Adult Intussusception Research Articles

INTUSSUSCEPTIONS IN ADULTS (ABOUT 06 CASES)

Background : Intussusception in adults is a rare condition that is difcult to diagnose due to its clinical polymorphism. Its diagnosis has become easier thanks to advances in medical imaging. The treatment of intussusceptions in adults is surgical because of the high incidence of causative organic lesions. Our work is a prospective study which aims to determine theObjective : clinical and etiological peculiarities of acute intussusceptions in adults, to specify the diagnostic and therapeutic difculties and to draw practical conclusions regarding the optimal therapeutic management of this rare condition. Our work is a retrospective study,Materials and methods: covering a series of 06 cases of acute intussusception operated on in the visceral surgery department of the Avicenne Military Hospital in Marrakech, over a period of 6 years, from January 2014 to May 2020. Data relating to clinical features, diagnosis, treatment and histological reports were collected and analyzed. Six cases of acute intussusceptions in adults were collected over a period of six years, amountingResults: one case per year. The average age was 52 with a female predominance of 66%. Four out of 6 patients had been seen urgently. The diagnosis was made preoperatively in all cases, ie 100% by using ultrasonography and CT. The ultrasound showed a "target" image in one case and a "pseudo- kidney" image in another. CT made it possible to make the diagnosis in all cases, and objectied an etiological diagnosis in 4 patients, ie 66.6% of cases. The pure enteric form was the most frequent (3 out of 6 cases), ie 50% of cases. There was one case of intestinal necrosis. Bowel resection was performed in 6 cases, or 100%. The cause of intussusception was found in all patients, including a benign tumor cause in 66.6% of cases. The immediate postoperative follow-up was straightforward in all patients We can conclude that the acute intussusception in adults is aConclusion: rare entity that should be considered in any patient with subacute abdominal pain. And we propose that oncological resection should be carried out in all cases of intestinal intussusception without attempting reduction regardless the site of the invagination, In view of the high rate of malignancy.

A rare case of adult colocolic intussusception secondary to splenosis

Intussusception is the invagination of a segment of bowel (intussusceptum) into the lumen of an adjacent segment (intussuscipiens). Adult intussusception is rare and typically asymptomatic, although bowel obstruction can be a predominant symptom, making it difficult to diagnose. Splenosis is an uncommon and benign disease, arising from the self-implantation of splenic tissue elsewhere in the body after splenectomy or splenic trauma. Colocolic intussusception secondary to splenosis is rare. We report a case of colon intussusception with a mass in the intussusception detected by ultrasound. Abdominal ultrasound identified the intussusception location but failed to distinguish its pathological properties. Colonoscopy revealed the exudation of necrotic and fibrous tissue. Surgery was performed because of suspicions of a malignant tumor.

Adult intussusception: Do we always have a lead point lesion?

A 21-year-old woman presented to our hospital Accident & Emergency department (A&E) with a 6-week history of vomiting, abdominal pain, constipation and weight loss (12 kg in 2 months).

Ileocolic intussusception caused by giant submucosal colonic lipoma: A rare case report.

IntroductionAn adult intussusception is associated with a pathological lesion involving a lead point, such as a benign polyp, enlarged mesenteric lymph node, lipoma, Meckel's diverticulum, lymphoma, gastrointestinal stromal tumor, primary, or metastatic adenocarcinoma. A lipoma is usually asymptomatic, however, lipomas >2 cm may cause intussusception by forming a lead point.Presentation of caseA 46-year-old South Korean man was admitted and presented with a two-week history of intermittent abdominal pain and discomfort. Abdominal pelvic computed tomography scan revealed that about 6.5 cm of fat attenuation mass is present in the ascending colonic loop with about 15 cm of ileal loop pulled into the ascending colonic loop through the ileocecal valve. Mechanical obstruction with ileocolic intussusception was found in distal ileum. The colonoscopy detected a huge mass in the mid-ascending colon blocking the passage of the colonoscope. The patient was diagnosed with an ileocolic intussusception which was suspected to be a huge lipoma. Laparoscopic assisted right hemicolectomy was performed and the follow-up pathologic examination showed that it is a submucosal lipoma.ConclusionThe present case report concerns a 46-year-old male with a long segment ileocolic intussusception due to a giant lipoma arising from the ascending colon and whose intussusception was surgically resected.

