Case Of Adult Intussusception Research Articles

Nine Adult Cases of Intussusception Caused by Colon Cancer

Nine Adult Cases of Intussusception Caused by Colon Cancer

A Case of Adult Intussusception Developing after Oral Intake of a Bowel Cleansing Agent

A Case of Adult Intussusception Developing after Oral Intake of a Bowel Cleansing Agent

Salmonella enteritis: A Rare Cause of Adult Intussusception.

Intussusception is a relatively rare condition in the adult population and is commonly secondary to a malignant process. Eight to twenty percent of cases of adult intussusception are thought to be idiopathic. In children, infection has been proven to precipitate intussusception in the absence of any other cause. We present a rare case of intussusception in a healthy adult patient secondary to salmonella infection and discuss infection as a potential explanation for a proportion of the cases of adult intussusception that are thought to be idiopathic. We recommend testing for infective causes of intussusception in adults when more common causes, such as malignancy, have been excluded.

Gastrogastric Intussusception Caused by Gastric Mass

A 65-year-old woman with a past medical history of peptic ulcer disease and migraine headaches presented to our GI clinic complaining of dull left upper quadrant abdominal pain without radiation for the past 3 years. In addition she complained of unintentional weight loss and intermittent melena. She denied use of NSAIDs or a family history of gastric cancer. On exam, a palpable left upper quadrant mass was appreciated. A CT scan of the abdomen and pelvis with oral and intravenous contrast showed a gastrogastric intussusception without a clear lead point. Upper endoscopy revealed a 4.5 cm subepithelial mass with an overlying ulceration arising from the anterior wall of the body of the stomach. Mucosal biopsies of the mass were non-diagnostic however given the clinical presentation and concern for GIST, surgery was recommended. Patient underwent a laparoscopic partial gastrectomy with pathology showing GIST.Figure: (A) portable Chest x-ray (CXR) revealing left hemi-thorax findings were suspicious for left diaphragmatic hernia containing bowel loops. (B, C,D) Axial and Coronal contrast-enhanced CT scan of the Abdomen with 3D reconstruction showing left hemi-diaphragm defect with a large portion of the stomach herniating through it. (L:liver; St:stomach; K:kidney; Sp:spleen).Figure: EGD findings: (A) ulcerative esophagitis. (B and C) Endoscopic exam of the stomach fundus showed hyperemic gastric mucosa, with two outlet channels, one of which was blind and other one was going into the pylorus with significant looping through this area. (D) pylorus. (E) Pyloric sphincter (F) Duodenum.Most documented cases of intussusception occur in children (90%) rather than adults (10%). 95% of children have primary intussusception, whereby the etiology is benign and idiopathic without defined causes. In contrast, almost 90% of the cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point, such as carcinomas, polyps, Meckel's diverticulum, colonic diverticulum, strictures or benign neoplasms. Secondary intussusception is believed to initiate from any pathologic lesion of the bowel wall or irritant within the lumen that alters normal peristaltic activity and serves as a lead point, which is able to initiate an invagination of one segment (intussusceptum) of the bowel into the other (intussuscipien). Classic triad of cramping abdominal pain, bloody diarrhea and a palpable mass is rare in adults. Symptoms could range from nausea, vomiting, and gastrointestinal bleeding to a change in bowel habits, constipation or abdominal distension. CT scan is the most sensitive radiologic modality to confirm intussusception with a characteristic “target” sign when the intussusception is perpendicular to the long axis or a “sausage” sign when it is parallel to the long axis. Intussusception in adult needs surgical resection or investigation given the high risks of secondary causes such as neoplasm.Figure: Sausage-shaped mass indicates gastrogastric intussusceptions.Figure. 4: 5 cm smooth with central ulceration mass arising from body of the stomach.Gastrogastric intussusception is rare. Fortunately for our patient the intussusception was transient allowing time for work up and elective surgery.

