Case Of Adult Intussusception Research Articles

Intussusception in adults: Clinical characteristics, diagnosis and operative strategies

To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. A retrospective review of patients aged > 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. There were 20 cases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine (85%). There were three (15%) cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.

Giant ileal inflammatory fibroid polyp causing small bowel obstruction: a case report and review of the literature

IntroductionThere are several types of small bowel pathology that can lead to small bowel obstruction or intussusception. The etiology causing small bowel obstruction varies by age. Benign disease is the typical cause in children and adolescents while malignant or adhesive disease is far more common in older patients. Although cases of adult intussusception caused by benign processes are rare, there are reports of inflammatory fibroid polyps causing adult intussusception of the terminal ileum published in the literature.Case presentationWe present the case of a 70-year-old man with a multiple year history of intermittent episodes of bowel obstruction who was found to have a giant ileal inflammatory fibroid polyp causing intermittent small bowel obstruction. The patient underwent operative intervention and has now been symptom-free for three years.ConclusionSmall bowel lesions include both malignant and benign etiologies. The malignant etiologies include adenocarcinoma, carcinoid or lymphoma while benign lesions are typically lipomas, inflammatory polyps or adenomas. Inflammatory fibroid polyps are rare, benign lesions that can occur anywhere within the gastrointestinal tract. They are typically an incidental finding, but on rare occasions have been presented as the source of intussusception or obstruction.

Severe pulmonary tuberculosis complicating Ileocecal intussusception due to intestinal tuberculosis: a case report

Adult intussusception is a rare clinical entity that is most often caused by a tumor, such as a lipoma, adenoma, or malignant tumor. A case of adult intussusception due to intestinal tuberculosis of the ileocecal region is reported. There are few cases of intussusception due to intestinal tuberculosis.

Adult Colonic Intussusception Caused by Cecum Adenoma: Successful Treatment by Emergency Laparoscopy: Report of a Case

Although intestinal intussusception is relatively common in children, in adults it remains a rare clinical entity. We report an emergency laparoscopy for an adult case of colonic intussusception caused by cecum adenoma. In the present case, owing to a successful reduction via laparoscopy, the extensive intussusception could be treated with a more limited resection (wedge resection) instead of an en-bloc wide resection (right hemicolectomy). Because of the theoretical risk of perforations which could lead to the seeding of tumor cells and microorganisms into the intra-abdominal cavity, most surgeons advocate an en-bloc resection without reduction. The experience gained from the present case suggests that laparoscopy may therefore be a useful diagnostic or therapeutic tool for selected cases of adult intussusception. The choice of using either a laparoscopic approach or an open approach depends on the clinical condition of a patient, the location and extent of intussusception, the possibility of underlying disease, and the availability of surgeons with sufficient laparoscopic expertise. Additional reports may help standardize the management of this uncommon disease.

Complex colo-colic intussusception: A case report

A rare case of adult intussusception involving the transverse colon and mesocolon, greater omentum and the distal third of the stomach is presented. The diagnostic difficulties and treatment options are discussed highlighting the use of on table antegrade colonic lavage. Keywords: Complex, colo-colic, intussusceptionNigerian Journal of surgical Sciences Vol. 16 (2) 2006: pp. 91-93

Adult Intussusception: A Retrospective Review

Whereas intussusception is relatively common in children, it is clinically rare in adults. The condition is usually secondary to a definable lesion. This study was designed to review adult intussusception, including presentation, diagnosis, and optimal treatment. A retrospective review of 22 cases of intussusception occurring in individuals older than aged 18 years encountered at two university-affiliated hospitals in Winnipeg between 1989 and 2000. The 22 cases were divided to benign and malignant enteric, ileocolic, colonic lesions respectively. The diagnosis and treatment of each case were reviewed. There were 22 cases of adult intussusception. Mean age was 57.1 years. Abdominal pain, nausea, and vomiting were the commonest symptoms. There were 14 enteric, 2 ileocolic, and 6 colonic intussusceptions. Eighty-six percent of adult intussusception was associated with a definable lesion. Twenty-nine percent of enteric lesions were malignant. All ileocolic lesions were malignant. Of colonic lesions, 33 percent were malignant and 67 percent were benign. All cases required surgical interventions except one. Adult intussusception is a rare entity and requires a high index of suspicion. Our review supports that small-bowel intussusception should be reduced before resection if the underlying etiology is suspected to be benign or if the resection required without reduction is deemed to be massive. Large bowel should generally be resected without reduction because pathology is mostly malignant.

