Large Bowel Intussusception Research Articles

Comparison Between Small and Large Bowel Intussusception in Children: The Experience of a Large Tertiary Care Pediatric Hospital.

Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to serious sequelae. The objective of this study was to determine the prevalence of ileoileal intussusception and to document and compare clinical outcomes with ileocolic intussusception. A retrospective cohort study of children with an abdominal ultrasound that diagnosed intussusception. Clinical data and diagnostic studies were retrieved, to compare ileoileal with ileocolic intussusception. A total of 488 patients were evaluated with an abdominal ultrasound on suspicion of intussusception; 54 (11%) had ileoileal intussusception and 30 (6%) ileocolic intussusception. The significant features distinguishing the 2 conditions were fever, more common in patients with ileoileal intussusception, and an abdominal mass, which was papable more commonly in ileocolic intussusception. None of the ileoileal intussusception patients required surgical intervention, and all were discharged without complication. With recent advances in abdominal ultrasound, the diagnosis of ileoileal intussusception has become easier than before. Patients presenting with small bowel intussusception may not need any immediate intervention. The presence of fever supports the diagnosis of ileoileal intussusception.

1548 Double Intussusception Deception

INTRODUCTION: We report a case of colo-colic intussusception caused by sigmoid adenocarcinoma with concomitant incidental entero-enteric intussusception in a middle aged female. Intussusception in adults is a known rarity, but it is important to note that more than 60% of large bowel intussusceptions are caused by a neoplasm. CASE DESCRIPTION/METHODS: A 50 year old female presented with intermittent abdominal pain for 2 months, worsening with oral intake and associated with abdominal distension and obstipation. Computed tomography of the abdomen & pelvis showed two areas of intussuscepted bowel in the left upper quadrant. One was thought to be an incidental loop of the jejunum. The other representing the splenic flexure and was causing obstruction within the small and large bowel proximal to this lesion. With the diagnosis of intussusception, exploratory laparotomy was performed. A mass was palpated at the splenic flexure, and this was found to originate at the sigmoid colon, leading to left hemicolectomy and transverse colostomy. The histological diagnosis of the mass was well-differentiated adenocarcinoma stage IIIb. The patient later underwent adjuvant chemotherapy with Capecitabine plus Oxaliplatin. DISCUSSION: Large bowel intussusception can be due to benign, malignant, or idiopathic etiologies. As the incidence of intussusception in adults is low, surgical exploration is imperative.

Multiple colic intussusceptions.

Adult large bowel intussusception represents a small minority of intestinal intussusceptions. Main causes involve primary or secondary bowel malignancies. Although multiple small intestine intussusceptions have already been reported, simultaneous large bowel intussusceptions have not been described in the literature so far.

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 intussusception: An institutional experience and review of literature

<b>Background:</b> In adults, intussusceptions represent an uncommon form of intestinal obstruction, diagnosed in only 1-5% of cases. It can be idiopathic or secondary to a pathology in the bowel, which may be a malignancy in 9.75% of small bowel intussusceptions and 50-60% of large bowel intussusceptions. The aim of this study was to make a 15 year institutional review of adult intussusceptions.<br> <b>Materials and Methods:</b> Over a period of 15 years from January 1998 to December 2012, a total of 17 patients were diagnosed and managed as intussusceptions in our institution. A retrospective analysis of clinical, imaging and management data along with specimen and histopathological analysis was carried out.<br> <b>Results:</b> The age range was 21-58 years (mean 35 years) with a male preponderance (11 males: 6 females). Intussusceptions affected the small bowel in 12/17 (70.59%) and the large bowel in 5/17 (29.41%) of cases. The most common clinical presentation was insidious abdominal pain with sub-acute obstruction in 15/17 (88.24) of cases. Computed tomography scan was diagnostic in 88.23% cases. Intestinal tuberculosis (TB) was the most common etiology in 23.53% of the patients. Small bowel intussusceptions were not associated with malignancy, but all cases due to post-operative causes or TB affected small bowel only. Malignancy was responsible for intussusceptions only in the large bowel.<br> <b>Conclusions:</b> On analysis of our cases, we found that malignancy is responsible for intussusception only in the large bowel. Small bowel intussusceptions were not associated with malignancy, but all cases due to post-operative cause or TB affected small bowel only.

Intussusception in Children Presenting to the Emergency Department

A retrospective chart review of children diagnosed with intussusceptions from March 2005 to March 2007 was conducted at a tertiary care pediatric hospital. There were 152 children with 170 episodes of intussusceptions during the study period. Around one third (30%) of children diagnosed with intussusceptions had a concurrent infection. There were 114 large bowel intussusceptions, with a mean age of 27 months (SD = 25) and a success rate of 91% for air enema reductions. Bowel resection was performed in 8.8% of children with large bowel intussusceptions. Small bowel intussusceptions (n = 38) were associated with gastrostomy tubes in 42% (n = 16) of patients, and 81% needed tube shortening. The varying age range of many children diagnosed with intussusceptions and the high incidence of intercurrent illnesses and fever in our study alert health professionals to suspect intussusceptions in children presenting with abdominal pain or crying.