Jejunal intussusception on jejunostomy tube: A rare cause of occlusion in adults.

IntroductionAcute intestinal intussusception (AI) in adults secondary to jejunostomy is a rare complication and a surgical emergency requiring early diagnosis and treatment.Presentation of caseWe report the case of a 44-year-old patient, without medical history, who presented dysphagia after caustic ingestion. The patient underwent a Witzel feeding jejunostomy. The evolution was marked by the installation of abdominal distension with vomiting and alteration of the general state, the diagnosis of an intussusception in the jejunostomy tube was made in the abdominal CT scan, which required a surgical intervention, and reduction of intussusception, with simple after effects.DiscussionAcute intestinal intussusception (IIA) secondary to jejunostomy tube placement is a rare abdominal emergency. It manifests with signs of upper gastrointestinal obstruction. Diagnosis is based on abdominal imaging by ultrasound or CT scan. Treatment is most often surgical (Chavrier et al., 1992) [1].ConclusionWe present a very rare example of acute intestinal intussusception in adults, complicating jejunostomy, with non-specific clinical signs, which needed an early radiological diagnosis for adequate management.

Colonic B-cell Lymphoma Induced Intussusception in 18 Years Old Female, A Case Report

Adult intussusception is a rare entity that differs from childhood intussusception. It can be challenging to diagnose due to its nonspecific presentation. In this case report we discuss an 18 year old female who presented with unspecific abdominal pain and was diagnosed with intussusception on CT. Further workup showed a mass and biopsy confirmed a lymphoma.

Adult intussusception: still a challenging diagnosis for the surgeon

Introduction and aimIntussusception is rare in adults and can occur in the small bowel and colon. Its atypical presentation makes the diagnosis difficult. The aim of the present study was to evaluate the causes, clinical characteristics, and treatment outcomes of adult intussusception and to determine whether there was an association between etiology and clinical presentation. Materials and methodsA retrospective study was carried out on patients above 18 years of age that were treated for intussusception at a tertiary care hospital, between 2000 and 2020. The findings were summarized utilizing descriptive and inferential statistics. ResultsTwenty-eight cases were identified. Median patient age was 46 years (18-80) and median symptom duration was 18 days. Abdominal pain was the most frequent symptom (96.42%). The intussusceptions registered were enteroenteric (14), ileocecal (4), ileocolonic (4), colocolonic (5), and colorrectal (1). Intussusception etiology was benign in 15 cases, 9 were associated with malignancy, and 4 were idiopathic. Surgery was performed on 11 patients with enteroenteric intussusception and on all the cases of ileocecal, ileocolonic, colocolonic, and colorectal intussusception. There were 2 events of perioperative mortality (8%) and 8 of postoperative morbidity (32%). No significant differences were found regarding symptom duration or length of hospital stay, when the etiologic groups were compared. ConclusionsIntussusception is rare in adults. Diagnosis is a challenge because of the nonspecific signs and symptoms. Surgical resection should be considered in the definitive treatment and management should be individualized according to the patient’s comorbidities, clinical presentation, and risk of malignancy.

Colon lipoma causing intussusception in adults: literature review

Colon lipoma causing intussusception in adults: literature review

Multiple Small Bowel Intussusceptions Detected by Diagnostic Laparoscopy in an Adult Patient with Previously Undiagnosed Coeliac Disease.

Enteric intussusception in adults is usually associated with the presence of a lead point seen on abdominal computerized tomography. However, as intussusception in coeliac disease may not have a lead point, a surgical procedure is often indicated in order to exclude small bowel tumour. We present the case of a male patient who presented with asymptomatic small bowel intussusception. During exploratory laparoscopy, five enteric intussusceptions were detected and a suspicion for coeliac disease was raised. Postoperative duodenal biopsy and CD3 immunohistochemical staining confirmed the diagnosis of coeliac disease, Marsh type 1.LEARNING POINTSCoeliac disease can present initially with multiple small bowel intussusceptions.Intussusceptions in coeliac disease present without a lead point.In such cases, diagnostic laparoscopy can help to establish the diagnosis.