Endoscopic Diagnosis of Colo-Colonic Intussusception

Colo-colonic intussusception is a rare disorder in the adult population. The diagnosis is typically made radiographically or upon surgical exploration. We present a case of colo-colonic intussusception diagnosed at endoscopy. A 44 year old man with a history of peptic ulcer disease and diabetes mellitus presented with hematochezia and left lower quadrant pain for one month. The pain was described as sharp, intermittent, radiating to the back and the legs, relieved by bowel movements and aggravated by food ingestion. He denied nausea, vomiting, fever and chills. He denied unusual food intake, travel or sick contacts. On exam the patient was afebrile, mildly hypertensive and tachycardic at 124 bpm. The abdomen was soft, non-distended, with left lower quadrant tenderness. Rectal exam showed brown guaiac negative stool. The patient underwent a colonoscopy, which revealed a large mass starting at 15 cm from the anal verge and occupying almost the entire lumen. Although the overlying mucosa of the mass appeared smooth and regular, it had a dusky appearance suggestive of ischemia. The colonoscope was advanced along the mass to a point of luminal twist, after which it could not be passed any further. The diagnosis of colo-colonic intussusception was entertained and as the area could not be passed endoscopically, surgical consultation was requested. An abdominal CT scan showed a region of probable intussusception in the sigmoid colon with associated mesenteric fatty infiltration. The patient underwent a laparoscopic segmental resection of the sigmoid colon. At the time of surgical intervention, no intussusception was noted, although a smooth 5 cm mass was seen. Pathologic assessment of the mass revealed a smooth muscle tumor of uncertain malignant potential, which was CD-117 negative. Three days postoperatively, he was discharged home in stable condition. The incidence of intussusception in the adult population is very low, and in most cases associated with an underlying lesion, such as an adenoma, lipoma or adenocarcinoma. Only 8–19% of cases of intussusception in adults are colo-colonic. The presentation of intussusception can range from symptoms of obstruction to gastrointestinal bleeding. Diagnosis is usually made either radiographically or by surgical exploration. Colonoscopy is rarely the first diagnostic tool and can often miss the intussusception. The treatment is almost always surgical due to the high prevalence of an underlying lesion and the propensity for recurrence.

Adult Intussusception — Need for en-bloc resection

Adult intussusception is an uncommon surgical presentation We report a case of adult intussusception, review the literature and discuss the optimal management. We describe a woman who presented with severe abdominal pain and a large supra-umbilical mass. Ileocolic intussception was confirmed on CT, and a laparotomy and en-bloc resection were carried out. Postoperatively she made an uneventful recovery. Adult intussusception is a rare clinical presentation. En-bloc resection should be the surgical treatment of choice in the majority of cases due to the high percentage of malignant lead points.

Intussusception of the small bowel discovered incidentally by computed tomography

Three cases of asymptomatic intussusception in adults are reported, discovered incidentally during a CT scan of the abdomen. It is being increasingly observed in adults, possibly aided by the reformatting capabilities of the new multislice CT scanners. It has been documented in children where it is considered to be transient and of no clinical significance.

早期盲腸癌に起因し，多彩な病変を有した成人型腸重積症の１例

症例は76歳,女性.腹痛,下痢が出現し当院入院.右下腹部に小児頭大の腫瘤を触知した.USおよびCTにてpseudokidney sign,multiple layer sign,multiple concentric ring signが認められ,内視鏡検査にて融合した2個の0-I型病変を認めたが,生検の結果は炎症細胞浸潤のみであった.以上より,成人型腸重積症と診断したが,腹膜刺激症状は認められず,自発痛も軽減したため,緊急手術は施行せず,術前精査後,待期手術を施行した.回腸結腸型(3筒性)腸重積症であり,Hutchinsonの手技で用手的に重積を解除し,結腸右半切除を施行した.盲腸底部に連続する2個の0-I型病変(腺腫内癌),上行結腸に0-Isp型腫瘍(腺腫内癌)と結節集簇様病変(腺管絨毛腺腫)を認めた.また横行結腸に潰瘍性病変(腫瘍性病変なし)を認めた,自験例のように起因した病変が早期癌であり,また多彩な病変を有した腸重積は珍しく臨床病理学的検討を加えて報告する.

