Gastrogastric Intussusception Research Articles

Gastro-Gastric Intussusception After Roux-en-Y Gastric Bypass: Case Report and Literature Review of an Unusual Complication

Gastro-Gastric Intussusception After Roux-en-Y Gastric Bypass: Case Report and Literature Review of an Unusual Complication

Gastrogastric intussusception and acute pancreatitis caused by a large pyloric gland adenoma treated with endoscopic submucosal dissection

Video 1Gastrogastric intussusception and acute pancreatitis caused by a large pyloric gland adenoma treated with endoscopic submucosal dissection: A 75-year-old woman with a several-week history of intermittent postprandial nausea and vomiting presented to the emergency room after experiencing syncope, following several hours of persistent abdominal pain, nausea, and vomiting. A contrast-enhanced CT scan of the abdomen and pelvis was arranged. Axial images show gastrogastric intussusception with the intussusceptum, indicated by the dashed lines, telescoping into the intussuscipiens indicated by the arrowheads. There is a lobulated mass indicated by the asterisk, serving as the lead point for the intussusception, and there is also a small volume of fluid indicated by the arrow, which delineates the mass from the duodenum. In the coronal images, we can again see a long-segment intussusception indicated by the dashed line with a lobulated mass indicated by the asterisk serving as the lead point and extending into the proximal duodenum. Then the lobulated mass occupying and expanding the duodenal lumen can be seen, indicated by the asterisk. Upon entry into the stomach through endoscopy, the gastrogastric intussusception can be seen. The lobulated mass serving as the lead point can be seen being pulled distally. With air insufflation, the intussusception spontaneously resolved. With continued insufflation, within a few minutes, the native confirmation of the polyp was established. It was located in the proximal body along the greater curve with a lobulated appearance with a Paris 1sp morphology. In addition, there was panatrophy in the background mucosa, which was consistent with autoimmune atrophic gastritis that was subsequently confirmed on histopathology and positive anti-parietal cell antibiotics. An EUS was performed and did not show any evidence of T2 disease. Doppler showed large central feeding vessel. A plan was made for endoscopic submucosal dissection (ESD). The strategy for the ESD was an initial circumferential incision and trimming with subsequent application of multipoint traction. After a circumferential incision, a rich vascular supply is seen. After completion of the incision and trimming, the snare was advanced over the scope and the clip advanced through the instrument channel. Multiple clips were then used to secure the snare to the distal end of the lesion. With traction applied, access to the submucosa became much easier and the ESD proceeded easily. For the final remnant of submucosa, it was more easily dissected in a forward view. Chess is one of the merits of multipoint traction in that traction can be applied both proximally and distally to the lesion. The lesion was resected en bloc. The specimen was retrieved using the attached snare, but unfortunately, some of the friable head was fragmented because of its large size, yet the base remained intact. Final pathology demonstrated PGD+HGD with clear margins vertically and laterally along the base. This case of gastrogastric intussusception, causing gastric outlet obstruction and acute pancreatitis secondary to a large pyloric gland adenoma, highlights several rare clinical entities. First, gastrogastric intussusception in adults is an exceptionally rare phenomenon, with only a few documented cases reported in the literature. Second, in the case of large gastric neoplasms causing intussusception, rarely the neoplasm may extend down into the duodenum and obstruct the ampulla of Vater causing acute pancreatitis. Furthermore, pyloric gland adenomas are rare gastric neoplasms that tend to be polypoid in morphology and are associated with autoimmune gastritis, predominantly occurring in female patients, as in this case. Lastly, the traditional management for lesions causing gastroduodenal intussusception is surgical because of the risk of malignancy. However, in this case, the patient underwent successful curative and therapeutic endoscopic resection with ESD.

Gastro gastric intussusception in the setting of unclear lead point Radiological imaging

Intussusception is defined as telescoping or invagination of the proximal part of the gastrointestinal tract (intussusceptum) into an adjacent section (intussuscipiens) which results in obliteration of the lumen [1-2]. It is considered as a form of bowel obstruction as it accounts for only 1-5% of cases of bowel obstruction [3]. Intussusception in children can occur at any site in the GI tract, and it often presents similar clinical and radiographic features at all sites. These characteristic features are the key to diagnose intussusception even at unusual sites [4]. While Intussusception is a common diagnosis among children, it is in fact a rare condition in adults with the incidence of approximately 2-3 per 1,000,000 per year [5-6]. Adult intussusception is usually presented with vaguely unusual symptoms where the use of EUS and CT is extremely useful to aid in diagnosis [1-7]. Our case presents an even rarer type of Intussusception called Gastro-gastric Intussusception. According to multiple sources it consists of only 10% of the adult Intussusceptions [7-8].

