Intussusception In Patients Research Articles

Global research landscape of Peutz-Jeghers syndrome and successful endoscopic management of intestinal intussusception in patients with recurrent laparotomies.

Peutz-Jeghers syndrome (PJS) has brought significant physical, psychological and economic burdens on the patients and their families due to its early onset, diagnostic and therapeutic challenges and increased recurrence risk. To explore the current research status and emerging hotspots of PJS. Studies on PJS published during 1994-2023 were gathered based on Web of Science Core Collection. Additionally, a case of PJS-induced intestinal intussusception, successfully treated with endoscopic methods despite three laparotomies, was highlighted. Comprehensive bibliometric and visual analysis were conducted with VOSviewer, R and CiteSpace. Altogether 1760 studies were identified, indicating a steady increase in the publication number. The United States had the highest influence, whereas the University of Helsinki emerged as the leading institution, and Aaltonen LA from the University of Helsinki was the most prolific author. Cancer Research, Oncogene and Endoscopy were the top three journals based on H-index. Keyword burst direction analysis revealed that "cancer risk", "management", "surveillance" and "familial pancreatic cancer" were the potential hotspots for investigation. Additionally, "early detection", "capsule endoscopy", "clinical management", "double-balloon endoscopy", "familial pancreatic cancer" and "molecular genetic basis" were identified as the key clusters of co-cited references. Endoscopic polypectomy remained effective on resolving intestinal intussusception in patients who underwent three previous laparotomies. In the last three decades, global publications related to PJS show a steadily increasing trend in number. Endoscopic management is currently a research hotspot.

Geospatial methodology for determining the regional prevalence of hospital-reported childhood intussusception in patients from India

Both developed and developing countries carry a large burden of pediatric intussusception. Sentinel site surveillance-based studies have highlighted the difference in the regional incidence of intussusception. The objectives of this manuscript were to geospatially map the locations of hospital-confirmed childhood intussusception cases reported from sentinel hospitals, identify clustering and dispersion, and reveal the potential causes of the underlying pattern. Geospatial analysis revealed positive clustering patterns, i.e., a Moran’s I of 0.071 at a statistically significant (p value < 0.0010) Z score of 16.14 for the intussusception cases across India (cases mapped n = 2221), with 14 hotspots in two states (Kerala = 6 and Tamil Nadu = 8) at the 95% CI. Granular analysis indicated that 67% of the reported cases resided < 50 km from the sentinel hospitals, and the average travel distance to the sentinel hospital from the patient residence was calculated as 47 km (CI 95% min 1 km–max 378 km). Easy access and facility referral preferences were identified as the main causes of the existing clustering pattern of the disease. We recommend designing community-based surveillance studies to improve the understanding of the prevalence and regional epidemiological burden of the disease.

Clinicopathologic analysis of intussusception among Pakistani adults

The intussusception adults are rare and almost always as a result of secondary condition. The aim of this study is to review the adult intussusception's presentation, diagnosis, and pathophysiology was the goal of this study. Methods: This retrospective analysis study was held in the surgical department of Lady Reading Hospital, Peshawar from April 2022 to September 2022. This study included 24 cases of intussusception in patients &gt;18 years of age. Results: 24 cases of intussusception among adult were reported. The mean age was 49.2 years on average (range 20-75 years). All patients' initial complaints in this study was pain accompanied by abdominal distension (37.5%), Vomiting (79.2%) and currant-jelly stools (33.3%) were other symptoms.12 patients (50%) had a palpable lump, while 8 patients (33.33%) had tenderness and generalized guarding was seen in 6(25%) of patients. Eleven patients (45.8%) had an acute intestinal obstruction on admission. The range of symptoms' lengths was 20 hours to 10 months, with a median of five days. The laparotomies were done in 19 patients. Five patients; two with ileoileal intussusception and three with ileocolic, were scheduled for surgery, but over the course of a few hours, their lump disappeared with symptoms improvement.

Changes in the Gut Microbiome Associated with Intussusception in Patients with Peutz-Jeghers Syndrome.

