Duodenojejunal Intussusception Research Articles

Duodenal intussusception due to periampullary duodenal adenoma: A case report

Duodenal intussusceptions are uncommon due to their fixed location in retroperitoneum except when associated with bowel malrotation abnormalities. We present a case of recurrent duodenojejunal intussusception in a 34-year-old female diagnosed on imaging. The lead point, in our case, was periampullary duodenal tubulovillous adenoma which was confirmed on endoscopy and subsequent punch biopsy. The patient underwent segmental duodenal resection anastomosis preserving the ampulla with reduction of the intussuceptum and fixation of the jejunal loops and its mesentery.

Macules and abdominal pain

A 15-year-old girl was brought to a family medicine clinic in Somaliland, Africa, for evaluation of intermittent abdominal pain and watery diarrhea of 12 years’ duration. Over the previous 2 months, her symptoms had included vomiting and weight loss. The patient had numerous hyperpigmented macules on her lips, buccal mucosa, fingers, and toes. Computed tomography (CT) and ultrasonography showed duodenojejunal intussusception. Upper gastrointestinal (GI) endoscopy revealed multiple polyps.What’s your diagnosis?

Duodenoduodenal and duodenojejunal intussusceptions in adults: A systematic review with a focus on demographics, diagnosis, and etiology

Background and Objectives Diagnosis and management of Duodenal Intussusception (DI) in adults present several clinical challenges. Available literature specific to the DI in adults is scant, mainly due to the rarity and emergency associated with DI. The objective of this study is to conduct a systematic review of the literature and elucidate key factors related to DI in adults. Methods and Materials PubMed, Scopus, Web of Science, and Cochrane databases were searched. Data on demographics, etiology, symptoms, physical examination, and diagnosis was extracted and analyzed for pooled incidence of adult DI (ADI; adult duodenal intussusception) and its specific subclasses i.e. duodenoduodenal (ADDI) and duodenojejunal (ADJI) intussusceptions. Results The database search yielded 234 results. A total of 51 studies, involving 54 patients with ADI, were included in the final analysis. The median (Interquartile, IQR) age of patients was 44.5 (26) years and 66.7% of patients were women. Among 54 ADI patients, 40.7% had ADDI and 59.3% had ADJI. The duration of symptoms varied widely with a median (IQR) of 60 (357) days. Abdominal pain and vomiting were the common reported symptoms. Physical examination and laboratory tests were inconclusive in several patients. CT scan was the most commonly used diagnostic modality. Only one case of ADI was idiopathic. Adenomas were the most frequent etiology, observed in about 50% of ADI patients. Peutz–Jeghers Syndrome was seen in 8 patients and all of them had ADJI. Out of the 12.5% cases that were malignant, only one had ADDI. Conclusion This study is probably the first attempt to systematically review ADI and its subclasses with the intention to provide key information specific to patient characteristics, diagnosis, and etiology of ADI. The findings of this review will possibly augment research in the area of the management and epidemiology of ADI.

INTUSSUSCEPÇÃO DUODENOJEJUNAL EM AMERICAN CURL

Intussuscepção é uma afecção relativamente comum na clínica veterinária, porém é uma condição rara em felinos. Caracteriza-se pela invaginação de um segmento intestinal em outro adjacente. Os fatores predisponentes de intussuscepção são desconhecidos, no entanto acredita-se que corpos estranhos, neoplasias, parasitismos e até mesmo causas idiopáticas podem levar a esta afecção. Os sinais clínicos em gatos são inespecíficos e geralmente incluem anorexia, perda de peso, desidratação e massa palpável abdominal. O diagnóstico se dá pelos sinais clínicos e exames complementares, como radiografias e ultrassonografias, mas em alguns casos à doença pode evoluir rapidamente, o que muitas vezes pode impedir um diagnóstico precoce, como no caso relatado de um felino fêmea, da raça American Curl de aproximadamente dois anos de idade, com histórico de êmese e emagrecimento. O animal apresentou rápida piora no quadro clínico e foi a óbito dois dias após o início dos sinais clínicos. As alterações macroscópicas encontradas no exame de necropsia foram compatíveis com intussuscepção duodenojejunal.

