Case Of Intussusception Research Articles

Uncommon etiology of a common presentation

Intussusception is the most common cause of bowel obstruction in infants. The authors present a rare case of intussusception in a SARS-CoV-2 positive infant, and a severity score of 5 on HRCT. This is the first documented case of survival in SARS-CoV-2 patient where intussusception was the primary manifestation, which required surgical intervention.

Rol de las imágenes en la evaluación de la invaginación intestinal del adulto: un estudio retrospectivo de 10 años

IntroductionIntussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception. MethodWe retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period. ResultsIn the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically. ConclusionThe increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously.

Immunogenicity, safety and reactogenicity of ROTAVAC® in healthy infants aged 6–8 weeks in Vietnam

BackgroundROTAVAC® is derived from human 116E rotavirus (RV) neonatal strain. In this study, we evaluated the immunogenicity, safety and reactogenicity of ROTAVAC® in Vietnam. MethodWe conducted a phase IV clinical trial in healthy infants aged 6–8 weeks using the complete regimen of ROTAVAC® with three doses. Serum anti-RV IgA was measured by enzyme-linked immunosorbent assay to assess the geometric mean concentration in infants who received the complete regimen of the vaccine. ResultsA total of 360 participants were enrolled in this clinical trial. The mean age ± standard deviation at enrollment was 6.9 ± 0.6 weeks. The anti-RV IgA titer was 4.01 ± 3.74 mg/ml pre-vaccination and substantially increased to 29.27 ± 80.64 mg/ml post-vaccination. The value of logIgA significantly increased (p = 0.003) from 0.28 ± 0.79 to 1.03 ± 0.54. The proportion of participants with equal to and greater than 3-fold and 4-fold shifts in pre- to post-vaccination antibody titer (IgA) were 55.4% and 48.3%, respectively. No adverse events or serious adverse events were recorded immediately within 30 min after the administration of each dose. The most common adverse events within 14 days after each visit were fever, unusual crying and irritability. Other adverse events occurred at a low rate, and no case of intussusception was noted. ConclusionsThe complete regimen of ROTAVAC® demonstrated an immunological response with clinically acceptable safety profile. Post-completion of this study, ROTAVAC® is now a WHO-prequalified vaccine and available in Vietnam.

Epidemiology of Hospitalized Intussusception Cases from Northern States in India.

To describe epidemiology of intussusception post-introduction of the rotavirus vaccine. Hospital-based active surveillance system was set up in three tertiary care hospitals in Chandigarh and Haryana, India, to enroll children <2 y of age admitted with intussusception as per Brighton Collaboration Level-I criteria. The clinical characteristics, treatment modalities, seasonal trends, and outcome of the illness episodes were described. A total of 224 cases were reported. Majority were males (71%) and infants (69.5%). Number of intussusception was more in summer season. Location of intussusception was ileo-colic in 85% of the cases. Nearly 54% cases were treated conservatively and 46% needed surgical intervention. Surveillance data provided the epidemiological description of intussusception cases post-introduction of the rotavirus vaccine in northern India. This data could be used to assess the impact of vaccine and safety with a special focus on intussusception.

A Hospital-Based Multi-Centric Study to Determine the Clinico-Epidemiological Profile of Intussusception in Children < 2Years in Rajasthan, India.

To determine the clinical and epidemiological profile of Intussusception in children aged <2 y after introduction of rotavirus vaccine in Universal Immunization Programme of Rajasthan. This was a hospital-based multi-centric surveillance study conducted at three tertiary care sentinel sites in Rajasthan over a period of 2 y. Children <2 y of age admitted with intussusception as per Brighton's criteria 1 were enrolled. Demographic details including age, sex, clinical presentation, diagnostic methods, duration of symptoms, mode of treatment, and complications were recorded and analyzed. During the study period of 2 y, the authors identified 164 cases of intussusception based on level-1 Brighton's criteria. Median age at presentation was 7 mo [Interquartile range (IQR) 5-10 mo] with a male to female ratio of 2:1. Pain abdomen and blood stained stool were the commonest presenting complaints (88.4% and 81.7%, respectively). Commonest site of intussusception was Ileocolic (82.32%). Pathological lead point was identified in 18.9% cases. Distinct seasonality was observed as maximum cases of intussusception were detected in the months of Jan-March (34.1%). Surgical intervention was required in the 89.63% cases. The median time duration between onset of symptoms and admission at sentinel site was 2 d (IQR 1-3 d). Proportion of cases that required surgery increased as the time interval between onset of symptoms and admission increases. Intussusception is a common surgical condition among children under-two years of age with majority of cases occurring during infancy. Case management is dependent primarily on time duration elapsed between symptoms onset and admission to tertiary care centre. Early case detection and timely referral may provide an opportunity to avoid surgical interventions.

