Bowel Intussusception Research Articles

A rare case: small bowel intussusception in adult caused of intraabdominal lipoma

Bowel obstruction caused by intussusception is a rare case. A non-typical sign makes the patient undergo several radiological examinations to establish diagnosis. From various intussusception causes, lipoma is a very rare cause. We reported a rare case of small bowel intussusception caused by lipoma who underwent ultrasonography (USG) and computed tomography (CT) scan examinations in Dr. Soetomo General Hospital, Surabaya, Indonesia.

Colo-enteric fistula associated with diffuse large B cell lymphoma that resulted in gastrointestinal bleeding: A case report and literature review

Introduction and importanceThe most common symptoms of primary gastrointestinal (GI) lymphoma are non-specific, such as nausea, vomiting, diarrhea, weight loss, and abdominal pain. The rare acute symptoms include bowel obstruction, intussusception, and perforation. Primary small bowel lymphoma accounts for the smallest proportion of all GI malignancies. We report a case of intestinal lymphoma presenting with bloody stools and anemia.Case presentationThe patient initially underwent both duodenoscopy and colonoscopy with negative findings. Isotopic red blood cell (RBC) scan was then performed due to persistent bleeding along with computed tomography angiography (CTA) because of suspected bleeding in the left abdomen. Successful embolization over the arcade of the sigmoid and left colic arteries was performed. However, the bleeding did not stop, and ischemic colitis was diagnosed by repeat colonoscopy. A coloenteric fistula was finally discovered during emergent laparotomy.Clinical discussionGI lymphomas are a rare disease entity among the all GI malignancies. Despite acute abdominal symptoms including obstruction, perforation, bleeding and intussusception, enteral fistula is also one of the complications. It was seen to be a long-term complication after treatment or disease process in most of cases, however it could occur as the initial manifestation. GI bleeding is a life-threatening condition and commonly needs prompt decision making. There were no standard managements for these patients, it depends on clinical judgements from physician individually.ConclusionThis is a rare condition that has not been previously described in Taiwan. Early diagnosis and timely management will decrease morbidity and mortality in the GI lymphoma population.

Ileocolic intussusception in pediatric SARS-CoV-2 patients: experience at a tertiary pediatric center.

PurposeCOVID-19 disease can manifest with intussusception in pediatric patients, but prevalence of abnormalities on ultrasounds performed for intussusception is uncertain. We aim to report our experience in children with COVID-19 presenting with suspected intussusception imaged with ultrasound.MethodsChildren under 18 years who had an ultrasound for possible intussusception underwent retrospective analysis and were tested for COVID-19 between April 1 and December 14, 2020. Patients’ demographic, clinical, radiological and surgical characteristics were reviewed.ResultsTwenty-four COVID-19-positive patients were identified; 19 boys with mean age 3 years (range: 3 months–18 years). Ultrasound was abnormal in 11 patients (11/24, 46%). Sonographic features of enterocolitis were documented in seven children (7/24, 29%). Three boys (3/24, 13%) were found to have ileocolic intussusception on ultrasound and underwent air enema with failed reduction (3/3, 100%), precipitating surgical reductions, all with favorable outcomes. One patient (1/24, 4%) was found to have a long segment of persistent small bowel–small bowel intussusception which was surgically repaired.ConclusionGiven the known association between failed reduction at air enema and delayed presentation, heightened awareness for intussusception in the setting of COVID-19 should be maintained, though more often, the etiology was attributed to other GI manifestations of COVID-19.

