Jejunal Intussusception Research Articles

Idiopathic jejunal intussusception in an adult

Intussusception is a common surgical diagnosis in the paediatric population and is most commonly idiopathic. In adults a substantial proportion of patients have a malignant leading cause and surgical intervention is mandatory. Intussusception involving the small bowel is thought to be more likely benign in nature and is frequently reduced before the leading cause is excised. Review of the literature to determine the incidence of malignancy in small bowel intussusceptions and discussion of the optimal operative strategy. We describe an unusual case of adult idiopathic jejunal intussusception, which was treated with excision without reduction and present the results of a relevant literature search. A number of reports have confirmed a high incidence of malignancy in small bowel intussusceptions and consequently excision without reduction should be undertaken. It is in the authors' view that excision without reduction should be the treatment of choice in small bowel intussusception unless preoperative imaging delineates benign leading pathology and in the rare occasion of a shortened gut.

Spontaneous Jejunal Intussusception after a Colectomy: A Rare Cause of Postoperative Intestinal Obstruction - A Case Report -

Intussusception is a rare cause of intestinal obstruction in adults and is most often due to a primary abnormality of the bowel, which serves as the leading point. Idiopathic intussusception in adults is distinctly uncommon, comprising 10% of diagnosed intussusceptions. We report a case of a spontaneous jejunal intussusception in a 48-year-old man that developed shortly after an open colectomy. The 48-year-old man, with no history of a laparotomy, underwent a left hemicolectomy and a left hemihepatectomy for descending colon cancer with liver metastasis. For 14 postoperative days, the patient complained of ileus, and conservative management with a long intestinal tube failed. When the patient underwent a laparotomy, intussusception of the mid jejunum was observed. The intussusception was resected, and no underlying bowel abnormality was identified. This report highlights the importance of considering this rare etiology in patients with ileus who have recently undergone a laparotomy.

A case report of B-cell lymphoma masquerading as superior mesenteric artery syndrome

Superior mesenteric artery (SMA) syndrome is a rare cause of intestinal obstruction, especially in children, whereas intussusception is far more common. We report the case of a child, who after an episode of acute weight loss presented with features suggestive of SMA syndrome. This child subsequently was shown at operation to have disseminated lymphoma causing a secondary high jejunal intussusception and tumor involvement of retroperitoneal lymph nodes causing compression of the third part of the duodenum. This case emphasizes that the SMA syndrome should be considered a sign rather than a diagnosis in itself. As such, an active search should be made to determine the cause of the condition. Routine preoperative imaging is recommended.

Adult Intussusception Caused by Heterotopic Pancreas

Heterotopic pancreas causing small bowel intussusception is rare. We report the case of a 24-year-old woman who presented with intermittent episodes of abdominal cramping and pain that had persisted for 10 days. A target-shaped lesion consisting of multiple concentric rings was found on the left side on contrast-enhanced computed tomography. Surgical intervention demonstrated jejunal intussusception caused by a jejunal heterotopic pancreas. Microscopically, several nesidioblastoses of pancreas were identified. Although very rare, small intestinal pancreatic rests may cause subacute bowel obstruction.

34: Reverse jejunal intussusception, may not be such a rare problem: A single group’s experience of 19 cases

Reverse intussusception of the jejunum is thought to be a rare occurrence, reported approximately 8 times in the literature. A review of our experience found 19 cases treated since 1996. This is the largest single center report to date.

Metastatic Osteosarcoma in the Jejunum with Intussusception: Report of a Case

We report a case of metastatic osteosarcoma in the jejunum causing intestinal intussusception. A 58-year-old woman underwent right femoral region amputation, lower lobectomy of the left lung and complete left pneumonectomy after four courses of chemotherapy for osteosarcoma of the right femur with left lung metastases. She was referred to our department 13 months later with progressive abdominal pain and vomiting. Abdominal radiography showed a small-bowel obstruction. She underwent emergency laparotomy, which revealed jejunal intussusception. The lead point was found to be an intraluminal tumor. We resected the jejunum containing the tumor and histological examination confirmed that the tumor was osteosarcoma metastasis.