A Case of Intussusception Caused by Small Intestinal Adenomyoma Associated With Ectopic Pancreas in a 1-Month-Old Infant

A Case of Intussusception Caused by Small Intestinal Adenomyoma Associated With Ectopic Pancreas in a 1-Month-Old Infant

A Case of Intussusception Caused by Colon Cancer in a Young Adult

A Case of Intussusception Caused by Colon Cancer in a Young Adult

A Case of Intussusception Caused by Cystic Lymphangioma in an Elderly Patient

A Case of Intussusception Caused by Cystic Lymphangioma in an Elderly Patient

Delays in presentation of intussusception and development of gangrene in Zimbabwe.

Introductionprompt diagnosis and treatment are considered key to successful management of intussusception. We examined pre-treatment delay among intussusception cases in Zimbabwe and conducted an exploratory analysis of factors associated with intraoperative finding of gangrene.Methodsdata were prospectively collected as part of the African Intussusception Network using a questionnaire administered on consecutive patients with intussusception managed at Harare Children´s Hospital. Delays were classified using the Three-Delays-Model: care-seeking delay (time from onset of symptoms to first presentation for health care), health-system delay (referral time from presentation to first facility to treatment facility) and treatment delay (time from presentation at treatment facility to treatment).Resultsninety-two patients were enrolled from August 2014 to December 2016. The mean care-seeking interval was 1.9 days, the mean health-system interval was 1.5 days, and the mean treatment interval was 1.1 days. Mean total time from symptom onset to treatment was 4.4 days. Being transferred from another institution added 1.4 days to the patient journey. Gangrene was found in 2 (25%) of children who received treatment within 1 day, 13 (41%) of children who received treatment 2-3 days, and 26 (50%) of children who received treatment more than 3 days after symptom onset (p = 0.34).Conclusionsignificant care-seeking and health-system delays are encountered by intussusception patients in Zimbabwe. Our findings highlight the need to explore approaches to improve the early diagnosis of intussusception and prompt referral of patients for treatment.

A rare case of adult ileo-colic intussusception: Hamartomatous polyp as a lead point with concurrent appendiceal neurofibroma in Neurofibromatosis Type 1

Intussusception is a rare cause of adult intestinal obstruction and unlike in children, adult intussusception is commonly caused by a lead point, requiring surgical intervention in most cases. Hamartomatous polyp is a non-neoplastic growth of tissue containing mature cells, distributed in an abnormal manner. It is often associated with intestinal polyposis syndromes such as Peutz-Jeghers syndrome and Juvenile polyposis. In the current case, we report an extremely rare case of ileo-colic intussusception secondary to a lead point of an isolated ileal hamartomatous polyp in an elderly gentleman with Neurofibromatosis type-1. Patient was successfully treated with ileo-colic resection involving the intussuscepted segment of bowel. There was an incidental finding of a nodule in the appendix and the histology confirmed this as a neurofibroma. Post-operative recovery of the patient was unremarkable.

A Rare Case of Idiopathic Adult Intussusception

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

A Case of Idiopathic Enteric Intussusception in an Oldest-old Individual

A Case of Idiopathic Enteric Intussusception in an Oldest-old Individual

Small Bowel Intussusception in a Preterm Infant

Intussusception is a common cause of intestinal obstruction in 6-18 months of age. However, in preterm infants, it is an extremely rare disease. The symptoms of intussusception in preterm infants are similar to those of necrotizing enterocolitis (NEC). Most preterm infants can often be clinically diagnosed with NEC. The NEC and small bowel intussusception treatments are different. In case of NEC, antibiotics and nothing per oral should be used, but small bowel intussusception could be resolved by spontaneous reduction or it should be treated with bowel reduction or bowel resection with laparotomy in case of symptomatic patients. Because of different treatments, an accurate and urgent diagnosis following clinical suspicion is critical using abdominal X-ray and ultrasonography. In this report, we present a case of small bowel intussusception in a premature infant with gestational age of 27 weeks and birth weight of 1,070 g who was diagnosed based on rapid clinical suspicion and prompt image studies.