Adult intussusception: unusual cause

Adult intussusception is a rare entity which accounts for 1-5% of intestinal obstructions in adults and just 5% of all cases of intussusception. The basic pathology and management of intussusception in adults differs from paediatric intussusception. Here we present an interesting case of adult intussusception with an unusual cause. A 33-year-old female presented with features of intestinal obstruction. Colonoscopy was done outside our institution which reported a smooth polypoidal mass in the terminal ileum, biopsy report was pending at that time. CT abdomen revealed dilated small bowel with narrowing in the ileo caecal junction. We proceeded with laparotomy. Intraoperatively dilated ileum with intussusception of the ileocecal junction into the ascending colon was found. Right hemicolectomy with ileotransverse colon anastomosis was done. Histopathology revealed Polyp with intussusception, 5cm from ileocecal junction, with sheets of lymphoid cells showing moderate pleomorphism, infiltrating submucosa, muscularis propria, and serosa, margins uninvolved with lymph node- 3/32 positivity. Immunohistochemistry suggested B- cell lymphoma with CD20 positivity and Bcl 2 focal positivity. Routine treatment of Lymphoma after confirming with biopsy have been Chemotherapy. Role of surgeon in lymphoma is presently limited to biopsy, but there are situations like obstruction and perforation, where surgeon should take the lead role

The Case Files

The Case Files

Laparoscopic operation after pre-operative reduction of an intussusception-induced inflammatory fibroid polyp

Intussusception occurs mainly in children but rarely in adults. About 80–90% of adult cases of intussusception are due to benign or malignant neoplasms as a lead point. One of the causes is an inflammatory fibroid polyp (IFP), a rare, benign entity that occurs more frequently in the stomach than the ileum. We describe an uncommon case of a patient who presented with intussusception-induced IFP of the ileum. A 35-year-old woman presented with a 2-day history of abdominal pain. A computed tomography scan demonstrated ileocolic intussusception. During colonoscopy, reduction by pressured air easily released intussusception, and we suspected a submucosal tumour of the ileum. Successful pre-operative colonoscopic reduction was helpful for performing laparoscopic ileocecal resection 2 days later. Results of the histopathological examination confirmed a large IFP. The patient's post-operative course was uneventful. Pre-operative reduction by colonoscopy is effective for the diagnosis and treatment of intussusception-induced IFP.

Transient Descending Colo-Colonic Intussusception Due to a Large Fecaloma in an Adult: A Rare Case Report

Introduction: Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%-5% of intestinal obstructions in adults, and 0.003-0.02% of all hospital admissions. Transient nonobstructing intussusception is frequently idiopathic and resolves spontaneously without any specific treatment. We describe a case of transient non-obstructing colo-colonic intussusception due to a large fecaloma. Case Report: 53 years old African American lady presented to Emergency Department with severe progressive lower abdominal cramping pain of 12 hours' duration. Abdominal examination was significant for bilateral lower abdominal tenderness with hypoactive bowel sounds. CT scan of the abdomen and pelvis demonstrated a “colocolonic intussusception” in the descending colon extending over a length of 3.5 cm. Subsequently she underwent an emergent colonoscopy for possible reduction of the intussusception. On colonoscopy, in mid-descending colon, solid stool was found which was packing the entire lumen and it was deemed not safe to advance further so procedure was aborted. Patient was managed conservatively in the absence of peritoneal signs and underwent a water-soluble rectal enema next day that showed a filling defect in the mid descending colon. She was subsequently prepped for an elective colonoscopy for further evaluation of colonic mucosa. Colonoscopy demonstrated the presence of a large stool ball (fecaloma) in left colon even after colonic prep with polyethylene glycol. She was started on round the clock laxatives and she continued to have multiple bowel movements in hospital and her abdominal pain subsided.Figure 1Figure 2Figure 3Discussion: The incidence of intussusception is low in adults, particularly in the descending colon, due to the anatomical attachment of the descending colon to the retroperitoneum. Primary or idiopathic intussusception is usually transient while secondary intussusception due to a lead point is usually permanent or recurrent. In our patient, Intussusception was secondary to a fecaloma that served as a lead point but was transient. Abdominal computed tomography (CT) is currently considered as the most sensitive radiologic method to confirm intussusception. 70 to 90% of adult cases of intussusception require definitive treatment and often surgical resection is the treatment of choice. However, an isolated episode of transient non-obstructive intussusception can be managed conservatively.

