Case Of Intussusception Research Articles

S2787 A Rare Case of Adult Ileocecal Intussusception Caused by an Ileocecal Valve Lipoma

S2787 A Rare Case of Adult Ileocecal Intussusception Caused by an Ileocecal Valve Lipoma

S2821 Ileocolonic Intussusception Associated Large B-Cell Lymphoma

INTRODUCTION: Intussusception is characterized by the telescoping of a more proximal portion of the gastrointestinal tract into a more distal portion. This is rare in the adult population, representing 5% of all cases of intussusception. Unlike in children, a pathological lead point is detected in 70–90% of cases, with up to 65% being malignant. Common malignancies leading to intussusception in the small intestine include primary adenocarcinoma, gastrointestinal stromal tumors, carcinoid tumors, and lymphoma. CASE DESCRIPTION/METHODS: A 35-year-old male presented with one month of intermittent right-sided abdominal pain. He reported normal bowel movements and denied nausea or vomiting. On presentation his vitals were unremarkable. Physical examination revealed mild abdominal distention with RLQ tenderness. CT abdomen/pelvis demonstrated RLQ ileocolonic intussusception without obstruction. Initial laboratory values were within normal limits. Colonoscopy revealed a dilated cecum and distal ileum with ileocolonic intussusception, with gross examination concerning for malignancy. Terminal ileal biopsy revealed benign small bowel mucosa with active inflammation. Alpha-fetoprotein was 8.5 ng/mL and carcinoembryonic antigen 0.5 ng/mL .CT chest showed no signs of metastasis. The patient underwent laparoscopic right hemicolectomy with extended small bowel resection. Surgical pathology revealed large B-cell lymphoma of the terminal ileum (positive for CD20, Ki-67) and twenty reactive lymph nodes. Postoperative course was uncomplicated and the patient was discharged home with Hematology/Oncology follow up. DISCUSSION: Intussusception is uncommon in adults, with the ileocolic or ileocecal variety comprising the most rare category. In a review of 14 papers in which 396 intussusception cases were presented, only 83 (20.9%) had ileocolic or ileocecal involvement. Of these, intussusception secondary to malignant causes occurred in 144 (36.4%) cases, with 23 of them resulting from lymphoma. Presentation usually includes non-specific symptoms such as colicky abdominal pain (85%–100%), nausea (41%–75%), vomiting (35%–70%), bleeding (16.4%–27.3%) diarrhea and constipation (22.5%–69%), which play a role in its challenging diagnosis. Considering adult intussusception in patients with recurrent abdominal pain is of critical importance given its high association with malignancy. This case highlights the uncommon diagnosis of adult intussusception caused by large B-cell lymphoma.Figure 1.: CT scan showing RLQ ileocolonic intussusception without obstruction.Figure 2.: Colonoscopy revealed ileocolonic intussusception.

Rotavirus: Preventive Vaccines and a Rare Side Effect

Rotaviruses are the most common cause of diarrhoeal disease among infants. Till now 108 countries have introduced rotavirus vaccines to prevent severe diarrhea. The Global Rotavirus Surveillance Network (GRSN) was established by WHO in 2008. Some studies reported that rotavirus vaccination can lead to a small increase in the risk of intussusception, a type of bowel blockage. This is a rare side effect. Intussusception, death of tissue of the intestinal wall due to lack of blood supply may cause life-threatening complications if left untreated. In infants idiopathic ileocolic intussusception is the most common form typically managed with operative or non operative reduction like hydrostatic or pneumatic enemas. Whereas, in adults and older children, intussusception is not very common and occurs more often in the colon of small intestine, pathogenesis is lead point in most of the symptomatic cases. Numerous countries have scrupulously noted the occurrence of intussusception post vaccination, and others yet to introduce the vaccine are gathering base line data on the incidence of intussusception which is an important safety issue in determining vaccine policy. However, it should be noted that naturally occurring intussusception, although rare, does occur in the very young. Due to heavy burden of rotavirus, some developing countries have introduced rotavirus vaccines. In India it is now part of the national immunization programme. Hospitalizations and deaths from rotavirus have been averted significantly because vaccination far exceeded the reported cases of intussusception with vaccination. The underlying rationale behind the differing risk of intussusception after rotavirus vaccination in various countries is not yet determined, therefore continuous monitoring is necessary.

