Case Of Intussusception Research Articles

The diagnosis and treatment of retrograde intussusception: a single-centre experience

Background/PurposeTo investigate the clinical manifestations, treatments of retrograde intussusception and summarize the experience.MethodsChildren with retrograde intussusception treated in our hospital from January 2011 to January 2021 were retrospectively analysed. Demographics, clinical manifestations, preoperative colour Doppler ultrasound (CDU) findings, findings during surgery and follow-up results were collected.ResultsA total of 4719 cases of intussusception were treated in our department, including 12 cases of retrograde intussusception (0.25%). There were 8 males and 4 females.The age ranged from 4.1 to 14.3 months, with an average of (8.3 ± 2.8) months.; The weight ranged from 5.5 to 12.6 kg, with an average of (9.4 ± 2.3) kg; The onset time ranged from 6 to 15 h, with an average of (10.0 ± 2.4) h. All the children received CDU examination before surgery, and in one case, the possibility of 2 intussusception masses was considered. Emergency surgical exploration was performed after the failure of air enema reduction. During the operation, multiple types of intussusception were found (coincidence of anterograde and retrograde intussusception). The pattern of anterograde intussusception was all ileo-ileo-colic variety and the retrograde intussusception was proximal sigmoid colon into descending colon. All the children were successfully reduced by manual reduction without intestinal necrosis or intestinal malformation. All children were discharged 6–7 days after surgery, and had no recurrence after 3–6 months of follow-up.ConclusionsRetrograde intussusception is easily misdiagnosed before surgery. During air enema, if the intussusception mass was fixed and did not move with increasing pressure, we should be aware of the possibility of retrograde intussusception, and the enema pressure should not be too large to avoid intestinal perforation. If the intraoperative position of the intussusception mass was not consistent with that of the preoperative enema, it was recommended to use bimanual examination to explore whether there was still a mass in the abdominal cavity to avoid misdiagnosis.

ASSESSMENT AND MANAGEMENT OF INTESTINAL OBSTRUCTION IN PATIENTS ATTENDING TERTIARY CARE INSTITUTE

Background and Aim: Bowel obstruction is the most common intra-abdominal problem faced by general surgeons in their practice. Therefore better understanding of pathophysiology, improvement in diagnostic techniques, fluid and electrolyte correction, much potent antibiotics and knowledge of intensive care is required. present study was undertaken to study the management and post-operative complications of intestinal obstruction.
 Material and Methods: This is a prospective study of 97 cases presenting with symptoms and signs suggestive of acute intestinal obstruction. All patients are subjected to required preoperative biochemical investigations. Patients who showed reduction in abdominal distention and improvement in general condition especially in individuals with postoperative adhesions, a chance of conservative management was taken (by extending the supportive treatment) for further 12 to 24 hours; those who showed improvement by moving bowels, reduction in pain and tenderness was decided for conservative treatment, such individuals were excluded in this study.
 Results: The occurrence of acute intestinal obstruction was common in male in comparison with female. The commonest presenting symptom was abdominal pain (100%) followed by vomiting (92.7%), distention of abdomen (87.6%) and absolute constipation (53.6%). In this study, Adhesive obstruction (56.7%) was the commonest cause of acute intestinal obstruction. Release of adhesions and bands was done in 43 cases. Resection and end-to-end anastomosis was done in 25 cases, which included cases of intussusceptions, adhesions, stricture, ileocaecal growth, colonic growth.
 Conclusion: Most common etiological factor for intestinal obstruction is postoperative adhesions. Obstructed Inguinal Hernia is second most common cause of intestinal obstruction. Clinic radiological and operative findings put together can bring about the best and accurate diagnosis of intestinal obstruction.
 Key Words: Abdominal pain, Adhesions, Bands, Bowel obstruction, Inguinal Hernia,

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.

The impact of social distancing during the COVID-19 pandemic on rates of pediatric idiopathic intussusception.

