Case Of Small Bowel Intussusception Research Articles

An adult case of small bowel intussusception caused by hemangioma presenting with intestinal obstruction: A case report

Both small bowel intussusception in adults and small bowel hemangioma are rare benign mass lesions. Moreover, a secondary effect of intussusception caused by hemangioma is extremely rare. A 87-year-old female suffered from intussusception and intestinal obstruction caused by hemangioma located in the small bowel (February 14, 2020), reporting abdominal distention without nausea and vomiting. Emergency abdominal and pelvic computed tomography showed an intussusception with the evidence of associated small bowel obstruction. Histological analysis revealed as small intestinal hemangioma accompanied by mesenteric ulcer. The patient underwent segmental resection of intussusception of intestine instead of invalid conservative treatment. Although the postoperative pathological results were inconsistent with preoperative imaging examination, the old woman recovered well. The literature on intussusception of small intestine has described several possible causes including hemangioma, which more likely results in gastrointestinal bleeding or abdominal pain. Yet we experienced a rare case presenting as abdominal distention without nausea and vomiting, Therefore, preoperative diagnosis and localization of these lesions is of great importance. We recommend high resolution contrast-enhanced computed tomography and magnetic resonance imaging should be considered in diagnosis while capsule endoscopy is not available owing to the intestinal obstruction, as long as in facilitating surgical excision.

Intussusception: Lab Report and Review of Literature

Objective: Intussusception is the invagination of a proximal portion of the gastrointestinal tract into an adjacent distal portion. This unusual form of bowel obstruction occurs less frequently in adults. We report a case of small bowel intussusception in a 39-year-old African male cadaver in the cadaveric laboratory in the, Department of Human Anatomy at, Uzima University. We have also performed a literature review of this rare condition. Method: Student cadaver groups at Uzima University were assigned with a ratio of 8:1 meaning that eight students received one cadaver to work on. There were a total of nine cadavers. One out of the nine assigned specimens had a lead point in the ileocecal valve resulting in ileocecal intussusception upon dissection. Results: At the ileocecal junction, an intussuscepted distal small bowel was discovered. We concluded it to be an ileocecal intussusception. Conclusion: The rarity of intussusception in adults makes it an exceptional finding in standard anatomy laboratory. Intussusception can occur anywhere in the gastrointestinal tract. Surgeons should consider intussusception as a severe cause of intestinal obstruction and consequently, anticipate different clinical presentations. Diagnosis of intussusception is difficult to make without surgery, therefore, surgeons need to familiarize themselves with different imaging modalities.

A rare case: small bowel intussusception in adult caused of intraabdominal lipoma

Bowel obstruction caused by intussusception is a rare case. A non-typical sign makes the patient undergo several radiological examinations to establish diagnosis. From various intussusception causes, lipoma is a very rare cause. We reported a rare case of small bowel intussusception caused by lipoma who underwent ultrasonography (USG) and computed tomography (CT) scan examinations in Dr. Soetomo General Hospital, Surabaya, Indonesia.

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.

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.

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.

AB172. SOH21AS181. Ileo-ileal intussusception in the adult patient: an organ-preserving approach to management

Background: Intussusception in adults is rare and frequently goes undiagnosed, which can have clinical consequences. We present a rare case of small bowel intussusception in an adult female due to a small bowel benign fibrous lesion. To our knowledge, this is the first reported case managed by intraluminal excision of the causative lesion by enterotomy as opposed to formal bowel resection and anastomosis.

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.

Can intussusceptions of small bowel and colon be transient? A prospective study.

