Ileocolic Intussusception Research Articles

Intussusception of the appendix secondary to endometriosis: a case report.

Intussusception of the appendiceal endometriosis is rare. Although approximately 200 cases of appendiceal intussusception have been reported in the literature, very few have ever been diagnosed preoperatively. Here, we report the case of intussusception of the appendiceal endometriosis with laparoscopic ileocecal resection. A woman in her 50s presented to the out-patients clinic with epigastric pain lasting for a several month. Contrast-enhanced computed tomography (CT) scanning revealed ileocolic intussusception in which a cecum polypoid mass lesion extended to the hepatic flexure of the ascending colon. A colonoscopy showed a large pedunculated polyp in the cecum. Laparoscopic ileocecal resection was performed. Pathology confirmed an invaginated appendix demonstrating endometriosis implants. Possible intrinsic causes of intussusception are varied, appendiceal intussusception secondary to endometriosis is extremely rare. Intussusception of the appendix is a rare finding, often mistaken for a polyp. We suggest considering inverted appendix as a differential diagnosis when investigating cecal lesions.

Bronchiolite inconsolabile, l'addome è trattabile?

Some viruses, such as adenovirus, have been associated with an increased risk of intussusception, although the link in community infections is less clear than with the rotavirus vaccine. The paper presents the case of a 3-month-old infant hospitalized for bronchiolitis, who subsequently developed irritability and gastrointestinal bleeding and refused to eat. The diagnosis of ileocolic intussusception was confirmed via barium enema and required urgent laparotomy for reduction. The post-operative course was uneventful with discharge on the fifth day. This case highlights the importance of monitoring infants with bronchiolitis to find possible signs of intussusception.

Ileocolic Intussusception Due to Low-Grade Appendiceal Mucinous Neoplasm.

We report a rare case of low-grade appendiceal mucinous neoplasm (LAMN) causing ileocolic intussusception. The case underscores the importance of considering ileocolic intussusception in differential diagnoses for nonspecific gastrointestinal symptoms. Early diagnosis via contrast-enhanced CT and scrupulous surgical intervention are crucial for favorable outcomes.

Practice variation in the management of pediatric intussusception: a narrative review.

This review has identified practice variations in several key areas of ileocolic intussusception management. The findings underscore the need for further research in these areas and the establishment of uniform standards aimed at improving the care of children with ileocolic intussusception. • Ileocolic intussusception necessitates rapid diagnosis and a collaborative treatment approach involving emergency medicine, radiology, surgery, and often anesthesia. • A previous study reported variations in the practice of pain management and sedation among these patients. • This narrative review identified practice variations in several key areas within the diagnostic and treatment pathways of ileocolic intussusception.

Association of Time Since Diagnosis of Pediatric Ileocolic Intussusception With Success of Attempted Reduction: Analysis in 1065 Patients.

BACKGROUND: Radiologists generally treat pediatric ileocolic intussusceptions emergently given potential worse outcomes from delayed reduction attempts. However, relevant literature is conflicting. OBJECTIVE: To identify factors associated with successful image-guided ileocolic intussusception reduction in children, with attention to the time interval since diagnosis. METHODS: This retrospective study included patients <6 years old who underwent attempted image-guided enema reduction of ileocolic intussusception between May 2009 and July 2023. Patients were separated into two groups: those presenting directly to the institution (nontransferred patients, who all underwent attempted reduction <8 hours after ultrasound diagnosis), and those transferred from outside facilities. EHR data were extracted. Each patient's first image-guided reduction attempt was classified as successful or unsuccessful. Univariable and multivariable analyses were performed. RESULTS: The study included 1065 patients (649 male, 416 female; mean age, 18.1 months; age range, 2.2-71.0 months; 793 nontransferred and 272 transferred patients). In nontransferred patients, the mean interval between ultrasound diagnosis and reduction attempt was 150.8 minutes; in transferred patients, the mean interval between outside facility advanced imaging and reduction attempt was 460.1 minutes (p<.001). Successful reduction occurred in 84.6% and 81.6% of nontransferred and transferred patients, respectively (p=.25). In nontransferred patients, success occurred in 85.6% of attempts <2 hours after diagnosis versus 84.0% of attempts 2-<8 hours after diagnosis (p=.54); the mean interval from diagnosis to attempted reduction was 149.7 minutes and 156.8 minutes for successful and unsuccessful attempts, respectively (p=.53). In multivariable analysis, factors showing independent associations with success were proximal intussusception location (OR=3.63, p<.001) and absence of high-risk ultrasound findings (OR=2.57, p<.001); success was not independently associated with age, sex, bloody stools, reduction method, or time since diagnosis <2 hours (p>.05). In transferred patients, the mean interval from outside advanced imaging to attempted reduction was 463.1 minutes and 440.2 minutes for successful and unsuccessful attempts, respectively (p=.74). CONCLUSION: Intussusception reduction may not require completion emergently (within 2 hours after diagnosis), but potentially may be safely performed on an urgent basis (within 8 hours). CLINICAL IMPACT: The findings have implications for determining the standard of care, including criteria for oncall activation of radiologic resources, in pediatric intussusception management.

