Colonic Intussusception Research Articles

Intestinal Obstruction Caused by Ileocolic and Colocolic Intussusception in an Adult Patient with Cecal Lipoma.

Introduction. Intussusception is a rare clinical entity in adults (<1% of intestinal obstructions). Colonic intussusception is even rarer, particularly when caused by lipomas. Case Presentation. A 47-year-old woman presented to our emergency department complaining of abdominal pain with vomiting and diarrhoea. X-ray and CT showed bowel obstruction due to ileocolonic and colocolonic intussusception; a giant colonic lipoma (9 × 4 × 4 cm) was recognizable immediately distally to the splenic flexure of the colon. The patient underwent emergency laparotomy and right hemicolectomy. Assessment of the resected specimen confirmed the diagnosis of giant colonic polypoid lesion near to the ileocecal valve, causing a 12 cm long intussusception with moderate ischemic damage. Conclusion. Colonic obstruction due to intussusception caused by lipomas is a very rare condition that needs urgent treatment. CT is the radiologic modality of choice for diagnosis (sensitivity 80%, specificity near 100%); since the majority of colonic intussusceptions are caused by primary adenocarcinoma, if the etiology is uncertain, the lesion must be interpreted as malignant and extensive resection is recommended. At present, surgery is the treatment of choice and determines an excellent outcome.

Mixed Adenoneuroendocrine Carcinoma Causing Colonic Intussusception.

Colonic intussusception is a rare cause of intestinal obstruction in adults and is caused by a malignant lesion in about 70% of cases. Early diagnosis and treatment are essential. We present a 64-year-old male patient with right colonic intussusception caused by a mixed adenoneuroendocrine carcinoma (MANEC), presenting as a giant pedunculated polyp (54 mm of largest diameter). The patient underwent right colectomy with primary anastomosis and adjuvant chemotherapy. The diagnosis of intussusception of the colon in adults is difficult because of its rarity and nonspecific clinical presentation. In this case, the cause was a rare histological type malignant tumor (MANEC).

腸重積をきたした低異型度虫垂粘液性腫瘍に対して整復後腹腔鏡下回盲部切除を施行した1例

症例は34歳，男性．腸重積の診断で整復後，精査加療目的に当院へ紹介となった．腸重積を再発したため，整復後手術の方針となった．注腸造影では横行結腸に閉塞所見を認め，整復後の腹部造影CT・MRI検査では，右下腹部に虫垂腫瘍を認めた．PET検査では，腫瘍部にFDGの異常集積はなく，良悪性の鑑別が困難であり，腹腔鏡下回盲部切除術+D2郭清を施行した．病理診断は，低異型度虫垂粘液性腫瘍（Low-grade appendiceal mucinous neoplasm：以下LAMN）であった．LAMNは従来の粘液嚢胞腺腫や粘液嚢胞腺癌に該当し，大腸癌取扱い規約第8版において新たに分類された．LAMNの治療法は明確な基準は存在しない．腸重積を整復後に腹腔鏡下手術を施行することは切除範囲を縮小し，低侵襲で安全に施行しえると思われた．

経肛門的に切除した腸重積合併S状結腸脂肪腫の1例

大腸脂肪腫は一般に無症状であるが，まれに閉塞や腸重積の原因となる．今回われわれは，自動縫合器を用いた経肛門的切除ののち腹腔鏡下に重積を整復しえたS状結腸脂肪腫による腸重積の1例を経験したので報告する．症例は24歳の女性．下腹部痛を主訴に当院を受診し，腹部CTにて直径約4cmのS状結腸脂肪腫を先進部とする腸重積と診断された．腸管の重積距離は長く，先進部は上部直腸内まで落ち込んでいたが，非観血的に整復不可能であった．腹腔鏡補助下S状結腸切除術を予定し，全身麻酔を導入した時点で先進部の脂肪腫はさらに下降し，経肛門的に腫瘍の把持が可能となった．このため，経肛門的に挿入した自動縫合器を用いて腫瘍を切除した後，腹腔鏡下に重積を解除し，大腸内視鏡で縫合線を確認して手術を終了した．腫瘤を先進部とする腸重積症例では，自動縫合器を用いた経肛門的切除により腸切除を回避できる可能性があると考えられた．