S1759 Early Post-Endoscopic Transverse Colo-Colonic Intussusception

INTRODUCTION: Intussusception is a form of bowel obstruction defined as the telescoping of proximal segment of bowel into a distal segment. Intussusception in adults accounts for 5% of all cases and is usually secondary to a lead point such as a tumor or polyp. Intussusception in adults presents with vomiting, abdominal pain, hematochezia, or constipation. Cases where organic lesions act as the lead point present as a bowel obstruction. CT scan is diagnostic, which can identify location and presence of a lead point. Those with lead points can cause obstruction and ischemia- surgery is the treatment. Intussusception developing after an endoscopic procedure is extremely rare. In several cases there was a polypectomy performed and the subsequent intussusception was attributed to bowel edema acting as a lead point. All cases were treated with surgical intervention. CASE DESCRIPTION/METHODS: A 54-year-old female patient with a history of diabetes presented to the ED with worsening colicky abdominal pain starting four hours after a colonoscopy with polpectomy in the transvsere colon was performed. She also experienced red mucus in her stools. Her vital signs were within normal limits. On exam, she had a non-distended abdomen, with mild tenderness over the RUQ without any palpable masses. Her blood work was significant for a white count of 13 with a normal metabolic profile and lactate. The patient had an abdominal X- ray and CT of the abdomen which showed a transverse colo-colonic intussusception with partial obstruction. The patient was seen by the surgical team who opted for a conservative management with IV fluids and nil per os. Her symptoms rapidly improved the next day. She was started on a liquid diet which was advanced without complications. She was discharged on the third day after a normal bowel movement. An MRI two months after discharge was unremarkable. DISCUSSION: Intussusception with colonoscopy as an etiology is very uncommon. In our patient, polypectomy in the setting of colitis likely contributed to her development of an intussusception and partial bowel obstruction. There are no standard guidelines for management. In all colonoscopy-related cases cited, surgical interventions were pursued. Conservative management was pursued for our patient who had complete resolution of her symptoms. This report demonstrates that in non-malignant intussusception cases a conservative approach at first, with surgery reserved for patients with worsening symptoms, is practical.Figure 1.: Intussusception shown on abdominal CT (orange arrow).Figure 2.: Followup MRI showing resolution of intussusception (orange arrow).

Risk of intussusception after monovalent rotavirus vaccine (Rotavac) in Indian infants: A self-controlled case series analysis

BackgroundAn association between rotavirus vaccination and intussusception has been documented in post-licensure studies in some countries. We evaluated the risk of intussusception associated with monovalent rotavirus vaccine (Rotavac) administered at 6, 10 and 14 weeks of age in India. MethodsActive prospective surveillance for intussusception was conducted at 22 hospitals across 16 states from April 2016 through September 2017. Data on demography, clinical features and vaccination were documented. Age-adjusted relative incidence for 1–7, 8–21, and 1–21 days after rotavirus vaccination in children aged 28–364 days at intussusception onset was estimated using the self-controlled case-series (SCCS) method. Only Brighton Collaboration level 1 cases were included. ResultsOut of 670 children aged 2–23 months with intussusception, 311 (46.4%) children were aged 28–364 days with confirmed vaccination status. Out of these, 52 intussusception cases with confirmed receipt of RVV were included in the SCCS analysis. No intussusception case was observed within 21 days of dose 1. Only one case occurred during 8–21 days after the dose 2. Post-dose 3, two cases in 1–7 days and 7 cases during 8–21 days period were observed. There was no increased risk of intussusception during 1–7 days after the doses 1 and 2 (zero cases observed) or dose 3 (relative incidence [RI], 1.71 [95% confidence interval {CI} 0.0–5.11]). Similarly, no increased risk during 8–21 days after the dose 1 (zero cases observed), dose 2 (RI, 0.71 [95% CI, 0.0–3.28]) or dose 3 (RI, 2.52 [95% CI, 0.78–5.61]). The results were similar for 1–21 day periods after the doses separately or pooled. ConclusionsThe risk of intussusception during the first 21 days after any dose of rotavirus vaccine (Rotavac) was not higher among the Indian infants than the background risk, based on limited SCCS analysis of 52 children.

Laparoscopic Treatment of Colonic Intussusception Caused by Sigmoid Colon Cancer.