A Teenager With Acute Abdominal Mass: A Case of Gastro-Gastric Intussusception

A previously healthy 17-year-old boy presented to the emergency department with worsening left upper quadrant abdominal pain, a history of nonbloody, nonbilious emesis for 2 days, more recent bloody emesis for 1 day, and an abdominal “mass.” He had eaten dinner as usual 3 days earlier and gone to sleep. He woke up that morning with abdominal pain and felt a “mass” in the left side of his upper abdomen, which he stated would decrease in size by applying pressure. He started vomiting the same day, which initially contained food contents and exacerbated his pain.

Gastrogastric Intussusception Secondary to Gastrointestinal Stromal Tumour: a Case Report

Intussusception is rare in adults and accounts for only 1–5% of cases of bowel obstruction; in the majority of cases, it is secondary to a lead point and most commonly occurs as ileocolic intussusception; gastrogastric intussusception is extremely rare. The case of a 60-year-old lady with gastrogastric intussusception secondary to a gastric gastrointestinal tumour is reported and the relevant literature briefly reviewed.

S3047 Intussusception: A Rare Presentation in the Proximal GI Tract

INTRODUCTION: Intussusception is a well-documented cause of bowel obstruction in pediatrics but is infrequently encountered in adults, accounting for less than 5% of all cases of intussusception. Typically observed in the small or large bowel, intussusception involving the stomach is rare. We present a unique case of gastro-gastric intussusception due to gastric adenocarcinoma arising in a pyloric gland adenoma with high grade dysplasia, with previous literature demonstrating only 5 other cases in the setting of an adenoma/adenocarcinoma. CASE DESCRIPTION/METHODS: A 57 year-old Caucasian female without significant past medical history presented with intermittent abdominal pain, nausea, vomiting, and weight loss for 3 months. Her labs on admission were notable for hypokalemia and hypomagnesemia, but were otherwise normal. A CT scan showed thickening of the gastric body with concern for gastro-gastric intussusception and underlying neoplasm (Figure 1). The surgical team requested an endoscopy by gastroenterology for biopsy and attempt at reduction, which confirmed the presence of gastric intussusception, beginning at 50 cm with a large, partially circumferential, frond-like mass noted in the gastric body, extending down into the intussusception. Multiple attempts were made to traverse the mass, but were unsuccessful and the pylorus was unable to be visualized nor was the intussusception able to be reduced. Multiple biopsies of the gastric mass were obtained during the procedure, demonstrating hyperplastic polyp tissue with low-grade dysplasia and negative for H. pylori (Figure 2). Two days later, the patient underwent a distal gastrectomy with Roux-en-Y gastrojejunostomy; intraoperative pathology revealed a hyperplastic polyp with high-grade dysplasia. Definitive pathology from the surgical specimen revealed a well-to-moderately differentiated adenocarcinoma arising from a 9 cm foveolar-type gastric adenoma with high-grade dysplasia and metastasis identified in 1 of 19 lymph nodes (Figure 3). DISCUSSION: Intussusception is rarely detected in the proximal GI tract, and when present, is most commonly seen in the setting of a surgical anastomosis, foreign body, or anatomic abnormality. This is the 1st documented case of gastro-gastric intussusception associated with a pyloric type adenoma with high grade dysplasia. Histology on endoscopic biopsies showed dysplasia without malignancy, highlighting that superficial biopsies may be misleading and a high index of suspicion for underlying malignancy should be maintained.Figure 1.: CT A/P with contrast shows thickening of the gastric body with concern for gastro-gastric intussusception and underlying neoplasm, no evidence of gastric obstruction or distant metastasis noted.Figure 2.: Superficial biopsy demonstrating adenomatous epithelium (pyloric gland type).Figure 3.: Invasive front of the tumor with overlying areas of high grade dysplasia.

Ulcerated gastrointestinal stromal tumor causing a gastrogastric intussusception.

When a gastrointestinal intussusception is found, an underlying lesion should be excluded.

Gastrogastric intussusception in adults: a case report with review of the literature

Intussusception of the gastrointestinal viscera is rarely encountered in adult patients and is frequently associated with a polypoidal lead point, which is often malignant. We would like to present the case of a 68-year-old male with a history of decompensated liver disease and multiple medical comorbidities, who was discovered to have an incidental gastrogastric intussusception on CT. No polypoidal lead point was seen and we believe this to be the first case of its kind to be described. We suggest that distortions in the patient’s visceral and vascular anatomy and raised intra-abdominal pressure resulting from concomitant ascites, hiatus hernia, portal hypertension and oesophageal varices have provided an alternative mechanism for a gastrogastric intussusception to develop.

