Adult Intussusception Research Articles

A rare case of adult Ileo-ileal intussusception due to inflammatory fibroid polyp

Inflammatory fibroid polyps are uncommon; moreover, that polyp causing secondary intussusception in an adult are still rarer. Here, we report a case of inflammatory fibroid polyp of the small bowel that presented as just vague pain in the abdomen in a 48-year-old woman. Even though investigations reported Ileo-ileal intussusception caused by a polyp, the patient did not have clinical symptoms that could be correlated. The rareness of the disease made it a clinical challenge to subject the patient to laparotomy. The rareness of non-neoplastic condition being the cause for adult ileo-ileal intussusception and the clinical challenge associated with it makes it a case worth reporting.

Factors predicting malignancy in adult intussusception: An experience in university-affiliated hospitals

Intussusception is one of the common causes of intestinal obstruction in children but is uncommon in adults. Unlike pediatric intussusception, most adult cases have a demonstrable etiology. The purpose of this study was to review our experience of adult intussusception and to identify the predictive factors for malignancy in this disease. We retrospectively reviewed the medical records of patients who were diagnosed with intussusception and admitted to the six Hallym University-affiliated hospitals between January 2005 and July 2016. The 77 patients had a mean age of 50.5years (range, 18-91years). Enteric intussusception is the most common type of adult intussusception (33.7%), and 11 patients (14.2%) had no definite lesion at operation. The most common symptom was abdominal pain (90.9%), and 18 (23.3%) presented with chronic symptoms. Computed tomography was the most common diagnostic modality used, with a diagnostic accuracy of 96.9%. The leading point was identified in 62 (80.5%) patients. Malignancy was more frequently present in the colonic type than in the other two types (61.5% vs. 10%, 37.9%). In a multivariate analysis, chronic symptom >14days (p=0.031) and colonic intussusception (p=0.026) were independent predictors for malignancy. Enteric intussusception is the most common type of adult intussusception, and the most common test is computed tomography. Because chronic symptoms and colonic-type intussusception were predictive factors for malignancy, en bloc resection should be considered in patients with chronic or colonic intussusception.

Adult intussusception: A case series and review.

AIMTo identify factors differentiating pathologic adult intussusception (AI) from benign causes and the need for an operative intervention. Current evidence available from the literature is discussed.METHODSThis is a case series of eleven patients over the age of 18 and a surgical consultation for “Intussusception” at a single veteran’s hospital over a five-year period (2011-2016). AI was diagnosed on computed tomography (CT) scan and or flexible endoscopy (colonoscopy). Surgical referrals were from the emergency room, endoscopy suites and the radiologists.RESULTSA total of 11 cases, 9 males and 2 females were diagnosed with AI. Median age was 58 years. Abdominal pain and change in bowel habits were most common symptoms. CT scan and or colonoscopy diagnosed AI, in ten/eleven (90%) patients. There were 6 small bowel-small bowel, 4 ileocecal, and 1 sigmoid-rectal AI. 8 patients (72%) needed an operation. Bowel resection was required and definitive pathology was diagnosed in 7 patients (63%). Five patients had malignant and 2 patients had benign etiology. Small bowel enteroscopy excluded pathology in 4 cases (37%) with AI. Younger patients tend to have a benign diagnosis.CONCLUSIONMajority of AI have malignant etiology however idiopathic intussusception is being seen more frequently. Operative intervention remains the mainstay however, certain small bowel intussusception especially in younger patients may be a benign, physiological, transient phenomenon and laparoscopy with reduction or watchful waiting may be an acceptable strategy. These patients should undergo endoscopic or capsule endoscopy to exclude intrinsic luminal lesions.

Colo-Colic Invagination on Lipoma

Intussusception in adults is rare and accounts for 1% to 5% of cases of acute bowel obstruction. Moreso, colic intussusception remains exceptional in adults and is usually secondary to an endoluminal lesion. Abdominal intestinal lipomas are rarely responsible for colonic invagination. They are often located on the caecum or the ascending colon and rarely on the left colon. We report the case of colo-colic invagination on a descending colon lipoma in a 50-year-old woman.

Ileocolic intussusception caused by a lipoma in an adult

Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.

電解質喪失症候群（EDS）を呈した直腸絨毛腫瘍の1症例

An 82-year-old woman with disturbance of consciousness was admitted to our hospital. Blood examination results showed renal failure, hyponatremia, and hypokalemia. Endocrine function was normal. Abdominal computed tomography images revealed a 53-mm tumor and intussusception in the recto-sigmoid. Contrast enema results revealed a concave pressure defect. Endoscopic examination revealed a continuous circumferential villous tumor located at 5 cm from the lower rectum, which could have intussuscepted due to peristalsis. We diagnosed EDS due to villous tumor of rectum and performed a Hartmann procedure ; the resected specimen showed a 140 × 110 mm circumferential villous tumor, and pathological investigation revealed adenocarcinoma with an adenoma component. EDS is a rare disorder characterized by a villous tumor leading to chronic secretory diarrhea which in turn leads hypokalemia, hyponatremia, and renal failure. Intussusception in adults is rare in comparison with children.