Peutz-Jeghers syndrome (PJS) is a rare hereditary disorder characterized by intestinal polyposis, and intestinal intussusception is one of the most urgent complications. While it is known that imbalance of the gut microbiota is highly associated with intestinal disorders, the role of the gut microbiome in the pathogenesis of PJS has not been reported. In this study, we performed 16S rRNA sequencing on stools from 168 patients and 68 healthy family members who lived together to determine the gut microbiome composition of PJS patients. Metagenomics sequencing was further performed on the representative samples (61 PJS patients and 27 healthy family members) to analyze the functional changes. We found that the fecal microbiome of patients with PJS showed a greater variation in β-diversity. An enhancement of Escherichia coli and a reduction of Faecalibacterium prausnitzii was identified in PJS patients. Further reduction of Faecalibacterium prausnitzii was the characteristic microbial change observed in patients with intussusception. Functional analysis revealed that the abundance of propanoate metabolism was enriched in PJS patients and further enriched in those with intussusception. Escherichia coli was the major contributor to the enrichment of this metabolism pathway, which was associated with the abnormal expression of methylglyoxal synthase (encoded by mgsA) and phosphate acetyltransferase (encoded by pta). Our findings showed a distinct gut microbiome signature in PJS patients and identified the connection between the gut microbiome and intussusception. Alterations in the gut microbiome might be involved in the pathogenesis of PJS and may serve as biomarkers for gastrointestinal surveillance. IMPORTANCE Recent research has established a link between the gut microbiome and polyps and neoplasia, and antibiotic use influences the microbiome and the development of colorectal polyps. Familial adenomatous polyposis (FAP), which is characterized by the early development of benign precursor lesions (polyps), is associated with enterotoxigenic Bacteroides fragilis and Escherichia coli biofilms. However, the relationship between the gut microbiome and the pathophysiology of PJS has not yet been established. In this study, we found that PJS patients had a distinct microbiome composition, with a greater variation in β-diversity, an increase in Escherichia coli, and a decrease in Faecalibacterium prausnitzii. A further reduction of Faecalibacterium prausnitzii was observed in patients with intussusception. Moreover, PJS involved increased propanoate metabolism as well as abnormal mgsA and pta expression. These findings may contribute to a better understanding of the etiology of PJS and improve disease control strategies.

S3424 Imaging-Negative Double Jejunal Intussusception Diagnosed on Laparoscopy With Intraoperative Enteroscopy in a Patient With Peutz-Jeghers Syndrome

Introduction: Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant syndrome characterized by gastrointestinal polyposis, mucocutaneous pigmentation, and an increased risk of malignancy. Although generally benign, PJ-type polyps can be large and can act as lead points for intussusception. We describe the case of a 25-year-old female with PJS who presented with recurrent abdominal pain in the setting of negative cross-sectional imaging who was found to have a double intussusception on diagnostic laparoscopy with intraoperative enteroscopy. Case Description/Methods: The patient’s surgical history was notable for five reductions of small bowel intussusception related to PJ-type polyps since age 9. She initially presented with intermittent abdominal pain six months prior to this admission, at which time seventeen small bowel PJ-type polyps were resected via anterograde small bowel enteroscopy. Her pain persisted despite intervention, and magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance enterography (MRE) four months prior to admission demonstrated two additional polyps in the terminal ileum which were resected via colonoscopy. The patient then presented with acutely worsening abdominal pain that she described as similar to her past episodes of intussusception. Although a computed tomography (CT) scan with IV contrast was unremarkable, there was high clinical suspicion for intussusception, so a multidisciplinary decision was made to proceed with diagnostic laparoscopy. Two jejunal intussusceptions related to large polyps were identified and reduced, and one large (25 mm) polyp was surgically resected (Figure A and B). On intraoperative enteroscopy via enterotomy, one smaller (15 mm) duodenal polyp and three large (20-25 mm) jejunal polyps were removed. The patient was discharged three days postoperatively with resolution of her pain. Discussion: Patients with PJS require multidisciplinary care given their significantly increased risk of both gastrointestinal and extraintestinal malignancy and complications such as intussusception. While CT is generally the preferred imaging study when evaluating for intussusception in adults, there is limited data on its sensitivity, with estimates ranging from 58-100%. Our case highlights two important points: first, although PJ-type polyps are generally benign, they may grow rapidly; and second, even if imaging is unremarkable, clinicians should still consider intussusception in patients with predisposing risk factors and a compatible clinical picture.Figure 1.: (A) Laparoscopic view of a small bowel intussusception (arrow) related to a Peutz-Jeghers-type polyp. (B) Endoscopic view of a large hamartomatous Peutz-Jeghers-type polyp.