Intussusception in adults

Intussusception in adult population is quite uncommon. It is usually seen in the pediatric age group. A wide range of causes can predispose to intussusception in adults. Majority of them are benign especially in cases of small bowel intussusception. However malignancy is quite often encountered in cases of colonic intussusception. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Computerized tomography is diagnostic. However majority of cases in adults are diagnosed at laparotomy. Surgical resection assuming the lesion to be malignant is the treatment of choice.

Giant colonic lipoma arising from the ileocecal valve and causing cecal-transverse colonic intussusception

SummaryIntussusception is rare in adults, representing only 1% of bowel obstruction and 5% of all intussusceptions. Previous reports have shown that &gt; 90% of adults diagnosed with intussusception had an identifiable pathological leading point—a malignant tumor in 43–63% of the cases. Colonic lipomas are rare nonepithelial neoplasms, but represent the most common benign tumors in the large intestine. Most colonic lipomas present as submucosal, sessile polypoid masses with intact mucosa, and they rarely produce symptoms when &lt; 2 cm in diameter. However, all the intussuscepted lipomas in the literature had a tumor size &gt; 4 cm in diameter. As the clinical presentations of adult intussusception are not pathognomonic and the image study may not provide a typical presentation, a precise preoperative diagnosis of whether a benign or malignant tumor is causing the colon intussusception can be difficult. Here, we report the case of a 50‐year‐old man who presented with abdominal pain and lower gastrointestinal bleeding and was diagnosed postoperatively with ileocecal valve lipoma with cecal‐transverse colon intussusception. This report emphasizes colonic lipomas &gt; 4 cm in diameter should receive surgical resection before intussusception develops. However, if the nature of the tumor causing colon intussusception cannot be identified before the operation, en bloc resection is recommended as there is a high risk of malignancy spreading.

Cecal Adenocarcinoma Presenting as Colonic Intussusception in Adulthood

Intussusception occurs when a proximal segment of intestine invaginates into a distal segment. It is a common cause of intestinal obstruction in children but is infrequent in adults. A 77-year-old woman presented with a 1-month history of intermittent abdominal pain associated with nausea and distended abdomen. Imaging showed a complex elongated sausage-shaped mass in the transverse colon with no obstructive pattern or free air. Surgery confirmed colonic intussusception in addition to a palpable cecal mass requiring a right hemicolectomy. Histologic study demonstrated adenocarcinoma in situ within a tubulovillous adenoma. Surgical excision of the affected intestine is the recommended treatment of choice.

A rare cause of colonic obstruction "colonic intussusception": report of two cases.

Colocolic intussusceptions are rare clinical entities in adults and almost always caused by a leading lesion which often warrants resection. Mostly being malignant, the leading lesions are rarely benign lesions where intraluminal lipomas are the most frequent among them. Most adult intussusceptions require surgical resection owing to two major reasons: common presence of a leading lesion and significantly high risk of malignancy—reaching as high as 65% regardless of the anatomic site—of the leading lesion. Resection of the affected segment is usually the treatment of choice, since preoperative diagnosis of the lesion is usually ineffective and most leading lesions are malignant. This paper represents two cases of adult colocolic intussusception caused by intraluminal lipomas with a brief review of the literature.

Hereditary Angioedema and Gastrointestinal Complications: An Extensive Review of the Literature.