Role of imaging in the evaluation of intussusception in adults: A 10-year retrospective study

IntroductionIntussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception. MethodWe retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period. ResultsIn the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically. ConclusionThe increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously.

Intususcepción en adultos: todavía un reto diagnóstico para el cirujano

Introduction and aimsIntussusception is rare in adults and can occur in the small bowel and colon. Its atypical presentation makes the diagnosis difficult. The aim of the present study was to evaluate the causes, clinical characteristics, and treatment outcomes of adult intussusception and to determine whether there was an association between etiology and clinical presentation. Material and methodsA retrospective study was carried out on patients above 18 years of age that were treated for intussusception at a tertiary care hospital, between 2000 and 2020. The findings were summarized utilizing descriptive and inferential statistics. ResultsTwenty-eight cases were identified. Median patient age was 46 years (18-80) and median symptom duration was 18 days. Abdominal pain was the most frequent symptom (96.42%). The intussusceptions registered were enteroenteric (14), ileocecal (4), ileocolonic (4), colocolonic (5), and colorrectal (1). Intussusception etiology was benign in 15 cases, 9 were associated with malignancy, and 4 were idiopathic. Surgery was performed on 11 patients with enteroenteric intussusception and on all the cases of ileocecal, ileocolonic, colocolonic, and colorectal intussusception. There were 2 events of perioperative mortality (8%) and 8 of postoperative morbidity (32%). No significant differences were found regarding symptom duration or length of hospital stay, when the etiologic groups were compared. ConclusionsIntussusception is rare in adults. Diagnosis is a challenge because of the nonspecific signs and symptoms. Surgical resection should be considered in the definitive treatment and management should be individualized according to the patient's comorbidities, clinical presentation, and risk of malignancy.

Colocolic intussusception secondary to colonic adenocarcinoma with impending caecal perforation in an elderly patient: A rare case report.

IntroductionIntussusception is a surgical emergency in which a part of the intestine slides into the distal adjacent part. Adult colocolic intussusception secondary to a tumoral process is a rare but serious clinical condition requiring immediate surgical intervention.Case presentationWe report a case of a 65-year-old male patient presenting with abdominal pain and distention, subsequently diagnosed with colocolic intussusception in the descending colon with closed-loop bowel obstruction with impending caecal perforation. An exophytic mass on the descending colon was discovered intra-operatively, prompting a subtotal colectomy with ileosigmoidal anastomosis and loop ileostomy with the suspicion of malignancy. The histopathological examination of the surgical specimen concluded a moderately-differentiated colonic adenocarcinoma with 40% mucinous component.Clinical discussionAdult intestinal intussusception is a rare but serious condition differing greatly in etiology from its pediatric counterpart. Its preoperative diagnosis is challenging in adults, which appears to be due to its imprecise presenting signs and symptoms; thus, the condition can be mistaken for other causes of intestinal obstruction. Adenocarcinomas remain the most common cause of malignant tumors in the colon, which also makes them one of the causes for colocolic intussusception.ConclusionIntussusception can appear as a surgical emergency even in the elderly, necessitating prompt surgical intervention to avoid intestinal ischemia and gangrene. Its diagnosis can be aided to a great degree by CT imaging.

Intussusception of the third portion of the duodenum secondary to a primary duodenal malignancy: A case report.

