Early Diagnosis Of Intussusception Research Articles

S1981 Adult Intussusception: Finding a Lead on a Rare Case

Introduction: Bowel intussusception is defined as a telescoping proximal loop within the distal loop of bowel, obliterating the bowel lumen. Although over 95% of cases occur in the pediatric population; intussusception in adults is strongly associated with tumors, with malignancy rates accounting for approximately half of all adult cases. Case Description/Methods: A 37-year-old female with no known past medical history presented to the Emergency Department complaining of suddenly worsening non-localized abdominal pain and distension. She reports a 5-day history of intermittent generalized cramps abdominal pain, which causes her to wake up several times throughout the night. Associated symptoms include anorexia, non-bloody emesis, and constipation, followed by small volume loose stools. Her physical exam was significant for generalized abdominal tenderness. Initial laboratory work-up with CBC, CMP, lipase and CRP were unrevealing except for a low serum bicarbonate (19). CT abdomen with contrast demonstrated a large colonic intussusception from the ascending colon to the splenic flexure, with suggestion of a large polyp or mass in the splenic flexure as a possible lead point (Figure). The patient underwent an exploratory laparotomy with right hemicolectomy and lymphadenectomy. Pathology of the resected colon was consistent with a Plasmablastic neoplasm involving the ileocecal valve. All surgical margins and 27 resected lymph nodes were negative. Discussion: Adult intussusception is a rare cause of bowel obstruction (< 1% on adult causes) that carries a high risk of complications, if not emergently identified and treated. Nonspecific abdominal pain is the most common clinical presentation of Adult Intussusception. The triad of red current jelly stool, colicky abdominal pain, and a palpable sausage-shaped mass; classically seen with children, is rarely present in the adult presentation. Due to high rates of malignancy, adult cases are traditionally treated with a large en-bloc resection. Early diagnosis of intussusception in adults requires a high level of clinical suspicion. Failing to recognize this may lead to complications such as bowel ischemia and perforation. Treatment in adults requires urgent operative management with oncologic resection and further investigation.Figure 1.: Left: Coronal CT revealing large colonic intussusception with lead point (yellow arrow). Right: Sagittal CT demonstrating target sign (green arrow).

Nghiên cứu các yếu tố xác định tháo lồng bằng phẫu thuật ở trẻ em dưới 2 tuổi bị lồng ruột cấp

FACTORS DETERMINING OF OPERATIVE REDUCTION IN ACUTE INTUSSUSCETION OF CHILDREN Background: Intussusception is the common cause of small intestinal obstruction in children under two years old. Late diagnosis can lead to a potentially worse condition. This prospective study aims to describe the clinical manifestation and develop the conservative management protocol for acute ileocaecal intussusception in children undertwo years old. Methods: This prospective study was carried out in 118 consecutive patients under two years old. Patients presented with symptoms and signs of acute intestinal obstruction and diagnosis of ileocaecal intussusception confirmed by ultrasound were included in this study. All the patients were managed with either pneumatic reduction or operation. Results: There were 70 boys and 48 girls ranging in age from three months to two years with a median of 12.5 months. Clinical presentation included abdominal pain (100%), vomiting (82.2%), bloody stool (11.9%) and a palpable mass (43.2%). Patients hospitalized with the symptoms and signs less than 24 hours were accounted for 80.5% of cases. The overall success rate of pneumatic reduction was 98.3%. Late hospital admission (≥ 24 hours from illness onset), bloody stool and presenting with the classic triad of symptoms of intussusception were found as the factors which correlated to the surgical management outcome. All patients were well recovery without any complication. The median of postoperative hospital stay was two days for pneumatic reduction group and six days for operation group. Conclusion: Early diagnosis of intussusception contributes the success of pneumatic reduction and reduces the requires of surgical intervention. Key words: intussusception, pneumatic reduction, surgical intervention.

Detection of intussusception by point-of-care ultrasound at emergency department: a case report

Case Report A 80-year-old man, with hypertension, hyperlipidemia, and secondary parkinsonism, presented to our ED due to intermittent periumbilical pain for hours. Initial vital signs were stable except high blood pressure (T:36.3’C P:62 beats/min R:18 breaths/min BP:178/91mmHg). Physical examination showed right side abdominal tenderness and positive peritoneal sign. He denied fever, dyspnea, nausea/vomiting, diarrhea, tarry or bloody stool passage, nor trauma history. Point-of-care Ultrasound (POC-US) was performed by ED physician revealing the target sign (Figure 1) and the pseudokidney sign (Figure 2) over right side abdomen without obvious fluid accumulation in the peritoneum. Abdominal computerized tomography (CT) with contrast enhancement was further done reporting highly suspecting ileocolic intussusception (Figure 3). Emergent laparotomy revealed ileocecal intussusception with one polypoid tumor on terminal ileum which might be the leading point. Right hemicolectomy with LN dissection and ileo-transverse anastomosis were done. He was discharged days later and had follow-up at Outpatient Department. Discussion Intussusception refers to a process in which a segment of intestine invaginates into the adjoining intestinal lumen.In adults, intussusception accounts only for less than 5 percent of mechanical bowel obstructions.12Typically, it's owing to pathologic lead point within the bowel, which is 50 percent due to malignancy. 34Among adults, intermittent abdominal pain may be the most common presentation. Due to low incidence rate and unspecified presentation among adults, the diagnosis isn't often made until abdominal computerized tomography (CT) was done. In this situation, point-of-care ultrasound (POC-US) can be helpful to have early diagnosis of intussusception and early intervention in order to avoid necrosis or perforation of intestines. In our patient, intermittent periumbilical pain was the initial presentation. POC-US was performed by ED physician and under impression of intussusception, further abdominal CT and GS consultation were arranged right away. Early diagnosis and early intervention may avoid further necrosis or perforation of intestines. By using POC-US, ED physicians could rapidly detect specified lesions by real-time images and could detect the dynamic changes. And, most important, POC-US is a non-invasive and radiation-free tool that may be used as the primary tool to screen acute abdominal emergencies.