Intestinal intussusception and obstruction due to entrapped Ascaris

Introduction: Intussusception is idiopathic in over 90% of cases. The main causes exceptionally found are Merkel′s diverticulum, polyps, and lymphomas. We report a case of ileo-ileal intussusception due to entrapped Ascaris. Case Report: A 3-year-ol

Gastroesophageal Intussusception in Canine

Background: Gastroesophageal intussusception is characterized by the invagination of the stomach into the esophagus, with or without the involvementof adjacent organs such as the spleen, pancreas, and omentum. In dogs, this condition has no breed or sex predisposition. As it is an infrequent disease in routine veterinary medical practice, this study reports a case of gastroesophageal intussusception in a dog necropsied at the Veterinary Hospital of the Federal Rural University of Pernambuco (HOVET - UFRPE), Recife, Brazil.Case: The body of a 12-year-old black mixed breed male dog was sent to the Pathology Department (Necropsy Sector of the Federal Rural University of Pernambuco - UFRPE) for a necropsy. The animal had a previous 4-year history of recurrent emesis and limb weakness, primarily in the anterior limbs, that worsened in the previous months and progressed to death. No previous treatments were reported by the owner. On external examination, the animal had a low body score (cachectic), forelimb joints with great flexibility, congested oral and ocular mucous membranes, enophthalmos, and increased volume in the perianal region. At the opening of the thoracic cavity, the final third of the esophagus was dilated and gastroesophageal intussusception, edema, and pulmonary congestion were noted. In the abdominal cavity, there was hepatic and renal congestion and large intestine and rectal ampoule dilation, with a large amount of solid and retained feces (fecaloma), perianal hernia, and testicular neoformation. These findings were consistent with those observed in death caused by cardiorespiratory failure secondary to gastroesophageal intussusception.Discussion: The pathophysiology of gastroesophageal intussusception is still not elucidated and is probably multifactorial. This condition causes reverse gastric peristalsis associated with a sudden and sustained increase in abdominal pressure. Some probable predisposing factors for this pathological condition are esophageal motility disorders, lower esophageal sphincter dysfunction, and hiatal enlargement. In dogs, gastroesophageal intussusception is associated with increased intra-abdominal pressure owing to emesis or blunt trauma, negative intrathoracic pressure caused by respiratory, and previous esophageal diseases, especially megaesophagus. Partial or total obstruction caused by intussusception leads to circulatory disorders in the organs, especially decreased venous return. Persistence of this condition can lead to gastric necrosis and rupture followed by endotoxic (or septic) shock and release of inflammatory mediators that can cause cardiovascular and respiratory dysfunction and rapid death. Impaired circulation is macroscopically evident in several organs, characterized by mucosal, lung, liver, and kidney congestion, in addition to cardiac dilation and mitral valve endocardiosis. The occurrence of stomach invagination into the esophagus dilated in the final portion is characteristic of gastroesophageal intussusception. Moreover, death owing to cardiorespiratory failure is related to cardiac (dilatation and endocardiosis) and pulmonary (edema and congestion) involvement secondary to gastroesophageal intussusception. Since thispotentially fatal condition has a low incidence in small animals and often goes unnoticed by professionals, early and correct diagnosis along with surgical treatment are essential for a good prognosis and favorable progression.

A Clinical Analysis of 10 Cases of Intussusception in Older Children

A Clinical Analysis of 10 Cases of Intussusception in Older Children

Intussusception in children: effect of symptom duration on the outcome of hydrostatic reduction

BackgroundIntussusception is a common cause of intestinal obstruction in children, especially in infants. Intussusception is a pediatric abdominal surgical emergency, and hydrostatic reduction is an effective modality of treatment in selected group of patients. There are lack of data in Nigeria on the effect of symptom duration on hydrostatic reduction.AimTo evaluate the effect of duration of symptoms on the outcome of hydrostatic reduction of intussusception.Patients and methodsThis was a prospective study on the effect of symptom duration on the success of hydrostatic reduction of intussusception in children. This study was carried out at the pediatric surgery unit of a teaching hospital over a 3-year period. The patients were categorized into two groups: group A included patients who had successful reduction, and group B included patients who had unsuccessful (failed) reduction.ResultsA total of 96 cases of intussusception were managed during the study period, of which 32 (33.3%) patients underwent hydrostatic reduction. Mean age of the patients was 7 months, with a range of 4–12 months. Male to female ratio was 1.9: 1. All the patients had abdominal pain. There was more successful hydrostatic reduction in patients who presented within 48 h of onset of symptoms (group A), and this was statistically significant (P = 0.04).ConclusionChildren with intussusception who present early (within 48 h of onset of symptoms) had more successful hydrostatic reduction when compared with patients who present after 48 h.