Adult Intussusception, a Rare Cause of Intestinal Obstruction, Case Report and Literature Review

Intussusception is an uncommon surgical presentation in the adult population, with only two to three cases per million per annum. Colo-colic intussusception is the most common type of intussusceptions in adults. Large-bowel intussusception is more likely to have a malignant etiology (in about 50–60% of cases). The preoperative diagnosis of intussusceptions is infrequent in the adult population due to the varying presentations. We report a case of adult intussusception diagnosed preoperatively by CT scan and MRI examination.

Intramural and subserosal echogenic foci on US in large-bowel intussusceptions: prognostic indicator for reducibility?

In large-bowel intussusceptions, several US signs are known to indicate a lower likelihood of reducibility by enema. US can demonstrate echogenic dots or lines (foci) in the bowel wall, which might indicate an ischemic bowel. To determine the presence of echogenic intramural and subserosal foci in large-bowel intussusceptions and to evaluate the degree of correlation with reducibility. Between 2001 and 2008, 74 consecutive US examinations were retrospectively evaluated by two pediatric radiologists for intramural and subserosal echogenic foci, or trapped gas, in the intussusception. The degree of correlation between the sonographic findings and reducibility was evaluated. Of 73 intussusceptions examined by US, 56 (76%) were reducible and 17 (23%) were not reducible. Out of 10 intussusceptions with intramural gas, 11 with subserosal gas, and 14 with intramural and subserosal gas, 8 (80%), 6 (56%), 9 (64%), respectively, were not reducible. The presence of intramural gas or subserosal gas or both predicted a lower chance of reduction, but with regard to the effect of these findings together, intramural gas was the only significant predictor. Having intramural gas in large-bowel intussusception significantly decreases the chance of reduction.

Tumor spectrum of adult intussusception

Adult intussusception is rare. Most general and colorectal surgeons are unfamiliar with its etiology and optimal management. Patients older than 16 years and diagnosed with intestinal intussusception between January 1990 and June 2006 were retrospectively reviewed. Data related to presentation, diagnosis, treatment, and pathology were analyzed. Seventy-two patients underwent surgery for intestinal intussusception. Neoplasm was identified as the cause of intussusception in 66 (92%) cases, and 6 (8%) were idiopathic. The incidence of malignant colonic intussusception (63%) was significantly higher than that of enteric intussusception (20%), P = 0.001. Primary colon adenocarcinoma (8 of 10 patients, 80%) and malignant lymphoma (2 of 10 patients, 20%) were the two most common underlying malignant lesions in the colon. Lipoma (15 of 40 patients, 38%) and Peutz-Jegher adenoma (10 of 40 patients, 25%) were the two most common lesions of benign small bowel neoplasms while 27% (3 of 11) of malignant enteric intussusception cases were malignant lymphoma and metastatic respectively. Lipoma is the most common benign tumor in both small and large bowel intussusception. Whereas 80% of tumors associated with small bowel intussusception were benign, two-thirds of colonic intussusceptions had resulted from primary adenocarcinoma.

Ascaris as a leading point for small-bowel intussusception in an adult: a rare cause of intussusception

Adult intussusception represents 1% of patients with bowel obstructions and requires a surgical approach. Malignancy is associated with 31% of small bowel intussusception and 70% of large bowel intussusception. Intestinal intussusception caused by ascaris, however, is very uncommon. This report describes our experience of this rare cause of intussusception and its clinical findings.

Adult Intussusception: Diagnosis and Treatment

Purpose: Adult intussusception occurs infrequently and differs greatly from childhood intussusception in etiology. Proper diagnostic of and surgical therapeutic methods for adult intussusception remain controversial. The aim of this study was to determine useful diagnostic modalities and proper surgical interventions in adult intussusception. Methods: A retrospective analysis performed at Chonbuk National University Hospital identified 38 patients, aged 15 and older, with a diagnosis of intussusception from January 1991 to January 2007. Results: There were 19 males and 19 females. The median age of the group was 44 years with a range of 20 to 80 years. The mean follow-up period was 82 months. Abdominal pain was the most common presenting complaint (89%). There were 30 small bowel intussusceptions and 8 colonic intussusceptions. A pathologic cause was identified in 79% of the patients, with 5 of 30 (17%) small bowel and 4 of 8 (50%) large bowel lesions being malignant. A preoperative diagnosis was made accurately in 25 of 38 (66%) patients. The diagnostic rates of pre-operative radiological methods were 77%, 60%, 79%, and 100% for barium enema, ultrasonography, abdominal computerized tomography, and both ultrasonography and abdominal computerized tomography, respectively. Operative treatment consisted of manual reduction only in 6 small bowel (20%) and 1 large bowel intussusception (12%), bowel resection after manual reduction in 8 small bowel (27%) and 2 large bowel intussusceptions (24%), and resection alone in 16 small bowel (53%) and 5 large bowel intussusceptions (64%). Conclusions: Both ultrasonography and abdominal computerized tomography are the most useful diagnostic modalities. Colonic intussusception should be treated with en-bloc resection without reduction due to the high incidence of malignancy. However, manual reduction only, bowel resection after reduction, and bowel resection alone can be chosen selectively in cases of small bowel intussusception. J Korean Soc Coloproctol 2007;23:416-419