A Case of Adult Intussusception Caused by Metastasis from Lung Cancer to the Small Intestine a Small-Intestinal Metastasis from Lung Cancer

A Case of Adult Intussusception Caused by Metastasis from Lung Cancer to the Small Intestine a Small-Intestinal Metastasis from Lung Cancer

Ileocaecal Intussusception with a Lead Point: Unusual MDCT Findings of Active Crohn's Disease Involving the Appendix.

Adult intussusception is a rare entity accounting for 1% of all bowel obstructions. Unlike intussusceptions in children, which are idiopathic in 90% of cases, adult intussusceptions have an identifiable cause (lead point) in the majority of cases. Crohn's disease (CD) may affect any part of the gastrointestinal tract, including the appendix. It was shown to be a predisposing factor for intussusception. Here, we report a rare case of adult intussusception with a lead point, emphasizing diagnostic input of multidetector computed tomography (MDCT) in a patient with active CD that involves the appendix.

Gastroduodenal Intussusception and Biochemical Pancreatitis Due to a Gastric Hyperplastic Polyp: A Case Report

Introduction: Gastroduodenal intussusceptions represent less than 10% of intussusceptions. Common etiologies include benign and malignant intestinal neoplasms. We present a rare case of a gastroduodenal intussusception caused by a hyperplastic gastric polyp. Case Report: A 76-year-old man with history of coronary artery disease presented to the emergency room with a 1-day history of abdominal pain and emesis. His medications included ticlopidine and aspirin for a bare metal stent that was placed 6 months ago. Laboratory studies were notable for mildly elevated liver tests and lipase, which peaked at 3,663. Computed tomography (CT) of the abdomen demonstrated gastric antral wall thickening without evidence of pancreatitis. Esophagogastroduodenoscopy (EGD) revealed a large, fungating, and multi-lobulated gastric polyp that was at least 10 cm in width. Endoscopic ultrasound demonstrated a polyp involving the superficial and deep mucosal layers of the gastric wall. Stack biopsies confirmed the presence of a hyperplastic gastric polyp without dysplasia. Further resection could not be performed due to the patient’s current use of ticlopidine and aspirin. Endoscopic resection was recommended 5 days after stopping anticoagulation and the patient was discharged home. The following day, he returned with worsening symptoms, and a repeat CT of the abdomen showed a gastroduodenal intussusception with gastric outlet obstruction secondary to the gastric mass acting as lead point. The lipase continued to be elevated without radiographic evidence of pancreatitis. The intussusception was endoscopically reduced by pulling the polyp back into the stomach using a through-the-scope 15-mm controlled radial expansion (CRE) balloon inflated beyond the lead point. Because of the high likelihood of recurrence, we attempted endoscopic resection of the polyp. Due to the broad-base and size of the lesion, we were only able to complete partial resection. We used an endoloop prior to resecting each of multiple pieces with a hot snare. The polyp was reduced in size by greater than 50% with the longest protruding piece being less than 3 cm in length. The patient has had no recurrence of symptoms or intussusception for over 6 months. Discussion: There are few documented cases of gastroduodenal intussusception in adults. We present a unique case of intermittent gastroduodenal intussusception and biochemical pancreatitis due to a large gastric polyp that was managed endoscopically with complete resolution of symptoms. To our knowledge, this is the first reported case of a large hyperplastic gastric polyp causing gastroduodenal intussusception and biochemical pancreatitis treated with endoscopic management alone.

