Intestinal Intussusception Research Articles

Acute Intestinal Intussusception Complicated By Peritonitis by Ileal Perforation in Pregnancy Apropos of a Case in the General and Visceral Surgery Department of the Ignace Deen National Hospital

Acute intussusception is a rare manifestation in adults, most often of malignant tumoral origin occurring on a small intestine loop. Its presence in a pregnant woman with a complication such as peritonitis by ileal perforation is an extremely rare case. We report a clinical case concerning a 32-year-old woman, amenorrhoeic for 24 weeks, referred to the general and visceral surgery department of the Ignace Deen National Hospital for acute intestinal obstruction in pregnancy in whom, after performing an X-ray of the abdomen without preparation which revealed mixed hydro-aeric levels and a biological assessment, she was taken to the block, at the celiotomy purulent liquid flowed out and the exploration revealed a pudding of ileo-coeco-colic intussusception whose disinvagination revealed three ileal perforations with respective diameters of 1.5cm, 2cm and 3cm located respectively 10cm, 30cm and 50cm from the ileocecal junction with pre-perforation zones. We performed a resection removing the perforations followed by an end-to-side ascending ileocecal anastomosis. The post-operative course was marred by complications such as evisceration, disembowelment and the birth of a full-term stillborn.

Factors associated with in-hospital recurrence of intestinal intussusception in children.

A minority of children experience in-hospital recurrence of intestinal intussusception after treatment. This study investigated the factors associated with in-hospital recurrence of intussusception in pediatric patients in China. This retrospective study included patients aged 0-18 years-old with intestinal intussusception treated at Hainan Women and Children's Medical Center between January 2019 and December 2019. Demographic and clinical characteristics were extracted from the medical records. Factors associated with in-hospital recurrence of intussusception were identified by logistic regression analysis. The analysis included 624 children (400 boys) with a median age of 1.8 years (range, 2 months and 6 days to 9 years). Seventy-three children (11.7%) had in-hospital recurrence of intussusception after successful reduction with air enema. Multivariate logistic regression analysis identified age > 1 year-old (odds ratio [OR]: 7.65; 95% confidence interval [95%CI]: 2.70-21.71; P < 0.001), secondary intestinal intussusception (OR: 14.40; 95%CI: 4.31-48.14; P < 0.001) and mesenteric lymph node enlargement (OR: 1.90; 95%CI: 1.13-3.18; P = 0.015) as factors independently associated with in-hospital recurrence of intussusception. Age > 1 year-old, secondary intussusception and mesenteric lymph node enlargement were independently associated with increased odds of in-hospital recurrence of intussusception after successful reduction with air enema.

Ileocolic Intussusception on Ileal Lipoma: A Case Report and Literature Review

Acute intestinal intussusception is a rare condition in adults. In the majority of cases, it is secondary to a tumor, which can be benign or malignant. Intestinal intussusception caused by a lipoma is exceptionally rare. We report a case of ileocolic intussusception caused by an ileal lipoma.

Laparoscopic Reduction of Sigmoidorectal Intussusception by a Modified Hutchinson’s Maneuver

Traditionally, adult intestinal intussusception is treated using Hutchinson’s maneuver, i.e., manual proximal bowel compression and reduction of intussusception. However, the lack of manual contact in laparoscopic surgery limits the application of Hutchinson’s maneuver. Moreover, when the lead point is located distal to the peritoneal refection, and the intussusception cannot be reduced prior to bowel resection, stoma construction (e.g., Hartmann surgery or abdominoperineal resection) becomes necessary. Here, we report a case of sigmoidorectal intussusception treated laparoscopically using a modified Hutchinson’s maneuver. A 74-year-old man was diagnosed with sigmoidorectal intussusception caused by sigmoid colon cancer. Colonoscopy revealed a malignant-appearing obstructing mass telescoping into the rectum, with the lead point at 3 cm from the anal verge. During the endoscopic examination, the lead point did not move. A biopsy of the mass showed adenocarcinoma, leading to a diagnosis of sigmoid cancer with sigmoidorectal intussusception. Since the patient had no symptoms of intestinal ischemia, and defecations were observed, elective laparoscopic surgery was planned. Intraoperatively, an attempt was made to pull out the intussuscepted segment proximally, but the presence of fibrous adhesions made the intussusception irreducible. Therefore, the rectum and mesorectum were mobilized completely up to the level of the levator ani so that the lower rectum could be wrapped with gauze on the anal side of the lead point of the intussusception. The gauze was then pulled up to the oral side and simultaneously, a surgeon pushed the distal end of the intussuscepted segment up using a laparoscopic bowel grasper, with another surgeon pushing the lead point through the anus with fingers. Thereby, the intussusception was reduced to some extent, allowing for low anterior resection. The resected specimen contained an ulcerated moderately differentiated adenocarcinoma of the sigmoid colon measuring 3.5 cm × 3.0 cm, combined with circumferential ischemia with mucosal loss and necrosis over an 8 cm length on the distal side of the tumor. The tumor was stage III (T3 N1). We provide a laparoscopic approach for treating intussusception using a modified Hutchinson’s maneuver. This method will be useful in reducing the intussuscepted segment while avoiding stoma construction.