Reports on the laparoscopic treatment for colonic intussusception are exceedingly rare. We report a case of colonic intussusception caused by sigmoid colon cancer which was treated with a laparoscopic approach. A 76-year-old man visited an emergency room with the chief complaint of lower abdominal pain. He was diagnosed with colonic intussusception probably due to sigmoid colon cancer on a CT scan. Upon laparoscopic exploration, sigmoid colon intussusception was noted. Manual reduction was impossible because the colonic walls were friable and due to the possibility of a cancerous leading point. Therefore, the bowel was resected with en bloc Hartmann procedure. Pathology of the resected specimen revealed a tumor measuring 4.5 cm in size and comprising moderately differentiated adenocarcinoma (pT3N0M0, pStage II). The patient's postoperative course was uneventful and was discharged on the 8th day after surgery.

A rare case of bowel intussusception due to adenocarcinomatous polyp in a 14 year-old child: case report

BackgroundIntussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. It is an uncommon condition in children older than 2 years and causes intestinal obstruction. On the contrary of adult intussusception, childhood intussusception does not usually happen on a lead point of a malignant organic lesion.Case presentationA 14-year-old male presented with complaints of heavy, bilious emesis and periumbilical colicky pain. Ultrasonography showed a dilated intestinal loop with absent bowel movement. CT scan revealed two masses in the abdomen.We performed an exploratory laparotomy that revealed invaginated intestines and showed a polyp near the area of interest. Necrotic segments and the polyp were removed and examined pathologically. Pathology showed adenocarcinoma in the polyp.After surgery, the general condition of the patient was normal and no complications occurred.ConclusionsIntussusception mainly occurs during infancy and early childhood. Mostly it is an idiopathic ileo-colic invagination. In our case, the patient had a jejuno-jejunal intussusception in his late childhood, and the lead point was an adenocarcinomatous polyp, which is rare in children. Amongst the many types of treatment, we chose surgical resection because of patient’s age.

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

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

Diffuse juvenile polyposis causing recurrent small bowel intussusception

Abstract Intussusception is a common cause of infantile bowel obstruction. The majority of patients (75%) present before the age of 2 years and have no identifiable lead point. A pathological lead point (PLP) causes secondary intussusception, with an incidence of 4–20%. Recurrent intussusception is a well-described post-operative occurrence, with an incidence of 8%. The laparoscopic reduction is becoming an accepted safe modality in the management of intussusception. We present a case of recurrent intussusception post laparoscopic reduction of a jejunoileal intussusception. The operative findings were recurrent intussusception with a rare aetiology of jejunal polyps as pathological lead points.

Accounting for indirect protection in the benefit-risk ratio estimation of rotavirus vaccination in children under the age of 5 years, France, 2018.

BackgroundRotavirus is a major cause of severe gastroenteritis in children worldwide. The disease burden has been substantially reduced in countries where rotavirus vaccines are used. Given the risk of vaccine-induced intussusception, the benefit–risk balance of rotavirus vaccination has been assessed in several countries, however mostly without considering indirect protection effects.AimWe performed a benefit–risk analysis of rotavirus vaccination accounting for indirect protection in France among the 2018 population of children under the age of 5 years.MethodsTo incorporate indirect protection effects in the benefit formula, we adopted a pseudo-vaccine approach involving mathematical approximation and used a simulation design to provide uncertainty intervals. We derived background incidence distributions from quasi-exhaustive health claim data. We examined different coverage levels and assumptions regarding the waning effects and intussusception case fatality rate.ResultsWith the current vaccination coverage of < 10%, the indirect effectiveness was estimated at 6.4% (+/− 0.4). For each hospitalisation for intussusception, 277.0 (95% uncertainty interval: (165.0–462.1)) hospitalisations for rotavirus gastroenteritis were prevented. Should 90% of infants be vaccinated, indirect effectiveness would reach 57.9% (+/− 3.7) and the benefit–risk ratio would be 192.4 (95% uncertainty interval: 116.4–321.3). At a coverage level of 50%, indirect protection accounted for 27% of the prevented rotavirus gastroenteritis cases. The balance remained in favour of the vaccine even in a scenario with a high assumption for intussusception case fatality.ConclusionsThese findings contribute to a better assessment of the rotavirus vaccine benefit–risk balance.