Hereditary Angioedema (HAE) is a rare autosomal dominant (AD) disease characterized by deficient (type 1) or nonfunctional (type 2) C1 inhibitor protein. The disorder is associated with episodes of angioedema of the face, larynx, lips, abdomen, or extremities. The angioedema is caused by the activation of the kallikrein-kinin system that leads to the release of vasoactive peptides, followed by edema, which in severe cases can be life threatening. The disease is usually not diagnosed until late adolescence and patients tend to have frequent episodes that can be severely impairing and have a high incidence of morbidity. Gastrointestinal involvement represents up to 80% of clinical presentations that are commonly confused with other gastrointestinal disorders such as appendicitis, cholecystitis, pancreatitis, and ischemic bower. We present a case of an HAE attack presenting as colonic intussusception managed conservatively with a C1 esterase inhibitor. Very few cases have been reported in the literature of HAE presentation in this manner, and there are no reports of any nonsurgical management of these cases.

P-144 Endoscopic Balloon Dilation of Ileo-Colonic Strictures in Children with IBD

Anastomotic strictures are well known complication in patients with Inflammatory bowel disease (IBD). They have historically been treated either by surgeons or under fluoroscopic guidance. Both these procedures have certain complications like perforation and radiation exposure. Through the endoscope (TTS) balloon dilation of strictures is a well-defined modality of treatment for esophageal strictures in pediatric population. However, it has not been extensively defined for ileo-colonic strictures. There were no pediatric studies found on PubMed/Medline search. A 16 year old female was diagnosed with ulcerative colitis 3 years back and required colonic resection with ileo anal anastomosis and pouch creation. She presented 6 months after definitive surgery with complains of abdominal distention and subsequent decrease in stool output. Her radiological studies were consistent with stricture at the anastomosis site. She had surgical dilation of stricture under fluoroscopic guidance with poor outcome. In the Endoscopy suite she underwent balloon dilation of the stricture with an upper pediatric scope (a pediatric colonoscope could not be advanced through the stricture). Patient required 3 sessions of dilation 4 weeks apart and that led to resolution of symptoms. There was no complication with the procedure. Patient remains asymptomatic till date (1 year) post dilation. Colonic obstruction may occur due to a wide variety of causes. Acute obstruction may result from colonic volvulus, intussusception and hernia. Less acute presentations result from strictures or extrinsic compression of the bowel. Anastomotic strictures have been reported to occur in up to 30% of patients undergoing colorectal surgery (as per adult studies). TTS stricture dilation has been shown to be effective for the treatment of strictures resulting from both surgical anastomosis and IBD in adult populations. It is technically successful in 73 to 97% of patients, although the majority of patients experienced recurrence, requiring repeated balloon dilation or surgery. Major Complications include bowel perforation, severe bleeding, infection or recurrence. A local steroid injection in conjunction with TTS dilation has shown to reduce the need for repeated procedures or surgeries. Endoscopic guided balloon dilatation holds promise as an alternative to surgical treatment in children with strictures of large bowel, and should be considered in select patients with short strictures.

A Case of Adult Intussusception

Introduction: A 38-year-old Indian man with B-cell adult lymphocytic leukemia on chemotherapy was admitted with diarrhea, nausea, vomiting, and worsening abdominal pain. On presentation, a CT of his abdomen and pelvis found a mild colonic and small bowel distention. The patient was managed with IV fluid hydration and pain medication, and his symptoms improved. Three days later, the patient developed severe colicky abdominal pain. On abdominal exam, he had peri-umbilical tenderness with guarding. The patient was neutropenic and thrombocytopenic throughout his hospital stay, with a WBC of 500/μL and platelets of 16000/μL. Given his acute change in symptoms, another CT scan was performed, which showed small bowel intussusception. Surgery evaluated the patient, and given his neutropenia and thrombocytopenia, opted for conservative management. Five days later, the patient had a repeat CT scan that showed resolution of the intussusception and the patient was eventually discharged home and continued on his chemotherapy regimen. Intestinal invagination or intussusception is the leading cause of intestinal obstruction in children. Intussusception in adults accounts for only 5% of intussuception cases. Intussusception can present as acute, intermittent, cramping, and abdominal pain with nausea and vomiting; however, vague abdominal symptoms is a common presentation. While in children, 95% of cases are idiopathic, about 90% of causes of intussusception in adults are due to a distinct pathologic abnormality. In the small bowel, this consists of benign neoplasms, inflammatory lesions, and adhesions. Malignant lesions are found in only 30% of cases of intussusception in the small intestine, in contrast to 60% in colonic intussusception. Abdominal x-rays often show signs of intestinal obstruction, and can give information regarding the site of obstruction. CT has been reported to be the most useful diagnostic tool for the diagnosis of intussusception, with an accuracy of 58-100% with a finding of a homogenous mass that is target or sausage-shaped. The optimal management of adult intussusception is controversial, particularly in the small bowel. While resection of colonic intussusception is generally advocated due to the high percentage of associated malignancies, small bowel intussusception is less commonly due to malignancy, and thus intraoperative manual reduction with careful palpation of the intestinal wall might allow for limited bowel resection. Intussusception in adults is rare, and can present with non-specific abdominal complaints. Gastroenterologists should be aware of this rare condition for abdominal pain and the current treatment methods.