Double origin of an occlusion after gastric bypass: Intestinal intussusception contained in a Petersen hernia.

Roux-en-Y gastric bypass (RYGB) is a surgical technique described in 1970 and performed laparoscopically since 1993. Occlusions are late complications that most often occur more than 6months after surgery. Internal hernias and intussusception are the two clinical situations that can occur after RYGB. The presentation is that of an occlusion or chronic abdominal pain. Diagnosis can be made by imaging, including abdominal and pelvic CT scans, with ingestion and injection of contrast agents if possible. Treatment is based on surgical exploration.

Intestinal intussusception due to Vanek’s tumour: A rare cause of intestinal obstruction in adults

Intestinal intussusception due to Vanek’s tumour: A rare cause of intestinal obstruction in adults

Intestinal Intussusception Secondary to Appendiceal Mucocele, Report of a Case in A 53-Year-Old Female

Appendiceal intussusception is defined as the invagination of a portion of the appendix into its own lumen or into that of the cecum. In adults, the most common etiology is endometriosis (33%), followed by appendiceal mucocele (19%) and appendiceal inflammation (19%) [4]. Symptoms may be absent or mild. Lower abdominal pain or mass may be confused with appendicitis or tuboovarian mass in women. The diagnosis of appendiceal mucocele is often difficult preoperatively, even with the use of imaging. The definitive diagnosis is by histopathology. Treatment is surgical resection with care. Do not spill the contents, to prevent peritoneal pseudomyxoma with a poor prognosis [2]. In the present work, a 53-year-old female is reported with a 72-hour evolution of abdominal pain in the mesogastrium, accompanied by nausea and vomiting, normal vital signs on physical examination, without acute abdominal symptoms, with laboratories within normal parameters. , a computed tomography of the abdomen is taken which reports extensive intussusception at the ileocecal level which extends to the transverse colon, adjacent neoplastic etiology must be ruled out. An exploratory laparotomy was performed, finding intussusception of the ileum in the transverse colon with a 5 x 5 cm blind sentence, for which it was decided to perform a right hemicolectomy + mechanical lateral ileotransverse anastomosis. Patient with favorable evolution, hospitalized for 6 days.

Clinical manifestation of canine Coronavirus enteritis and intestinal intussusception as its complication

Clinical manifestation of canine Coronavirus enteritis and intestinal intussusception as its complication

A clinical case of small intestinal intussusception caused by metastatic melanoma

Intestinal obstruction is observed in about 9.0 % of patients with acute surgical pathology of the abdominal cavity. The disease occurs at any age, but more often between 25–50 years. Mixed intestinal obstruction is only 3–7 %. The most common form of mixed intestinal obstruction is intestinal invasion. The most common cause of intussusception in adults is an intestinal tumor. Early diagnosis and the optimal amount of surgical treatment are the main components of successful treatment of the patient.&#x0D; Aim: to familiarize practitioners with a rare case of intestinal obstruction in adults and its management strategies in a surgical hospital.&#x0D; Materials and methods. The patient was treated in the surgical department of the Communal Non-Profit Enterprise “City Hospital No. 7” Zaporizhzhia City Consul. The patient underwent preoperative preparation and surgical intervention.&#x0D; Results. The patient underwent an emergency median laparotomy under total intravenous anesthesia with artificial lung ventilation. During the examination of the abdominal cavity, multiple distended loops of the small intestine were visualized. During the revision, at a distance of 1.5 meters from the ligament of Treitz, a volumetric formation of the small intestine of dense-elastic consistency, represented by small-intestinal invasion, up to 10 cm long, was detected. The proximal sections of the small intestine are distended, light purple in color. The sections of the small intestine that were distal to the site of invasion were inflamed. Manual disinvagination of the small intestine was performed. The visual examination showed that the intestine was viable. There was a tumor was found on the antrumeral margin, measuring 1.8 × 2.5 cm, dense in consistency, finely tuberculated, dark purple heterogeneous in color, infiltrating and deforming the wall of the small intestine. Resection of the invaded area of the small intestine with the tumor was performed with the imposition of a small-small intestinal anastomosis “side to side” with two-row nylon sutures.&#x0D; Conclusions. In this clinical case, it was possible to establish the final diagnosis and determine further surgical strategy only intraoperatively. Only early diagnosis of melanoma will allow avoiding the complications identified in this patient.