Reducing the Time in Making the Diagnosis and Improving Workflow With Point-of-Care Ultrasound

During the past decade, point-of-care ultrasound (POC US) has been increasingly performed in emergency medicine for a variety of indications. However, pediatric emergency physicians have been slower to understand the importance of POC US in the diagnosis of critical care cases. This study aimed to illustrate the usefulness of POC US in improving workflow in the emergency department (ED) with an early diagnosis in a critically ill child by a pediatric emergency attending physician. On arrival to the ED, an early diagnosis of intussusception was made using real-time POC US by a pediatric emergency medicine attending physician well trained in pediatric US. This report illustrates the impact that POC US can make during an early diagnosis of intussusception. With thorough knowledge of the US features characteristic of intussusception, its accurate diagnosis using POC US has the potential to reduce morbidity and mortality as well as improve patient flow and throughput time in the ED.

Strangulating Ileocolic Intussusception in Pregnancy

Intestinal obstruction in general, and intussusceptions in particular, is an uncommon clinical event which may complicate pregnancy with significant maternal and fetal mortality. We report a case of strangulating ileocolic intussusception during pregnancy at 22 weeks of gestation and its successful management. The usefulness of ultrasound in early diagnosis of intussusception in pregnancy is briefly discussed.

Decreasing morbidity and improving workflow with point‐of‐care ultrasound in the Emergency Department

Point‐of‐Care Ultrasound (POC US) has been increasingly performed in emergency medicine for a variety of indications. However, pediatric emergency physicians have been slower to understand the importance of POC US in the diagnosis of critical care cases.Here I report a case of a two year‐old male that presented to the emergency department (ED) with vomiting and abdominal pain. On arrival to the ED, an immediate diagnosis of intussusception was made using real‐time POC US by a pediatric emergency attending well trained in pediatric US. This illustrates the impact that POC US can make with an early diagnosis of intussusception. This diagnosis is best made by an experienced sonographer, such as the radiologist. However, in some pediatric hospitals, radiology department US may not be readily available. The intussusception mass is a large structure and characteristically does not contain any bowel gas, which makes it readily identifiable with US. Studies have shown that extensive training and experience is not necessary for high accuracy in diagnosing intussusception.With thorough knowledge of the US features characteristic of intussusception, its accurate diagnosis using POC US has the potential to reduce morbidity and mortality as well as improve patient flow, work flow and throughput time in the ED. Training of pediatric emergency physicians in POC US is highly advised.

Intussusception in pregnancy: report of a case

A 35 year old Gravida 10 Para 8+1 (7 alive) presented with three months amenorrhoea and acute onset of abdominal pain with vomiting and constipation. Clinical and sonological evaluations were supportive of an intussusception occurring in a first trimester twin pregnancy. She was resuscitated and had ileal resection with end to end anastomosis. She subsequently had home delivery at term with resultant perinatal death of the second twin and severe anaemia. As intestinal obstruction is a rare but serious event in pregnancy, the importance of high index of suspicion in the evaluation of abdominal pain in pregnancy is emphasised. The usefulness of ultrasound in the early diagnosis of intussusception in pregnancy is discussed.

398: Diagnostic Accuracy of an Abdominal Radiograph With Predictive Signs and Symptoms for Intussusception

Early diagnosis of intussusception is vital to prevent morbidity and mortality. The classic signs and symptoms of intussusception are vomiting, abdominal pain, right upper quandrant (RUQ) mass, and bloody stools. Abdominal radiography and ultrasonography can assist in the diagnosis although physicians may rely on the clinical picture and a highly suggestive abdominal radiograph to proceed directly to barium enema, which is both diagnostic and therapeutic. The objective of the study was to compare the accuracy of an abdominal radiograph combined with predictive signs and symptoms of intussusception and compare that to the diagnostic accuracy of an abdominal ultrasound.

Sonographic Findings of Intussusception in Peutz-Jeghers Syndrome — A Case Report and Review of the Literature

Peutz-Jeghers syndrome is a rare hereditary disorder characterized by polyps in the gastrointestinal tract and focal mucocutaneous pigmentation. Some patients also suffer from intussusception. Early diagnosis of intussusception in patients with Peutz-Jeghers syndrome is important. With clear past history taking and sonographic examination, an exact diagnosis can be made preoperatively. Here, we present a patient with Peutz-Jeghers syndrome in whom sonography was used to detect intussusception when he presented with acute abdomen. The symptoms were relieved by surgical treatment.

Intrauterine Intussusception and Ileal Atresia Presenting as Acute Perforation

A case is reported of a girl born by caesarean section at 28 weeks gestation who developed an acute perforation of the ileum due to intussuspetion 11 days after birth. This was treated successfully by resection of the affected segment of ileum and by performing a temporary ileostomy followed by end-to-end anastomosis. She made a complete recovery. This case also demonstrates the difficulty of early diagnosis of intussusception in the neonatal period.

The Early Diagnosis of Intussusception

The Early Diagnosis of Intussusception