BackgroundThe causes of idiopathic ileocolic intussusception are unknown, with infection as the most likely culprit. Recently, social distancing measures were implemented during the coronavirus disease 2019 (COVID-19) pandemic to decrease transmissible infectious diseases, creating an opportune setting to study the role of infection on the pathogenesis of intussusception on a population level.ObjectiveTo investigate the impact of social distancing on intussusception.Materials and methodsWe retrospectively reviewed air contrast enemas and pylorus ultrasounds performed between March 2010 and March 2021 to identify cases of ileocolic intussusception and hypertrophic pyloric stenosis (HPS), using the latter as a negative control. The study time frame was divided into two periods: pre-pandemic (March 2010–February 2020) and pandemic (April 2020–March 2021). The number of cases that occurred in these two time periods were compared using the Poisson regression model.ResultsOf the 407 cases of idiopathic ileocolic intussusception identified, 396 occurred in the pre-pandemic time period (mean = 39.6 per 12-month period) and 11 occurred in the 12-month pandemic time period. The mean monthly number of intussusceptions showed a decline of 72% (95% confidence interval [CI] 49–85%) between the pre-pandemic and pandemic time periods (3.3 vs. 0.9 monthly cases; P < 0.001). In contrast, the mean monthly number of HPS did not differ significantly (P = 0.19).ConclusionSocial distancing—imposed to curb the spread of infection during the COVID-19 pandemic—resulted in a significant decline in ileocolic intussusception, lending strong support to the theory that infection is the dominant cause of intussusception.

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.

S2970 Multiple Jejunal Intussusceptions in a Patient With Portal Hypertension and Decompensated Liver Cirrhosis

Introduction: Intussusception is telescoping a part of the intestine into itself. Common complaints including abdominal pain, nausea, vomiting, bleeding, melena and constipation. Treatment largely depends on patients' clinical status, age, and the part of the intestine involved. Treatment approaches include fluoroscopic, sonographic, surgery or observation. 90% of adult intussusception occurs due to lead points. We present a case of intussusception in a patient with decompensated liver cirrhosis and portal hypertension (PH). Given no identifiable lead point, we postulate that the patient’s medical conditions contributed to development of idiopathic intussusception. Case Description/Methods: A 48yo undomiciled female with unknown past medical history was brought to the Emergency Department for alcohol intoxication. In the ED she complained of abdominal pain but was unable to further qualify specific features of her symptoms. She was nauseous and had several episodes of non-bilious, non-bloody vomiting. Upon further questioning, she endorsed drinking 5 beers/day. Vital signs were notable for blood pressure of 90s/60s mmHg. She had significant scleral icterus and a distended abdomen with dullness. Initial labs are as shown in table 1. CT revealed cirrhotic liver, evidence of PH, three intussusceptions in the jejunum without associated obstruction (Figure 1). She was treated for severe hyponatremia due to beer potomania. In view of her anemia, she was transfused packed RBCs and EGD was performed. It revealed non-bleeding large esophageal varices which was banded. Mild PH gastropathy was also found in the entire stomach. She was treated supportively; the hyponatremia was corrected and her abdominal pain improved. Repeat CT scan one week later revealed resolution of jejunal intussusception. Discussion: Adult intussusception is uncommon in comparison to the pediatric population. A clear lead point can be identified 90% of cases with two thirds being due to neoplasms and 60% of neoplasms being malignant. PH can cause vascular changes in the intestine including colorectal varices, angiodysplasia-like lesions, telangiectasias, dilated and congested capillaries. It is unclear if those vascular changes in PH and cirrhosis cause lead points for intussusception. There are some case series demonstrating intussusception in cirrhotic patients but there is no comment on the relationship between PH and intussusception1. Further studies can be done to show the relation between PH/cirrhosis and intestinal intussusception.Table 1.: Initial Significant Lab Values.Figure 1.: Jejunal intussusceptions on CT of Abdomen and Pelvis.

A Rare Case of Appendicular Intussusception in an Adult Due to Adenocarcinoma of Appendix

Intussusception is primarily a pediatric disorder and is infrequent in adults. Intussusception of the appendix is a rare disorder with much surgical curiosity. Here we present a rare case of adenocarcinoma of appendix that presented as appendiculocaecal Intussusception. This case is presented to address the importance of understanding clinical presentation, radiological findings, treatment modalities and histopathological examination in evaluating a case of appendicular intussusception in adult.

Decreased incidence of intussusception during the COVID-19 pandemic. Trends in pediatric surgical emergencies.

PurposeRecent reports suggest that the COVID-19 pandemic may be influencing disease morbidity. The purpose of this study was to investigate pandemic-related changes in the incidence of pediatric surgical emergencies.MethodsData from patients with one of 8 typical conditions considered to be pediatric emergencies who presented at 3 hospitals close to central Tokyo were collated retrospectively from accident and emergency (AE) department records for 2020 and compared with data for 3 years prior to 2020.ResultsAll subjects had similar demographic profiles. The total number of pediatric AE attendances from 2017 to 2020 was 2880 (2017: n = 600, 2018: n = 736, 2019: n = 817, and 2020: n = 727). Annual attendances were similar. Of the 8 conditions, there were significantly less cases of intussusception in 2020 than previously (23/727; 3.1% versus 132/2153; 6.1%) p < 0.01 and the number of emergency surgical interventions for intussusception was also significantly less in 2020 (0/23; 0% versus 13/132; 9.8%) p < 0.01.ConclusionThe implementation of preventative measures to combat the COVID-19 pandemic in 2020 would appear to have influenced the etiopathogenesis of intussusception enough to significantly decrease its overall incidence and the requirement for emergency surgical intervention.