Small bowel obstruction precipitated by intussusception of Meckel’s diverticulum

Small bowel obstruction (SBO) secondary to intussusception of Meckel’s diverticulum (MD) is a rare cause of acute abdominal pain that may warrant urgent surgical treatment. Volvulus or intussusception of the small bowel with presence of MD as the lead point is the most commonly reported etiology of Meckel’s related obstructions. We report an interesting case of a small bowel obstruction caused by the intussusception of an MD within its own lumen. The case involves a 30-year-old male who presented to the emergency room with acute, severe abdominal pain with an abdominal computed tomography (CT) showing a distal high-grade SBO. Decision was made to take the patient to the operating room urgently due to his clinical examination and radiologic imaging, specifically CT scan. Diagnostic laparoscopy was performed and subsequently converted to an exploratory laparotomy, which revealed the intussuscepted MD with focal necrosis into the distal small bowel causing an SBO. A segmental small bowel resection with hand sewn primary anastomosis was performed. The case presents an interesting challenge in deciding when to take a patient with an SBO to the operating room versus initial conservative management and what the treatment should be if an MD is encountered. In addition, the case emphasizes the importance of history and physical exam findings in coordination with radiologic imaging in helping to make appropriate decisions in a timely manner for operative vs conservative management of an SBO. It reminds us that, Meckel’s diverticulum, although less commonly the cause of a small bowel obstruction in the adult population, needs to be on the differential diagnosis and we need to have a high clinical suspicion for this possibility to ensure appropriate treatment in a timely manner.

Epidemiology and causes of intestinal obstruction in Ethiopia: A systematic review.

Objective:This systematic review was aimed to address the prevalence and causes of intestinal obstruction in Ethiopia.Methods:Systematic searches were conducted on PubMed, EMBASE, CINAHL, Scopus, African Journals Online, HINARI, and other supplementary sources, including Google Scholar. We conducted methodological quality assessments for the articles by employing a critical appraisal checklist of Joanna Briggs Institute.Results:The reported prevalence of intestinal obstruction in Ethiopia ranges from 18.6% to 50.7% among patients with acute abdomen. However, the prevalence varies from 4.3% to 34.6% among total surgical admissions. The leading causes of small intestinal obstruction were small bowel volvulus, intussusception, and adhesion. Sigmoid volvulus was the most commonly reported cause of large intestine obstruction, followed by colonic cancer.Conclusion:The highest reported prevalence of intestinal obstruction in Ethiopia was 50.7% among patients with acute abdomen and 34.6% among surgical admissions. Small intestine volvulus and sigmoid volvulus were the common causes of small and large bowel obstructions, respectively. Therefore, clinicians have to consider the common causes during the diagnosis and management of intestinal obstruction.

Point-of-Care Ultrasound For Differentiating Ileocolic From Small Bowel-Small Bowel Intussusception.

Intussusception is a common pediatric emergency. The two types of intussusception are ileocolic intussusception (ICI) and small bowel-small bowel intussusception (SB-SBI), and neither are easily distinguished clinically. ICI requires radiology personnel and potentially surgical assistance for its reduction. SB-SBI is managed expectantly, as many resolve spontaneously. Differentiating between ICI and SB-SBI through point-of-care ultrasound (POCUS) requires an understanding of their salient features. Identification of the correct type of intussusception immediately assists decision making and patient disposition. Our objective was to provide guidance on POCUS technique for intussusception identification, and to review the ultrasound literature differentiating ICI from SB-SBI. We systematically searched 3 separate databases and gray literature to identify articles that met our criteria and assessed them for final review. The final articles were graded for quality using The National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. A total of 858 articles were identified. Six articles were included in the final review. All studies were conducted in pediatric patients in different countries. Most were found to have a fair quality of evidence. The linear transducer is used when evaluating intussusception. Both ICI and SB-SBI are identified easily on POCUS, but they differ sonographically with respect to region within the abdomen, intussusception parameters, lymph nodes, and other salient features seen on real-time video. ICI and SB-SBI can be identified and differentiated using several sonographic features. POCUS is capable of expeditiously aiding the emergency physician's decision making and disposition when managing intussusception.