PEUTZ-JEGHERS POLYP AS A LEAD POINT FOR ILEOCOLIC INTUSSUSCEPTION IN A YOUNG FEMALE: A CASE REPORT

Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. It is common in children, and idiopathic ileocolic intussusception is the most common form. It is rare in adults, and again, hamartomatous polyposis is a rare cause of intussusception in adults. But, this complication is most frequent for patients with Peutz-Jeghers syndrome (PJS). It represents 5% of all intussusceptions and accounts for only 1–5% of intestinal obstruction in adults. PJS is a clinical diagnosis based on any one of the following World Health Organization criteria: three or more histologically confirmed Peutz-Jeghers polyps; any number of PJ polyps with a family history of PJS; characteristic, prominent, mucocutaneous pigmentation with a family history of PJS; or any number of Peutz-Jeghers polyps and characteristic prominent, mucocutaneous pigmentation. Here we report a case of intussusceptions in a 21 y old male with underlying PJ polyp in the intestine and mucocutaneous pigmentation.

Gastrointestinal Stromal Tumor of Small Intestine Presenting with Ileocolic Intussusception in an Adult - A Rare Case with Review of Literature

Gastrointestinal Stromal Tumor of Small Intestine Presenting with Ileocolic Intussusception in an Adult - A Rare Case with Review of Literature

An unusual case of longest intussusceptum without any pathological lead point in an adult: A rare case report from a peripheral tertiary care institute of Eastern India

Bowel obstruction is known to be caused by intussusception, which is far more common in pediatric patients. The majority of people with adult intussusception require a predisposing cause, which might be a benign lesion, a malignant lesion, or an irregularity of the intestinal wall such as inflammatory bowel disease. Adult intussusception is a very rare condition. We present the case of a patient presenting with upper abdominal pain, nausea, vomiting, and weakness. The patient had ongoing mild intermittent abdominal pain for months which was investigated with an upper gastrointestinal endoscopy that showed gastritis. There were features of peritonism on clinical examination and this was associated with raised inflammatory markers. A contrast-enhanced multidetector computed tomography (MDCT) scan showed a long-segment telescoping of the ileum into the cecum with ascending colon with proximal bowel distension suggesting bowel obstruction: Ileocolic intussusception. The patient underwent emergency surgical resection with a double-barrel stoma. Histopathology assessment did not identify a causative factor for the intussusception. An uncommon instance of adult idiopathic enteroenteric intussusception is presented here. The diagnosis can be established with the use of the clinical history of chronic intermittent abdominal pain, entire abdomen ultrasonography, and abdomen MDCT. In patients who are unstable and exhibit indications of peritonitis, surgery remains the only choice, even though a more cautious strategy is outlined in the literature. Adult intussusception is a rare and challenging diagnosis to make. Individuals suffering from intussusception may experience prolonged bouts of sporadic abdominal pain that intensify suddenly as a result of acute obstruction. The most helpful investigative technique for confirming the intussusception diagnosis is CT.