Introduction and importanceIntussusception is invagination of the bowel and is rare in adults, representing only 5% of all cases of intussusception. Duodenal intussusception is also very rare. To the best of our knowledge, there is only one previous report of a malignant tumor in the fourth portion of the duodenum as the lead point of intussusception (Vaibhav et al., 2021 [1]). This reports a duodenal-duodenal intussusception caused by a malignant tumor in the third portion of the duodenum.Case presentationA 36-year-old woman with abdominal pain was diagnosed with duodenal intussusception by abdominal ultrasonography and computed tomography scan. Double balloon endoscopy showed that the intussusception had spontaneously reduced, and a tumor was found in the third portion of the duodenum. Open resection was performed because of the tumor location. Pathologic examination revealed adenocarcinoma with an adenoma of the duodenum. The patient had no evidence of recurrence for 4 years after resection.Clinical discussionThis patient had a primary duodenal malignancy and presented with intussusception, Duodenal intussusception is a rare condition requiring prompt intervention, usually requiring surgery. In this patient, since endoscopic resection was difficult, partial resection of duodenum was performed by open surgery assisted by double balloon enteroscopy. The pathological diagnosis of the resected specimen was primary duodenal malignancy.ConclusionThis is a report of adult duodenal intussusception caused by a primary duodenal malignancy. This rare condition posed an intriguing challenge for the optimal operative approach.

An ileo-colic intussusception reaching down to the descending colon - A case report.

Introduction and importanceIntussusception in healthy adults is rare and often associated with oncologic diseases. This case report presents a case of an ileo-colic intussusception reaching down to the descending colon in a healthy adult that required ileo-colic resection.Case presentationWe present a case of a 78-year-old male patient with acute onset unspecific abdominal pain. The medical history was unremarkable. Preoperative radiologic assessments showed an invagination of the small intestine into the colon without any signs of polyps or tumours. An emergency laparotomy with resection of the affected intestine was performed. The pathologist described a 49 cm length of intussuscepted colon and an additional 7 cm intussusception of the terminal ileum. A circular area with multiple polyps extending over 8 cm in the colon could be identified. The microscopic findings showed a low-grade dysplasia within this area. Following surgery, the patient was discharged to rehabilitation after a ten-day hospitalization.Clinical discussionIntussusception in adults is rare and the clinical presentation includes unspecific symptoms making the diagnosis challenging. In 90% of the cases, a pathologic lesion is found (two-thirds are neoplasms). An intussusception involving the colon should be treated surgically without prior reduction due to the high incidence of a neoplasm and the risk for perforation and tumour dissemination.ConclusionIn the literature, neoplastic disease represents the major cause for intussusception in adults. This report presents a rare case of an ileo-colic intussusception reaching down to the descending colon treated successfully with a subtotal colectomy.

Inflammatory fibroid polyp (Vanek's tumor) causing double compound ileo-ileal intussusception in an adult patient, a case report

Introduction and importanceThe majority of the of small bowel intussusception causes are benign, and different types of benign tumors have been reported as the lead points of an intussusception. Among these, some studies have reported inflammatory fibroid polyp as a cause of small bowel intussusception. However, according to our knowledge this is the first case to be reported in Africa of an adult double compound intussusception due to an inflammatory fibroid polyp.Case reportA 32-year-old female presented with epigastric abdominal pain, nausea, vomiting and diarrhea for 2 weeks. Investigations revealed a small bowel obstruction due to intussusception, and exploratory laparotomy was planned.Clinical discussionInflammatory fibroid polyp causing this unique feature of double compound ileo-ileal intussusception should be observed in adult patients who presents with intestinal obstruction. A CT scan is the diagnostic modality of choice, and we think that the disease is the first of its kind to be reported in Africa.ConclusionsDouble ileo-ileal intussusception is a rare cause of intestinal obstruction in adult patients.Interventions and outcomeLaparotomy reviled an ileo-ileal intussusception. After manual reduction of this intussusception, another intussusception was observed and containing a polyp. A clear margin resection and end-to-end primary anastomosis were performed. The histopathological report established the diagnosis of Inflammatory Fibroid Polyp. After the procedure, the patient's condition improved well with no complications.MethodsThis case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [1]).

ADULT JEJUNOJENUNAL INTUSSUSCEPTION CAUSED BY A SUBMUCOSAL LIPOMA IN THE JEJUNUM.

