Small Bowel Intussusception In Adults Research Articles

An adult case of small bowel intussusception caused by hemangioma presenting with intestinal obstruction: A case report

Both small bowel intussusception in adults and small bowel hemangioma are rare benign mass lesions. Moreover, a secondary effect of intussusception caused by hemangioma is extremely rare. A 87-year-old female suffered from intussusception and intestinal obstruction caused by hemangioma located in the small bowel (February 14, 2020), reporting abdominal distention without nausea and vomiting. Emergency abdominal and pelvic computed tomography showed an intussusception with the evidence of associated small bowel obstruction. Histological analysis revealed as small intestinal hemangioma accompanied by mesenteric ulcer. The patient underwent segmental resection of intussusception of intestine instead of invalid conservative treatment. Although the postoperative pathological results were inconsistent with preoperative imaging examination, the old woman recovered well. The literature on intussusception of small intestine has described several possible causes including hemangioma, which more likely results in gastrointestinal bleeding or abdominal pain. Yet we experienced a rare case presenting as abdominal distention without nausea and vomiting, Therefore, preoperative diagnosis and localization of these lesions is of great importance. We recommend high resolution contrast-enhanced computed tomography and magnetic resonance imaging should be considered in diagnosis while capsule endoscopy is not available owing to the intestinal obstruction, as long as in facilitating surgical excision.

Role of clinical and CT findings in the identification of adult small-bowel intussusception requiring surgical intervention.

BackgroundIn adults, intussusception has been considered traditionally to have an underlying aetiology. The aim of this study was to determine CT and clinical features of small-bowel intussusceptions that required surgical intervention.MethodsAdult patients were identified in whom small-bowel intussusceptions were noted on CT images. The appearance, number, type (enteroenteric versus enterocolic), length and maximum short-axis diameter of intussusceptions, and presence of bowel obstruction (short-axis diameter of proximal small bowel greater than 3 cm) were analysed. The outcome was defined as surgical (complicated) or self-limiting (uncomplicated). Associations between complicated and uncomplicated intussusceptions and patient characteristics were investigated.ResultsAmong 75 patients (56 male) with a mean age of 45 years, 103 intussusceptions were identified, of which 98 (95 per cent) were enteroenteric and 5 (5 per cent) enterocolic. Only 12 of 103 intussusceptions (12 per cent) in 12 of 75 (16 per cent) patients required surgical therapy and were considered to be complicated, with half of these having a neoplastic lead point. Length (P < 0.001), diameter (P < 0.001) and type (P = 0.002) of intussusception as well as presence of vessels (P = 0.023) within an intussusception on a CT scan, clinical symptoms (P = 0.007) and signs of bowel obstruction (P < 0.001) were associated with a surgical outcome.ConclusionClinical symptoms, signs of bowel obstruction, type and length of intussusception, and a visible tumour within an intussusception on CT scan were critical signs of complicated intussusception, requiring surgical intervention.

An Unusual Presentation of Small Bowel Intussusception

Adult small bowel intussusception is a very rare entity that accounts for 5% of all cases of intussusception and 1%–5% of intestinal obstructions. It is more common in children but can occur in adults. It is an important etiology to consider when a patient presents with recurrent abdominal pain. The diagnosis can be challenging as symptoms are nonspecific and include abdominal pain, nausea and vomiting. This paper presents a rare case of duodenal intussusception, followed by a review of the literature discussing the diagnosis and treatment of adult intussusception.

Multidetector computed tomography diagnosis of small bowel intussusceptions in adults: observations in a 10-year single-center study.

The etiologies of small bowel intussusception (SBI) in adults are varied. To investigate multidetector computed tomography (MDCT) characteristics in adults with neoplastic and non-neoplastic SBI. Clinical data and MDCT images diagnosed with SBI in adults from January 2010 to May 2020 were retrospectively reviewed. The study included a total of 71 patients. Forty-two patients had a combined total of 55 neoplastic intussusceptions, including 29 patients with benign tumors and 13 patients with malignant tumors. Twenty-nine patients had a combined total of 36 non-neoplastic intussusceptions, of which the condition was idiopathic in 23 patients and cased by non-neoplastic benign lesions in six patients. There were no significant differences in patient age or sex ratio in the neoplastic and non-neoplastic groups. In the non-neoplastic group the intussusceptions were shorter in length (3.6 cm vs. 13.2 cm, P<0.05) and smaller in transverse diameter (2.8 cm vs. 4.2 cm, P<0.05), and less likely to be associated with intestinal obstruction (2 vs. 18, P<0.05). The percentage of patients with multiple intussusceptions was greater in the neoplastic group (10/42, 23.8% vs. 4/29, 13.8%). In the non-neoplastic group only one lead point was detected (in a patient with Meckel's diverticulum), whereas lead points were detected in all 55 intussusceptions in the neoplastic group. There are differences in the clinical and MDCT manifestations of adult neoplastic and non-neoplastic SBIs. Whether a lead point is present or not has implications with regard to deciding on the most appropriate treatment and avoiding unnecessary surgery.