Хірургічні ускладнення пурпури Шенляйн-Геноха в дітей

Henoch-Schönlein purpura is the systemic pathology that affected the small vessels of the skin, gastrointestinal tract, kidneys, and joints. Typical clinical manifestation of Henoch-Schönlein purpura include palpable purpura, abdominal pain syndrome, arthralgia, renal involvement, and, in some children, externa genitalia involvement. The aim of this study was to present the own experience in the management of three children with the surgical complications of Henoch-Schönlein purpura. The own experience includes three children with Henoch-Schönlein purpura, particularly two children with ileum intussusception (both of 3 years old) and one patient of 4 years old with the syndrome “acute scrotum”. Gastrointestinal involvement may appear in most of patients with Henoch-Schönlein purpura and intussusception is the most common complication, which require the urgent treatment. Appearance of typical palpable purpura followed the abdominal pain syndrome and ultrasonography is the main method of diagnostic in this group of patients. Ileum and ileocolic are the common types of intussusception in children with Henoch-Schönlein purpura. The main method of treatment in case of ileum intussusception is surgical reduction, while in case of ileocolic intussusception non-surgical reduction can be applied. Besides the typical manifestation of Henoch-Schönlein purpura, in some children could be the scrotal involvement, which developing after appearance of palpable purpura, and rare caused by inflammation or torsion of testis or hydatid. It is believed that patients with Henoch-Schönlein purpura and scrotal involvement have more severe clinical course when compared with patients with abdominal manifestation, which agreed with our observation. Conclusions. In children older than one year, with the abdominal pain, with or without bloody stools, and ultrasonographic signs of intussusception, it is necessary consider about possibility the presence of Henoch-Schönlein purpura in these patients. In children with Henoch-Schönlein purpura despite the corticosteroids’ treatment, could be developed the syndrome of “acute scrotum”, which required emergent surgery. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the authors.

Antegrade long giant ileocolic intussusception via colon–cecum cancer lead points: case report with focus on the sign of the python colon

BackgroundIleocolic intussusception is a rare condition that is difficult to diagnose. A pathological lead point, usually malignant, is often the cause of adult intussusception. In emergency scenarios, radiologists must be able to identify this entity and its causes and express their opinions on associated complications.Case presentationThe hospital's emergency room admitted a 75-year-old woman who was suffering from intermittent abdominal pain and constipation. An abdominal contrast-enhanced computed tomography revealed a long giant ileocolic intussusception. Considering the clinical stability and the absence of signs of complications on CT, the patient did not undergo an urgent surgical procedure but underwent a colonoscopy the following day. Surprisingly, the colonoscopy highlighted the spontaneous resolution and revealed the presence of the three tumour lead points in the cecum and ascending colon. A CT was performed after the colonoscopy, confirming the intussusception's resolution. The surgeon performed a right oncological hemicolectomy. The malignant lead points on histological examination were moderate to poorly differentiated adenocarcinomas.ConclusionsA giant and long ileocolic intussusception with a long embedded visceral segment (the python colon sign) could suggest pathological lead points in the cecum and ascending colon. Despite the large size, a spontaneous resolution of the python colon is possible. In this scenario, even if, on imaging, it is impossible to macroscopically identify a lead point, in cases of giant and long ileocolic intussusceptions, every effort must be undertaken to search for the cause of the intussusception.

A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children.

Surgery remains the mainstay in treating intussusception in developing nations. A correspondingly high bowel resection rate exists despite a shift to nonoperative reduction in high-income countries. We aimed to study the clinical profile of the patients with intussusception presenting to our hospital and to assess the clinical and radiological predictors of success or failure of nonoperative management of intussusception. This prospective study was conducted in the Department of Pediatric Surgery over a period of 3 years and included a total of 118 patients who presenting to our emergency division with features suggestive of intussusception and were managed accordingly either with hydrostatic reduction or by surgical intervention. We observed that the majority of the patients were males (65.5%). The mean age was 13.54 months. Intermittent pain was the most common symptom. Both pain and vomiting did not affect the outcome. Lab parameters like raised total leukocyte counts (TLC), C-reactive protein (CRP) and lactate levels were significantly associated with failure of hydrostatic reduction. Patients with air fluid levels on X-ray were more likely to end up in surgery. Ultrasound findings of bowel wall edema, aperistaltic gut loops and a pathological lead point was associated with failure of hydrostatic reduction as well. The overall success rate of hydrostatic reduction was 85.5%. Hydrostatic reduction of intussusception is a safe and effective method of management of intussusception whenever indicated. Factors that might reduce the chance of its success include continuous pain, irritability, tenderness, deranged lab parameters like TLC, CRP and lactate levels, air fluid levels on X-ray, bowel wall edema, aperistalsis and the presence of a lead point. Shah JY, Banday I, Hamdani HZ, et al. A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children. Euroasian J Hepato-Gastroenterol 2024;14(1):81-85.