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.

Gastrogastric intussusception secondary to a gastric carcinoma: Report of a case

Intussusception is uncommon in the proximal gastrointestinal tract, although a few case reports have been published on gastroduodenal intussusception associated with an anatomical abnormality or intussusceptions at a site of gastrojejunostomy after gastric surgery. We herein present a case of gastrogastric intussusception secondary to a gastric cancer, which presented as vomiting and poor oral intake. A 73-year-old woman was diagnosed with gastric cancer during a cancer screening by esophagogastroduodenoscopy and biopsy. Twenty days later, she presented with acute vomiting, a high fever, an increased heart rate, and severe anemia. Esophagogastroduodenoscopy demonstrated that the mass had been intussuscepted into the gastric lumen and distorted the distal antrum of the stomach. Standard distal subtotal gastrectomy was performed without reduction. Her postoperative course was uneventful.

Novel bariatric technology: laparoscopic adjustable gastric banded plication: technique and preliminary results

Background The laparoscopic adjustable gastric band has been widely accepted as 1 of the safest bariatric procedures to treat morbid obesity. However, because of variations in the results and the complications that tend to arise from port adjustment, alternative procedures are needed. We have demonstrated, in a university hospital setting, the safety and feasibility of a novel technique, laparoscopic adjustable gastric banded plication, designed to improve the weight loss effect and decrease gastric band adjustment frequency. Methods We enrolled 26 patients from May 2009 to August 2010. Laparoscopic adjustable gastric banded plication was performed using 5-port surgery. We placed Swedish bands using the pars flaccida method, divided the greater omentum, and performed gastric plication below the band to 3 cm from the pylorus using a single-row continuous suture. The data were collected and analyzed pre- and postoperatively. Results The mean operative time was 87.3 minutes without any intraoperative complications. The average postoperative hospitalization was 1.33 days. The mean excess weight loss at 1, 3, 6, 9, and 12 months after surgery was 21.9%, 31.9%, 41.3%, 55.2%, and 59.5%, respectively. The mean follow-up time was 8.1 months (range 2–15), and the gastric band adjustment rate was 1.1 times per patient during this period. Two complications developed: gastrogastric intussusception and tube kinking at the subcutaneous layer. Both cases were corrected by reoperation. No mortality was observed. Conclusion Laparoscopic adjustable gastric banded plication provides both restrictive and reductive effects and is reversible. The technique is safe, feasible, and reproducible and can be used as an alternative bariatric procedure. Comparative studies and long-term follow-up are necessary to confirm our findings.

True Gastrogastric Intussusception: A Rare Radiologic Diagnosis with Surgical Correlation

True Gastrogastric Intussusception: A Rare Radiologic Diagnosis with Surgical Correlation

A CASE OF GASTRIC INTUSSUSCEPTION AFTER AN OPERATION FOR A COLONIC CANCER WHICH WAS CAUSED BY AN INDWELT DORAINAGE TUBE

A 73-year-old man was admitted to another hospital because of abdominal pain and diagnosed as intestinal obstruction. About one moth later a right hemicolectomy was performed with a diagnosis of cecal cancer. On and after the 8th postoperative day he became suffered from frequent vomiting. The patient was referred to the hospital. Upper gastrointestinal series showed deformity and obstruction of the distal stomach. Endoscopic examination revealed the anterior wall of the antrum protruding into the prepylorus. From these findings the pyloric obstruction due to extrinsic pressure on the anterior wall of the antrum was supposed and the patient was operated on. On lapalotomy, it was gastric intussusception due to extrinsic pressure of a drain indwelt after the hemicolectomy and the intussusception was reduced. We commonly address gastroduodenal intussuception due to a gastric tumor or gastrojejunal intussusception after distal gastrectomy as gastric intussuseception. So far there has been no case report of gastrogastric intussusception caused by extrinsic pressure outside the stomach, and this occurrence is also a rare complication of drainage.

GASTROGASTRIC INTUSSUSCEPTION IN A DOG

A three‐year‐old, intact male, Rottweiler is presented with a gastrogastric intussusception. This is one of only two known reports of gastrogastric intussusception in the dog. Lateral and ventrodorsal radiographs and ultrasound revealed a gastric mass, however the diagnosis of gastrogastric intussusception was made during surgery. The patient in this report had no associated tumor and the pyloric antrum was the intussusceptum. Cause of the intussusception is unknown.

Gastro-gastric Intussusception Produced by Pedunculated Intragastric Tumour

Gastro-gastric Intussusception Produced by Pedunculated Intragastric Tumour