Jejunal Polyps that Lead to Small Bowel Intussusception in Adults: A Rare Case Report

Small intestine polyps are very rare in adults. Incidental finding of those polyps; sending them for histopathology that comes out to be Peutz-Jeghers syndrome (PJS) is extremely rare. PJS is an inherited disease characterized with typical hamartomas polyps in intestine along with distinctive skin pattern and mucocutaneous pigmentation. Gene mutation is responsible for 93% of PJS cases, among which majority of cases occur due to mutation in STK11 gene. PJS patients have 15-fold higher risk of developing cancer, including intestinal, extra-intestinal, breast, lung, pancreatic and colorectal cancer. Although PJS incidence is very low but its early recognition is very important for lowering morbidity and mortality. In this study, we have reported a very rare case of PJS in adults that was operated for small bowel obstruction secondary to intussusception. These cases are very rare in literature.

2594 An Unusual Case of Small Bowel Intussusception

INTRODUCTION: Intussusception is the telescoping of a part of the intestine into a more distal segment. The first case of intussusception was reported in 1674 by Barbette and detailed in 1789 by John Hunter. It is often classified by location into entero-enteric (65%), Ileocecal (19%), Colo-colic (9%) and finally duodeno-duodenal (&lt;5%). It typically presents between the age of 6 and 36 months making adult presentation rare. We report a rare case of Duodeno-duodenaI intussusception secondary to tubular adenoma. CASE DESCRIPTION/METHODS: A 57 year old African American female with a history of rheumatoid arthritis and hysterectomy presents to the emergency room with complaints of epigastric pain for two days. The pain was intermittent, aggravated by food, and associated with nausea and two episodes of vomiting. She denies any other symptoms or similar episodes in the past. Last bowel movement was reported a day prior to presentation. Vital signs upon admission were within normal limits. On physical examination abdomen was soft, non distended with epigastric tenderness. Blood work on admission was unremarkable except for White blood cell count of 11.6 k/ul and Lactate level of 1.6 mmol/L. Computer Tomography (CT) scan of Abdomen showed telescoping of the apparent 2nd and 3rd portions of the duodenum compatible with intussusception (Figure 1). Patient underwent upper endoscopy with biopsies that showed a 3 cm duodenal polypoid lesion with pathology revealing tubular adenoma (Figures 2 and 3). Patient's symptoms resolved 2 day after presentation with supportive care only. Patient underwent endoscopic submucosal dissection of the lesion. DISCUSSION: Adult small bowel intussusception is a very rare entity that accounts for 5% of all cases of intussusception and 1%-5% of intestinal obstructions. The diagnosis can be challenging as symptoms are nonspecific and includes abdominal pain, nausea and vomiting. CT scan was found to be the preferred imaging study with specificity of 100% and sensitivity of up to 87% in adults. It often shows a “target sign” on the sagittal view or a sausage-shaped mass on axial and coronal views. It is always associated with a lead point such as a lipoma, hamartomatous polyps. The etiology in our case was a tubular adenoma which makes it more intriguing. Although duodenal intussusception is rare, recognition is critical for institution of appropriate therapy and prevention of complications. It should be considered in the differential diagnosis of any abdominal pain with signs of bowel obstruction.

Adult Small Bowel Intussusception and Resolution Captured on Pelvic Ultrasound

While abdominal pain is one of the leading causes for ED visits, intestinal intussusception is an infrequent etiology in adults. We present the case of a 22-year-old woman with five days of left lower quadrant abdominal pain with initial workup investigating for a genitourinary source utilizing pelvic ultrasound which revealed small bowel-small bowel intussusception. During the study, resolution of the intussusception correlated temporally with the patient’s symptoms. Transient small bowel intussusception in adults has been previously described; however, direct visualization of both the intussusception and its resolution on pelvic ultrasound has not been previously published.

Intestinal Intussusception: Etiology, Diagnosis, and Treatment.

Intussusception 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.