Impact of a 6–12-h delay between ileocolic intussusception diagnostic US and fluoroscopic reduction on patients’ outcomes

BackgroundImage-guided reduction of intussusception is considered a radiologic urgency requiring 24-h radiologist and technologist availability.ObjectiveTo assess whether a delay of 6–12 h between US diagnosis and fluoroscopic reduction of ileocolic intussusception affects the success frequency of fluoroscopic reduction.Materials and methodsRetrospective review of 0–5-year-olds undergoing fluoroscopic reduction for ileocolic intussusception from 2013 to 2023. Exclusions were small bowel intussusception, self-reduced intussusception, first fluoroscopic reduction attempt>12 h after US, prior bowel surgery, inpatient status, and patient transferred for recurrent intussusception. Data collected included demographics, symptoms, air/contrast enema selection, radiation dose, reduction failure, 48-h recurrence, surgery, length of stay, and complications. Comparisons between<6-h and 6–12-h delays after ultrasound diagnosis were made using chi-square, Fisher’s exact test, and Mann–Whitney U tests (P< 0.05 considered significant).ResultsOf 438 included patients, 387 (88.4%) were reduced in <6 h (median age 1.4 years) and 51 (11.7%) were reduced between 6 and 12 h (median age 2.05 years), with median reduction times of 1:42 and 7:07 h, respectively. There were no significant differences between the groups for reduction success (<6 h 87.3% vs. 6–12 h 94.1%; P-value = 0.16), need for surgery (<6 h 11.1% vs. 6–12 h 3.9%; P-value=0.112), recurrence of intussusception within 48 h after reduction (<6 h 9.3% vs. 6–12 h 15.7%; P-value=0.154), or length of hospitalization (<6 h 21:07 h vs. 6–12 h 20:03 h; P-value=0.662).ConclusionA delay of 6–12 h between diagnosis and fluoroscopic reduction of ileocolic intussusception is not associated with reduced fluoroscopic reduction success, need for surgical intervention after attempted reduction, recurrence of intussusception following successful reduction, or hospitalization duration after reduction.Graphical

Inflammatory fibroid polyp– a rare aetiology for adult ileocolic intussusception

We report a case of an adult ileocolic intussusception secondary to an inflammatory fibroid polyp (IFP), a rare and unexpected association between a surgical condition, and an underlying histopathological process. Intussusception is an uncommon surgical diagnosis in adults, and an IFP is rare mesenchymal tumour. Surgical intervention of the intussusception in an adult patient, given the uncertain aetiology of the lead point, is recommended as gold standard.

Adult Ileocolic Intussusception Secondary to Cecal Lipoma: A Case Report

Adult Ileocolic Intussusception Secondary to Cecal Lipoma: A Case Report

Ileostomies for severely ill children with ileo-colic intussusception: our experience at the University of Uyo Teaching Hospital

Context: Complicated intussusception is associated with life-threatening intestinal gangrene and peritonitis. In critically ill children, a primary ileocolic anastomosis may increase their morbidity and mortality and, thus, a temporary ileostomy may be a safer option. Objective: The purpose of this study is to report the indications, outcomes, and complications after temporary ileostomies for infants with ileocolic intussusception in our institution. Materials and methods: This was a retrospective study of infants who had ileostomies created in our institution following complicated ileocolic intussusceptions between January 2014 and December 2022. The indications, postoperative complications, duration of hospital stay, and recovery were noted and compared. Results: Thirty-four infants had ileostomies created for complicated ileocolic intussusception during this period. There were 13 girls and 21 boys aged 3-10 months (median = 6 months). The indications for ileostomy were intestinal gangrene, colonic perforation, peritonitis, and haemodynamic instability. Ileostomies were created in the primary surgery in 24 patients while 10 had stomas created as a secondary procedure following an anastomotic dehiscence. Postoperative complications occurred in 25 patients (73.5%). Four children died shortly after surgery from the primary disease, while one child died from re-feeding syndrome. Children who required stoma creation following dehiscence of a primary anastomosis had more complications, a longer hospital stay, and a longer delay in commencing feeds. However, there was no difference in mortality rates or time of stoma closure. Conclusion: Temporary ileostomies could potentially reduce intussusception-related mortality and morbidity, ultimately improving the outcome of very ill infants.