Cancer Risk of Peutz-Jeghers Syndrome and Treatment Experience: A Chinese Medical Center.

Peutz-Jeghers syndrome (PJS), also known as hereditary mucocutaneous pigmented gastrointestinal polyposis, is a clinically rare autosomal dominant genetic disease, which falls into the category of hereditary colorectal cancer. There are ∼7,000 new cases of PJS in China every year, and 170,000 PJS patients may survive for a long time in society. PJS polyps are characterized by an early age of onset, difficult diagnosis and treatment, and easy recurrence. With repeated growth, polyps can lead to serious complications such as intestinal obstruction, intussusception, gastrointestinal bleeding, and cancerization, which cause serious clinical problems. Due to repeated hospitalization and endoscopic follow-up, PJS patients and their families suffer from great physical and mental pain and economic burden. With the in-depth understanding of PJS and the development and popularization of endoscopic techniques in the past decade, an integrated treatment modality based on endoscopy plus surgery has gradually become the preferred treatment in most hospitals, which greatly improves the quality of life of PJS patients. However, there is still a lack of effective drug prevention and cure means. In this paper, the current clinical treatment means for PJS polyps were summarized by literature review combined with the treatment experience of our medical center, with a focus on their clinical diagnosis, treatment, and cancer risk.

Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management

ObjectiveIntestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. Materials and methodsThis retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged <16 years. Thus, 21 cases in adults (mean age, 57 years) were analyzed. ResultsThe most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumours were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). ConclusionsCT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its aetiology and therapeutic management.

Intestinal intussusception in a child with Peutz-Jeghers syndrome: case report.

A clinical observation of a 5-year-old patient with a complicated course of PJS is presented. Emphasis on recurring episodes of acute abdomen, clinical diagnosis including polyp histopathology, and surgical management is emphasised. While an inpatient, bloodwork demonstrated severe iron deficiency anaemia (haemoglobin 72g/l, red blood cell 3.1×1012/l) and multiple melanin pigmentations measuring 2-4mm in size on the lip mucosa during a physical examination. Erosive duodenopathy and polyposis of the stomach were discovered via fibroesophagogastroduodenoscopy (multiple gastric polyps 5-10mm in size). Acute intussusception of the intestine was discovered by ultrasonography. A mid-median laparotomy was performed alongside manual disinvagination with gut viability intact. Histopathology of excised polyps revealed smooth muscle hyperplasia and Ki67 protein (MIB-1) positivity with small intestinal hamartomatous polyps seen macroscopically. Conservative management was initiated for standard postoperative care and intestinal motility. Patient was discharged 9 days postoperatively. Based on literature data, modern ideas concerning aetiology, diagnosis, and management of patients with PJS are considered. Attention is focused on the high risk of developing cancer of various localisation in PJS, recommendations are given for cancer screening and clinical observation of patients with hereditary gastrointestinal syndromes in childhood.

Role of artificial intelligence in oncologic emergencies: a narrative review.