Intestinal intussusception in infants: Interest of ultrasound-guided hydrostatic reduction

Ultrasound-guided hydrostatic reduction of acute intussusception is a nonoperative technique, simple, performed under ultrasound guidance without risk of irradiation. Purpose: Our study aimed to evaluate the efficiency and utility of Ultrasound-guided hydrostatic reduction in the management of infant intussusception. Material and Methods: We conducted a retrospective study of cases of intussusception in infants (1-24 months) treated in the pediatric surgical emergency service of Rabat children’s Hospital during the period 2016-2020. Of the 135 cases collected during the study, 109 patients received ultrasound-guided hydrostatic reduction while 26 infants inderwent primary surgery. Results: This condition was most common in the age group (3-9 months) with 78% of cases. The sex ratio M/F was 2.29. The ileocolic type was the most encountered (56%). The complete ultrasound hydrostatic reduction was achieved for 88 infants with a success rate of 81% and an average hospitalization time of 1.4 days. 21 cases (19%) of which 16 failed hydrostatic reduction and 05 recurrences within 24 hours, were taken up by surgery with manual reduction and bowel resection for respectively 19 and 02 cases. Conclusion: Ultrasound guided hydrostatic reduction is a safe, quick and efficient method with a high success rate, a decrease in the occurrence of recurrences and complications and should be recommended first.

Intestinal Intussusception Associated with Cloacal Protusion in Trachemys scripta elegans

Background: Gastrointestinal dysfunction in reptiles is a common condition seen in animal medicine, and is often caused by inappropriate husbandry. The purpose of this report is to describe the case of a surgical procedure for enterectomy of the small intestines, performed as treatment for an intussusception with cloacal protrusion that occurred in a red-eared slider (Trachemys scripta elegans) kept as a pet.Case: A 20-year-old red-eared slider (Trachemys scripta elegans) was taken into medical care after the owner’s observation of a cloacal protrusion that had started 72 h previously. During physical examination the protrusion was noted as an intestinal segment of approximately 5 cm, which was not reducible. Complementary examinations, including radiography and hematological profiling, were performed and revealed no significant findings; therefore, it was decided that an exploratory celiotomy would be conducted. The patient was referred to the surgical unit for the procedure and underwent surgical anesthesia. After appropriate antisepsis of the surgical area, a plastron osteotomy was performed using a previously sterilized oscillatory saw at a 45º angulation. The celomatic membrane was subsequently incised to enable both cavity and intestinal inspection allowing observation of the intussusception in the small intestine of the animal with the intussuscept segment protruding through the cloaca. The intussusception was undone, and an enterectomy was performed to remove the unviable intestine, using intestinal resection and subsequent anastomosis with simple interrupted sutures using 4-0 nylon, followed by intestinal reposition in the cavity. The celomatic membrane was closed using continuous suture with 4-0 nylon. The plastron fragment was then repositioned with the aid of eight cerclage fixations using 2-0 stainless steel wire. It was subsequently covered in self-polymerizing resin acrylic in order to promote impermeability and to protect the surgical wound. During the recovery period, supportive treatment and analgesia and antibiotic therapy were performed. The patient’s first defecation was observed five days after the procedure, and gastrointestinal tract functions returned to normal after four weeks. In six weeks, the patient was discharged.Discussion: In this case, exploratory celiotomy was performed due to the extension of the necrotic areas of the protruded mucosa. Plastron osteotomy is generally indicated because of the possibility of wide organ exposure. During the long healing period of reptiles, a surgical wound can be a gateway for pathogens that lead to postoperative surgical complications. As such, the use of acrylic resin in the present case was to create a protective barrier that would offer more resistance and impermeability. End-to-end enterectomy, in this instance, proved to be an efficient treatment for the small intestines cloacal protrusion, just as it was for the intussusception that preceded it. The probable cause of this case of intussusception was not well defined, and reptiles kept as pets have several diseases that can affect the gastrointestinal tract. The environment temperature also strongly influences gastrointestinal tract functions, which can lead to motility decline and imbalance of the intestinal flora, followed by the production of gases and toxins by microorganisms responsible for dysfunctions. Inadequate temperature management was the suspected main cause of intussusception in this case, as the patient was kept without access to sunlight or a heating source. In conclusion, the enterectomy with subsequent anastomosis that we performed was successful in the treatment of cloacal protruded intussusception of the small intestines in this red-eared slider (Trachemys scripta elegans).

Laparoscopic management of adult ileoileal intussusception due to an inflammatory fibroid polyp: A case report with review of literature

Intussusception is a rare phenomenon in adults and usually presents with bowel obstruction. Unlike pediatric intussusception, adult intussusception (AI) is seldom idiopathic and frequently associated with secondary causes such as benign and malignant tumors. AI accounts for 5% of all cases of intussusception and almost 1%–5% of all cases of bowel obstruction. We hereby present the rare case of a 42-year-old female patient with ileoileal intussusception caused by an inflammatory myofibroblastic polyp. We also delve into a review of literature on AIs, touching different common and uncommon types as well as their diagnostic modalities and therapeutic options.