Adult Intussusception in Patients with Peutz-Jeghers Syndrome: Case Series and Review of Literature

Background: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder characterized by gastrointestinal hamartomatous polyps and mucocutaneous pigmentations in the mouth, facial skin, hands & feet. Small bowel obstruction, intussusception, bleeding, intestinal and extra-intestinal malignancies are the major complications of PJS. The aim of this study is to analyze the clinical characteristics, preoperative diagnosis, and surgical management of PJS associated-intussusception in adults. Patients and Methods: This study included 5 cases with intussusception in PJS patients presented to Surgical Oncology Unit, General Surgery Department, Tanta University Hospital, Egypt and Hamad General Hospital, Hamad Medical Corporation, Qatar, between October 2011 and March 2016. Patients’ demographics were collected. After thorough clinical examination, abdominal X-ray, US, & CT scan were done. All the patients were submitted to midline laparotomy with resection anastomosis of the affected bowel segment. Results: The mean age was 28.4 years. Female: male ratio was 3:2. Abdominal pain was the most common presenting complaint with or without intestinal obstruction manifestations. Palpable abdominal mass was found in 3 patients (60%). Intussusception was proved pre-operatively in all the cases by abdominal ultrasound and CT scan. The intussusception was found in the jejunum in 3 patients, ileum in 1 patient, & in 1 patient, there was double intussusception (one jejunal & one ileo-cecal). Histopathological examination revealed the presence of typical Peutz-Jeghers hamartomatous polyp. No morbidity or mortality was reported at a mean follow-up period of 32 months. Conclusion: Family history, physical examination, abdominal ultrasound and CT scan were important in the diagnosis of acute intussusception caused by PJS. Surgical management of PJS associated intussusception is the recommended treatment to relieve patient’s symptoms and to avoid missing underlying malignancy. Patients with PJS should be followed up throughout their lives because of the increased risk of malignant changes.

Intussusception due to colon carcinoma in a young man: An unusual presentation

Adult intussusception is a rare disease without classical symptoms. A delay in diagnosis may result in a fatal progression to complete bowel obstruction, ischemia, necrosis, and perforation. The association of a tumor with intussusception in young adults is rare. We report a case concerning a young male without a family history of bowel cancer presenting with a proximal ascending colon intussusception secondary to colonic carcinoma. This case puts insights on how intussusception and possible colon carcinoma must be included in the differential diagnosis even in young adults who have a persistent abdominal complaint. A high index of suspicion and an early computed tomography scan were required to prevent delayed diagnosis and the development of complications.

A Case of Adult Idiopathic Intussusception Reduced by Gastrografin®

A Case of Adult Idiopathic Intussusception Reduced by Gastrografin®

Secondary Small Bowel Volvulus in which Adult Intestinal Intussusception was Triggered by a Small Bowel Adipose Tumor

Secondary Small Bowel Volvulus in which Adult Intestinal Intussusception was Triggered by a Small Bowel Adipose Tumor

Endoscopic Treatment of Intussusception due to Intestinal Tuberculosis

Traditionally, adult intussusception has required a bowel resection because of the malignancy risk. A patient with anorexia, weight loss, and abdominal pain visited our clinic. A physical exam and imaging study revealed no acute peritoneal signs. A colonoscopy for biopsy and bowel reduction was attempted. The tissue sample was consistent with intestinal tuberculosis. We report intestinal tuberculosis complicating intussusception which was treated without surgical intervention.

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.

Spontaneous acute intussusception in a pregnant woman

Acute intussusception in adults is rare and particularly so in pregnant women. Its incidence ranges from 0.067% to 0.0015% (Choi et al., 2005 Choi et al. (2005) [1]). The non-specific presenting symptoms may be attributed to the pregnancy itself, making the diagnosis difficult. When it happens, however, it causes considerable morbidity and mortality for the pregnant woman and the fetus. In adults, such intussusceptions are mainly secondary to an intestinal disease and frequently a tumor.We present the case of a 21-year-old pregnant woman who was diagnosed of spontaneous acute intussusception at nine weeks of gestation and therapeutic management.