TUBULOVILLOUS ADENOMAS OF THE DUODENUM

Intussusception is the telescoping of one segment of the gastrointestinal tract into the distal segment. It is most commonly seen in infants, and present as bowel obstruction. The presentation in adults is rare. A 41-year-old, non-alcoholic male, presented with complaints of intermittent abdominal pain of 2 years duration and acute pancreatitis with pseudocyst of the pancreas due to duodenojejunal intussusception caused by a duodenal tubulo-villous adenoma. The patient was successfully treated by reducing the intussusception and wide local excision of the large adenoma. A complete literature review for tubulovillous adenomas was done and summarized.

Brunner′s gland adenoma presented with duodenojejunal intussusceptions: A case report and review of literature

Brunner's gland adenoma (BGA) is a very rare benign duodenal lesion, usually asymptomatic. BGA presents with duodenojejunal intussusception (DJI) is a very rare condition; only 2-3 cases have been reported. Here, we present a 45-year-old male, Yamani, presented with a 6-month history of recurrent upper abdominal pain and melena. Computed tomography (CT) with contrast revealed target sign. Laporatomy confirmed DJI with duodenal polyp that acting as a lead point. Histopathology confirmed BGA. To conclude, BGA presents with DJIs is very rare conditions; nonspecific symptoms and less dramatic presentation are possible causes of delay in diagnosis, CT with contrast is usually diagnostic.

G IST Jinx – A Rare Case of Acute Massive Life Threatening Bleed from a Jejunal Gastro-Intestinal Stromal Tumour

A 55-year-old lady presented to us in the emergency services with melaena. Haemoglobin was 3.4 g/dL. A massive blood transfusion was given. Upper Gastrointestinal (GI) endoscopy showed antral erosions without active bleed and colonoscopy was inconclusive. An Ultrasonogram (USG) of the abdomen showed multiple haemangiomas of the liver and no bowel pathology. A Contrast Enhancing Computed Tomogram (CECT) of the abdomen showed an intensely enhancing lesion in the jejunum. Laparotomy revealed a firm hypervascular mass 3x3cm in the proximal jejunum 6cm distal to the duodeno-jejunal junction. The mass was resected and on histopathological examination was found to be a low-risk GIST with adequate margins and c-KIT (CD 117) positivity. Clinically, severe pallor was present. The abdominal examination was within normal limits. Digital rectal examination revealed melaena staining. On proctoscopy, the lower rectum could not be visualised due to the melaena. Laboratory findings: Haemoglobin 3.4 g/dL, bleeding and coagulation parameters were within normal limits On Endoscopy of Upper GI, Antral erosions were noted with no active bleeding. Colonoscopy was inconclusive as rectum was filled with melaena resulting in poor visibility. Abdominal USG showed multiple haemangiomas in the liver with no abnormal bowel pathology visualised. CECT abdomen showed Duodeno-Jejunal intussusception [Table/Fig-1] with intensely enhancing submucosal lesion with the same intensity as that of blood vessels with probable diagnosis being a growth of vascular origin. Multiple liver haemangiomas were also visualised [Table/Fig-2]. [Table/Fig-1]: An abdominal CT transverse slice showing intensely enhancing lesion with duodeno-jejunal intussusception (white arrow). [Table/Fig-2]: An abdominal CT coronal slice showing liver haemangiomas (black arrow) and duodeno-jejunal intussusception with intensely enhancing submucosal lesion (white arrow). Gross findings: Laparotomy revealed a firm well circumscribed mass 3x3cm, arising from the anti-mesenteric border of the jejunum 6 cm distal to the duodeno-jejunal flexure with dilated peritumoural vessels. The intraluminal portion of the affected bowel showed a full diameter transverse slit across the tumour representing rupture which probably caused the massive bleed [Table/Fig-3,​,44]. [Table/Fig-3]: Intraoperative photograph showing the lesion near the duodeno-jejunal junction [Table/Fig-4]: Intra-luminal photograph showing the lesion with intraluminal rupture. Microscopy: Microscopy with classical haematoxylin and eosin staining revealed clusters of spindle shaped cells with elongated nuclei with areas of mitosis. Immunohistochemistry demonstrated positivity for CD 117 [Table/Fig-5,​,66]. [Table/Fig-5]: Photomicrograph showing spindle shaped cells with irregular large nuclei with intervening stroma (H & E, x 400). [Table/Fig-6]: Photomicrograph demonstrating spindle shaped cells with large nuclei with CD117 positivity in few cells (Immunohistochemistry staining, x 100). GISTs are the most common sarcomatous tumours of the GIT, typically seen in patients more than 50 years with slight male preponderance. The most common sites in the GIT include stomach (50-60%), small intestine (25-30%), rectum (5%), oesophagus (2%). Jejunal GISTs are rare, contributing to only 10% of GISTs arising from the GIT [1,2]. Histologically, GISTs consist of a combination of spindle and epitheloid cells. Immunohistochemistry for GISTs typically shows positivity for the tyrosine kinase receptor protein – c-KIT (CD 117) [3]. Most patients with GISTs present symptomatically with variable clinical presentation. Small GISTs usually present as vague abdominal pain or with bleeding. Bleeding is most common into the lumen of the GIT which is usually chronic in presentation. Acute massive life threatening intraluminal bleed is very rare. CECT abdomen findings typically are of a well circumscribed submucosal mass or of an exophytic lesion. Endoscopy can also be used for pre-operative diagnosis in accessible locations. A pre-operative diagnosis is difficult especially in cases presenting as emergency and diagnosis is usually confirmed at surgery. Complete surgical resection forms the mainstay of treatment. Small bowel GIST is an unusual tumour of the GIT and can have varied clinical presentation. Its presentation as acute massive GI haemorrhage is rare. Aggressive resuscitation, a high index of suspicion and thorough clinical and radiological evaluation are necessary to provide the best possible treatment.