A case of ileocecocolic intussusception without acute symptoms in a Holstein heifer

3 カ月齢のホルスタイン種育成牛が下痢症状を示し，抗菌剤や整腸剤等の投与により症状は一時的に改善したがその後再発を繰り返し，発育不良が徐々に進行した．9 カ月齢時に腹部超音波検査を行った結果，target-like sign を示す構造物が右膁部から描出された．同月齢時に予後不良と判断し病理解剖を行った結果，回腸の一部および盲腸全体が結腸内に嵌入していた．重積部腸管における重度の充血や出血，壊死などの変化は認められなかった．重積部に大型の被嚢化膿瘍がみられ，腸重積発生の原因となった可能性が考えられた．一般に腸重積症は激しい疝痛や虚脱などの重篤な急性症状を伴うと考えられているが，本症例から明瞭な急性症状を伴わない腸重積症の存在が考えられた．さらに，腸重積症が慢性下痢や発育不良の発現に関与した可能性も示唆された．

Single-center experience of managing childhood intussusception

Background: Intussusception is one of the emergencies encountered in early childhood requiring emergent interventions. The purpose of the study is to determine the outcomes and prognosis of our methods and management strategies employed in children who developed intussusception. Methods: This is a retrospective case series performed by reviewing the patient medical records, sonographic and radiological reports, and surgical notes of the patients managed for intussusception at our hospital from 2009–2018. Results: A total of 355 cases of intussusception were managed during the study tenure. The etiology was idiopathic in 97.4% whereas the remaining patients had Meckel’s diverticulum, lymphoma, and intestinal polyp as pathological lead point (PLP). Ultrasound was used for the diagnosis as the primary investigation tool in all the patients, with 100% diagnostic accuracy in the current study. Non-operative management by hydrostatic reduction was performed successfully in 79.43% of the patients. Total episodes with recurrence were 23 (6%); 30% had recurrence within 48 hours. Recurrence occurred by an average of 7.68 months after the successful reduction. Conclusions: The majority has idiopathic etiology, but secondary cause with some pathological lead point is also not uncommon. Profound attention is required for prompt identification and treatment to avoid bowel ischemia. Ultrasound remains the preferred diagnostic modality in our patients. Even with recurring episodes of intussusception, the primary treatment remains hydrostatic reduction.

Small intestinal submucosal lipoma: a rare cause of secondary intussusception in a child

BackgroundIntestinal lipomas are benign, non-epithelial, intestinal tumors with an exceptionally rare localization at the ileum. Lipomas in the small intestine occur mainly in elderly patients and seldom occur in childhood. They are frequently asymptomatic, possibly due to their slow growth. These tumors may act as a lead point of intussusception.Case presentationWe report a rare case of double compounded ileo-ileal intussusception due to a submucosal intestinal lipoma in an 8-year-old female. To our knowledge, this is only the seventh pediatric case to be reported in the medical literature.ConclusionsSmall intestinal submucosal lipoma should be considered in case of intussusception in pediatric patients. Surgical resection seems sufficient in case of symptomatic intestinal lipoma with low morbidity.

Acute intestinal intussusception among children under five years of age admitted in an Ouagadougou hospital, Burkina Faso, 2008-2013: epidemiological, clinical and therapeutic aspects.

Introductionacute intestinal intussusception is a life-threatening surgical condition. In some settings, rotavirus vaccines have been associated with a low-level increased risk of intussusception. We describe the epidemiology, clinical manifestations and management of intussusception in a tertiary referral hospital in Burkina Faso prior to the introduction of rotavirus vaccine in October 2013.Methodswe retrospectively reviewed medical records of all children under 5 years of age treated at the Charles de Gaulle Pediatric Hospital for intussusception meeting the Brighton level 1 diagnostic criteria, from October 31st, 2008 to October 30th, 2013. We report the incidence of intussusception as well as descriptive characteristics of these cases.Resultsa total of 107 Brighton level 1 intussusception cases were identified, representing a hospital incidence of 21.4 cases / year. There were 69 males and 38 females (sex ratio of 1.8), with a median age of 8 months (range 2 months to 4 years). Sixty-two percent of intussusception cases occurred among infants (n = 67 cases). The average time from symptom onset to seeking medical consultation was 3.8 days +/- 2.7 (range 0 to 14 days). Treatment was mainly surgical (105 patients, 98.1%) with 35 patients (32.7%) undergoing intestinal resection. Thirty-seven patients (35.5%) experienced post-operative complications. The mortality rate was 9.3%. Intestinal resection was a risk factor for death from intussusception.Conclusionin this review of intussusception hospitalizations prior to rotavirus vaccine introduction in Burkina Faso, delays in seeking care were common and were associated with mortality.