A Case Report of a Primary Intususseption in Pregnancy

Intussusception is defined as invagination of one part of the bowel into another which leads to intestinal obstruction and compromise the mesenteric blood flow with resultant inflammation and the potential for ischemia [1,2]. This condition is very rare condition in pregnancy and very difficult to diagnose due to its rarity and because of the anatomical changes of pregnancy which leads to displacement of the bowel by the gravid uterus which hamper adequate abdominal assessment as well it’s vague symptoms [3]. Usually the disease is common in pediatric age but rare in adults as 95% of cases occur in children and only 5% seen in adults [4]. Adult age intussusception is usually secondary to a lesion which is called a lead point which is present in 90% of adult intussusception and it is rare to find a primary type of intussusception (i.e. with no lead point) [4,5]. In this report we present a case of a 23 years old woman who presented at 26 weeks of her first pregnancy with vague upper abdominal pain with nausea and emesis which was thought to be either gastritis or cholecystitis. She was treated with intravenous (IV) fluid hydration and analgesics with no improvement. The patient’s clinical condition deteriorated after 3 days and re assessment showed that the abdomen was distended with absent bowel sounds and generalized tenderness with her vomiting getting worse and associated with constipation. A plain abdominal x ray showed features suggestive of intestinal obstruction which failed to improve on conservative management and the patient was counseled about doing a CT (computed tomography) to confirm the diagnosis because the safer alternative which is the MRI (Magnetic resonance imaging) was not available in our hospital. After confirmation, the patient underwent a laparotomy and was found to have a jujenal intussusception with no lead point, bowel resection with end to end anastomosis was done and the patient had a good postoperative recovery. We recommend that a high index of suspicion is necessary by the obstetricians and surgeon when they deal with a pregnant woman with vague abdominal pain which fails to respond to usual conservative measures so they will not miss such a rare condition in pregnancy which can be associated with high risk of fetal and maternal morbidity and even mortality if the timely diagnosis and treatment was delayed [6,7,8].

Recurrent Intussusception due to Multiple Intestinal Metastases From Lung Adenocarcinoma

Metastasis to the small intestine presents occasionally as multiple lesions and is associated with numerous complications. However, metastasis-induced intussusception in adults is a rare phenomenon. We report a case of recurrent intussusception induced by metastatic lesions from lung cancer. A 54-year-old male was referred to our hospital with intermittent lower right abdominal pain. Chest computed tomography (CT) revealed a mass, suggesting lung cancer, and abdominal CT showed characteristic target-shaped lesions highly suggestive of enteric intussusception in the ileum. The patient underwent segmental resection of the intussuscepted ileum, and analysis of the resected specimen identified a poorly differentiated adenocarcinoma that was pathologically and immunohistologically identical to the lung specimen obtained by percutaneous needle biopsy. Although the symptoms transiently resolved after surgery, intussusception recurred 3 weeks later, and the patient died 28 days after surgery. Multiple metastatic lesions should be considered in adult intussusception, particularly in patients with a history of malignancy.

Intussusception: An Initial Presentation of Colorectal Malignancy at Young Age

Introduction: Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment and is found frequently in children. It is less common in adults. Most of the intussusceptions in adults are caused by a definite underlying disorder such as neoplasm or by postoperative condition. We report a similar case in a young adult presenting as intussusception with no family history of colon cancer. Case report: A 26 year old male with no family history of colon cancer presented with acute worsening of left lower quadrant abdominal pain that he was experiencing for three months. It was associated with diarrhea and constipation. His vitals were stable on presentation. Examination showed minimal tenderness in the left lower quadrant with no palpable mass. Labs were unremarkable except for mild microcytic hypochromic anemia. Abdominal CT scan showed intussusception along with regional pericolic lymph nodes. He was managed conservatively initially, as per surgical team recommendations. Subsequently, colonoscopy was performed which showed a 5 cm ulcerated, partially obstructing mass in the descending colon. Histopathology results showed tubulovillous adenoma with high grade dysplasia. CEA level was 9.6 ng/ml. Patient underwent laparoscopic left hemicolectomy later and biopsy results showed moderately differentiated invasive adenocarcinoma, mucinous type, with no lymphovascular or perineural invasion. Patient is now scheduled to follow up medical oncology for further management. Discussion: The interesting fact about this case is the diagnosis of colon cancer at very young age with no previous family history of colon cancer, which presented as intussusception. Adult intussusception occurs relatively rarely; accounting for 5% of all cases of intussusceptions. A specific lead point is identified in more than 90 % of cases while 10% cases are idiopathic. Malignant lesions account for up to 30 % of cases in small intestine and 66 % of the cases in the large intestine. Abdominal CT scan is diagnostic modality of choice in these patients. It may also help in defining the location, the nature of the mass and it may help staging the patient with suspected malignancy causing the intussusception. Intussusception associated with malignancy should be managed by multispecialty collaboration.Figure 1Figure 2Figure 3

Should Lack of Etiology Determine Treatment in Adult Intussusception?