Idiopathic proximal small bowel intussusception in an adult

Rationale: Intussusception is fairly uncommon in adults accounting for 5% of all intussusception cases and is a cause in 1% of intestinal obstruction cases. The condition is usually associated with a pathological lead point. Idiopathic intussusception is comparatively rarer in adults. Patient Concerns: 24-year-old male with right lower abdominal pain and intermittent loose stools for fifteen days. Diagnosis: Proximal small bowel intussusception. Intervention: Resection of the involved segment with primary jejunojejunal anastomosis. Outcome: Uneventful postoperative course and full recovery. Lessons: Idiopathic intussusception, though rare in adults, should be suspected in all adults presenting with non-specific abdominal pain particularly in absence of distinct abdominal signs. Management is surgical and usually entails resection of the involved bowel.

AN UNCOMMON CASE OF GANGRENOUS JEJUNOILEAL INTUSSUSCEPTION SECONDARY TO JEJUNAL POLYP

Small bowel intussusceptions are much less common than the ileocolic type, with jejunoileal intussusceptions among the rarest [1].Gangrenous Intussusception is a dangerous condition requiring immediate revival, early exploration,and resection of the affected bowel to lessen mortality and morbidity. Jejunal polyps causing such pathology are uncommon and noteworthy. Here we present one such case.

Submucosal Lipoma at the lead point of Small bowel Intussusception in an Adult

Abstract Introduction/Objective Morbidity and mortality among adult patients presenting with acute abdominal pain are high, and these patients often require hospitalization with prompt surgical consultation Important differentials include small bowel obstruction from previous surgeries and hernias, acute mesenteric ischemia, and ruptured abdominal aortic aneurysm. Intussusception in adults is rare accounting for about 1% - 5% of small bowel obstructions and thus requiring a high index of suspicion for early detection. In most cases, the lead point is a benign mass, commonly a lipoma, but histopathologic examination of the resected segment is required to rule out malignancy. Methods/Case Report We present a case of a 50-year old male with a medical history of psoriasis and hypertension who was admitted on account of a 1-day history of sudden onset persistent abdominal pain with associated nausea non-bilious emesis. Physical examination reveals no fever and soft non-distended abdomen with diffuse tenderness. CT scan demonstrated long segment small bowel-small bowel intussusception with markedly edematous and dilated bowel, compatible with obstruction. The lead-point was suspected to be a 3.9cm lipoma. Segmental resection and primary re-anastomosis were performed. Gross examination revealed a 13cm segment of bowel telescoping into a distal segment with a lead-point demonstrating mucosal congestion and submucosal thickening corresponding to a well-circumscribed 3.5cm tan yellow soft lobulated mass with yellow cut surface. Histopathology was consistent with lipoma. The patient made an uneventful postoperative recovery. Results (if a Case Study enter NA) N/A Conclusion Intussusception should be kept in the differential diagnosis of adults presenting with sudden onset abdominal pain and pathologic examination of the resected segment is necessary to rule out malignancy.

EP.FRI.543 A rare case of acute jejuno-jenual intussusception in a patient with Roux-en-Y bypass secondary to a benign polyp

Abstract Introduction Roux-en-Y Gastric bypass (REYGB) amounts for a third of surgical bariatric interventions. Small bowel obstruction (SBO) is a long-term complication in REYGB and can be caused by intussusception of bowel, in approximately 0.5% of procedures. Intussusception in REYBG is mostly attributed to dysmotility. This report demonstrates a rare case of intussusception in REYGB secondary to a benign polyp. Case description A 45 year old female, three years post REYGB, presented to A&E with acute, extreme upper abdominal pain, with three days absolute constipation. She was tender on examination with normal blood tests. CT scan demonstrated small bowel intussusception. Initial concerns were of intussusception of the jejuno-jejunostomy anastomosis causing SBO. She had an exploratory laparotomy, which confirmed intussusception, however this was 20cm distal to the jejuno-jejunostomy. Bowel was gently reduced, and deemed viable. On thorough run-through, a small segment at the transition point, was considered abnormal on palpation. This region was resected and a 1x1cm intraluminal polyp was identified as the causative lead point. The patient did well postoperatively. Discussion Small bowel intussusception in adults is typically attributed to pathological lead point, such as benign or malignant lesions. Intussusception in REYBG is a rare but well-documented cause of intestinal obstruction, usually attributed to dysmotility, secondary to ectopic pacemaker cells particularly around anastomoses. In this case, the intussusception was caused by an unusual pathology separate from the jejuno-jejunal anastomosis. We recommend thorough examination of all adjacent bowel to exclude lesions, in this case a polyp, which could result in recurrence.