Intussusception and COVID-19 in Infants: Evidence for an Etiopathologic Correlation.

Nonrespiratory conditions related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been largely described. Ileocolic intussusception has been reported in association with SARS-CoV-2 infection in 10 children, raising the possibility of an etiopathologic role for the virus, but none of these cases documented tissue pathology that would have supported SARS-CoV-2 intestinal inflammation. We report 2 cases of intussusception in patients with SARS-CoV-2 infection who were treated at different pediatric tertiary centers in Europe and provide evidence of the presence of the virus in mesenteric and intestinal tissues of the patients.

S2970 Multiple Jejunal Intussusceptions in a Patient With Portal Hypertension and Decompensated Liver Cirrhosis

Introduction: Intussusception is telescoping a part of the intestine into itself. Common complaints including abdominal pain, nausea, vomiting, bleeding, melena and constipation. Treatment largely depends on patients' clinical status, age, and the part of the intestine involved. Treatment approaches include fluoroscopic, sonographic, surgery or observation. 90% of adult intussusception occurs due to lead points. We present a case of intussusception in a patient with decompensated liver cirrhosis and portal hypertension (PH). Given no identifiable lead point, we postulate that the patient’s medical conditions contributed to development of idiopathic intussusception. Case Description/Methods: A 48yo undomiciled female with unknown past medical history was brought to the Emergency Department for alcohol intoxication. In the ED she complained of abdominal pain but was unable to further qualify specific features of her symptoms. She was nauseous and had several episodes of non-bilious, non-bloody vomiting. Upon further questioning, she endorsed drinking 5 beers/day. Vital signs were notable for blood pressure of 90s/60s mmHg. She had significant scleral icterus and a distended abdomen with dullness. Initial labs are as shown in table 1. CT revealed cirrhotic liver, evidence of PH, three intussusceptions in the jejunum without associated obstruction (Figure 1). She was treated for severe hyponatremia due to beer potomania. In view of her anemia, she was transfused packed RBCs and EGD was performed. It revealed non-bleeding large esophageal varices which was banded. Mild PH gastropathy was also found in the entire stomach. She was treated supportively; the hyponatremia was corrected and her abdominal pain improved. Repeat CT scan one week later revealed resolution of jejunal intussusception. Discussion: Adult intussusception is uncommon in comparison to the pediatric population. A clear lead point can be identified 90% of cases with two thirds being due to neoplasms and 60% of neoplasms being malignant. PH can cause vascular changes in the intestine including colorectal varices, angiodysplasia-like lesions, telangiectasias, dilated and congested capillaries. It is unclear if those vascular changes in PH and cirrhosis cause lead points for intussusception. There are some case series demonstrating intussusception in cirrhotic patients but there is no comment on the relationship between PH and intussusception1. Further studies can be done to show the relation between PH/cirrhosis and intestinal intussusception.Table 1.: Initial Significant Lab Values.Figure 1.: Jejunal intussusceptions on CT of Abdomen and Pelvis.

S2967 Small Bowel Intussusception Due to Hamartomatous Polyp Related to Peutz-Jeghers Syndrome