Resection of Over 290 Polyps During Emergency Surgery for Four Intussusceptions with Peutz–Jeghers Syndrome: Report of a Case

A 41-year-old male patient with aggravated epigastralgia and nausea was admitted to Central Aizu General Hospital in February 1997. His past history showed a colonic polyp and anemia in the fourth decade. The patient looked healthy, but showed abdominal distension and tenderness, and pigmented lips. A plain abdominal X-ray revealed a dilation of the small intestine with niveau. Computed tomography disclosed multiple target signs. An emergency laparotomy clarified four intussusceptions of the small intestine with numerous polyps. Three were successfully reduced, while one jejunal intussusception was resected. Due to a fear of recurrence, a total of over 290 polyps were removed. His illness was diagnosed to be Peutz-Jeghers syndrome with a histology of hamartomatous polyps. He thereafter did well for 6 years, when he underwent an ileal resection for another intussusception caused by a newly grown lipoma. He was able to retain his job, but anemia and hypoproteinemia due to the proliferation of polyps necessitated treatments at the outpatient clinic. In May 2005, he underwent a third emergency laparotomy for an intussusception, followed by a resection of the ileum and 54 polyps. Since then he has been able to lead a normal life.

Diagnosis: Peutz-Jeghers syndrome with jejunal and colonic intussusception

Diagnosis: Peutz-Jeghers syndrome with jejunal and colonic intussusception

Small bowel obstruction caused by secondary tumors

Small bowel obstruction in an oncology patient is a common and serious medical problem which is associated with diagnostic as well as therapeutic dilemmas. While the condition is most commonly caused by postoperative adhesions and peritoneal carcinomatosis, other causes have been reported [Cormier WJ, Gaffey TA, Welch JM, et al. Linitis plastica caused by metastatic lobular carcinoma of the breast. Mayo Clinical Proceedings 1980;55:747-53; Clavien P-A, Laffer U, Torhos J, et al. Gastrointestinal metastases as first clinical manifestation of the dissemination of a breast cancer. European Journal of Surgical Oncology 1990;16:121-6; Bender GN, Maglinte DD, McLarney JH, et al. Malignant melanoma: patterns of metastasis to the small bowel, reliability of imaging studies, and clinical relevance. American Journal of Gastroenterology 2001;96:2392-400; Gatsoulis N, Roukounakis N, Kafetzis I, et al. Small bowel intussusception due to metastatic malignant melanoma. A case report. Technical Coloproctology 2004;8:141-3; Hung GY, Chiou T, Hsieh YL, et al. Intestinal metastasis causing intussusception in a patient treated for osteosarcoma with history of multiple metastases: a case report. Japanese Journal of Clinical Oncology 2001;31(4):165-7; Chen TF, Eardley I, Doyle PT, Bullock KN. Rectal obstruction secondary to carcinoma of the prostate treated by transanal resection of the prostate. British Journal of Urology 1992;70(6):643-7; Kamal HS, Farah RE, Hamzi HA, et al. Unusual presentation of rectal adenocarcinoma. Roman Journal of Gastroenterology 2003;12(1):47-50; Hofflander R, Beckes D, Kapre S, et al. A case of jejunal intussusception with gastrointestinal bleeding caused by metastatic testicular germ cell cancer. Digestive Surgery 1999;16(5):439-40]. One of these, reported thus far in only very few patients, is obstruction caused by secondary tumors, i.e. metastases from other organs to the small bowel wall. As cancer patients live longer with improved therapy, physicians are more likely to cope with rare phenomena of neoplasms, such as small bowel obstruction caused by secondary tumors. We hereby present a review of the relevant medical literature. The goal of this article is to define current knowledge on this phenomenon, with emphasis on its epidemiology and clinical characteristics, and to increase the awareness of the clinician treating cancer patients of such possibility.

Intussusception of jejunum into stomach through a gastro-enterostomy stoma

Intussusception of jejunum into stomach through a gastro-enterostomy stoma

Spontaneous jejunal intussusception after open radical nephrectomy

Adult bowel intussusception is distinctly uncommon and most often due to a primary abnormality of the bowel serving as the nidus.1 We illustrate a case of spontaneous jejunal intussusception developing shortly after transperitoneal nephrectomy, highlighting the importance of considering this rare etiology in the urologic patient.2–5