We performed a prospective study to explore a diagnosis and treatment protocol of transient intussusception in children (TIC). Totally, 143 children with intussusception who met the inclusion criteria were firstly divided into intussusception involving only the small bowel and intussusception involving the colon group. And in each group, they were further divided into short-segment (≤ 3.0cm) and long-segment (> 3.0cm) groups according to the length of intussusception. After a period of conservative treatment, the incidence of TIC, the incidence of surgery, and recurrence were collected and analyzed. Finally, we found that the incidence of TIC in the short-segment group of small bowel intussusception (96.29%) was significantly higher than that in other groups (P ≤ 0.001). Besides, the incidence of surgery and recurrence in this group was relatively low too. Therefore, we summarized the inclusion criteria and treatments to the short-segment group of small bowel intussusception as the suggested protocol to TIC.Conclusion: For cases of small bowel intussusception with no identified pathologic lead point, a short duration of symptoms, a length of ≤ 3.0cm, a relatively abundant vascular flow signal, and a stable general condition, the spontaneous reduction could be expected and a period of conservative treatment with careful monitoring is recommended. What is Known: • The phenomenon of spontaneous reduction in intussusception (transient intussusception) among pediatric patients has been widely reported. • To distinguish the transient intussusception from the other types is important for the transient ones only need conservative treatment rather than enema reduction or surgery. What is New: • This is the first prospective study to explore a diagnosis and treatment protocol of transient intussusception in children. • Short-segment small bowel intussusceptions have a higher rate (96.29%) to get spontaneous reduction than the other types of intussusception.

A Case of Small Bowel Intussusception in an Adult Caused by Heterotopic Gastric Mucosa in the Jejunum: A Case Report and Review of the Literature

A Case of Small Bowel Intussusception in an Adult Caused by Heterotopic Gastric Mucosa in the Jejunum: A Case Report and Review of the Literature

Ileo-ileal intussusception in adult caused by Vanek's tumor: a report of five cases

Background: Inflammatory fibroid polyps (IFPs) (Vanek’s tumor) are rare, benign lesions of the gastrointestinal tract. Its treatment is surgical. The debate focused on the issue of primary en bloc resection of intussuscepted bowel versus initial reduction followed by more limited resection. We report five cases of small bowel intussusception in adult caused by Vanek’s tumor. Methods: The retrospective study reviewed epidemiological data, clinical features, diagnosis and management of adults with a diagnosis of intussusception admitted to our department from August 2010 to April 2014. Only intussusception caused by Vanek’s tumor was included in our study. Results: There were 4 males and 1 female. Their average age was 53 years. All of them were admitted with abdominal pain. The abdominal exam revealed an abdominal distension in 4 patients and a palpable abdominal mass in 2 patients. One patient had a normal physical examination. CT demonstrated >, a sign pathognomonic for ileo-ileal intussusception. All of the patients underwent surgical treatment by laparotomy for 4 patients and laparoscopy approach for 1 patient. 4 patients had an ileo-ileal intussusception; which was resected after partial reduction and followed by end-to-end anastomosis. In one case, we found an ileo-caeco-colic intussusception, which was resected and side-to-side ileo-colic anastomosis was performed. Diagnosis of Vanek’s tumor was confirmed by immunohistochemical examination. Postoperative course was uneventful. Conclusions: The recommended treatment of adult intestinal invagination is surgical resection. Discussion continues as to whether or not a reduction has to be done before a resection.

A Case of Small Bowel Intussusception Caused by Jejunal Hamartoma Confused as Hepatitis A in an Adult

Intussusception in adult is a rare disease and laparotomy is usually considered because of the probability of malignancy. Especially with obstruction symptom or sign, it might be needed emergency operation. This case was a simultaneous development of small bowel intussusception and acute hepatitis A. The patient had abdominal pain and vomiting. Intitial laboratory examination with elevated aminotransferase revealed that the diagnosis was acute hepatitis. As managing acute hepatitis, the abdominal pain was not improved and the patient had tenderness on periumbilical area on physical examination. A jejunal intussusception with a lead point was proved on the abdominal computed tomography scan. Fortunately, symptom of intussusception was relieved while nulli per os (NPO) and intravenous hydration. After recovery of acute hepatitis, laparotomy was done. The lead point was 2.5×3.0 cm sized hamartoma. This was the case that the symptom of intussusception was confused with that of acute hepatitis.