Introduction: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant syndrome manifested by multiple hamartomatous polyps, predominantly present in the gastrointestinal tract, and mucocutaneous pigmentation changes. Cumulative lifetime risk of intussusception in patients with PJS has been reported to be as high as 69% with 80% of the cases presenting as an acute abdomen. The median size of polyps causing intussusception is 3.5 cm. We present a case of small bowel intussusception attributed to hamartomatous polyps. Case Description/Methods: A 39-year-old male with a history of PJS and prior small bowel resection due to obstruction, presented with abdominal pain and multiple episodes of hematochezia. His hemoglobin on arrival was 6.5 g/dL, however remained hemodynamically stable with blood transfusion. CT of the abdomen and pelvis with contrast revealed a new small bowel (SB) intussusception measuring 7 cm with the intussuscipiens measuring 3.7cm [Fig. A,B]. Since the patient remained clinically stable, an enteroscopy was performed to identify the site of intussusception with possible endoscopic reduction. Multiple large small bowel polyps were identified, the largest measuring 5 cm in the jejunum, 50 cm distal to the site of anastomosis and likely lead point of the intussusception [Fig C.]. A repeat enteroscopy was performed with piecemeal resection of the large jejunal polyp with hot snare and clip placement [Fig. D]. The patient’s hematochezia and abdominal pain resolved. He was discharged with planned staged resection of remaining large SB polyps and surveillance colonoscopy. Histology of the polyps showed proliferation of smooth muscle into the lamina propria in branching pattern and normal intestinal epithelium consistent with Peutz-Jeghers hamartomatous polyp [Figure E]. Discussion: Peutz-Jeghers syndrome is associated with increased risk of both gastrointestinal and non-gastrointestinal malignancy including, but not limited to, colon, pancreas, breast, lung, and ovarian cancer. Gastrointestinal complications are related to polyps and include anemia from bleeding, intussusception, obstruction and infarction. Timely recognition and treatment is important as the complications can be fatal. Fortunately with advancements in small bowel endoscopy, these complications can be prevented and managed by endoscopic surveillance and polypectomy, reducing the need for urgent surgical intervention.Figure 1.: A. Transverse view of small bowel intussusception B. Sagittal view of small bowel intussusception C. Endoscopic view of large pedunculated polyp D. Prior site of piecemeal resected polyp with subsequent placement of clips E. Histology slide of resected polyp confirming hamartomatous polyp.

Intussusception Caused by Percutaneous Endoscopic Gastrostomy With Jejunal Extension in Patients With Severe Motor and Intellectual Disabilities

The risk of intussusception related to percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in patients with severe motor and intellectual disabilities (SMID) remains unknown. In a cross-sectional study, a review of 26 patients (mean age, 11.6 ± 6.4 years) with SMID who underwent PEG-J was performed. During the follow-up period, 6 of 26 (23%) patients developed intussusception. The median period from PEG-J to the onset of intussusception was 364 (range, 8–1344) days. No significant difference was observed in the Cobb angle between the intussusception and nonintussusception groups; however, body mass index at the time of PEG-J was significantly lower in the intussusception group. Intussusception related to PEG-J occurs relatively frequently in patients, and it is possibly attributable to factors such as deformity caused by undernutrition and weight loss. If enteral nutrition via PEG-J has been established, earlier enterostomy can be recommended because of the high risk of intussusception in patients with SMID.

S2821 Ileocolonic Intussusception Associated Large B-Cell Lymphoma

INTRODUCTION: Intussusception is characterized by the telescoping of a more proximal portion of the gastrointestinal tract into a more distal portion. This is rare in the adult population, representing 5% of all cases of intussusception. Unlike in children, a pathological lead point is detected in 70–90% of cases, with up to 65% being malignant. Common malignancies leading to intussusception in the small intestine include primary adenocarcinoma, gastrointestinal stromal tumors, carcinoid tumors, and lymphoma. CASE DESCRIPTION/METHODS: A 35-year-old male presented with one month of intermittent right-sided abdominal pain. He reported normal bowel movements and denied nausea or vomiting. On presentation his vitals were unremarkable. Physical examination revealed mild abdominal distention with RLQ tenderness. CT abdomen/pelvis demonstrated RLQ ileocolonic intussusception without obstruction. Initial laboratory values were within normal limits. Colonoscopy revealed a dilated cecum and distal ileum with ileocolonic intussusception, with gross examination concerning for malignancy. Terminal ileal biopsy revealed benign small bowel mucosa with active inflammation. Alpha-fetoprotein was 8.5 ng/mL and carcinoembryonic antigen 0.5 ng/mL .CT chest showed no signs of metastasis. The patient underwent laparoscopic right hemicolectomy with extended small bowel resection. Surgical pathology revealed large B-cell lymphoma of the terminal ileum (positive for CD20, Ki-67) and twenty reactive lymph nodes. Postoperative course was uncomplicated and the patient was discharged home with Hematology/Oncology follow up. DISCUSSION: Intussusception is uncommon in adults, with the ileocolic or ileocecal variety comprising the most rare category. In a review of 14 papers in which 396 intussusception cases were presented, only 83 (20.9%) had ileocolic or ileocecal involvement. Of these, intussusception secondary to malignant causes occurred in 144 (36.4%) cases, with 23 of them resulting from lymphoma. Presentation usually includes non-specific symptoms such as colicky abdominal pain (85%–100%), nausea (41%–75%), vomiting (35%–70%), bleeding (16.4%–27.3%) diarrhea and constipation (22.5%–69%), which play a role in its challenging diagnosis. Considering adult intussusception in patients with recurrent abdominal pain is of critical importance given its high association with malignancy. This case highlights the uncommon diagnosis of adult intussusception caused by large B-cell lymphoma.Figure 1.: CT scan showing RLQ ileocolonic intussusception without obstruction.Figure 2.: Colonoscopy revealed ileocolonic intussusception.