Intestinal Intussusception

To identify and propose unusual presentations of a common disease entity. A 36 year old Irish male was referred to the Crohn's and Colitis Center of NJ for evaluation of a jejunal intussusception found on CT scan. We were consulted to rule out Crohn's disease as the cause of the intussusception. He had a history of seminoma, and was status post orchiectomy. His oncologist felt that the lesion was unrelated to the seminoma. The patient denied fevers, chills or night sweats. There was no history of diarrhea, blood per rectum or anemia. There was no family history of inflammatory bowel disease. The patient did note recent visual field defects, arthralgias, and a 15 pound weight loss. There was no travel history. Physical examination revealed temporal wasting. Cardiac, pulmonary, abdominal and skin examination was normal. A small bowel follow through was ordered and was normal. With this constellation of symptoms and negative imaging studies, a diagnosis of Crohn's disease was felt to be unlikely. The patient continued to have weight loss. A follow up CT scan revealed mesenteric adenopathy. An MRI of the brain revealed bilateral optic nerve hypoplasia. Endoscopy was performed to rule out occult celiac disease. At the time of endoscopy an area of questionable jejunal prominence was noted and biopsied. A celiac disease antibody profile was ordered concurrently. Biopsy results revealed subtotal villous atrophy. Tissue transglutaminase antibodies and antigliadin antibodies were all noted to be highly positive. The patient started a gluten free diet. Six weeks after instituting the gluten free diet the patient has gained weight, his arthralgias have improved, and he feels better. His optic nerve hypoplasia has not progressed and is believed to be unrelated to celiac disease. Celiac disease is a common disease entity. The most common presentation is occult anemia. Weight loss and diarrhea are other clues to this disease process. Jejunal intussusception seen at CT may be an early clue that a patient has celiac disease. Enteroenteric intussusceptions are usually nonneoplastic entities. Celiac disease is an example of a functional disturbance that may cause intussusception without gross mural abnormality. Gluten sensitivity causes muscular flaccidity which may lead to a transient intussusception.

Epigastraglia with tarry stools in a middle-aged female caused by jejunal intussusception due to a hamartoma

Upper gastrointestinal (GI) hemorrhage is a common presentation to an emergency department. Often, the diagnosis is peptic ulcer disease in which vague or sharp abdominal pain is associated with bleeding. In contrast, intussusception is a rare cause of abdominal pain and coincident GI bleeding. In this case, we report a 41-year-old woman who had an intussuscepting jejunal obstruction due to a hamartoma of the small bowel. The diagnosis was established by ultrasonography. In review of the literature, abdominal pain and bleeding are two common manifestations of intussusception when the lesion originates in the small bowel. Intussusception is frequently included in the differential diagnosis of pediatric patients with coincident abdominal pain and bleeding. However, it is rarely mentioned as an adult cause of these two findings. Because of the delayed and nonspecific presentations of abdominal discomfort in adult patients with intussusception, the diagnosis is often delayed. This case points out the need for considering intussusception even in middle-aged patients whose initial presentation is concomitant bleeding and pain.

A peculiar multiple polypoid mucosal prolapse causing jejunal intussusception

A case of jejunal intussusception caused by a multiple polypoid mucosal prolapse of jejunum in a 10-year-old girl is reported. The rarity of the lesion, its location, symptoms, and diagnosis are discussed.

Jejunale Invagination eines inflammatorischen fibrinoiden Polypen

Intussusception of parts of the intestine in adulthood is a rare cause of ileus. In more than 90 % of all cases there is a malignant or benign tumour situated in the parts of the intestine affected. We describe a 55-year-old patient who was admitted to hospital as an emergency because of signs of a proximal intestinal obstruction. Abdominal sonography suggested the diagnosis of a typical jejunal intussusception, whereas gastroscopy yielded no pathological findings. Laparotomy was performed immediately and confirmed the diagnosis. After intraoperative de-invagination 9 cm of jejunum and an inflammatory fibrinoid polyp of 3 cm were resected.

A Spontaneous and Fatal Jejunal Intussusception in a European Brown Hare Associated withEimeria leporis

A recently dead adult female European brown hare (Lepus europaeus Pallas) was found in the wild with no evidence of trauma or external injury. Necropsy revealed symptoms consistent with endotoxic shock and a haemorrhagic jejuno-jejunal intussusception with a necrotic intussusceptum. Small, unattached nodules were present extensively in the jejunal lumen and within the intussuscipiens. These nodules proved to be masses of unsporulated Eimeria leporis oocysts. Review of the literature reveals E. leporis to be a common parasite of wild hares, with protracted pathogenic potential under some circumstances. This is the first report of intussusception in this species and the most severe lesion seen associated with E. leporis. This case suggests that E. leporis may be more harmful to the wild European brown hare population than previously supposed.