An Unusual Case of Obstruction Due to Colonic Intussusception in a Patient With Scleroderma

An Unusual Case of Obstruction Due to Colonic Intussusception in a Patient With Scleroderma

Lipoma-Induced Asymptomatic Colocolonic Intussusception

Introduction: Intussusception ia a rare condition in adults and about 50% of the cases have an underlying malignant lesion. Benign lesions may include polyps and diverticula. We present a rare case of asymptomatic colocolonic intussusception caused by a lipoma. Case Report: A 63-year-old female with history of ascending colonic lesion with prior inconclusive biopsy by colonoscopy presented with episodes of painless bright red bleeding per rectum. On examination, abdomen was soft, nontender, and nondistended. Digital rectal examination revealed soft stool mixed with altered blood. The patient underwent colonoscopy which showed a 4-cm polypoid lesion in the ascending colon with fatty tissue eroding through the mucosa. CT abdomen showed development of interval intussusception of the ascending colon. Patient underwent right hemicolectomy with primary anastomosis after finding a 6.0 x 6.0 cm red-purple ulcerated polypoid mass in the ascending colon near the hepatic flexure. Biopsy revealed mature adipocytes, with tumor compressing normal tissue and no invasion. Discussion: Lipomas in the GI tract are rare and most commonly found incidentally during colonoscopy for other reasons. There are many signs described for lipoma, such as “cushion sign” describing the pillowing effect seen when pressed with forceps, “tenting sign” describing when the mucosa is grabbed by forceps resulting in a tent-like appearance, and “naked fat” sign, which happens when fat grossly extrudes after biopsy. Intussusception is rare in adults. The causes include organic lesions such as IBD, postoperative adhesions, Meckel’s diverticulum, benign and malignant lesions, iatrogenic due to jejunostomy feeding tubes, or after gastric surgery. Eight percent to 20% of cases are idiopathic. It can present with a variety of nonspecific symptoms that can have an acute, intermittent, or chronic course, and rarely asymptomatic as in our case, caused by lipoma. Diagnosis of lipoma is sometimes challenging due to its submucosal nature, with endoscopic biopsy showing nonspecific inflammation. Other modalities such as CT scan and barium enema can help in the diagnosis.There are no definitive guidelines for the treatment of colonic lipoma. Endoscopic approach is favorable for medium-sized lesions, while surgical resection is preferred for patients with large lesions greater than 4 cm, which can present as an obstruction or intussusception, or when coexisting malignancy cannot be excluded by endoscopic approaches. Conclusion: Lipoma-related colonic intussusception in adults is a very rare condition with often nonspecific symptoms or, rarely, asymptomatic as in our case. The mainstay of treatment is the resection of the involved bowel segment.