Clinical management and recommendations for children with more than four episodes of recurrent intussusception following successful reduction of each: an institutional review

To describe patterns and risk factors of multiple recurrences to optimise management for pediatric patients with more than four episodes of intussusception. Following IRB approval, all sonographic evaluations for intussusception in patients <18 years over a 6-year period were reviewed. Data extracted included age at onset of first intussusception, gender, presenting symptoms, symptoms upon recurrence, presence of pathological lead points, and surgical findings. During a 6-year period, five cases had four or more instances of recurrence after enema reduction attempts. All patients were male with an average age of 16 months. Two of the five cases resolved after the fourth enema reduction and no lead points were identified. Two other cases involved surgical reduction with intraoperative findings of Meckel's diverticulum and juvenile polyp. The final case had five recurrence episodes and six separate enema reductions. Ultimately, lymphoid hyperplasia was discovered on colonoscopy and the patient never recurred after being treated with steroids. Given the favorable reduction rate in re-recurrent cases and complete lack of perforation observed, up to four attempts at enema reduction is recommended before considering an alternative strategy. If recurrence continues past the fourth reduction attempt, computed tomography (CT) is recommended to identify a lead point. If CT remains inconclusive, then consider exploratory laparotomy.

Appendiceal intussusception, a peroperative surprise: A case report

Intussusception of the appendix is very uncommon and when encountered, it may alter surgical procedures. For this reason, it should be kept in mind that appendiceal intussusception may occur in every patient diagnosed with acute appendicitis. It is critical to consider appendiceal intussusception in patients presenting with recurrent nausea, vomiting and chronic abdominal pain.

2624 A Classic Case of Peutz-Jeghers Syndrome Presenting as Recurrent Intussusception

INTRODUCTION: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant genetic disorder associated with mucocutaneous hyperpigmentation and hamartomatous gastrointestinal polyps. Here, we present a case of PJS presenting as abdominal pain due to recurrent intussusception in a patient without family history of gastrointestinal conditions. CASE DESCRIPTION/METHODS: A 28-year-old African American female with a remote history of intussusception and small bowel resection presented with 5 days of epigastric pain. An EGD and colonoscopy from years prior reportedly revealed multiple benign polyps. There was no family history of PJS, gastrointestinal, ovarian, or endometrial cancer. On exam, right lower abdomen was tender and oral mucosa revealed hyperpigmentation. Labs were notable for iron deficiency anemia with a hemoglobin of 8.3 g/dL. Abdominal CT revealed a left lower quadrant enteroenteric intussusception with a 2.3 cm small bowel tumor functioning as a lead point and a 3 cm cecal mass. Retrograde enteroscopy to evaluate the small bowel tumor revealed ileal nodules, no intraluminal cecal mass, and 2 ileal polyps that were resected. Pathology showed polypoid fragments of ileal mucosa with marked submucosal lymphoid aggregates. Upright abdominal Xray was obtained for worsening abdominal pain and peritoneal signs, which showed an air fluid level in the small bowel, concerning for obstruction. She underwent a diagnostic laparoscopy revealing a cecal mass and ileal intussusception. She had an ileocecectomy and small bowel resection with a large polypoid mass in the resected ileum. Histology of the cecal mass revealed a cystic nodule of benign small bowel mucosa and the ileal polypoid mass demonstrated a hamartomatous polyp with ectopic extension into the muscularis propria, suggestive of PJS. Subsequent STK11 gene analysis revealed an exonic deletion, confirming the diagnosis. DISCUSSION: Up to 69% of patients with PJS experience intussusception. The risk of intussusception reaches 50% by age 20 in these patients. Although the association of PJS with intussusception is well-known due to polyps functioning as lead points, PJS is rarely diagnosed on recurrence of intussusception. Endoscopic polyp removal is recommended in these patients to avoid complications of surgery but surgical resection remains the definitive treatment in most cases. Recurrent intussusception in adult patients is a finding that should elicit consideration of PJS in patients with a history of polyps and no significant family history.