A case of small-bowel intussusception caused by intestinal lipomatosis: preoperative diagnosis and reduction of intussusception with double-balloon enteroscopy

A case of small-bowel intussusception caused by intestinal lipomatosis: preoperative diagnosis and reduction of intussusception with double-balloon enteroscopy

Does all small bowel intussusception need exploration?

Small bowel intussusception (SBI) in infants and children are ususally associated with a lead point. With increased use of radiological investigations, more idiopathic SBIs are identified. As reduction by hydrostatic or air enema are less successful in these cases, most of them require surgical exploration in children. However, now many cases of SBI have been found to reduce spontaneously. We report two cases of SBI with spontaneous reduction and review the literature for the management guidelines.

A rare case of small bowel intussusception through a loop ileostomy

ANZ Journal of SurgeryVolume 79, Issue 12 p. 960-961 A rare case of small bowel intussusception through a loop ileostomy Yiyi Chen MB BS Bsc(med), Yiyi Chen MB BS Bsc(med) Surgery, St. George Hospital, Kogarah andSearch for more papers by this authorHarrison Richard MB BS, Harrison Richard MB BS Surgery, Wagga Wagga Base Hospital, Wagga Wagga,New South Wales AustraliaSearch for more papers by this author Yiyi Chen MB BS Bsc(med), Yiyi Chen MB BS Bsc(med) Surgery, St. George Hospital, Kogarah andSearch for more papers by this authorHarrison Richard MB BS, Harrison Richard MB BS Surgery, Wagga Wagga Base Hospital, Wagga Wagga,New South Wales AustraliaSearch for more papers by this author First published: 10 December 2009 https://doi.org/10.1111/j.1445-2197.2009.05164.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume79, Issue12December 2009Pages 960-961 RelatedInformation

Invagination intestinale aiguë de cause inhabituelle: Hyperplasie hétérotopique pseudo-tumorale des glandes de brunner

We report the first case of small-bowel intussusception caused by a tumour-like Brunner's gland hyperplasia in a 26 year old woman. The patient presented with intense abdominal pain. Abdominal and pelvic contrast enhanced CT-scan suggested small bowel intussusception involving the first jejunal loop. A 15 cm long polypoid mass was found in the jejunumectomy specimen (2nd and 3rd loops). Histological examination revealed Brunner's gland hyperplasia in the jejunal mucosa and submucosa. Considering the jejunal location of the lesion, it must be considered malformative and heterotopic Brunner's gland hyperplasia.

Do All Adult Patients with Small Bowel Intussusception Need Surgery?

Introduction: Intussusception of the small bowel accounts for less than 1% of cases of small bowel obstruction in adults. It has traditionally been regarded as a condition requiring surgery, because up to 90% of cases are said to be associated with a lead point disease. We present a case of small bowel intussusception in an adult, which was transient and managed conservatively without surgical intervention. Case: A 23-year-old man presented to the Emergency Department with a three-day history of right-sided abdominal pain, nausea and bilious vomiting. On arrival, his temperature was 97.7° F and his pulse rate was 79 beats per minute. Examination revealed a non-distended abdomen with right lower quadrant tenderness without guarding or rebound tenderness. His white cell count was 13,000 per cmm and hematocrit was 50 percent. Plain-film radiograph of the abdomen revealed a non-obstructive bowel gas pattern. Computed tomographic scanning of the abdomen showed a “target lesion”, suggestive of small bowel intussusception (Figure 1). However, no abnormality was demonstrated on barium small bowel follow-through performed the next day. The patient's general condition improved with bowel rest. Discussion: The reported frequency of lead point disease with adult small bowel intussusception is based on surgical series in which patients had obstructive symptoms and the diagnosis was made intraoperatively. However recent series using CT or MRI diagnosis of intussusception found increased rate of idiopathic transient intussusception approaching 50%, especially in small bowel. Features suggestive of transient intussusception are incidental presentation, proximal small bowel location, absence of peristaltic obstruction, absence of any apparent cause, target like lesion on CT scan and intussusception length less than 3.5 centimeter. Many cases of adult small bowel intussusception that are detected with computerized tomography are self-limiting. This highlights the need for considering conservative approach in management of small bowel intussusception in adults.[figure 1]Figure