Conservative management of adult small bowel intussusception detected at abdominal computed tomography

The incidence of adult small bowel intussusception detected at CT has increased with advanced imaging techniques and universal utilization of CT scan. We aimed to identify factors that could predict the necessity of surgical intervention in adult patients with small bowel intussusception detected at CT during the past decade. There were 39 cases of adult small-bowel intussusception detected at CT from January 2004 to June 2014. The data on clinical factors, radiological factors and outcomes were collected by retrospectively reviewing all available medical records. Patients were classified as surgical group and conservative group according to the outcome. Association between predictive factors and outcome was assessed by Fisher's exact test and logistic regression models. Among a total of 39 patients, there were 32 patients (82%) in the conservative group and 7 patients (18%) in the surgical group. Spontaneous reduction was confirmed at short-term follow-up studies (abdominal ultrasonography [n=14], single contrast small bowel series [n=14], CT [n=4]) in the conservative group. No recurrence occurred during the median follow-up period of 14.1 months (range, 0-67.5 months). Patients in the surgical group had significantly higher white blood cell (WBC) counts (OR 1.001, p=0.048), more frequent obstruction (n=4 vs. n=4, p=0.022) or leading point (n=5 vs. n=0, p<0.001) and longer intussuception length (OR 1.929, p=0.032). Factors associated with the necessity to resort to surgical intervention in adults with small bowel intussusceptions were higher WBC counts, presence of obstruction or leading point, and longer intussuception length. Conservative management can be considered with short-term follow-up for those without these predictive factors.

Adult intestinal intussusception — A report of 2 cases and literature review

Abstract Every five years or so a case of adult small bowel intussusception secondary to pathologies such as inflammatory fibroid polyp (IFP) appears in English literature. Likewise rare cases of adult colonic intussusception due to a tumour have been reported including, more recently, their successful management by laparoscopic approach. We describe two such cases, one each of small bowel and large bowel intussusception, due to IFP and caecal tumour respectively and discuss their management. We also suggest role of combined laparoscopy/endoscopy in selected cases of colonic resections.

Laparoscopy-Assisted Small Bowel Resection for Treatment of Adult Small Bowel Intussusception in a Patient with Factor VII Deficiency

Factor VII deficiency is a rare congenital bleeding disorder characterized by episodes of spontaneous bleeding in severely affected individuals. It is rare intussusception due to submucosal hematoma in coagulation factor deficiency patient. We recently experienced an adult small bowel intussusception in a patient with factor VII deficiency. A 36-yr old female patient with coagulation factor VII deficiency who was referred to our hospital underwent emergency surgery for treatment of the small bowel intussusceptions. Emergency laparoscopy-assisted small bowel resection was performed for treatment of small bowel intussusception caused by submucosal hematoma. The patient was successfully treated with close laboratory monitoring and laparoscopy-assisted small bowel resection.

Does Adult Intestinal Invagination Need Surgery? Report of a Case and Review of Literature

Benign intestinal tumors are the most frequent cause of small bowel intussusception in adults. This report presents a case of a 67-year-old male with abdominal pain, leukocytosis and C-reactive protein elevation. After ultrasonography and double contrast CT-scan consistent with ileal intussusception patient underwent laparoscopy, which confirmed diagnose. Intestinal resection and anastomosis were performed via minilaparotomy. Further histological study showed a fibroid inflammatory polyp or Vanek’s tumor as intussusception’s lead point.

Laparoscopic Resection of Ileal Lipoma Diagnosed by Multidetector-row Computed Tomography

Intussusception is rare in adults and it is difficult to diagnose on admission. We present the case of a 43-year-old woman with the chief complaint of nausea and upper abdominal pain. Abdominal multidetector-row computed tomography showed ileo-ileal small bowel intussusception with an intraluminal soft tissue mass with attenuation numbers suggestive of a lipoma. The patient was treated with a laparoscopic-assisted extracorporeal partial resection of the small bowel including ileal lipoma, followed by a functional end-to-end anastomosis. Histologic diagnosis of the resected tumor, 2.4×2.0×2.0 cm, was an intestinal lipoma. This case serves as the basis of a review of small bowel intussusception in adults secondary to lipomas. It focuses on the utility of multidetector-row computed tomography and the cosmetic, physical, and economic benefits of laparoscopic surgery as well as the rarity of the disease.

Consider celiac disease

Re: “Idiopathic small-bowel intussusception in an adult.” [1][1] An important but under-recognized etiology of adult small bowel intussusception without a “lead point” is celiac disease. In rare cases, intussusception may be the initial presentation of adult celiac disease. If not done

Adult jejunojejunal intussusception caused by metastasized pleomorphic carcinoma of the lung: Report of a case

Adult small-intestinal intussusception is rare and very different from childhood intussusception. Both benign and malignant pathologies can underlie small intestinal intussusception in adults, but malignancy is much less frequent. We report a case of jejunojejunal intussusception caused by an intestinal metastasis of the sarcomatoid component of pleomorphic carcinoma of the right lung. The patient, a 61-year-old man, underwent successful segmental jejunal resection. Adult small bowel intussusception, though an unusual cause of acute abdomen, requires early diagnosis and timely management. To our knowledge, this is the first report of adult jejunojejunal double intussusception caused by metastatic sarcomatoid carcinoma of the lung.