1568 A Case of Small Bowel Intussusception Occurring Six Years After Laparoscopic RYGB

Abstract Introduction We present a case of small bowel intussusception occurring in a female who had previously undergone Laparoscopic RYGB. Few case reports of retrograde intussusception occurring in pregnant patients with a history of LRYBG have been published. Up to our knowledge, this is the first case of this rare complication presenting in the postnatal period. Case report Our patient, a female in her thirties, gave birth to a healthy baby via caesarian section six years after her LRYGB. On the day following her operation, she experienced epigastric severe, progressive abdominal pain associated with nausea and vomiting. Abdominal examination showed epigastric and left upper quadrant tenderness, hypoactive bowel sounds and no palpable masses. Small bowel obstruction was suspected. A nasogastric tube was inserted and an abdominal CT scan with oral contrast was ordered. The CT scan showed multiple concentric segments of small bowel loops representing the intussusceptum pulled into the intussuscipiens, giving the classic doughnut sign. The patient was subsequently taken to theatre for a laparotomy. The mass was comprised of the biliopancreatic limb which was dilated as the common limb was retrogradely intussuscepting into it. The bowel was ischemic and remained so after manual reduction. A 45cm ischemic segment was resected and then primary re-anastomosis was done. Her postoperative course was unremarkable. Discussion Intussusception can present years after the original surgery, and imaging is not always reliable. Seeing as bariatric surgery is getting more popular, physicians should be well aware of this serious complication as delay in diagnosis increases morbidity and mortality.

S2967 Small Bowel Intussusception Due to Hamartomatous Polyp Related to Peutz-Jeghers Syndrome

Introduction: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant syndrome manifested by multiple hamartomatous polyps, predominantly present in the gastrointestinal tract, and mucocutaneous pigmentation changes. Cumulative lifetime risk of intussusception in patients with PJS has been reported to be as high as 69% with 80% of the cases presenting as an acute abdomen. The median size of polyps causing intussusception is 3.5 cm. We present a case of small bowel intussusception attributed to hamartomatous polyps. Case Description/Methods: A 39-year-old male with a history of PJS and prior small bowel resection due to obstruction, presented with abdominal pain and multiple episodes of hematochezia. His hemoglobin on arrival was 6.5 g/dL, however remained hemodynamically stable with blood transfusion. CT of the abdomen and pelvis with contrast revealed a new small bowel (SB) intussusception measuring 7 cm with the intussuscipiens measuring 3.7cm [Fig. A,B]. Since the patient remained clinically stable, an enteroscopy was performed to identify the site of intussusception with possible endoscopic reduction. Multiple large small bowel polyps were identified, the largest measuring 5 cm in the jejunum, 50 cm distal to the site of anastomosis and likely lead point of the intussusception [Fig C.]. A repeat enteroscopy was performed with piecemeal resection of the large jejunal polyp with hot snare and clip placement [Fig. D]. The patient’s hematochezia and abdominal pain resolved. He was discharged with planned staged resection of remaining large SB polyps and surveillance colonoscopy. Histology of the polyps showed proliferation of smooth muscle into the lamina propria in branching pattern and normal intestinal epithelium consistent with Peutz-Jeghers hamartomatous polyp [Figure E]. Discussion: Peutz-Jeghers syndrome is associated with increased risk of both gastrointestinal and non-gastrointestinal malignancy including, but not limited to, colon, pancreas, breast, lung, and ovarian cancer. Gastrointestinal complications are related to polyps and include anemia from bleeding, intussusception, obstruction and infarction. Timely recognition and treatment is important as the complications can be fatal. Fortunately with advancements in small bowel endoscopy, these complications can be prevented and managed by endoscopic surveillance and polypectomy, reducing the need for urgent surgical intervention.Figure 1.: A. Transverse view of small bowel intussusception B. Sagittal view of small bowel intussusception C. Endoscopic view of large pedunculated polyp D. Prior site of piecemeal resected polyp with subsequent placement of clips E. Histology slide of resected polyp confirming hamartomatous polyp.