2069 Colocolonic Intussusception in a Patient With Ulcerative Colitis

INTRODUCTION: Intussusception is common in children, but rare in adults accounting for 5-16% of all cases of intussusception. Giant pseudopolyps are polyps that measure more than 1.5 cm in diameter. These can function as lead points for intussusception in patients with inflammatory bowel disease (IBD). We present here an unusual case of intussusception due to a giant pseudopolyp in an adult patient with ulcerative colitis. There are only a limited number of case reports that describe this occurrence. CASE DESCRIPTION/METHODS: A 20-year-old man with a history of ulcerative colitis in remission on 5-ASA and 6-Mercaptupurine was found on surveillance colonoscopy to have a large inflammatory pseudopolyp resulting in partial obstruction. He was asymptomatic and physical examination was unremarkable. CT Abdomen/Pelvis showed transverse colon intussusception (Figure 1). He underwent a repeat colonoscopy with plan for endoscopic submucosal dissection of the large polyp. A 15 × 15 cm, frond-like/villous, broad based pseudopolyp without a stalk was seen in the proximal transverse colon (Figure 2a). Due to the large size of the polyp and inability to visualize the dissection plane, endoscopic submucosal dissection could not be performed. Debulking was achieved using piecemeal mucosal resection with a snare. A 15 × 15 cm area was resected and retrieved (Figure 2b). Histopathology showed fragmented pseudopolyp with ulceration, extensive granulation tissue and regenerative epithelial changes (Figure 3). He did well post procedure and was discharged home. He was advised to undergo colectomy but he remains undecided. He will undergo surveillance colonoscopy in 6 months. DISCUSSION: In adults, intussusception is a rare finding and most cases are due to colonic malignancy. Colocolonic intussusception secondary to giant pseudopolyps is an extremely rare occurrence in IBD patients. Presentation of these patients can vary from asymptomatic, abdominal pain, rectal bleeding, obstruction or intussusception. Although giant pseudopolyps do not have a malignancy risk, there has been one reported case of occult malignancy in a giant pseudopolyp. In addition, IBD patients at baseline are at an increased risk for malignancy. Asymptomatic patients can be managed medically. Successful endoscopic therapy with polypectomy has been reported in a few cases of giant pseudopolyps. Complications such as obstruction or intussusception require surgery. However, all of these patients will require frequent endoscopic surveillance.

Management of intussusception in patients with melanoma.

Increased cross-sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. We performed a multi-institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre-emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre-emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma.. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.

Clinical and radiological predictors of the outcome of hydrostatic reduction of primary intussusception in childhood

Introduction Success of hydrostatic reduction of intussusception using saline enema could be affected by several factors. Aim This study aimed to detect the clinical and radiological predictors of successful hydrostatic reduction of primary intussusception. Patients and methods This retrospective cross-sectional study included all patients with primary intussusception from the age of 6 months to 3 years. Patients with signs of peritonitis or bowel perforation were excluded from the study. Patients’ age, sex, duration and type of symptoms, general, abdominal, and digital rectal examination findings as well as findings in ultrasound of the abdomen (the presence and the site of an abdominal mass) and plain radiograph (PXR) of the abdomen standing (air fluid levels) were recorded and analyzed by appropriate statistical tools with the software SPSS version 10.0. Results Factors that affected the success of hydrostatic reduction significantly included age at presentation (Student’s t test: 3.46, P=0.001), BMI (Student’s t test: 2.383, P=0.019), long duration of symptoms (Student’s t test: 8.812, P=0.000), passage of red currant jelly stools (χ2-test: 91.777, P=0.000), presence of palpable abdominal mass (χ2-test: 55.813, P=0.000), on the left side of the abdomen (χ2-test: 52.439, P=0.000), and positive findings in PXR abdomen standing (χ2-test: 59.911, P=0.000). Conclusion Primary intussusception in patients with younger age group, low BMI, long duration of symptoms, passage of red currant jelly stool, palpable abdominal mass on the left abdominal side being confirmed by ultrasound of the abdomen, and the presence of air fluid levels in PXR abdomen standing have a lower rate of successful hydrostatic reduction.