Oncologic emergencies are a wide spectrum of oncologic conditions caused directly by malignancies or their treatment. Oncologic emergencies may be classified according to the underlying physiopathology in metabolic, hematologic, and structural conditions. In the latter, radiologists have a pivotal role, through an accurate diagnosis useful to provide optimal patient care. Structural conditions may involve the central nervous system, thorax, or abdomen, and emergency radiologists have to know the characteristics imaging findings of each one of them. The number of oncologic emergencies is growing due to the increased incidence of malignancies in the general population and also to the improved survival of these patients thanks to the advances in cancer treatment. Artificial intelligence (AI) could be a solution to assist emergency radiologists with this rapidly increasing workload. To our knowledge, AI applications in the setting of the oncologic emergency are mostly underexplored, probably due to the relatively low number of oncologic emergencies and the difficulty in training algorithms. However, cancer emergencies are defined by the cause and not by a specific pattern of radiological symptoms and signs. Therefore, it can be expected that AI algorithms developed for the detection of these emergencies in the non-oncological field can be transferred to the clinical setting of oncologic emergency. In this review, a craniocaudal approach was followed and central nervous system, thoracic, and abdominal oncologic emergencies have been addressed regarding the AI applications reported in literature. Among the central nervous system emergencies, AI applications have been reported for brain herniation and spinal cord compression. In the thoracic district the addressed emergencies were pulmonary embolism, cardiac tamponade and pneumothorax. Pneumothorax was the most frequently described application for AI, to improve sensibility and to reduce the time-to-diagnosis. Finally, regarding abdominal emergencies, AI applications for abdominal hemorrhage, intestinal obstruction, intestinal perforation, and intestinal intussusception have been described.

A brief review of diagnostic properties of point-of-care ultrasound for adult bowel intussusception: Making the case for ultrasound.

Undifferentiated abdominal pain in adults is a common chief complaint in acute care clinics and emergency departments worldwide, representing up to 10% of visits to emergency departments. Many patients have a non-specific presentation and an initial workup with labwork, urine analysis or X-ray might not reveal a specific diagnosis. Although bowel intussusception is a primarily pediatric disease, adult intussusception is a recognized but rare cause of bowel obstruction often requiring surgical intervention. However, recent data from advanced multi-detector computed tomography imaging shows that milder or recurring cases in adults have been underrecognized. Multi-detector computed tomography is still the imaging gold standard for detecting intussusception in adults, but new data showed that sonographers with basic training using the point-of-care ultrasound approach have a reasonable accuracy in detecting this pathology. As the point-of-care ultrasound for undifferentiated abdominal pain is an emerging core skill in the acute care setting, knowledge of sonographic signs of intestinal intussusception should be included in the skill set of physicians. Sonographic findings in adults mimic pediatric cases, but different location patterns and higher malignancy rates exist in adults. In this manuscript, we will review the current literature on adult intussusception and summarize key knowledge of intestinal intussusception in adults. We will present four adult patients diagnosed with different types of adult acute bowel intussusception using the point-of-care ultrasound and describe a focused scanning approach with typical sonographic findings.

Intestinal Intussusception in Adults

Acute intestinal intussusception is a pathology of infants and small children. Its occurrence in adults is very unusual. It is of various etiologies. In the vast majority of cases, it is secondary to a tumour which may be benign or malignant. A benign fibrous tumour of Meckel’s diverticulum revealed by intestinal intussusception is a very rare entity. We report the case of a 42-year-old female patient admitted to the emergency department of the Mohammed VI University Hospital in Marrakech, Morocco, for an intestinal obstruction. Abdominal CT scan showed an acute ileocecal intestinal intussusception, associated with a tumor lesion of 25 cm in diameter. Treatment was open surgical carcinological resection. Pathological and immunohistochemical examination of the surgical specimen concluded that the tumour was benign Meckel’s diverticulum. Intestinal intussusception is a rare condition in adults. It most often leads to the discovery of an organic cause which may be tumour. From this new case and after analysis of the literature, we discuss the clinical and diagnostic characteristics and the therapeutic possibilities of this rare pathology.

Peutz-Jeghers syndrome from the point of view of a radiologist and an endoscopist

INTRODUCTION: Peutz-Jeghers syndrome (PJS) is a rare (orphan) hereditary disease with a family history, primarily characterized by massive polyposis of the gastrointestinal tract and its complications. Every year, the syndrome is registered in 1 patient per 25,000–300,000 population. OBJECTIVE: To demonstrate the effectiveness of the combined use of diagnostic radiology and endoscopic imaging techniques in the diagnosis of this syndrome and its complications. A case report of a patient aged 47 years is given. A patient complained of persistent gastrointestinal bleeding, thrombosis of the arteries of the upper extremity, ventral hernia after the elimination of intestinal intussusception. A patient was admitted to the A. V. Vishnevsky NMRC of Surgery of the Ministry of Health of Russia (Moscow) to determine the tactics of treatment. Computed tomography of the abdominal organs and CT angiography of the upper extremities, esophagogastroduodenoscopy and colonoscopy were performed. CONCLUSION: The difficulties of the diagnosis and treatment of PJS and its associated complications were illustrated. A brief review of the literature (21 publications) by Russian and foreign authors on the problems of diagnosis, clinical manifestations and treatment of PJS were performed. According to the performed studies, total gastrointestinal polyposis, thrombosis of the arteries of the upper left limb, ventral postoperative hernia were revealed. Taking into account the ongoing complications of PJS, the patient was prescribed a gastrectomy.