S1851 Chilaiditi Syndrome: A Case Report

Introduction: Chilaiditi’s sign was first defined over one hundred years ago by Demetrius Chilaiditi. Chilaiditi sign has a 0.025% to 0.28% incidence worldwide with a male to female ratio of 4:1. The bowel segments most commonly found interposed between the liver and diaphragm are the colonic hepatic flexure and transverse colon, however interposition of the small bowel can also occur. The following criteria must be met to diagnose Chilaiditi sign based on radiological findings: the right hemidiaphragm must be elevated above the liver by the intestine, the bowel must be distended by air to illustrate pseudo-pneumoperitoneum, and the superior margin of the liver must be depressed below the level of the left hemidiaphragm. Case description/methods: A 75 year-old-male presented with right sided flank pain for the past 9 months. He denied symptoms of nausea, vomiting, fever, chills, change in appetite, unexplained weight change, night sweats, melena or hematochezia. He reported chronic intermittent constipation, but he typically stooled daily or every other day. He had normal colonoscopy one year prior. Due to chronic nature of his pain, CT abdomen and pelvis was obtained. It showed anterior interposition of the hepatic flexure of the colon along the liver and right hemidiaphragm; this may be seen with Chilaiditi syndrome (Figure 1). Surgical correction was discussed, but conservative measures including diet, stool softeners, and exercise to promote weight loss and bowel regularity was instituted with resolution of gastrointestinal symptoms. Discussion: Patients with anatomical variants including absence, laxity, or elongation of the suspensory ligament are at increased risk for developing pathologic interposition. In patients with Chilaiditi syndrome, most common presenting symptoms abdominal pain, abdominal distention, nausea, emesis, constipation, and obstipation. The differential of Chilaiditi syndrome includes bowel obstruction, volvulus, intussusception, ischemic bowel, diverticulitis, appendicitis, subphrenic abscess, and pneumoperitoneum. In asymptomatic patients with Chilaiditi sign, treatment is usually conservative with stool softeners/laxatives and no interventions needed. Surgical intervention is indicated when the obstruction does not resolve with conservative management or there is evidence of bowel ischemia. The appropriate surgical approach depends on which segment of colon is interposed.Figure 1.: CT shows anterior interposition of the hepatic flexure of the colon along the liver and right hemidiaphragm.

V09-02 URETERAL INTUSSUSCEPTION: A RARE COMPLICATION OF A URETERAL MASS

INTRODUCTION AND OBJECTIVE:While small bowel intussusception is well described, ureteral intussusception is extremely rare. Only 31 cases have been reported in the literature between 1937-2021. Ure...

Meckel’s Diverticulitis Causing Small Bowel Intussusception: A Case Report

Meckel's diverticulum (MD) is considered the most common congenital gastrointestinal malformation affecting 2% of the population. Complications including hemorrhage, diverticulitis, and intestinal obstruction occur in only 4% of patients with MD. This article presents the imaging findings of a small bowel intussusception caused by Meckel’s diverticulitis in a 10-year-old girl.

Management of Adult Intussusception-A Case Series Experience from a Tertiary Center.