大腸内視鏡で診断した回腸悪性リンパ腫による成人腸重積症の1例

大腸内視鏡で診断した回腸悪性リンパ腫による成人腸重積症の1例

A Case of Jejunal Diverticulitis with Perforation Combined with Intussusception Caused by Inflammatory Fibroid Polyp

Diverticulosis of the small intestine is a rare entity, compared with that of duodenum or colon, and is found in only 1% of autopsied patients. The main complications are diverticulitis with or without a perforation, obstruction and hemorrhage, which are associated with a high mortality. Intussusception is primarily a disease of childhood; with only 5 to 10% of cases occurring in adults. In contrast to childhood intussusception, 90% of adult intussusception cases are had an associated pathologic processes. An inflammatory fibroid polyp is an uncommonly localized non-neoplastic lesion of the gastrointestinal tract. It occurs most often in the stomach and secondly in the ileum. It rarely occurs in other organs such as the colon, jejunum, duodenum and esophagus. We report a case of jejunal diverticulitis with a perforation combined with intussusception caused by an inflammatory fibroid polyp. A 78-year-old female presented with abdominal pain, fever and chill. Contrast CT scan showed intussusception of the ileum. The patient was treated with a small bowel segmental resection. After surgery, the specimen showed jejunal diverticulitis with perforation.

Intussusception in a Young Adult With Bloody Diarrhoea

Bloody diarrhoea is a common presenting symptom in acute surgery, medicine and also in out-patient clinics. Intussusception, although a common cause of small bowel obstruction and rectal bleeding in infants, is rare in adults. In contrast to paediatric cases, where the majority can be treated by pneumatic or hydrostatic reduction, the vast majority of adult cases of intussusception are due to a tumour of some kind and will require operation and resection. Diagnostically plain radiology, CT, ultrasound and endoscopy are useful since the clinical picture is often unclear. We present a case of a young man who presented with acute bloody diarrhoea. The diagnosis was made colonoscopically and he was treated surgically. The case underlines the need for surgeon to maintain an open mind when investigating unexceptional symptoms.

Preoperative Diagnosis of a Case of Adult Intussusception Caused by Lipomas

Preoperative Diagnosis of a Case of Adult Intussusception Caused by Lipomas

3 Cases of Adult Intussusception due to a Malignant Tumor

3 Cases of Adult Intussusception due to a Malignant Tumor

リンパ管腫による成人大腸腸重積症の１例

成人の腸重積症は比較的まれであり,その中でもリンパ管腫に起因する大腸腸重積症は極めて少ない.今回,リンパ管腫による成人大腸腸重積症を経験したので報告する.症例は53歳,女性.肺炎で入院中に腹痛と下血を認め,CT検査,大腸内視鏡検査を施行したところ腸重積が疑われたため緊急手術を行った.術中所見では盲腸が上行結腸に重積しており,整復後に回盲部切除術を行った.先進部は盲腸の粘膜下腫瘍であり,病理組織学的検査で海綿状リンパ管腫と診断された.

回腸脂肪腫による成人腸重積症の1例

回腸脂肪腫による成人腸重積症の1例

横行結腸癌による成人腸重積症の１例

横行結腸癌による成人腸重積症の１例

The diagnosis and treatment of adult intussusception.

Intussusception in adults is often diagnosed on computed tomography (CT), and the optimal treatment of this entity is not universally agreed upon. We report our experience in an attempt to clarify the usefulness of CT scan and the optimal treatment of this entity. Seven cases of adult intussusception were encountered at our institute between 1991 and 2001. Data related to presentation, diagnosis, treatment, and pathology were analyzed. Preoperative diagnosis was made in four patients by CT scan and/or ultrasonography. Two patients had colonic cancer and one had jejunal cancer. Three of four patients with small bowel intussusception underwent reduction before resection and the other one underwent resection without reduction because of severe ischemic bowel. The CT scan is most useful in making the diagnosis of intussusception. Colonic lesions should be resected without reduction. Small bowel lesions should be reduced only in patients in whom a benign diagnosis has been strongly suggested preoperatively or in patients in whom resection may result in short gut syndrome.

漿膜側脂肪組織を巻き込んだ内翻Meckel 憩室による成人腸重積症の1例

漿膜側脂肪組織を巻き込んだ内翻Meckel 憩室による成人腸重積症の1例