A rare case of duodenojejunal intussusception due to tubulovillous adenoma

Intussusception of the duodenum is a relatively rare event and usually results from the presence of a benign tumor. Duodenojejunal intussusception secondary to duodenal tumors is an uncommon entity. The classic coiled-spring appearance, fairly visible in the jejunum, is not apparent in the duodenum due to its fixed position. We present a case of duodenojejunal intussusception secondary to tubulovillous adenoma in a 37-year-old female. Surgical excision of the polypoidal mass and duodenojejunal intussusception was performed. Pathological examination found the mass to be a tubulovillous adenoma.

Duodenojejunal intussusception caused by a solitary Peutz – Jeghers type hamartomatous polyp

Introduction: A solitary Peutz-Jeghers type hamartomatous polyp in the duodenum is rare. As compared with Peutz-Jeghers syndrome, Peutz-Jeghers type hamartomatous polyps are regarded as a different disorder. case report: We are reporting a case of a solitary hamartomatous polyp in the duodenum. A 24-year-old female was referred to our hospital with a diagnosis of duodenojejunal intussusception. We identified a polyp in the distal part of the duodenum. the patient underwent an endoscopic polypectomy. the polyp was confirmed to be a Peutz-Jeghers type of hamartomatous polyp. the patient underwent colonoscopy and small intestines follow-up with no evidence other polyps. conclusion: Previous reports have shown that solitary Peutz-Jeghers type hamartomatous polyps have malignant components in some cases. Patients with a duodenal solitary hamartomatous polyp should undergo treatment with complete removal of polyp and they need periodical follow- up examinations.

A duodenal duplication cyst manifested by duodenojejunal intussusception and chronic pancreatitis

A 31-year-old patient was admitted to the Department of Gastrointestinal Surgery because of epigastric pain after meals, nausea, and lack of appetite. Laboratory data, including hepatic and pancreatic profiles, were within normal limits. Computed tomography demonstrated an intussusception of the transverse part of the duodenum into the small intestine (Fig 1, A and B). At laparotomy, a duodenojejunal intussusception was found, with the duodenal bulb invaginated into the proximal jejunum (Fig 2, A).