Laparoscopic-assisted small bowel resection for treatment of adult small bowel intussusception: a case report

BackgroundIntussuception is a rare cause of intestinal obstruction in adults. Diagnosis is often difficult due to the variable and sometimes episodic nature of symptoms. Surgery is the recommended treatment option in adults if the diagnosis is proven.Case presentationWe present a case of a 33 year old Caucasian female admitted with a small bowel obstruction and no history of previous abdominal surgery. Patient did not improve with medical management consisting of bowel rest and nasogastric tube decompression. Surgery was consulted and patient was taken to the operating room for a laparoscopic-assisted small bowel resection for a small bowel intussusception caused by a submucosal fibroma.ConclusionOur case highlights the feasibility and potential benefits of laparoscopy in assisting the diagnosis and treatment of small bowel obstructions.

V12: Laparoscopic reduction of small bowel intussusception in a 33-week pregnant gastric bypass patient

Small bowel intussusception in adults following gastric bypass surgery is an uncommon but previousely reported complication. Most reported cases are retrograde in nature, mainly involving the common channel. A probable etiology includes the presence of an ectopic pacemaker causing retrograde peristalsis. Patients usually present with intermittent abdominal pain or recurrent episodes of bowel obstruction. Reduction of post-operative small bowel intussusception via the open approach has been widely used due to many technical challenges of the laparoscopic approach.

Transient small-bowel intussusceptions in adults: significance of ultrasonographic detection

To investigate the frequency, clinical significance, and outcome of small-bowel intussusceptions in adults detected using ultrasound in an outpatient setting. In two different retrospective (January 2001 to April 2003) and prospective (May 2003 to June 2005) periods, 33 small-bowel intussusceptions were found in 32 patients (13 females; mean age: 38.1 years) with known or suspected intestinal disease. Patients underwent diagnostic work-up to assess any organic disease. Patients with self-limiting intussusception were submitted to clinical and ultrasonographic follow-up. Of the 32 patients with small-bowel intussusception, 25 were identified in the prospective series of 4487 examinations (0.53%) and seven in the retrospective series of 5342 examinations (0.15%; p=0.002). Four patients had persistent and 28 self-limiting intussusceptions. Self-limiting intussusceptions were idiopathic in 11 patients (39%) or associated with organic diseases in 17 (Crohn's disease in 11 patients, celiac disease in three, ulcerative colitis in one patient, and previous surgery for cancer in two). Self-limiting intussusceptions were asymptomatic in 25% of patients. Small-bowel intussusceptions in adults are not rare and are frequently self-limiting, idiopathic, or related to organic diseases, mainly Crohn's disease and coeliac disease.

Frequency and significance of ultrasonographic detection of non-acute transient small-bowel intussusceptions in adults

Frequency and significance of ultrasonographic detection of non-acute transient small-bowel intussusceptions in adults

Do All Adult Patients with Small Bowel Intussusception Need Surgery?

Introduction: Intussusception of the small bowel accounts for less than 1% of cases of small bowel obstruction in adults. It has traditionally been regarded as a condition requiring surgery, because up to 90% of cases are said to be associated with a lead point disease. We present a case of small bowel intussusception in an adult, which was transient and managed conservatively without surgical intervention. Case: A 23-year-old man presented to the Emergency Department with a three-day history of right-sided abdominal pain, nausea and bilious vomiting. On arrival, his temperature was 97.7° F and his pulse rate was 79 beats per minute. Examination revealed a non-distended abdomen with right lower quadrant tenderness without guarding or rebound tenderness. His white cell count was 13,000 per cmm and hematocrit was 50 percent. Plain-film radiograph of the abdomen revealed a non-obstructive bowel gas pattern. Computed tomographic scanning of the abdomen showed a “target lesion”, suggestive of small bowel intussusception (Figure 1). However, no abnormality was demonstrated on barium small bowel follow-through performed the next day. The patient's general condition improved with bowel rest. Discussion: The reported frequency of lead point disease with adult small bowel intussusception is based on surgical series in which patients had obstructive symptoms and the diagnosis was made intraoperatively. However recent series using CT or MRI diagnosis of intussusception found increased rate of idiopathic transient intussusception approaching 50%, especially in small bowel. Features suggestive of transient intussusception are incidental presentation, proximal small bowel location, absence of peristaltic obstruction, absence of any apparent cause, target like lesion on CT scan and intussusception length less than 3.5 centimeter. Many cases of adult small bowel intussusception that are detected with computerized tomography are self-limiting. This highlights the need for considering conservative approach in management of small bowel intussusception in adults.[figure 1]Figure