Intussusception in Childhood Acute T Cell Lymphoblastic Leukemia: An Unusual Complication - Report of 2 Cases.

Clinically significant gastrointestinal complications in children with acute lymphoblastic leukemia (ALL) have been reported. However, intussusception is a very rare complication. In one study of 286 children with ALL gastrointestinal complications occurred in 5.6% of patients with intussusception seen in only 0.3% of patients. We describe two cases of intussusception during chemotherapy for T-cell leukemia. Patient #1 was an 8 year old girl on chemotherapy for T-cell ALL. Around week 9 following POG 9404 protocol of consolidation chemotherapy, patient presented with severe abdominal pain and vomiting, and had marked, diffuse tenderness of the abdomen with guarding and hypo-active bowel sounds. Abdominal radiograph showed thickening of the descending colon; abdominal sonogram was normal; abdominal computed tomography (CT) scan however, revealed a soft tissue and fluid-filled mass extending from the cecum to the descending colon. These findings were consistent with a large bowel intussusception, which was successfully reduced with a barium enema. Patient #2 was a 15 year old male receiving chemotherapy for T-cell ALL following POG 9404 protocol. At week 14 of consolidation chemotherapy, patient presented with a 2 day history of nausea and colicky peri-umbilical and right lower quadrant abdominal pain. An abdominal CT scan revealed an ileocolic intussusception without bowel obstruction and mild wall thickening of the cecum. Barium enema resulted in successful reduction of the intussusception. Interestingly, both our patients were treated with high dose methotrexate 5gm/m2 during this time period and both experienced delayed excretion of methotrexate. To our knowledge, there is no known reported association between high dose methotrexate and intussusception. We speculate that the two could be related. The increased use of high dose methotrexate therapy in T-cell ALL may result in a higher incidence of intussusception in this population. Although, intussusception in ALL is a very rare complication, awareness of this entity and early recognition with radiological intervention may prevent unnecessary surgery and the associated morbidity and mortality in these patients.

Late Postoperative Partial Recurrent Retrograde Ileoileal Intussusception

Late Postoperative Partial Recurrent Retrograde Ileoileal Intussusception

Ileo-ileal intussusception in a child; a case report.

Intussusception of the small and large bowel in infants and children has been well documented. The gratifying decrease in mortality in the past fifteen years is a tribute to the increasing alertness of physicians, to improvement in surgical technic and speed in preparing the patient for operation, and to the technic of reducing large bowel intussusceptions by retrograde hydrostatic pressure, especially by barium enema under direct fluoroscopic observation. Although numerous cases have been reported in which both the intussusceptum and intussuscipiens involved the small bowel only, film demonstrations of this particular situation are uncommon. A case of ileo-ileal intussusception is recorded here, originating in a Meckel's diverticulum and preceded by Henoch's purpura, in a child of two. P. R., a 2-year-old white girl, was under frequent observation and treatment by a pediatrician for Henoch's purpura. Mild associated gastrointestinal bleeding had been a minor sign of the condition. At 3:00 a.m. on June 12, 1953, the child awoke suddenly, screaming with pain in the abdomen. Characteristically she doubled-up and pulled up her knees with each cramp. At 8:30 a.m. the same morning, she was brought to the Department of Radiology under heavy sedation, with a request for barium enema examination, intussusception suspected. Abdominal examination prior to starting the barium enema revealed a mass, the size of an orange, in the suprapubic area. This mass was slightly mobile and felt like grouped loops of bowel. As the course of the barium enema was observed during fluoroscopy, the entire colon filled and the appendix was identified. The palpable mass was separate from the colon. A small amount of air was then introduced through the enema tubing, and reflux of barium occurred into the ileum. This flowed without obstruction for 6 to 8 inches. At this point the cup-shaped deformity of intussusception was identified in relation to the palpable mass. Much of the barium enema was siphoned back. Surgery was performed under Avertin cyclopropane anesthesia at noon, nine hours after symptoms first appeared. The report of the surgeon, R. A. Stiefel, M.D., reads as follows: “A lower mid-line incision was made. On opening the abdomen there was a considerable quantity of straw-colored fluid in the peritoneal cavity. This was removed with suction. The mass which was palpable preoperatively just below the umbilicus was brought into the wound and identified as ileum. Proximally, there was an ileo-ileal intussusception with definite gangrene of the outer segment of the ileum for a distance of about 1 1∕2 feet. The intussusception was reduced by milking it from the proximal end toward the distal end. The inner segment was also gangrenous for a distance of about 1 1∕2 feet.