Intussusception and Kawasaki disease after rotavirus vaccination in Taiwanese infants

BackgroundSince 2006, two rotavirus vaccines have been licensed in Taiwan, either as a 2- (RV1) or 3-dose (RV5) schedule administered at ages 2, 4, and 6 months. This study assessed the risk of intussusception and Kawasaki disease (KD) associated with rotavirus vaccines among infants. MethodsCases of intussusception and KD in infants aged less than 365 days were identified from the National Health Insurance databases, from 1 January 2007 through 31 December 2014, using the first-ever ICD-9-CM diagnosis codes. Histories of rotavirus vaccination were obtained from the National Immunization Information System. The modified self-controlled case series design included vaccinated cases, and compared incidence rate ratios (IRRs) between the risk period (postvaccination days 1–21 [intussusception] or days 1–28 [KD]) and control period (ages 0–364 days outside the −14 to +21 [intussusception] or +28 [KD] days of vaccination) by each type and dose of vaccine. Conditional Poisson regression models were adjusted for age using age-in-week (7-day) categorization. ResultsOverall 2064 intussusception cases and 2079 KD cases were diagnosed in 567,726 recipients (5313 [0.9%] received both RV5 and RV1). An increase in intussusception risk was observed in the 1–7 days (IRR 12.59, 95% confidence interval [CI] 8.07–19.66) and 8–21 days (IRR 1.78, 95% CI 1.00–3.16) post dose 1 of RV1, but not RV5. Risk of KD was higher during the third week post dose 2 of RV5 (IRR 2.33, 95% CI 1.35–4.00), and fourth week post dose 1 of RV1 (IRR 1.98, 95% CI 1.16–3.40). ConclusionOur finding of an increased risk of intussusception associated with RV1 in the first week after dose 1 is consistent with results of previous postlicensure studies. Further research should verify a potentially delayed risk of KD after rotavirus vaccination.

Acute duodenal obstruction secondary to intussusception caused by the duodenal diverticulum: a case report

BackgroundThe duodenal intussusception is rarely reported and usually occurs secondary to organic diseases of the duodenum such as polyps, tumors and duplication cysts. Herein we report a case of duodenal intussusception caused by duodenal diverticulum.Case presentationA 21-year old male patient presented with abdominal pain and vomiting for one day. A contrast enhanced computed tomography of the abdomen revealed duodenal intussusception. On emergency laparotomy, the intussusception had reduced spontaneously while an invaginated diverticulum was seen at the junction of the descending and horizontal segments of the duodenum. The diverticulum was resected and the patient had uneventful recovery.ConclusionDuodenal intussusception is a rare complication of duodenal diverticulum. Being aware of this complication of diverticulum can help in timely diagnosis and treatment.

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.

A case of flank pain caused by ureteral intussusception accompanied with ureteral polyp

BackgroundUreteral intussusception, a rarely reported unique condition, occurs primarily as a complication of ureteric tumours.Case presentationWe present a case of ureteral intussusception accompanied with a large ureteral polyp periodically protruding into the bladder cavity occurring in a 56-year-old man who experienced vague flank pain and intermittent haematuria. The patient was successfully treated by ureteroscopic cauterization combined with partial ureterectomy with reanastomosis.ConclusionsThis is the first report that describes polyp-related ureteral intussusception using comprehensive and representative ureteroscopic images and video. Our findings suggest that ureteroscopy is vital for diagnosis. Extensive biopsies through ureteroscopy are less invasive, and make it easier to exclude the presence of ureteral malignancies. Ureteroscopic resection of the whole polyp with its stalk and intussusceptum using Holmium: YAG laser did not seem viable in this case. However, cauterization of partial polyp tissues followed by open surgery for segmental resection of the ureter with reanastomosis is helpful in controlling such patient well-being.

A Case of Kawasaki Disease with Intussusception

Kawasaki disease (KD) is a systemic vasculitis of unknown cause and is associated with various digestive disorders, although only a few cases of intussusception associated with KD have been reported. We describe a case of intussusception followed by KD in a 3-year-old boy. The patient was admitted to our hospital for evaluation of severe abdominal pain. Because the target sign was seen on ultrasonography, intussusception was diagnosed and hydrostatic reduction was performed. On the second day after admission, he developed a high fever (38°C) and an irregular rash over his whole body. On the fourth day after admission, the high fever continued, and bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, strawberry tongue, indurated edema of the dorsa of the hands and feet, and diffuse erythema of the palms and soles appeared, and KD was ultimately diagnosed. He was treated with intravenous immunoglobulin 2 g/kg, aspirin 30 mg/kg/day, and prednisolone 2 mg/kg/day. The high fever and other clinical symptoms resolved immediately after the start of treatment. There was no relapse of KD symptoms after initial treatment, and periungual desquamation was observed on the 10th day after admission. He was discharged on the 15th day, without abnormalities such as coronary dilatation, 3 months after the onset of KD symptoms. Patients with intussusception and KD were older (≥3 years vs <3 years) than those with intussusception alone. In addition, the site of intussusception in KD was mainly colonic rather than ileocolic. If intussusception precedes development of the characteristic clinical symptoms of KD, diagnosis of KD may be delayed. KD should be considered in children older than 3 years with intussusception at a colonic site.