Adult Intussusception: A Retrospective Review

BackgroundIntussusception is common in children but rare in adults. The goal of this study was to review retrospectively the symptoms, diagnosis, and treatment of intussusception in adults.MethodsFrom 1997 to 2013, we experienced 44 patients of intussusception in patients older than 18 years. The patients were divided into enteric, ileocolic, ileocecal, and colocolonic (rectal) types. The diagnosis and treatment of these patients were reviewed.ResultsOf the 44 patients of adult intussusception, 42 were diagnosed with abdominal ultrasonography and abdominal computed tomography. There were 12 patients of enteric intussusception, six patients of ileocolic intussusception, 16 patients of ileocecal type intussusception, and 10 patients of colonic (rectal) intussusception. Among them, 77.3 % were associated with a tumor. Among 12 patients of enteric intussusception, three were associated with a metastatic intestinal tumor, and one was associated with a benign tumor. Among six patients of ileocolic intussusception, two patients were associated with malignant disease. Also, 93.8 % of ileocecal intussusceptions were associated with tumors, 80.0 % of which were malignant. Similarly, 90.0 % of colonic intussusceptions were associated with malignant tumors. Intussusception was reduced before or during surgery in 28 patients. Surgery was performed in 41 patients, and laparoscopy-assisted surgery was performed for ab underlying disease in 12 patients.ConclusionsPreoperative diagnoses were possible in almost all patients. Reduction greatly benefited any surgery required and the extent of the resection regardless of the underlying disease and surgical site.

A 4-cm lipoma of the transverse colon causing colonic intussusception: A case report and literature review.

Colonic lipomas are rare benign tumors. Colonic intussusception is an uncommon complication of colonic lipoma. The current study presents an unusual case of a 4-cm symptomatic lipoma of the transverse colon causing colonic intussusception. A 65-year-old female was admitted to Wenzhou Central Hospital (Wenzhou, Zhejiang, China) with intermittent pain in the left abdomen that had been present for two weeks. Colonoscopy revealed a 4×5-cm intraluminal spherical mass with erosional mucosa 60 cm above the anal verge, indicating the presence of a malignant gastrointestinal stromal tumor. Contrast-enhanced computed tomography revealed a well-defined fatty tissue mass of 4 cm in diameter in the distal transverse colon proximal to the splenic flexure, with intussusception. The patient underwent segmental resection of the transverse colon and intraoperative frozen sections were obtained. The intraoperative frozen sections revealed a submucosal lipoma of the transverse colon and thus, a conclusive diagnosis was achieved. The patient was followed up for one year and 10 months following the segmental resection of the transverse colon, with a good prognosis. This study may increase clinical awareness with regard to colonic lipomas. Furthermore, open surgery combined with use of intraoperative frozen sections should be recommended for large symptomatic colonic lipomas accompanied by colonic intussusception, thus avoiding unnecessary radical resection and improving patient prognosis.

GASTROINTESTINAL TORSIONS AND INTUSSUSCEPTION IN NORTHERN KOALAS (PHASCOLARCTOS CINEREUS) AT SAN DIEGO ZOO (1976–2012)

The recent classification as threatened status of the northern koala (Phascolarctos cinereus) by the Australian Government highlights the importance of the conservation and health management of this iconic Australian marsupial. This case series describes gastrointestinal torsion and intussusception in six northern koalas (three males, three females, 2-11 yr old) at the San Diego Zoo from 1976 to 2012. Two koalas died shortly after presentation. Diagnoses of ileocecal intussusception, resulting from enteritis in one case and cecal torsion in the other, were made at postmortem examination. One koala died 4 days after an exploratory laparotomy, with negative findings, and an acute double colonic intussusception was diagnosed at postmortem examination. Two small intestinal mesenteric torsion and one proximal colon mesenteric torsion cases were successfully corrected surgically. In the case of colonic mesenteric torsion, the koala had recurrent clinical signs 2 wk later, and a second surgery requiring resection and anastomosis of ischemic jejunum was performed, with the koala dying shortly afterward. One koala with small intestinal torsion had a recurrence of torsion 22 mo later and subsequently died. The koala with the second case of small intestinal torsion remains alive 14 mo postsurgical correction. All six koalas presented with signs of colic that included anorexia, lethargy, depression, acute abdominal distension, abdominal stretching, decreased fecal output, open-mouth gasping, or a combination of symptoms. Abdominal radiographs may show stacked gastrointestinal linear gas patterns and contrast stasis. Prevalence of torsion and intussusception is low at this institution (2%), although recurrence in individuals is common (50%) and overall survival is poor (83%), which emphasizes the importance of timely recognition, surgical correction, and postoperative management. While inciting etiologies were unable to be determined in these cases, monitoring generalized gastrointestinal health and differing Eucalyptus sp. effects on individual koala's gastrointestinal function, parasite control, and stress minimization through standardized husbandry practices are likely important.