Should Lack of Etiology Determine Treatment in Adult Intussusception?

Transient Descending Colo-Colonic Intussusception Due to a Large Fecaloma in an Adult: A Rare Case Report

Introduction: Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%-5% of intestinal obstructions in adults, and 0.003-0.02% of all hospital admissions. Transient nonobstructing intussusception is frequently idiopathic and resolves spontaneously without any specific treatment. We describe a case of transient non-obstructing colo-colonic intussusception due to a large fecaloma. Case Report: 53 years old African American lady presented to Emergency Department with severe progressive lower abdominal cramping pain of 12 hours' duration. Abdominal examination was significant for bilateral lower abdominal tenderness with hypoactive bowel sounds. CT scan of the abdomen and pelvis demonstrated a “colocolonic intussusception” in the descending colon extending over a length of 3.5 cm. Subsequently she underwent an emergent colonoscopy for possible reduction of the intussusception. On colonoscopy, in mid-descending colon, solid stool was found which was packing the entire lumen and it was deemed not safe to advance further so procedure was aborted. Patient was managed conservatively in the absence of peritoneal signs and underwent a water-soluble rectal enema next day that showed a filling defect in the mid descending colon. She was subsequently prepped for an elective colonoscopy for further evaluation of colonic mucosa. Colonoscopy demonstrated the presence of a large stool ball (fecaloma) in left colon even after colonic prep with polyethylene glycol. She was started on round the clock laxatives and she continued to have multiple bowel movements in hospital and her abdominal pain subsided.Figure 1Figure 2Figure 3Discussion: The incidence of intussusception is low in adults, particularly in the descending colon, due to the anatomical attachment of the descending colon to the retroperitoneum. Primary or idiopathic intussusception is usually transient while secondary intussusception due to a lead point is usually permanent or recurrent. In our patient, Intussusception was secondary to a fecaloma that served as a lead point but was transient. Abdominal computed tomography (CT) is currently considered as the most sensitive radiologic method to confirm intussusception. 70 to 90% of adult cases of intussusception require definitive treatment and often surgical resection is the treatment of choice. However, an isolated episode of transient non-obstructive intussusception can be managed conservatively.

Case Report: Repetitive Surgical Resections for Intestinal Intussusception due to Multiple Ileal Lipomatosis

Adult intestinal intussusception is a rare disease known to be associated with intestinal tumors. We describe a case requiring partial ileal resection in 2 occasions due to intussusception from multiple lipomatosis. A 45-year-old Japanese man was referred to our hospital for detailed examination after positive fecal blood test results and intermittent abdominal pain. He was diagnosed with intussusception of the ileum due to multiple lipomatosis and underwent partial ileal resection. Three years after the first surgery, he again experienced intermittent abdominal pain and nausea, and was referred to our department. Contrast-enhanced computed tomography at this time also showed intussusception near the ileocecal valve, with several fat-density tumors. He underwent partial ileal resection as an emergency surgery, with the histologic diagnosis confirming ileal multiple lipomatosis. Repeated surgical resections are sometimes required for patients with intestinal intussusception due to lipomatosis, since lipomas not causing symptoms are often left untouched after minimal resection. Close follow-up such as contrast-enhanced CT and small-bowel endoscopy after surgery should be performed regularly so that the patients can avoid emergency surgeries because of the insufficient preoperative examinations.

Spectrum of Etiology among Adult Intussusception Patients: Study of 11 Cases at a Tertiary Care Hospital in Bangladesh

Background: Intussusception in adult patients is occurred in different reasons. Objectives: The purpose of the present study was to see the spectrum of etiology among adult intussusception patients. Methodology: This case series was performed in the Department of Surgery at Shaheed Suhrawardy Medical College, Dhaka from July 2014 to June 2015 for a period of 1(one) year. All the patients presented with intussusceptions were selected as study population. A detailed history was obtained from each patient. Patients with the age of ?18 years, regardless the symptoms like onset, duration, intensity, progression were included for this study. Per-operative diagnosis was further confirmed by histopathology of the resected specimen. Result: A total number of 11 cases were recruited after fulfilling the inclusion and exclusion criteria. Gastro intestinal stromal tumour (GIST) was the most common etiology of intussusceptions which was 5(45.5%) cases followed by adenocarcinoma which was 2(18.2%) cases. Meckel’s diverticulum, Intestinal TB, Lipoma and Leiyomyomatous polyp were also found in 1 case each. Conclusion: Adult intussusception is most commonly occurred due to gastro intestinal stromal tumour followed by adenocarcinoma. Journal of Science Foundation, January 2016;14(1):3-7