Lead Point For Intussusception Research Articles

Mantle Cell Lymphoma of Gastrointestinal Tract as a Lead Point for Intussusception: A Case Report

Mantle Cell Lymphoma of Gastrointestinal Tract as a Lead Point for Intussusception: A Case Report

High Grade Appendiceal Mucinous Neoplasm Presenting as Intussusception In an Elderly Female-A Case Report

Introduction: Appendiceal mucinous neoplasms (AMNs) are rare and account for 1% of gastrointestinal neoplasms and the diagnosis is mostly incidental. In spite of advances in the understanding of AMNs and their association with peritoneal disease, AMNs are still confusing entities in respect to their diagnosis and treatment alike.
 Case Report: We report a case of a 51year old female who presented with abdominal pain and vomiting and was diagnosed as ileo-colic intussusception on ultrasonography and CECT abdomen. Histopathological examination of right hemicolectomy specimen revealed a high grade appendicular mucinous neoplasm with low grade areas. The peri-appendiceal mucin deposition forming a mass in the cecum at the base of appendix was the lead point for intussusception in this case. No features of pseudomyxoma peritonei was seen in this case. This patient is well after 18 months of follow up period.
 Conclusion: Appendiceal mucinous neoplasms are rare and diagnosis is often difficult as presentation is mostly non-specific. Hence, awareness and further classification of these tumours is essential for diagnosis, determining the risk of recurrence and malignancy and also prognostication.

Meckel's Diverticulum Mimicking Inflammatory Bowel Disease

AbstractIntermittent abdominal pain is the most common gastrointestinal (GI) complaint in the pediatric age group. When basic investigations and sonograms do not give etiological basis, functional GI disorders are diagnosed. Meckel's diverticulum (MD), being the common GI surgical condition, can be missed in absence of classical symptoms. Clinical presentation varies based on the size, location, and presence of ectopic gastric mucosa. We report a case of an adolescent female with MD presenting as chronic abdominal pain. Abdominal ultrasonogram was normal. Abnormal fecal calprotectin level and colonoscopy directed for a suspicion of inflammatory bowel disease. Persistence of symptoms with increasing severity prompted a relook into the diagnosis. The presence of intussusception on abdominal scan during one of the painful episodes warranted emergency exploratory laparotomy. Intraoperatively, the lead point for intussusception was identified as MD, which was resected. Postoperative period was uneventful. There are no abdominal symptoms since a year during the follow-up period.

Helminth Infections in Children.

Helminth Infections in Children.

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.

Neonatal intussusception secondary to intestinal duplication cyst: A case report

Background: Intussusception is a rare cause of bleeding per rectum in neonates. Duplication cyst as a pathological lead point for intussusception is rarer too. Case Presentation: A female neonate presented with bilious vomiting and bleeding per rectum. Ultrasonography diagnosed it as intussusception. Intraoperatively, on reduction of intussusception, a mass was found which on histopathological examination (HPE) revealed a duplication cyst. Conclusion: A high index of suspicion is required for an early diagnosis of neonatal intussusception, which is essential for preventing complications and mortality.

Ileocolic Intussusception in an Infant with Ileal Duplication Cyst as a Lead Point- A Case Report

Gastrointestinal duplication cysts are uncommon congenital malformations, with small intestine being the most common site, followed by colon and stomach. It can have variable presentations such as intestinal obstruction, bleeding, palpable mass, or rarely volvulus. Here, the authors report a case of intussusception in a two-year-old child, presented with complaints of bilious vomiting and abdominal distension for three days with X-ray features suggestive of bowel obstruction. Ultrasonography revealed intussusception with ileal duplication cyst as the lead point, which was confirmed on exploratory laparotomy. In a paediatric patient, enteric duplication cyst should be included in the differential diagnosis of a cystic lesion as the lead point in intussusception.