Amebiasis Masquerading Colonic Lymphoma in an Intestinal Intussusception Patient

Intussusception which presents with palpable mass, abdominal pain and bloody diarrhea is a rare condition in adulthood. Most of adult intussusception cases are secondary to benign or malign lesions. Entamoeba histolytica is a common pathogen leading to chronic bloody diarrhea in developing countries . We report a 22-year-old patient presenting with abdominal pain and chronic bloody mucoid diarrhea, which intestinal amebiasis delayed diagnosis of intussusception secondary to colonic diffuse large B-cell lymphoma. J Med Cases. 2014;5(8):441-444 doi: http://dx.doi.org/10.14740/jmc1854w

Adult Intussusceptions: A Series of 5 Cases

Intussusception in adult patients is rare in comparison to paediatric patients. We are hereby reporting a series of five cases of adult intussusception. In most of the cases, USG findings were diagnostic and organic lesions were found as causative factors but the diagnosis of intussusceptions from any cause in pregnancy is made more difficult by the common overlapping complaints of nausea, vomiting and abdominal pain, which may persist during the second trimester. The very low incidence rate of 1/30,000 of all hospital admissions makes it far more difficult to diagnose. A very much vigilant mind can only reduce the morbidity out of this condition by use of meticulous Ultrasonography Key wards: intussusception, Ileo-caecal, colo-colic,

Amebiasis Masquerading Colonic Lymphoma in an Intestinal Intussusception Patient

Intussusception which presents with palpable mass, abdominal pain and bloody diarrhea is a rare condition in adulthood. Most of adult intussusception cases are secondary to benign or malign lesions. Entamoeba histolytica is a common pathogen leading to chronic bloody diarrhea in developing countries . We report a 22-year-old patient presenting with abdominal pain and chronic bloody mucoid diarrhea, which intestinal amebiasis delayed diagnosis of intussusception secondary to colonic diffuse large B-cell lymphoma. J Med Cases. 2014;5(8):441-444 doi: http://dx.doi.org/10.14740/jmc1854w

Retrograde colon intussusception in an adult due to adenoma: Treatment by combined laparoscopic and endoscopic approach

This report describes the case of a young patient who underwent laparoscopic surgery to reduce for a retrograde intussusception of the sigmoid-descending colon caused by adenoma of the sigmoid colon. A 36-year-old woman visited our hospital, complaining primarily of vomiting and abdominal pain. Abdominal CT scan showed the typical finding of intussusception. An emergency colonoscopy revealed that the invaginated colon with a polypoid mass was protruding into the descending colon. A gastrografin enema showed the invaginated bowel segment at the descending colon. We performed endoscopic polypectomy and then hand-assisted laparoscopic reduction. The pathological finding showed tubular adenoma. Laparoscopy is a diagnostic or therapeutic tool for selected cases of adult intussusception. Benign tumor is one of the causes of intussusception in adults and a good indication for laparoscopic surgery.

Adult Intussusception: Clinical Experience from a Single Center

Though frequently observed in children, intussusception is a rare state in adults. The treatment of intussusception in adults is different. In this trial, we have presented intussusception cases in adults that were treated and followed up in our department. The records of 31 adult intussusception cases surgically treated in our department between January 1993 and July 2012 were evaluated retrospectively. Among the 31 adult cases of intussusception that were treated during a period of 19years, 10 were men, and 21 were women. The mean age was determined as 39.7 ± 5.3. The presentation symptom was abdominal pain in all the patients. Failure to pass gas or feces was observed in 23 patients (74.2%); nausea and vomiting, in 22 patients (70.9%); hematochezia, in 16 patients (51.6%); and weight loss, in 3 patients (9.6%). The mean duration of symptoms was 4.8days. Abdominal tenderness was found in all the patients. Muscular defense and rebound tenderness were determined in 13 patients (41.9%). Findings of intussusception were found in 80.9% of patients examined by abdominal ultrasonography and in 63.1% of cases examined by computerized tomography. Resection of the intussuscepted bowel segment was performed in 87% of the patients. In conclusion, intussusception in adults is a rare clinical entity. Intussusception should be considered in the differential diagnosis in patients presenting with spasmodic abdominal pain, especially in cases with intestinal obstruction. The recommended surgical method is en bloc resection of the intussuscepted segment in cases suspected to carry a risk of malignancy.