Intussusception in adults: an unusual and challenging condition for surgeons

Intestinal intussusception in adults is a rare entity and there is an ongoing controversy regarding the optimal management of this problem. The purpose of this study was to determine the causes and management of intussusception in adults. A retrospective review of patients more than 18 years of age with a diagnosis of intestinal intussusception between January 1996 and December 2003 was conducted. Data related to presentation, diagnosis, treatment, and pathology were analyzed. A total of 13 patients were operated on due to intestinal intussusception. There were 6 men and 7 women with a mean age of 45 years (range 24--61 years). Abdominal pain was the most common presenting complaint (100%). Eight (61.5%) patients presented with acute symptoms and underwent emergency laparotomy. The diagnosis of gastrointestinal intussusception was made preoperatively only in 4 (30.7%) patients by abdominal ultrasonography and computerized tomography. The lead point of intussusception was located in the small intestine in 10 (76.9%) patients, in the colon in 2 (15.4%), and in the ileocecal valve in 1 (7.7%). A pathologic cause for the intussusception was identified in 12 (92.3%) cases and 1 (7.7%) was idiopathic. Of the cases with a defined cause, 58% of the cases were benign and 42% were malignant. Forty percent of cases of small bowel intussusception and 33.3% of cases of colonic intussusception were due to malignant lesions. All cases of small intestinal intussusception were reduced and no perforation occurred. Segmental intestinal resection was performed in 9 patients and excision of the Meckel's diverticulum was made in 1. In cases of colonic intussusception, reduction was not attempted and en-bloc resection was carried out. No perforation or spillage of the contents of the intussusception was observed. There was no surgical mortality. Adult intussusception is an unusual and challenging condition that represents a preoperative diagnostic difficulty. We think that colonic intussusceptions should be resected in an en-bloc manner without reduction due to the risk of perforation and spillage of micro-organisms and malignant cells, whereas cases of small intestinal intussusception can be reduced without complications unless there is strangulation.

Twenty-one cases of small bowel intussusception: the pathophysiology of idiopathic intussusception and the concept of benign small bowel intussusception.

Ultrasonography (US) was used to study intussusceptions prospectively at Kiyama Hospital in 1999 and 2000 under the classification of small bowel intussusception (SBI) and large bowel or ileo-ileo-colic intussusception (LBI). The clinical features, management, outcome and etiology were analyzed. All LBIs and SBIs with ischemic symptoms and SBIs complicated by LBI were treated by enema reduction, whereas SBIs considered to be nonischemic were observed. SBI was seen in 21 patients with a mean age of 62.6+/-31.2 months. Four cases (19.0%) were diagnosed during the course of LBI. US showed mesenteric lymphoid hyperplasia in 15 (71.4%). Hydrostatic enema reduction was successful in 9/9, and SBI reduced naturally in the other 12 (benign SBI). LBI occurred in 38 patients with a mean age of 27.8+/-21.2 months. Mesenteric lymphoid hyperplasia was observed in 29 (76.3%). Hydrostatic enema reduction was successful in 37/38. SBI occurs more frequently and in a wider age group than previously considered. Many SBIs reduced naturally, suggesting that they were only transient invagination phenomena and should be called benign SBI. The frequent association of SBI with LBI and also the frequent association of mesenteric lymphoid hyperplasia with both SBI and LBI seem the key to the pathophysiology of intussusception.

Small Bowel Intussusception: an Unusual Complication of Retroperitoneal Lymph Node Dissection

Modified bilateral retroperitoneal lymph node dissection is used widely in the staging and treatment of patients with nonseminomatous germ cell testis tumors. Complications are uncommon and include vascular injury, infertility and small bowel obstruction from fibrous adhesions. Small bowel intussusception following retroperitoneal lymph node dissection has not been reported previously. We report 2 cases of small bowel intussusception after retroperitoneal lymph node dissection, and discuss the etiology and possible preventive measures. (J. Urol., 142: 826–827, 1989)