Intussusception in adults is rare.The clinical picture of intussusception in adults is subtle and the diagnosis is therefore elusive. The presence of a structural abnormality in the great majority of the adult cases mandates high clinical suspicion. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity.The present report describes a case of jejunojejunal intussusception in an adult with a history of severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was suspected preoperatively but computed tomography could not rule out malignancy. Exploratory laparotomy revealed jejunojejunal intussusception secondary to a lipoma which was successfully treated with segmental resection.

Metastatic melanoma to the small bowel causing intussusception: A case report.

Introduction and importanceMelanoma is a malignant skin neoplasm with a high metastatic potential. Several reports have shown that metastatic melanoma has a predilection to metastasize to the GI tract; however, diagnosing metastatic melanoma as a cause of intussusception has been reported in only few cases with variable presentations.Case presentationWe present the case of a 48-year-old woman with a long history of metastatic melanoma who presented with recurrent enteric intussusception due to a melanoma lesion acting as a pathologic lead point despite immunotherapy treatment. We contribute the management plan, diagnostic modalities, and surgical approach of this rare form of adult intussusception in guidance of future management plans.Clinical discussionThe variability in presentation of adult intussusception makes diagnosis difficult and the lack of consensus on management and surgical strategies poses challenging hurdles. A diagnostic laparoscopy followed by reduction and resection of the intussuscepted lesion in a small surgical field is an effective and beneficial palliative procedure with favorable outcomes. Our patient developed intussusception despite receiving a trial of dual immunotherapy after chemotherapy.ConclusionIt may be insufficient to control disease even with dual immunotherapy after chemotherapy. Further studies are needed to determine the optimal surgical and oncological management in treating gastrointestinal metastasis of malignant melanoma.

Jejunal intussusception due to an atypical lipomatous tumor: a rare case report.

Intussusception in adults is rare, and the clinical symptoms of intussusception are subtle, making the diagnosis quite challenging. Gastrointestinal lipomas are rare benign tumors and are essentially adipose growths, most frequently found within the small intestine wall or mesentery. Limited up-to-date evidence exists regarding such lipomas. Intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity, and the diagnosis of duodenal lipoma mainly depends on endoscopy examination, supplemented by computed tomography and magnetic resonance imaging. The present report describes a case of jejunal intussusception in an adult with a history of intermittent colicky abdominal pain located in the left upper quadrant over the last month. Contrast-enhanced computed tomography of the abdomen showed the typical target sign of a small intestinal intussusception along the left upper quadrant and a well-defined, low-density tumor in the intussusception. Exploratory laparotomy revealed jejuno-jejunal intussusception secondary to a lipoma, which was successfully treated with segmental intestinal resection.

A rare case of colonic lipoma causing colo-colonic intussusecption

Gastrointestinal tract (GIT) lipomas are rare, benign mesenchymal neoplasm affecting all segments of the GIT and colon is affected most frequently. Reported incidence of colonic lipomas varies from 0.2% to 4.4%. Adult intussusception represents 1% of all bowel obstructions and 5% of all bowel intussuceptions. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointestinal lipoma constitute an infrequent clinical entity. Although intussusception is a common disease in children, intussusception caused by colonic lipoma in adults is a rare condition, and is usually caused by a large pedunculated lipoma. The majority are asymptomatic but may cause abdominal pain, obstruction or bleeding. The treatment for symptomatic or large lipomas is surgical excision. We would like to report a unique case of an elderly lady with colonic lipoma causing colo-colonic intussusception. After thorough investigations, exploratory laparotomy with colo-colonic anastomosis was done.

Colorectal Intussusception Due to Tubulovillous Adenoma in the Sigmoidorectal Junction: A Case Report

Adult intussusception is a rare disease with various clinical presentations and can cause grave surgical problems. The condition is associated with malignant and benign leading points in adults, unlike in children who mostly experience the latter. The colonic intussusception type can be more malignant than the enteric type, especially in distal parts of the colon. Sigmoidorectal intussusception is less common in adults; it usually presents as bowel obstruction or lower gastrointestinal bleeding. We reported a case of a middle-aged woman with sigmoidorectal intussusception who was treated by transrectal endoscopic surgery.