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.

Ileal Lipoma - A Rare Cause of Ileocolic Intussusception in Adults: Case Report and Literature Review

Intestinal intussusception in adults is rare, accounting for only 5% of intestinal intussusception and almost 1%-5% of intestinal obstruction [1, 2]. The condition is detected in less than 1 in 1300 abdominal operations in 100 patients operated for intestinal obstruction. The intestinal intussusception of the adult often leads to the discovery of an organic cause that can be a tumor or not, the ratio of children to adults is greater than 20:1. We describe a rare case of ileocolic intussusception in an adult secondary to an ileal lipoma.

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.

A POCUS-first pathway to streamline care for children with suspected ileocolic intussusception.

As point-of-care ultrasound (POCUS) has emerged as a valuable tool for intussusception screening, this quality improvement study aimed to implement a "POCUS-first" pathway in a Pediatric Emergency Department (ED) to streamline workflow and expedite care for children with suspected intussusception. This was a prospective analysis of children diagnosed with ileocolic intussusception in a Pediatric ED between June 2022 and June 2023. The study compared the "POCUS-first" cohort with the group receiving only radiology-performed ultrasound. Key outcomes included physician initial assessment to radiology-performed US time and physician initial assessment to reduction time. Continuous improvement efforts incorporated pediatric emergency medicine physician training, education, and pathway dissemination through plan-do-study-act cycles. The study included 29 patients in the "POCUS-first" pathway group and 70 patients in the non-POCUS group. The "POCUS-first" pathway demonstrated a significantly shorter physician initial assessment to reduction time compared to the non-POCUS group (170.7min vs. 240.6min, p = 0.02). Among non-transferred patients, the "POCUS-first" group also had a significantly shorter emergency department length of stay (386min vs. 544min, p = 0.047). Implementation of a "POCUS-first" pathway for managing ileocolic intussusception led to notable improvements in process efficiency. The shorter physician initial assessment to reduction time highlights the potential for expedited decision-making and intervention. These study findings support the potential of this pathway to optimize the management and outcomes of children with ileocolic intussusception.

Clinical presentation and management outcome of pediatric intussusception at Wolaita Sodo University Comprehensive Specialized Hospital: a retrospective cross-sectional study.

To assess the pattern of clinical presentations and factors associated with the management outcome of pediatric intussusception among children treated at Wolaita Sodo University Comprehensive Specialized Hospital, Ethiopia. This retrospective cross-sectional study included the medical records of 103 children treated for intussusception from 2018 to 2020. The data collected were analyzed using SPSS 25.0 (IBM Corp., Armonk, NY, USA). In total, 84 (81.6%) patients were released with a favorable outcome. Ileocolic intussusception was a positive predictor, with a nine-fold higher likelihood of a favorable outcome than other types of intussusception [adjusted odds ratio (AOR), 9.16; 95% confidence interval (CI), 2.39-21.2]. Additionally, a favorable outcome was three times more likely in patients who did than did not undergo manual reduction (AOR, 3.08; 95% CI, 3.05-5.48). Patients aged <1 year were 96% less likely to have a positive outcome than those aged >4 years (AOR, 0.04; 95% CI, 0.03-0.57). Most patients were discharged with favorable outcomes. Having ileocolic intussusception and undergoing manual reduction were associated with significantly more favorable outcomes of pediatric intussusception. Therefore, nonsurgical management such as hydrostatic enema and pneumatic reduction is recommended to reduce hospital discharge of patients with unfavorable outcomes.