An unusual case of duodenal beaking

A 35-year-old female presented with complaints of several episodes of malaena and frank blood in the stools for the past 1 year. The frequency of these episodes had increased in the past 2 months. The patient complained of extreme weakness and palpitations. There was no history of abdominal pain, nausea, vomiting or haematemesis. There was no history of fever, jaundice, weight loss or constipation. Physical examination was unremarkable except for the presence of severe pallor. Digital rectal examination revealed black tarry stools staining the glove. There was no palpable growth; first degree haemorrhoids were visible at the 3 o'clock position; no active bleeding was discernible. Her haemoglobin was 4 g dl−1, packed cell volume 12.5%, total leukocyte count 7900 cells mm−3and platelet count 5.34×105 mm−3. Peripheral smear showed features of anaemia. Total serum bilirubin was 2.5 mg dl−1 (direct bilirubin 1.2 mg dl−1). The rest of the liver function tests were within normal limits. HBsAg (the surface antigen of the hepatitis B virus) was negative and human immunodeficiency virus was non-reactive. A chest radiograph demonstrated mild cardiomegaly and the lung fields were clear. Colonoscopy was within normal limits. An upper gastrointenstinal endoscopy was performed, which showed a normal stomach and first part of duodenum. The endoscope could not be negotiated into the third part of the duodenum. A barium meal examination was done for further evaluation of the upper gastrointestinal tract. Two radiographs of an upper gastrointestinal barium series are shown (Figure 1). Figure 1 (a) Barium meal upper gatsrointestinal tract: smooth narrowing or “beaking” at the junction of the second and third parts of the duodenum, with mucosal folds running parallel to the lumen and a small C-loop of the duodenum. (b) Barium ...

Synchronous presentation of acute pancreatitis and splenomegaly with intussusceptions in Peutz‐Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant inherited disorder characterized by gastrointestinal hamartomatous polyps and pigmented mucocutaneous lesions. Intussusceptions and gastrointestinal tract bleeding are frequent complications of PJS caused by larger polyps, but acute pancreatitis and splenomegaly are very rare. Previously, surgical intervention was the only curative modality despite the associated complications. In recent years, double-balloon enteroscopy (DBE) has become the alternative method as the ideal treatment. We report the case of a 20-year-old woman diagnosed with PJS, as she suffered from 4-day nausea and vomiting with acute abdominal pain, and clinically manifested acute pancreatitis, splenomegaly and duodenojejunal intussusceptions secondary to a huge proximal jejunal polyp (10 cm × 2 cm). We removed the polyp via DBE and found that the acute pancreatitis, splenomegaly and duodenojejunal intussusceptions were simultaneously ameliorated 2 days after treatment. Currently, the patient has been symptom free for 3 months after polypectomy. Acute pancreatitis, splenomegaly and intussusceptions can synchronously occur in PJS patients, and polypectomy via DBE is the effective treatment alternative to surgical intervention for this disease, thereby obviating some complications associated with the latter.

Duodenojejunal intussusception in Peutz-Jeghers syndrome: Report of a case

Recurrent intussusception is one of the common modes of presentation in patients with Peutz-Jeghers syndrome. This report presents a case of Peutz-Jeghers syndrome with synchronous duodenojejunal and jejunojejunal intussusceptions due to hamartomatous polyps. Very few cases of duodenojejunal intussusception in Peutz-Jeghers syndrome patients have so far been reported in the literature.

Duodenal Duplication Cyst that Manifested as Duodeno-jejunal Intussusception in an Adult: A Case Report

Duodenal duplication cyst account for 4% or 5% of all gastrointestinal duplications. Duodenal duplication acting as a lead point for an intussusception is an extremely rare event as it is largely a fixed retroperitoneal structure. We report here on the radiologic findings of a case of duodenal duplication cyst that manifested as duodeno-jejunal intussusception in an adult.