Unusual colocutaneous fistula from intussuscepted paediatric descending colon lymphoma: A very rare pathology

Occurrence of Non-Hodgkin lymphoma in the colon of children is extremely rare. Ignorance, nonavailability of experts and poverty affect management of affected patients. Descending colon and sigmoid colon are very uncommon sites for the involvement of Non-Hodgkin lymphoma and less than 10 cases involving children have been described in world literatures. A 13 year old Kanuri boy presented with 3 years of recurrent abdominal colics and distension and eventual spontaneous enterocutaneous fistula 4 days prior to presentation. Patient was chronically ill looking and grossly wasted. The abdomen was soft with a non tender suprapubic mobile mass measuring 10cm x 14 cm. There was diagnostic dilemma which was not assisted by cheap ultrasonography and patient could not afford the sophisticated CT scan and contrast enema. Exploratory laparotomy revealed colocutaneous fistula and descending colon intussusception with a huge fungating mass as the lead point confirmed histologically to be a Non-Hodgkin's lymphoma. The challenge of lack of fund affected prompt presentation and also limited decision taken on investigation and management of the patient. High index of suspicion and meticulous management of the patient in spite of the challenges led to a good outcome. This probably might be the first reported case of a descending colon lymphoma from this subregion or even in Africa.Keywords: Abdominal masses in children, acute abdomen, enterocutaneous fistula, lymphoma, poverty, ignorance and neglect, scarcity of specialists,

Adult intestinal intussusception — A report of 2 cases and literature review

Abstract Every five years or so a case of adult small bowel intussusception secondary to pathologies such as inflammatory fibroid polyp (IFP) appears in English literature. Likewise rare cases of adult colonic intussusception due to a tumour have been reported including, more recently, their successful management by laparoscopic approach. We describe two such cases, one each of small bowel and large bowel intussusception, due to IFP and caecal tumour respectively and discuss their management. We also suggest role of combined laparoscopy/endoscopy in selected cases of colonic resections.

Adult colonic intussusception: a case report

Intussusception is the penetration of a digestive tract segment into an adjacent segment. It is rare in adults and difficult to diagnose. For adults it generally involves a precipitating factor. This paper describes an adult patient who entered the emergency department with acute surgical abdomen. Emergency laparotomy revealed colonic intussusception. The pathology confirmed a lipoma as the head of this intussusceptum.

Intussusception of rectosigmoid colon cancer mimicking a pedunculated tumor.

Intussusception in adults is a rare phenomenon involving the colon in approximately 20% of cases. A 65-year-old man was hospitalized with anorexia, anemia, dehydration, and melena. Digital rectal examination revealed a palpable mass approximately 5 cm from the anal verge. The mass moved between the rectosigmoid colon and the rectum below the peritoneal reflection during radiographic examinations and during sigmoidoscopy. We strongly suspected a rectosigmoid pedunculated tumor and performed a low anterior resection. Intraoperatively we observed intussusception of the rectosigmoid colon with easy manual reduction. The tumor was palpable in the rectosigmoid colon. The postoperative course was uneventful. This case illustrates intussusception of a rectosigmoid type 1 colon adenocarcinoma mimicking a pedunculated tumor.