Idiopathic Ileocolic Intussusception Research Articles

Idiopathic Ileocolonic Intussusception in the Elderly: Case Report and Literature Review

Background: Adult intussusception is rare, in sharp contrast to childhood intussusception. It’s often considered a distinct disease entity from the paediatric intussusception because of dissimilarities in the aetiology, clinical presentation and management options. Operative treatment is mandatory for the management of colonic intussusception in the adult patient as many cases are associated with bowel tumours. Case presentation: An 86-year-old male retired civil servant presented with clinical and radiological features of ileocolonic intussusception. He had extended right hemicolectomy. The histology revealed an idiopathic ileocolic intussusception without an associated bowel tumour. He made an uneventful recovery and was discharged on the 8th day after surgery. Conclusion: Adult intussusception is not only rarer than the childhood disease, but requires mandatory surgical operation for treatment. This case involving an elderly patient in his 9th decade of life is reported to highlight the deviation from the usual pattern of presentation of this disease in an adult patient.

The impact of social distancing during the COVID-19 pandemic on rates of pediatric idiopathic intussusception.

BackgroundThe causes of idiopathic ileocolic intussusception are unknown, with infection as the most likely culprit. Recently, social distancing measures were implemented during the coronavirus disease 2019 (COVID-19) pandemic to decrease transmissible infectious diseases, creating an opportune setting to study the role of infection on the pathogenesis of intussusception on a population level.ObjectiveTo investigate the impact of social distancing on intussusception.Materials and methodsWe retrospectively reviewed air contrast enemas and pylorus ultrasounds performed between March 2010 and March 2021 to identify cases of ileocolic intussusception and hypertrophic pyloric stenosis (HPS), using the latter as a negative control. The study time frame was divided into two periods: pre-pandemic (March 2010–February 2020) and pandemic (April 2020–March 2021). The number of cases that occurred in these two time periods were compared using the Poisson regression model.ResultsOf the 407 cases of idiopathic ileocolic intussusception identified, 396 occurred in the pre-pandemic time period (mean = 39.6 per 12-month period) and 11 occurred in the 12-month pandemic time period. The mean monthly number of intussusceptions showed a decline of 72% (95% confidence interval [CI] 49–85%) between the pre-pandemic and pandemic time periods (3.3 vs. 0.9 monthly cases; P < 0.001). In contrast, the mean monthly number of HPS did not differ significantly (P = 0.19).ConclusionSocial distancing—imposed to curb the spread of infection during the COVID-19 pandemic—resulted in a significant decline in ileocolic intussusception, lending strong support to the theory that infection is the dominant cause of intussusception.

Intususcepción intestinal en la población pediátrica vs. población adulta

La intususcepción intestinal se define como la invaginación de un segmento del intestino en un segmento inmediatamente adyacente. Su forma más frecuente en la población pediátrica es la intususcepción idiopática de tipo ileocólica, la cual es considerada una de las urgencias abdominales más frecuentes. Ésta es tratada de manera general por medio de una reducción no quirúrgica, tal como un enema neumático y/o hidrostático. En la población adulta, por su parte, la presencia de intususcepción es poco común y ocurre con mayor frecuencia en el intestino delgado que en el colon. En la mayoría de los casos en esta población, la intususcepción se asocia con un punto pivote patológico que provoca la presencia de síntomas de obstrucción intestinal. Generalmente, la invaginación a nivel de intestino delgado tiene una etiología benigna, aunque cuando es maligna se asocia con mayor frecuencia a una enfermedad metastásica difusa. Por el contrario, la etiología maligna en la invaginación intestinal de tipo ileocólica y colónica se encuentra con mayor frecuencia asociada a un adenocarcinoma primario. De manera general, su diagnóstico se realiza de forma intraoperatoria o mediante imágenes transversales, tales como TAC o RMN del abdomen, permitiendo diagnosticar más fácilmente las intususcepciones asintomáticas y/o transitorias, las cuales pueden observarse adecuadamente sin ninguna intervención. Por su parte, en los casos que este justificada la intervención quirúrgica en la población adulta, se realiza una resección intestinal de tipo oncológico, esto debido a la frecuente asociación con malignidad de la intususcepción en dicho grupo de edad.