Duodenojejunal intussusception secondary to hamartomatous polyps of duodenum surrounding the ampulla of Vater

Duodenojejunal intussusception is a rare pediatric emergency. A case of duodenojejunal intussusception secondary to hamartomatous polyps of the second portion of duodenum in a 10-month-old boy is reported. Surgical excision of the polyps and reduction of the intussusception were performed. Pathologic examination found hamartomatous polyps. This is the third case report of children in literature, but this is the first case of a child with intussusception surrounding the ampulla of Vater and a successful excision performed without damaging the ampulla of Vater. J Pediatr Surg 36:1073-1075. Copyright © 2001 by W.B. Saunders Company.

Duodenal duplication cyst manifested by duodeno-jejunal intussusception and hyperbilirubinemia

A rare case of duodenal duplication cyst containing stones in a 17-year-old patient is presented. The cyst, acting as a leading point for duodeno-jejunal intussusception caused proximal small bowel obstruction and hyperbilirubinemia. Preoperative diagnosis was based on abdominal computerized tomography. At operation, the cyst wall was unroofed creating free drainage into the duodenal lumen without damaging the biliary and pancreatic ducts with resolution of symptoms.

A CASE OF DUODENAL TUMOR WITH INTUSSUSCEPTION AND INTESTINAL MALROTATION

This report documents a patient with duodenal tumor associated with intestinal malrotation and intussusception. A 44-year-old woman was admitted to the hospital because of an abdominal mass and occasional abdominal pain lasting for 2 years for further examination. A solid tumor at the right side of the abdomen was detected by ultrasonography and computed tomography. A barium study of the upper gastrointestinal tract showed a doudenal tumor, stenosis suggesting intussusception, and non-rotation of the midgut. Gastrointestinal fiberscope confirmed a 40 × 40 mm sized papillary tumor in the duodenum. She underwent laparotomy. During surgery, we found a midgut non-rotation, and duodeno-jejunal intussusception headed by the duodenal tumor. Ladd's procedure and pancreatoduodenectomy were performed, because we could not rule out a possible malignancy. Pathologically the duodenal tumor was tubular adenoma. In this case both intestinal malrotation caused by some embryonal abnormality and the duodenal tumor intermittently induced weak invagination of the duodenum into the jejunum or jejunum into the jejunum that had not been strangulated.

Duodenojejunal intussusception secondary to a duodenal lipoma presenting in a young boy

A case of duodenojejunal intussusception secondary to a single multilobulated duodenal lipoma mimicking acute pancreatitis in a 12-year-old boy is presented. Duodenojejunal intussusception is a rare entity because of the somewhat fixed position of the duodenum within the retroperitoneum.

Duodenojejunal Intussusception Secondary to Hamartomatous Polyp of Brunner's Glands

SummaryA case of duodenojejunal intussusception secondary to a large hamartomatous polyp of Brunner's glands was reported in a 15‐year‐old girl. Despite a great preponderance of ileocolic intussusception in childhood, this is the first reported case of duodenojejunal intussusception occurring in that age group. The diagnosis was not made by clinical examination; complete duodenal obstruction was shown in upper gastrointestinal series and by endoscopy. The intussusception was reduced manually at laparotomy, and the polyp was excised. Pathological examination revealed a preponderance of normal‐appearing Brunner's glands in the tumor, consistent with the diagnosis of Brunner's gland hamartoma.

Duodenojejunal Intussusception Secondary to Hamartomatous Polyp of Brunnerʼs Glands

A case of duodenojejunal intussusception secondary to a large hamartomatous polyp of Brunner's glands was reported in a 15-year-old girl. Despite a great preponderance of ileocolic intussusception in childhood, this is the first reported case of duodenojejunal intussusception occurring in that age group. The diagnosis was not made by clinical examination; complete duodenal obstruction was shown in upper gastrointestinal series and by endoscopy. The intussusception was reduced manually at laparotomy, and the polyp was excised. Pathological examination revealed a preponderance of normal-appearing Brunner's glands in the tumor, consistent with the diagnosis of Brunner's gland hamartoma.