The management of intussusception is controversial. Clinical presentation, with the aid of imaging modalities, enables a better selection of patients for the appropriate treatment algorithm. Conservative management versus surgical intervention with bowel resection is considered accordingly. Retrospective review of a computerized database of patients who were admitted with intussusception between January 1, 2010, and December 31, 2020, in a single tertiary center in Israel. Patients who were treated conservatively were compared to those who underwent surgery. Patients who underwent bowel resection were compared to those that had surgery without a resection. A total of 76 patients were diagnosed with intussusception, and 49 were operated. Bowel resection was performed in 32 cases. 20/76(26%) were successfully managed conservatively. Patients with a lead point (OR = 5.59) and colonic involvement (OR = 13.72) had a higher likelihood for resection. The likelihood of bowel resection was found to be significantly lower with proximal small bowel intussusception (OR = 0.071). Young patients presenting with intussusception may be treated conservatively when adequate criteria are met in order to avoid unnecessary surgical interventions.

Malignant Solitary Fibrous Tumor of Ileum with Intussusception

Solitary fibrous tumor (SFT) is rare mesenchymal neoplasm of fibroblastic or myofibroblastic origin. Especially, extrapleural SFT is known to be extremely rare. Here, we report a case of malignant SFT of ileum, resulting in small bowel intussusception in a 74-year-old female patient.

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.

The radiological characteristics of childhood intussusception including unusual features and rare pathological lead points

PurposeTo describe the radiological characteristics for childhood intussusceptions including unusual radiological features and rare pathological lead points (PLP). Material and methodsThe medical records of all childhood intussusceptions between 1/1/2010 -1/10/2020 were retrospectively reviewed. 95 cases were identified in 82 patients. The demographic data, presenting symptoms, diagnostic and treatment methods, radiological features, and PLPs among the different types of intussusception were analyzed. ResultsIleocolic intussusception (ICI) represented 53.7% (51/95). The average age for ICI was 1.87 years. Males constituted 72.1% (31/43). 29.4% (15/51) were treated primarily surgically due to peritonitis. Small bowel intussusception (SBI) represented 40% (38/95) in which females constituted 51.5% (17/33). Ileo-ileal represented 63.2% (24/38). 81.8% (27/33) were transient. On ultrasound; There was a statistically significant difference in the size of the outer diameter of ICI compared to SBI (P-value 0.00012). Ileo-ileocolic and colo-colic intussusceptions constituted 3.2% (3/95); each and were more common in females. Vomiting was the most common symptom for intussusception and ultrasound was diagnostic in the majority of cases. PLPs were seen in 36.6% (30/82) of the patients of which the average age was 7 years. PLPs/risk factors were benign in 80% (24/30). A case of colo-colic intussusception was seen in a 16-year-old female due to clear cell sarcoma which was not reported before. 12.2% patients (10/82) had recurrent intussusception. ConclusionOur study showed that ICI is the most commonly encountered type. SBIs are mostly transient. It is important to radiologically determine the type of intussusception and to identify PLPs or unusual radiological features to avoid unnecessary intervention and significant patient morbidity.

Intussusception in Adults: A Retrospective Review from a Single Institution

PurposeIntussusception is uncommon in adults and often manifests as nonspecific symptoms. Owing to its low incidence and the lack of knowledge on the symptoms, causes, and treatment of adult intussusception (AI), many surgeons may have limited experience in the diagnosis and treatment of intussusception. This study aimed to describe the experience of AI and discuss its clinical presentation, etiology, and management.Material and MethodsI retrospectively reviewed patients aged 19 years and older who were diagnosed with intussusception at a single institution between March 2010 and December 2019.ResultsAmong 28 patients who were finally analyzed, abdominal pain was the most commonly observed symptom. Ileocolic and ileoileal intussusceptions were the most common locations, and a lead point was observed in 19 cases (68%), of which malignancy was observed in six (21%). Bowel resection was performed in 27 cases. According to the pathological findings of the tissue from the resected section, nine and three cases of small bowel intussusception (SBI) were benign and malignant, respectively, whereas 13 and three cases of colonic intussusception (CI) were benign and malignant, respectively. On comparing SBI and CI, it was observed that most variables did not significantly differ, except for the duration of symptoms.ConclusionSBI had a higher lead point than CI. The rate of malignancy in CI cases in this study was lower than that reported in other studies. En-bloc resection can be considered the first option for the treatment of AI.