Rotavirus: Preventive Vaccines and a Rare Side Effect

Rotaviruses are the most common cause of diarrhoeal disease among infants. Till now 108 countries have introduced rotavirus vaccines to prevent severe diarrhea. The Global Rotavirus Surveillance Network (GRSN) was established by WHO in 2008. Some studies reported that rotavirus vaccination can lead to a small increase in the risk of intussusception, a type of bowel blockage. This is a rare side effect. Intussusception, death of tissue of the intestinal wall due to lack of blood supply may cause life-threatening complications if left untreated. In infants idiopathic ileocolic intussusception is the most common form typically managed with operative or non operative reduction like hydrostatic or pneumatic enemas. Whereas, in adults and older children, intussusception is not very common and occurs more often in the colon of small intestine, pathogenesis is lead point in most of the symptomatic cases. Numerous countries have scrupulously noted the occurrence of intussusception post vaccination, and others yet to introduce the vaccine are gathering base line data on the incidence of intussusception which is an important safety issue in determining vaccine policy. However, it should be noted that naturally occurring intussusception, although rare, does occur in the very young. Due to heavy burden of rotavirus, some developing countries have introduced rotavirus vaccines. In India it is now part of the national immunization programme. Hospitalizations and deaths from rotavirus have been averted significantly because vaccination far exceeded the reported cases of intussusception with vaccination. The underlying rationale behind the differing risk of intussusception after rotavirus vaccination in various countries is not yet determined, therefore continuous monitoring is necessary.

Rate of Spontaneous Resolution of Idiopathic Ileocolic Intussusception

Rate of Spontaneous Resolution of Idiopathic Ileocolic Intussusception

Intestinal Intussusception: Etiology, Diagnosis, and Treatment.

Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. Idiopathic ileocolic intussusception is the most common form in children and is typically managed with nonoperative reduction via pneumatic and/or hydrostatic enemas. In the adult population, intussusception is uncommon and occurs more often in the small intestine than in the colon. It is associated with lead point pathology in most symptomatic cases presenting as bowel obstruction. When lead point pathology is present in adult small bowel intussusception, it is usually benign, though when malignant it is most frequently due to diffuse metastatic disease, for example, melanoma. In contrast, adult ileocolic and colonic intussusception lead point pathology is most frequently primary adenocarcinoma when malignant. The diagnosis is typically made intraoperatively or by cross-sectional imaging. With increasingly frequent CT/MRI of the adult abdomen in the current era, transient and/or asymptomatic intussusceptions are increasingly found and may often be appropriately observed without intervention. When intervention in the adult population is warranted, usually oncologic bowel resection is performed due to the association with lead point pathology.

Idiopathic postoperative ileo-colic intussusception in an adult with rectal cancer

A 39-year-old female presented with symptoms of complete gut obstruction caused by a locally advanced rectal malignancy. She underwent a mini-laparotomy and creation of a proximal transverse loop colostomy (TLC). No other points of obstruction were noted. Post-operatively, clinical and radiological evidence of gut obstruction prompted a re-exploration. This revealed an ileo-colic intussusception. A right hemicolectomy was performed. No identifiable lead point was documented. The patient later underwent long course chemoradiation to address the locally advanced tumor. She, eventually, had a low anterior resection. In this study, it was illustrated that prompt and vigilant detection of such rare occurrences allow for the institution of a management plan that maintains adherence to oncologic principles.

Treatment of adult idiopathic ileocolic intussusception with non-operative reduction under fluoroscopic guidance

Treatment of adult idiopathic ileocolic intussusception with non-operative reduction under fluoroscopic guidance