Intussusception in the Aged: Ileal-Ileal Type With Spontaneous Auto-Amputation and Expulsion of the Necrotic Segment

Intussusception occurs infrequently in adults and rarely in the aged. Several recent statistical studies attest to this: Finklestein1 reviewed the records of the Beth Israel Hospital in Brooklyn for the 11 year period prior to 1938, and found only one adult case in 62,632 hospital admissions. Likewise, Miller reviewed 75,000 admissions to the Nashville General Hospital and found only one adult case. We have reviewed the records at the Cook County Hospital in Chicago for the 11 year period 1940 to 1950, inclusive, and found only four cases of adult intussusception among approximately 700,000 hospital admissions. This is to be contrasted with the report by Oberhelman and Condon3 who reviewed the records of the Childrens' Hospital of the Cook County Hospital in Chicago for the 21 year period 1925 to 1946, and found 95 cases in children among 141,580 admissions. These statistics reaffirm the earlier teachings that most cases of intussusception occur in children, particularly under two years of age. No statistics are available for studying the frequency in the aged but our review of the published adult cases indicates that this is rare. In the adult large bowel intussusception occurs more frequently than the enteric type which is most common in children. While occasional cases are found in which no definite etiology is discernible (idiopathic type), most adult cases have a specific etiologic factor such as tumor, diverticulum, ulceration, etc. The causes of intussusception are adequately listed by Iason.4 In the light of our present knowledge of the mechanics and pathologic physiology involved, intussusception must be considered an acute surgical condition at any age. However, occasionally the condition of the patient may contraindicate surgery, especially in the aged, or the correct diagnosis may not be immediately established because of the unusual or bizarre symptoms presented. In such cases, rarely, the intussuscepted segment (intussusceptum) may be spontaneously amputated, the gangrenous segment passed rectally and an adequate anastomosis may develop at the site of the amputation to re-establish bowel

Chronic Recurrent Intestinal Intussusception

ALTHOUGH chronic recurrent intussusception of the large bowel is uncommon, it must be considered in the differential diagnosis of obscure intra-abdominal conditions. The writers have had the opportunity of observing eight cases diagnosed radiographically and confirmed by operation. Each patient was examined by means of a barium meal from above, as well as by opaque enemas, post-enema radiograms, and barium-air contrast enema radiograms. Repeated examinations were made in several instances. The post-evacuation and barium-air contrast enema studies were so helpful in establishing the diagnosis that we now regard them as indispensable. Seven patients had cecocolic intussusception secondary to cecal tumors. In these cases, the ileum also intussuscepted. Pathologic examination revealed five adenocarcinomas and two leiomyosarcomas. The eighth patient had a colocolic invagination associated with a pedunculated leiomyosarcoma arising from the hepatic flexure. The association of chronic large bowel intussusception with leiomyosarcoma is unusual. We have been unable to find reports of similar cases in the available literature. Symptomatology.—The clinical picture of the seven patients with ileocecocolic intussusception was essentially the same. All complained of more or less persistent pain in the right lower quadrant, radiating to the epigastric and substernal regions. The pain varied considerably in intensity at different times. Nausea and anorexia were frequent. Vomiting and bloody stools were often observed. There were relatively long intervals of freedom between the acute episodes, and cathartics on occasion aggravated the symptoms. The history presented by the patient with colocolic invagination was somewhat more acute, only one attack of persistent right upper quadrant pain occurring before surgical intervention. The chronicity of the symptoms, repeated subacute episodes, and the changing radiographic findings are in contrast with the syndrome usually observed in the acute forms of intussusception. The relationship between the size of the intussuscipiens and intussusceptum no doubt plays an important role in the severity of the symptoms. In this connection Ehnmark (1) recalls that the large and small bowel of children are approximately the same size, whereas the large bowel of an adult is about three times as large as the small. Hence an intussusception in an adult involving the presence of ileum within the large bowel may be expected to produce symptoms of less severity than a colocolic invagination. This is supported by the findings in the cases here reported, in which the patients with ileocecocolic invagination had relatively chronic courses while the patient with colocolic invagination had but one attack before operation.