Jejunostomy tube-induced intussusception

Intussusception involves the telescoping of a segment of bowel into an adjacent segment. It is the leading cause of intestinal obstruction in the pediatric age group; however, it is relatively rare and accounts for just about 1% of the cases of small bowel obstruction in adults. Jejunostomy tube-induced intussusception is an extraordinarily rare complication of feeding jejunostomy tube placement, the exact mechanism of which is not definitively known. The diagnosis of jejunostomy tube-induced intussusception is not easy as it generally does not interfere with the enteral feeding. Computed tomography (CT) scan is widely considered to be the imaging modality of choice in the diagnostic evaluation of adult intussusception. The finding of a heterogeneous sausage-shaped soft-tissue mass consisting of an outer intussuscipiens and central intussusceptum is virtually pathognomonic of intussusception. Surgery is the mainstay of management in an adult with intussusception. Nonoperative treatment strategies including radiologic reductions aided by hydrostatic/contrast/air enemas, which have mainly been attempted in the pediatric age group, have shown unpredictable results and are not recommended in adults. We present an unusual cause of jejunostomy tube-induced intussusception following a salvage laryngopharyngoesophagectomy and gastric pull-up in a patient with a postchemoradiation residue of a locally advanced carcinoma of the postcricoid region. A high degree of suspicion among clinicians and timely imaging with a CT scan are prerequisites for diagnosing intussusception in patients who complain of persistent gastrointestinal symptoms, especially with a jejunostomy tube in situ.

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.

High cumulative risk and clinical feature of intussusception in patients with Peutz-Jeghers syndrome

Objective To analyze the characteristics,risk and induced factors of intussusception in Peutz-Jeghers syndrome (PJS).Methods From March 2nd 2005 to May 25th 2013,a total of 130 patients with PJS were selected.The clinical data of patients were collected,which included gender,age,the diagnostic age of PJS,family history,the diagnostic age of intussusception,clinical features,location,treatment and the maximum diameter of polyps which caused intussusception.Kaplan-Meier was performed to analyze the cumulative risk of intussusception.Results Among 130 patients with PJS,90 cases had intussusception.The age when first time diagnosed was from four to 33,median age was 16.The cumulative risks of intussusception at 10,15,20,25 and 30 years were 12.308％ (16/130),31.538％(41/130),51.538％(67/130),64.615％(84/130) and 66.923％(87/130).There was no significant difference in the cumulative risk of intussusception between male and female; with family history and no family history (both P＞0.05).A total of 131 intussusception happened in 90 patients,of which diagnosed by surgery,imaging examination and history reviewer was 125,four and two times,respectively.The initial symptom of 111 times of intussusception was acute abdomen and 15 were abdominal pain and vomiting.The left five intussusception was found by regular:examination.One hundred and fifteen intussusception was in small intestine and 16 in colon.There was 127,three and one time treated with surgery,conservative treatment,endoscopic therapy (dual airbags intestinal endoscopic polypectomy),respectively.The maximum diameter of polyps which caused intussusception was from 15 to 70 mm,average 40 mm.Conclusions Intussusception of patients with PJS is at young age and with a high cumulative risk.Intussusception is generally caused by diameter over 15 mm polyps. Key words: Peutz-Jeghers syndrome; Intussusception; Endoscopy, gastrointestinal; Intestine,small; Intestinal polyps

In patients with rectoceles and obstructed defecation syndrome, surgery should be the option of last resort

The indications for operation in patients with obstructed defecation syndrome (ODS) with rectocele are not well defined. A total of 90 female patients with ODS and rectocele were prospectively evaluated and treated with fiber supplements and biofeedback training. Univariate and multivariate regression was used to determine factors predictive of failing medical management. Obstructive symptoms were the most prevalent presenting complaint (82.2%). Ultimately, 71.1% of patients responded to medical management and biofeedback. Multivariate regression analysis suggested that the presence of internal intussusception was associated with a lower chance of undergoing surgery to address ODS symptoms [odds ratio 0.18; P = .05], whereas inability to expel balloon, contrast retention on defecography, and splinting were not (P ≥ .15). Rectoceles with concomitant intussusception in patients with ODS appear to portend a favorable response to biofeedback and medical management. We argue that all patients considered for surgery for rectoceles because of ODS should first undergo appropriate bowel retraining.