Invagination intestinale aiguë du nourrisson et de l’enfant

Intussusception is the most common abdominal emergency in infancy and early childhood, but it can occur at any age. The penetration of an intestinal segment into the distal contiguous segment causes obstruction of the digestive lumen and vascular compression at the neck level. The radiologist's role is essential for diagnosis as well as for treatment. Sonography (US) has become the gold standard to diagnose or exclude intussusception. US detects an intestinal mass of 20 to 45mm in anteroposterior diameter, with a doughnut or target shape centered by the invaginated segment and its meso. It enables identification of the anatomic form, suspicion of vascular compromise, and depiction of a focal pathological leadpoint, providing guidance for therapeutic management. An enema is performed solely for therapeutic reasons. US may also be indicated to guide hydrostatic enema, to check for a successful reduction and to detect recurrence during follow-up. Idiopathic ileocolic intussusception, by far the most common form, is due to lymphoid hyperplasia of the ileocecal area. It is usually reduced by enema therapy. Surgery should be undertaken only when there is an ischemic bowel and/or a pathological leadpoint. In contrast, pathological small bowel intussusception is very rare and produces bowel obstruction. It is associated with a predisposing condition (recent surgery, Henoch-Schonlein purpura, cystic fibrosis, Peutz-Jeghers syndrome) and/or with a pathologic leadpoint (Meckel's diverticulum, localized Burkitt lymphoma, cystic duplication, polyp). It usually requires surgery except in proven disseminated lymphoma where chemotherapy can produce spontaneous reduction. Colocolic invagination, exceptional, is secondary. It is easily reduced by therapeutic enema, but will recur if the leadpoint (polyp) is not removed. Transient small bowel intussusception is very frequent, small (10 to 19mm in anteroposterior diameter), peristaltic, with no bowel obstruction and reduces spontaneously. It must be differentiated from pathological intussusceptions.

Adenomyoma of the small intestine a rare pathological lead point for intussusception in an infant.

IntroductionIntussusception is a typical abdominal emergency in early childhood.Case descriptionWe report a case of an infant in the typically affected age group with an intussusception triggered by a rare benign intramural intestinal adenomyoma as a pathological lead point. The infant had the typical symptoms of a recurrent idiopathic ileocolic intussusception.Discussion and evaluationIdiopathic intussusception is frequent in the infant age group. Contrary to that, reports on pathological lead points for intussusceptions are sparse in the toddler age.ConclusionsThat case illustrates that even in intussusceptions in the typically affected age group, it is important to be aware of pathological lead points, especially if the intussusceptions are recurrent.

External manual reduction of paediatric idiopathic ileocolic intussusception with US assistance: a new, standardised, effective and safe manoeuvre

The ultimate goal in the management of paediatric ileocolic intussusception is to achieve non-operative reduction and therefore patient cure. The standard non-surgical treatment consists of enema (air or liquid media). The purpose of this study is to present external manual reduction for paediatric ileocolic intussusception. We present a new manoeuvre that is standardised, simple, safe and effective for the radiologist in the non-surgical management of this pathology. External manual reduction is performed under sedation. Execution of the manoeuvre is detailed and illustrated. The procedure was carried out 15 times in 13 paediatric patients with idiopathic ileocolic intussusception. Complete reduction exclusively by external manual reduction was accomplished on 12 occasions (80%). In the remaining three procedures, partial reduction to the cecum was obtained. Subsequent enema achieved complete reduction in two. Overall non-surgical reduction rate was 93%. External manual reduction is a radiation-free, safe and effective procedure. In case of incomplete reduction, it facilitates enema performance. External manual reduction incorporates and additional initial step in the non-surgical reduction of intussusception and should be considered a first-line procedure.

External manual reduction of paediatric idiopathic ileocolic intussusception with ultrasound assistance