Epidemiology of intussusception among infants in Ethiopia, 2013-2016.

Introductionintussusception is a condition in which one segment of the bowel prolapses into another causing obstruction. Information on the epidemiology of intussusception in sub-Saharan Africa is limited. We describe the sociodemographic and clinical characteristics of children with intussusception in Ethiopia.Methodsactive surveillance for children < 12 months of age with intussusception was conducted at six sentinel hospitals in Ethiopia. Limited socio-economic and clinical data were collected from enrolled children. Characteristics among children who died and children who survived were compared using the Wilcoxon rank sum test for continuous variables and Chi-square tests for categorical variables.Resultstotal of 164 children < 12 months of age with intussusception were enrolled; 62% were male. The median age at symptom onset was 6 months with only 12 (7%) of cases occurring in the first 3 months of life. Intussusception was reduced by surgery in 90% of cases and 10% were reduced by enema; 13% of cases died. Compared to survivors, children who died had a significantly longer time to presentation to the first health care facility and to the treating health care facility (median 3 days versus 2 days, p = 0.02, respectively).Conclusionthe high mortality rate, late presentation of intussusception cases, and lack of modalities for non-surgical management at some facilities highlight the need for better management of intussusception cases in Ethiopia.

A Rare Case of Ileocecal Intussusception in an Adult

Question: A 91-year-old woman with ulcerative colitis in clinical and endoscopic remission on mesalazine presented with a 2-day history of severe right lower abdominal pain, nausea, and vomiting. Physical examination showed abdominal distention and tenderness in the right side of the abdomen. A computed tomography scan of the abdomen showed dilated small bowel loops and a typical target sign (Figure A, arrow), suggesting colonic intussusception and a lead point intussusception with invaginated mesenteric fat and vessels (Figure B, arrow). Colonoscopy revealed the invagination of the terminal ileum (intussusceptum) into the ascending colon (Figure C) and localized marked edematous swelling of the ileocecal valve as the lead point. The ileocecal region showed no mucosal changes suggestive of ischemia. What is the most likely diagnosis? How should the patient be managed? See the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI. The swollen ileocecal valve was punctured with an endoscopic needle knife, causing clear fluid to leak out (Figure D, E). The submucosa was confirmed to be highly edematous and filled with fluid. The swollen mucosa then became completely deflated, and the intussusception was immediately resolved (Figure F, Video). Histologic findings of the biopsy specimens revealed no pathological findings other than edema in the submucosa and the lamina propria. No malignant cells were found in the examined fluid. There was no evidence of a causal factor of intussusception, such as bowel ischemia, inflammation, diverticulum, lesions that were either benign or malignant, or any other pathological trigger. The cause of the localized edema of the ileocecal valve was unknown. Based on these findings, the diagnosis of adult idiopathic ileocecal intussusception was made. The patient completely recovered and was discharged without procedure-related complications. No recurrence of intussusception occurred over a 3-year follow-up period. Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%–5% of bowel obstructions in adults, and most cases involve identifiable etiologies such as benign or malignant tumors.1Azar T. Berger D.L. Adult intussusception.Ann Surg. 1997; 226: 134-138Crossref PubMed Scopus (677) Google Scholar In contrast, idiopathic intussusception is frequent in children, but rare in adults. Owing to the high rate of malignancy or other structural change causing adult intussusception, a surgical approach has been served as the treatment of choice.1Azar T. Berger D.L. Adult intussusception.Ann Surg. 1997; 226: 134-138Crossref PubMed Scopus (677) Google Scholar,2Lindor R.A. Bellolio M.F. Sadosty A.T. et al.Adult intussusception: presentation, management, and outcomes of 148 patients.J Emerg Med. 2012; 43: 1-6Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar However, intestinal resection surgery may be overly invasive when the intussusception does not involve neoplastic lesions.3Imasato M. Kim H.M. Higashi S. et al.Laparoscopic surgery for idiopathic adult intussusception successfully reduced by colonoscopy.J Anus Rectum Colon. 2019; 3: 49-52Crossref PubMed Google Scholar If endoscopic reduction is possible, as in our case, emergency surgery can be avoided and appropriate treatment can be performed. Therefore, a nonoperative approach with endoscopic reduction should be attempted when the lead point is thought to be benign or idiopathic. https://www.gastrojournal.org/cms/asset/f81955b8-fb7a-47f7-b5b2-a48da942c0eb/mmc1.mp4Loading ... Download .mp4 (45.01 MB) Help with .mp4 files Supplementary Video

Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection

Background: Aortic intimal intussusception is well described in the natural progression of type A aortic dissection. Only 3 cases of aortic intimal intussusception were reported to be related to thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. In our study, we are reporting a rare but potentially fatal complication, the intraoperative stent-graft (SG)-induced aortic intimal intussusception (ISAII); this study reports a series of endovascular repair for ISAII cases. By presenting the ISAII definition, the diagnostic steps to rule out or to identify the condition, and the techniques to resolve it, we intended to raise the awareness of this severe complication, so that physicians can adapt to overcome the complications while performing TEVAR. Materials and Methods: ISAII was defined as the partial or circumferential disruption of the distal intimal flap as an intraoperative complication of endovascular treatment. From January 2014 to June 2020, 1,096 patients underwent TEVAR for Stanford type B aortic dissection at our hospital. Among them, 14 ISAII complications were witnessed. All these patients underwent endovascular repair for ISAII lesions, and their data were extracted for analysis. Results: The ISAII lesions were classified into 3 types according to their location in different aortic segments: type I, ISAII was limited within the intended SG coverage segment; type II, ISAII occurred after SG introduction or deployment, and the detached intimal flap extended beyond the intended SG coverage segment but did not affect the abdominal aortic visceral branches; type III, ISAII occurred during SG introduction or deployment, and the detached intimal flap descended to the abdominal aortic segment with visceral branches. Our results showed ISAII as a rare complication with an incidence of 1.28% (14/1096), and endovascular repair for all types of ISAII is an effective treatment. With a mean follow-up of 27.36 months (range 5–71 months), all the ISAII lesions were stable, and all the major aortic branches, SGs, and bare stents were patent. Conclusions: The management of this potentially devastating intraoperative complication relies on accurate diagnosis and prompt management. Our results suggested that endovascular repair for ISAII is effective and durable for correcting this complication. Graphical

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.

Safety and immunogenicity of two formulations of rotavirus vaccine in Vietnamese infants

Background and aimsROTAVIN-M1® (licensed, frozen vaccine) and ROTAVIN (second-generation, liquid candidate vaccine) are two rotavirus vaccine formulations developed from a live attenuated G1P8 (KH0118) strain by Center for Research and Production of Vaccines and Biologicals (POLYVAC), Vietnam. This study compared the safety and immunogenicity of these two formulations. MethodsA Phase 3, randomized, partially double-blinded, active-controlled study was conducted in healthy infants aged 60–91 days in Vietnam. Infants received two doses of ROTAVIN or ROTAVIN-M1 in a ratio of 2:1 with an interval of 8 weeks. Solicited reactions were collected for 7 days after each vaccination. Blood samples were collected pre-vaccination and 4 weeks after the second vaccination in a subset of infants. Non-inferiority criteria required that the lower bound of 95% confidence intervals (CIs) of the post-vaccination anti-rotavirus IgA GMC (Geometric Mean Concentration) ratio of ROTAVIN/ROTAVIN-M1 should be >0.5. A co-primary objective was to compare the safety of the two vaccines in terms of solicited reactions. ResultsA total of 825 infants were enrolled. The post-vaccination GMC was 48.25 (95% CI: 40.59, 57.37) in the ROTAVIN group and 35.04 (95% CI: 27.34, 44.91) in the ROTAVIN-M1 group with an IgA GMC ratio of 1.38 (95% CI: 1.02, 1.86) thus meeting the pre-set criteria for non-inferiority. A total of 605 solicited reactions were reported in 297 (36.0%) participants with 35.4% in the ROTAVIN group and 37.2% in the ROTAVIN-M1 group. There were no cases of intussusception or death reported in the study. ConclusionsBased on the data generated, it can be concluded that ROTAVIN is immunologically non-inferior and has similar safety profile to ROTAVIN-M1 when administered to infants in a two-dose schedule. Therefore, it can be considered as a more suitable option for programmatic use to prevent rotavirus diarrhoea in Vietnam and the Mekong region. Trial registration numberClinicalTrials.gov identifier: NCT03703336, October 11, 2018.

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.

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.