Jejunal tubulovillous adenocarcinoma in adenoma presenting with entero-enteric intussusception.

A 73-year-old male was admitted to our institution with complaints of nausea, vomiting, and abdominal distension. Plain abdominal computed tomography (CT) suggested intussusception in the jejunum. Enhanced abdominal CT revealed the 'target-like' sign and ultrasonography revealed the 'multiple concentric ring' sign; therefore, a diagnosis of entero-enteric intussusception was made. The small intestinal obstruction and cause of the intussusception were not evident. The patient was treated conservatively with fasting and transfusion therapy to prevent intestinal obstruction. However, with no spontaneous resolution of intussusception, surgical treatment was decided. The operative findings revealed a jejunal tumor about 30cm from the Treiz ligament, and the jejunum including the tumor with a 5cm margin were partially resected. The resected tumor was a 35×50mm soft mass spreading laterally with nodules. The pathological examinations revealed tubulovillous adenocarcinoma in the adenoma. Intussusception is rare in adults compared to children. About 45% of cases of intussusception in adults are due to small intestinal tumors such as malignant lymphoma or lipoma, but a tubulovillous adenocarcinoma with adenoma is a rare cause of intussusception. We present a rare case of jejunal tubulovillous adenocarcinoma in adenoma presenting with entero-enteric intussusception.

Adult intussusception: a single-center 10-year experience

Adult intussusception (AI) is a rare condition, usually with a lead point, and for which surgery is the treatment of choice. Given the risks and possible complications of untreated AI, an accurate preoperative diagnosis is of the utmost importance. Although AI remains difficult to diagnose, computerized tomography (CT) is presently considered the best diagnostic tool. Sixteen patients of 20 years and older with intraoperative diagnosis of intussusception, who underwent surgery between January 2000 and December 2009, were reviewed retrospectively. Patients were assessed concerning clinical presentation, imagiological findings, surgical treatment, and postoperative histological evaluation. Most patients (93.8 %) were admitted via emergency room (ER) due to abdominal pain. Fourteen (87.5 %) AI cases showed an underlying organic cause, e.g., masses or tumors. The most frequent comorbidities were Peutz–Jeghers syndrome (PJS; 18.8 %) and HIV (12.5 %). Eight (50.0 %) intussusceptions were ileocolic and six (37.5 %) were in the small bowel. Total 43.8 % of lesions were malignant. Preoperative diagnosis of intussusception was possible in 50.0 % of cases by ultrasonography (US) and in 81.8 % by CT. US showed no predictive value concerning intussusception location. Total 27.3 % of CTs correctly identified the location, but only 9 % accurately identified the lead point. We propose that all AI cases should be treated with surgical resection without attempting reduction, even when no lead point is detected by imaging studies, and this approach should be based on the oncological criteria. CT can be regarded as the most accurate diagnostic tool for intussusception, although its predictive value concerning location and lead point is still far from ideal.

腸重積が発見契機となった原発性小腸癌の1例

腸重積が発見契機となった原発性小腸癌の1例

Adult intussusception: Diagnostic pitfalls, morbidity and mortality in a developing country

To study diagnostic pitfalls, morbidity and mortality of adult intussusception. Retrospective study of adult patients records operated between 1979 and 2007 with the diagnosis of adult intussusception. We found 41 cases of adult intussusception. The mean age was 35.2 years (standard deviation (SD)=7.1). The delay between onset and medical consultation was 15 days. The diagnosis was made pre-operatively in 11 cases. Abdominal ultrasound showed an abdominal mass in 11 cases. Ileo-ileal intussusception was most frequent (16 cases). Intussusception was secondary in 24 cases. There were seven instances of intestinal necrosis. Intestinal resection was performed in 34 cases. Surgical site infection occurred in four patients, three patients died. The pre-operative diagnosis of acute intestinal intussusception is difficult. Morbidity and mortality rates are high. Improved diagnostic investigations in developing countries could improve the prognosis of this condition.