRIPTION/METHODS: A 29-year-old Peruvian male with no significant medical history presented with right lower quadrant abdominal pain and diarrhea for two weeks with an unintentional 15 pound weight loss. Abdominal CT demonstrated intussusception with likely underlying mass in the region of the ileocecal valve. Colonoscopy revealed an ileocecal mass (Figures 1 and 2) that was too large to pass with the endoscope. The patient subsequently underwent a right hemicolectomy and omental flap. Pathology of the mass showed diffuse large B-cell lymphoma (DLBCL), germinal center type. Further evaluation revealed a positive HIV test with a CD4 count of 29 cells/mL. DISCUSSION: Adult intussusception is a rare clinical entity and requires prompt imaging and diagnosis to prevent severe complications. A retrospective review of 44 cases found that ultrasound and CT resulted in a combined preoperative diagnosis rate of 95.5%. Literature review suggests surgical resection is the optimal management in adults given the high incidence of underlying malignancies. Controversy remains regarding the ideal surgical approach between primary resection versus reduction followed by resection. Several retrospective studies propose resection without reduction is the best approach for ileocecal intussusception to avoid potential intraluminal seeding or venous tumor dissemination. Our patient was diagnosed via CT and treated by surgical resection without complications. Further diagnostic workup revealed the etiology to be a DLBCL in the setting of HIV/AIDS. This case highlights the importance of identifying an underlying mechanism for the development of intussusception in young adults. The incidence of primary lymphoma in the small intestine is rare and accounts for 1-4% of all gastrointestinal malignancies and 10-20% of small intestine malignancies. Through this case presentation, we hope to contribute to the limited available data on cases of adult intussusception.

Adult intussusception as rare anomaly: case reports and management

Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, aetiology, and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms and most cases are diagnosed at emergency surgery. Use of computed tomography in the evaluation of patients with abdominal pain, the condition can be diagnosed more reliably. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial. Laparoscopic management has been reported to be a safe and feasible option regardless of the etiology. This paper presents the diagnosis and management of two cases of adult intussusception, their presentation and management.

Ileal lipoma: a rare lead point for adult ileocolic intussusception

Intussusception is the telescoping of a segment of the gastrointestinal tract within the lumen of an adjacent segment. Adult intussusceptions are rare, with ileal lipoma responsible for only 6% of cases. Clinically, adult intussusception remains an elusive diagnosis. The triad of abdominal pain, vomiting and passage of bloody stool is not frequently seen in adults. Abdominal computed tomography is the gold standard for identifying ileal lipoma as the lead point of an adult intussusception. Definitive management is by surgical excision of the involved segment. This is a case report of a 38-yearold female with intussusception with a 5-cm subserosal ileal lipoma as the lead point. This is the first (to the best of our knowledge) reported case of adult intussusception caused by ileal lipoma in Africa.Keywords: Intussusception, Ileal, Lipoma, Subserosal, Intestinal obstruction, Adult

INFLAMMATORY FIBROID POLYP;

There are several pathologies causing intussusception. Benign diseases are the typical causes for childhood bowel obstruction. However, malignant or adhesive diseases are for common in adults. Although cases of illeal intussusception in adults due to inflammatory fibroid polyp is quite rare but few cases has been reported in literature. A 35 year old presented with a history of multiple episodes of abdominal pain, distention, relative constipation and vomiting over a period of 3 month. He also had a history of appendectomy 2 months back. Exploratory laparotomy was done and inflammatory fibroid polyp found to be the cause of obstruction.

Laparoscopic surgery for idiopathic adult intussusception successfully reduced by colonoscopy.

Most cases of adult intussusception are caused by neoplastic lesions, and idiopathic adult intussusception is very rare. We present a case in which laparoscopic surgery was performed for idiopathic adult intussusception initially reduced by colonoscopy. A 53-year-old woman presented to the emergency department of our hospital with intermittent lower abdominal pain. Contrast-enhanced computed tomography and ultrasonography of the abdomen showed a concentric structure in the ascending colon. We diagnosed intussusception. Colonoscopy achieved successful reduction before surgery. Twelve days after this reduction, laparoscopic surgery was performed. Histopathological examination did not reveal any causative pathology; therefore, idiopathic adult intussusception was diagnosed. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. Preoperative colonoscopy should be utilized to diagnose the main lesion and may be useful for reducing adult intussusception. Laparoscopic surgery is both minimally invasive and safe and can be performed following endoscopic reduction.