Ileocolic Intussusception secondary to caecal diverticulum in a 4-month-old boy

Abstract We present a case of intussusception in a 4-month-old boy without the classic symptom triads who were presented to the Emergency Department with abdominal distension, vomiting, and constipation. No history of high-pitched cry and red currant jelly stool. On abdominal examination, he had only abdominal distended, increased peristaltic, and no palpable mass. Intussusception was diagnosed on X-ray abdominal and ultrasound, also operative findings revealed an Ileocolic intussusception secondary to a caecal diverticulum as a pathological lead point. Milking invagination and a diverticulectomy together were conducted. Postoperative, there was no complaint and hospital discharge on the fourth day after surgery.

A case of intussusception due to early cecal cancer

A case of intussusception due to early cecal cancer

Assessment of risk of intussusception after pilot rollout of rotavirus vaccine in the Indian public health system

BackgroundPre-licensure trials of ROTAVAC® were not adequately powered to assess risk of intussusception, a rare adverse event associated with other rotavirus vaccines in some settings. We examined the risk of intussusception after ROTAVAC® vaccination among Indian infants during pilot rollout of the vaccine in the public health system in three states - Himachal Pradesh, Maharashtra and Tamil Nadu. MethodsPassive surveillance for intussusception was set up in 35 sentinel health facilities covering 26.3 million population in the three states under monitoring of an Interministerial-Interagency Steering Committee. Clinical and immunization data were collected by independent teams. An expert committee blinded to vaccination status, classified intussusception cases using Brighton criteria. The self-controlled case-series method was used to estimate risk of intussusception (Brighton Level 1) after ROTAVAC® vaccination. Results151 intussusception cases were included in the analysis. The relative incidence (incidence during the risk period compared to the control period) 1–21 days after doses 1 and 2 combined was 1.56 (95% CI, 0.0–5.28) and that for three doses combined was 1.88 (95% CI, 0.76–4.30). Attributable risk 1–21 days after doses 1 and 2 combined was 0.11 (95% CI, 0.0–0.25) and that for 3 doses combined was 0.42 (95% CI, 0.0–0.70) per 100,000 doses. ConclusionsNo increased risk of intussusception within 21 days of receipt of the first two doses combined or all 3 doses combined of ROTAVAC® was detected.

Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals

ObjectiveIntussusception has been linked with rotavirus vaccine (RVV) as a rare adverse reaction. In view of limited background data on intussusception in India and in preparation for RVV introduction, a surveillance network was established to document the epidemiology of intussusception cases in Indian children. MethodsIntussusception in children 2–23 months were documented at 19 nationally representative sentinel hospitals through a retrospective surveillance for 69 months (July 2010 to March 2016). For each case clinical, hospital course, treatment and outcome data were collected. ResultsAmong the 1588 intussusception cases, 54.5% were from South India and 66.3% were boys. The median age was 8 months (IQR 6, 12) with 34.6% aged 2–6 months. Seasonal variation with higher cases were documented during March-June period. The most common symptoms and signs were vomiting (63.4%), bloody stool (49.1%), abdominal pain (46.9%) and excessive crying (42.8%). The classical triad (vomiting, abdominal pain, and blood in stools) was observed in 25.6% cases. 96.4% cases were diagnosed by ultrasound with ileocolic location as the commonest (85.3%). Management was done by reduction (50.8%) and surgery (41.1%) and only 1% of the patients’ died. 91.1% cases met Brighton criteria level 1 and 3.3% Level 2. Between 2010 and 2015, the case load and case ratio increased across all regions. ConclusionIntussusception cases have occurred in children across all parts of the country, with low case fatality in the settings studied. The progressive rise cases could indicate an increasing awareness and availability of diagnostic facilities.

Colocolic intussusception in a child due to a sigmoid polyp

Intussusception cases in children are mostly ileocolic, whereas, the colocolic variety is uncommon and few cases have been reported in literature. Together with intestinal malrotation, ileocolic intussusception is frequently the cause of an intestinal obstruction in children and rarely due to a lead point. In children, if present, the lead point is located in the ileum and is related to o lymphoma o lymphangioma or rarely to ectopic mucosa. We describe the case of o 8-year child with colocolic intussusception (CCI) and rectal bleeding due to a voluminous sigmoid polyp. The intussusception was reduced two times in 36h and then the polyp was resected by colonoscopy.