After submission of our paper published in this issue of Pediatric Radiology [1], we had the opportunity to perform external manual reduction in two additional children. The first was an 8-month-old boy whose symptoms included pain and nonbilious vomiting for 12 h. He had an intussusception reaching the transverse colon without trapped fluid or significant adenopathy. While the boy was under sedation, successful and uneventful external manual reduction was achieved in approximately 10 min. The boy was observed for 1 1/2h in the post-anaesthesia care unit, then transferred to the ward and discharged after a total hospital stay of 72 h. This was our 16th procedure. The second child, who was encountered after this work was presented at the 2012 European Society of Paediatric Radiology meeting, was a 9-month-old boy with symptoms of remaining in a prostrate position with bilious vomiting and blood in the stool for 6 h. He had an intussusception almost reaching the splenic flexure. Abdominal plain film did not show obstruction of the small bowel. On US examination, the intussusception had trapped peritoneal fluid and there was significant adenopathy and preserved blood flow. We proceeded with external manual reduction with the boy under sedation, achieving reduction up to the mid-right colon. Subsequently, we administered two hydro-enemas, reducing the intussusception with abundant reflux of liquid into the small bowel. Most of the liquid was drained out of the colon through a rectal catheter. Given the boy’s clinical condition, he was monitored in the paediatric intensive care unit, recovering at a slower rate than prior patients. Twenty-four hours after the procedure, he began experiencing progressively worsening abdominal pain. US showed fluid-filled bowel loops and no intussusception recurrence. He was observed for a few hours. He clinically worsened, and at surgery volvulus of the small bowel was found with a two-anda-half turn clockwise rotation. There was no malrotation, Meckel diverticulum, duplication or adhesion. A portion of the small bowel was resected, sparing the ileocaecal valve and terminal ileum. J. L. Vazquez (*) Department of Radiology, Complejo Hospitalario Universitario de Vigo, Rua de Pizarro 22, Vigo, Spain 36204 e-mail: luis.vazquez.castelo@sergas.es

Endoscopic treatment of a large colonic polyp as a cause of colocolonic intussusception in a child

Colocolonic intussusception is an uncommon cause of intestinal obstruction in children. The most common type is idiopathic ileocolic intussusception. However, pathologic lead points occur approximately in 5% of cases. In pediatric patients, Meckel's diverticulum is the most common lead point, followed by polyps and duplication. We present a case of recurrent colocolonic intussusception which caused colonic obstruction in a 10-year-old boy. A barium enema revealed a large polypoid mass at the transverse colon. Colonoscopy showed a colonic polyp, 3.5 centimeters in diameter, which was successfully removed by endoscopic polypectomy.

Familial intussusception

Intussusception, although a common cause of emergency in pediatric surgery, occurs rarely in more than one member in the same family. A genetic predisposition has been suggested in some cases. The authors report on 4 members of a family in 3 generations who suffered each an episode of idiopathic ileocolic intussusception over a period of 52 years. This is the only instance we found after reviewing 99 cases of intussusception in our hospital during the last 10 years. There was no recurrence of intussusception in any case, and no underlying anatomic abnormality was found in the 2 patients who underwent surgery. J Pediatr Surg 37:1549-1551. Copyright 2002, Elsevier Science (USA). All rights reserved.

Familial idiopathic intussusception: A report of two families

The authors report on two families with 5 out of 10 and two of two siblings who presented with idiopathic ileocolic intussusception. This may suggest hereditary predisposition as an etiologic factor.

Colo-Colonic Intussusception Caused by Lipoma

Intussusception is primarily seen among children, most often as idiopathic ileocolic intussusception (1, 4), and only 5 to 16% of all intussusceptions are seen in adults (1, 8). In contrast to childhood invagination, in adults underlying pathologic processes are identified in 18 to 90% (1, 8). This report presents 2 cases of colo-colonic intussusception caused by a colonic lipoma. The ultrasonic features of this benign tumour are rather characteristic. A definitive diagnosis can be provided by CT.

Colo-Colonic Intussusception Caused by Lipoma

Intussusception is primarily seen among children, most often as idiopathic ileocolic intussusception (1, 4), and only 5 to 16% of all intussusceptions are seen in adults (1, 8). In contrast to childhood invagination, in adults underlying pathologic processes are identified in 18 to 90% (1, 8).This report presents 2 cases of colo-colonic intussusception caused by a colonic lipoma. The ultrasonic features of this benign tumour are rather characteristic. A definitive diagnosis can be provided by CT.

Colo-Colonic Intussusception Caused by Lipoma

Intussusception is primarily seen among children, most often as idiopathic ileocolic intussusception (1, 4), and only 5 to 16% of all intussusceptions are seen in adults (1, 8). In contrast to childhood invagination, in adults underlying pathologic processes are identified in 18 to 90% (1, 8). This report presents 2 cases of colo-colonic intussusception caused by a colonic lipoma. The ultrasonic features of this benign tumour are rather characteristic. A definitive diagnosis can be provided by CT.