Intussusception Secondary to Metastasis from a Low-Grade Retroperitoneal Liposarcoma

Liposarcomas are the most prevalent soft tissue sarcomas in adults. Low-grade liposarcomas are the most frequent and least aggressive and are noted as having a low risk of metastasis. We present a case of low-grade myxoid liposarcoma that metastasized to the small bowel resulting in intussusception. This case involves a 44-year-old woman with a recurrent retroperitoneal liposarcoma. Approximately 30 months after initial diagnosis, the patient was found to have a solitary metastasis to the small bowel that presented as a jejunal intussusception. Interestingly, there was no indication of a round cell component in either the metastasis or recurrent tumor, although the original tumor did contain a small round cell component. This is the first report in the English literature of liposarcoma metastasizing to the small bowel. We suggest that atypical presentations of liposarcoma metastases should always be considered in the management of patients with a history of liposarcoma.

Adult retrograde triple Jejuno-Jejunal Intussusception mimicking gastric outlet obstruction: Case Report

Jejuno – jejunal intussusception is rare, both in children and in adults. Equally rare is triple intussusceptions. Work done by Gross showed that ileo – ileal intussusception accounted for five percent of 702 cases, ileo –colic for 77%, ileo –colic for 12% multiple intussusception for one percent of cases, retrograde intussusception for 0.2%, and Other types of intussusception for 2.8% of the cases studied. Malignant tumour of the small bowel is relatively infrequent, comprising about two percent of gastrointestinal malignant neoplasms. Adenocarcinoma is however the most frequent. Method and Results: A case is here presented of triple retrograde Jejuno – jejunal intussusception associated with adenocarcinoma of the jejunum, and mimicking gastric outlet obstruction. Key Words: Jejuno – jejunal, intussusception, triple, adenocarcinoma. Tropical Journal of Medical Research Vol.8(1) 2004: 5-9

Jejunojejunal intussusception secondary to adenocarcinoma

s e F o s t 75-year-old woman was admitted with a 5-day history of bdominal pain associated with vomiting and absent defeation. Three months before, a barium enema study had hown diverticulosis coli, but no signs of tumor or stenosis. he had a body temperature of 38.3°C, a blood pressure of 00/70 mm Hg, and a pulse of 100 beats per minute. hysical examination revealed abdominal distension, hypoctive bowel sounds, and mild tenderness predominantly on he right side, but there were no peritoneal signs. Initial aboratory tests showed a white blood cell count of 19,700 ells per /L (normal levels 4.0 to 10.0), C-reactive protein f 13 mg/L ( 10), serum urea of 23.6 mmol/L (2.5 to 6.7), erum creatinin of 486 mol/L (55 to 90), and slightly levated liver function tests. Plain radiography of chest and bdomen, as well as ultrasonography of the kidneys, howed no abnormalities. In particular, no marked signs of owel obstruction were noted. At that stage, diverticulitis nd dehydration with prerenal insufficiency were considred, and conservative treatment was initiated. For the next 7 days, the clinical picture alternately imroved and worsened. On the seventh day after admission, epeat radiography of the abdomen was normal, although linically the abdomen remained distended. Subsequently, omputed tomography scanning revealed dilation of duodeum and proximal part of the jejunum, and part of the ejunum was intussuscepted (Fig. 1A). The cause of the ntussusception was seen on the ventral left part of the ejunum, namely, a tumorous process (Fig. 1B). At laparotmy, a large 30-cm jejunal intussusception was recognized. anual reduction was performed, after which the cause, a mall tumor, became obvious. A segment extending 5 cm oth proximal and distal to the tumor was resected with rimary end-to-end anastomosis. Histologic examination

Inflammatory Pseudotumor of the Jejunum Presenting as Intussusception: Case Report

Inflammatory pseudotumors are tumor-like, benign lesions of uncertain pathogenesis and have most commonly been reported in the lungs. They occur rarely in the gastrointestinal tract and may cause small bowel obstruction due to intussusception or, less commonly, as an incidental finding on radiologic examination or screening endoscopy. We present a case of surgically proven jejunal intussusception caused by inflammatory pseudotumor.