Single-incision laparoscopic surgery for intestinal intussusception due to neuroendocrine tumor

BackgroundSmall intestinal neuroendocrine tumor (NET) is uncommon, but intestinal intussusception caused by NET is even rare. We report a rare case of single-incision laparoscopic surgery (SILS) for intestinal intussusception due to NET G1.Case presentationA 72-year-old woman presented with vomiting, diarrhea, and abdominal pain. Contrast-enhanced computed tomography (CT) revealed the target sign in the ascending colon. An enhanced nodule was detected at the lead point, leading us to suspect a tumor. Colonoscopy showed a tumor at the lead point of the intestinal intussusception. Histological findings led to a diagnosis of NET G1. Single-incision laparoscopic ileocecal resection with regional lymphadenectomy was then performed. The patient was discharged 10 days postoperatively with no complications.ConclusionWe achieved SILS with regional lymphadenectomy for preoperatively diagnosed intestinal intussusception due to NET G1. Although this condition is rare, surgeons should take this possibility into consideration in cases showing similar findings.

INTUSSUSCEPTIONIS IN ADULT, CASE REPORT OF ACUTE INTUSSUSCEPTIONON DUE TO METASTASIS FROM A TESTICULAR TUMOR

Intestinal intussusception is a rare pathology in adulthood and often secondary to an organic cause, reporting the observation of a young 36-year-old patient with no particular pathological history, who was diagnosed with intussusception due to metastasis of a testicular tumor.

A retrospective review of small intestinal intussusception in 126 cattle in Switzerland.

Intussusception is a form of ileus of the intestines in which an oral intestinal segment slides into the adjacent aboral intestinal segment, causing obstruction of the bowel. We analysed the medical records of 126 cattle with intussusception of the small intestine. Demeanour and appetite were abnormal in 123 cattle. Non-specific signs of pain occurred in 26.2%, signs of visceral pain in 46.8% and signs of parietal pain in 56.4%. Intestinal motility was decreased or absent in 93.7% of the cattle. The most common findings of transrectal palpation were rumen dilation (37.3%) and dilated small intestines (24.6%). In 96% of the cattle, the rectum was empty or contained little faeces. The principal laboratory findings were hypokalaemia (89.6%), hypocalcaemia (76.5%), base excess (72.9%), hypochloraemia (71.8%), azotaemia (62.1%) and haemoconcentration (61.1%). The main ultrasonographic findings were reduced or absent intestinal motility (98.2%) and dilated small intestines (96.0%). A diagnosis of ileus was made in 87.8% and a diagnosis of ileus attributable to intussusception was made in another 9.8%. Right-flank laparotomy was carried out in 114 cattle. Fifty-six (44.4%) cows were discharged. Clinical findings of intussusception in cattle are often non-specific. Ultrasonography may be required to diagnose ileus.

Bannayan Zonana Syndrome: An Unusual Cause of Intussusception and Protein Losing Enteropathy in a Child

Bannayan-Zonana syndrome (BRRS) is a rare genetic disorder characterized by macrocephaly, numerous soft tissue and visceral hamartomas, and lipomas. Because of the risk of fatal bleeding and visceral neoplasia in adulthood, recognizing this disease is critical. We reported a new pediatric case of BRRS in an 18-month-old female infant with lipomas, macrocephaly, and gastrointestinal hamartomatous polyps that prompted ileo-ileal intussusception and protein-losing enteropathy. Patients with BRRS require a comprehensive approach. Our case is unique in its sporadic occurrence and the presence of protein-losing enteropathy as a gastrointestinal polyposis manifestation. Pediatric patients with multiple lipomas, protein-losing enteropathy, and intestinal intussusception should be assessed for BRRS.