Intussusception Induced by Burkitt Lymphoma in an Adult Patient

Intussusception is defined as the telescoping of an intestinal region into an adjacent region of intestine. We present an interesting case of a retrograde intussusception due to an underlying Burkitt lymphoma. Case Presentation: We have a 41-year-old Caucasian male who presented to the Emergency Department (ED) with complaints of left sided periumbilical abdominal pain that began several months prior. Computed tomography (CT) scan of the abdomen and pelvis with oral and IV contrast showed a colonic mass in the region of the ileocecal valve. Patient denied any fever, vomiting, melena, or hematochezia. He was scheduled for a colonoscopy with surgical services. Upon colonoscopy, intussusception in the region of the ileocecal valve was discovered and cecectomy was scheduled for the same day. Intussusception was removed via hand assisted laparoscopic cecectomy with functional end-to-end anastomoses. Gross dissection of the specimen post cecectomy revealed a 5cm by 5cm mass as the lead point for intussusception (Figures 4, 5). The mass was sent for pathology which revealed Burkitt lymphoma. Conclusion: Intussusception is a rare cause of abdominal pain in adults but should be considered because it may be an indicator of underlying malignancy. Unlike intussusception in the pediatric patient, which can be managed non-operatively, treatment in adults is usually surgery.

2637 An Unusual Cause of Persistent Abdominal Pain and Hematochezia an Adult Male; Small Bowel Meckel’s Diverticulum Causing Intussusception

INTRODUCTION: Symptomatic Meckel’s diverticulum (MD) in adults is extremely rare. The prevalence of MD in the entire population ranges from 0.3%–-2.9% with a lifetime incidence of symptoms at 4.2%. The common presentations of symptomatic MD are obstruction, gastrointestinal (GI) bleed, and inflammation; these complications are significantly more frequent in childhood. This case report highlights direct observation by traditional colonoscopy of small bowel MD as a lead point of intussusception in an adult. CASE DESCRIPTION/METHODS: A 25-year-old male presented to the hospital with acute on chronic periumbilical abdominal pain worsening over several days. He reported intermittent watery diarrhea and an episode of hematochezia. He was also hospitalized earlier in the year for bowel obstruction of unknown etiology, but found to have intussusception status-post diagnostic laparotomy and partial ileal resection. His vital signs were stable and the physical exam revealed peri-umbilical tenderness. Laboratory data resulted with fecal calprotectin 517.7 mg/kg, hemoglobin 10.2 g/DL, WBC 11.6 × 10exp9/L, ESR 33 mm/h, CRP 78.51 mg/L, and a negative Clostridium difficile PCR test. A CT abdomen/pelvis revealed mild thickening and mucosal hyperenhancement of the terminal ileum. A colonoscopy was performed due to concern for GI bleed and inflammatory bowel disease. On colonoscopy, the colon was normal, but a partially obstructing, mobile, villous mass was noted in the ileum. Subsequently, an exploratory laparotomy found recurrent small bowel intussusception. The ileal mass was resected and pathology showed ectopic gastric and pancreatic tissue confirming MD. An ulcer and acute inflammation were noted on the mass. His follow-up course was unremarkable and the patient’s symptoms have since improved. DISCUSSION: The symptoms of MD are significantly more common in other etiologies. In addition, symptomatic MD is rarely diagnosed in adulthood which makes the diagnosis of MD in adults a challenge. MD is often diagnosed by imaging modalities or direct observation during surgery. Balloon-assisted enteroscopy and capsule endoscopy are other diagnostic measures being explored. Endoscopy is indicated in patients presenting with GI bleed and was completed in this patient. A large portion of this patient’s distal ileum was previously resected and his altered anatomy allowed the direct observation of MD by colonoscopy. This case highlights a unique endoscopic finding that endoscopists should be aware as the etiology for GI bleed.

A case of intussusception developed at the site of ileocolic anastomosis after laparoscopic right hemicolectomy

BackgroundIntussusception is a relatively common condition seen in children. In comparison, adult intussusception is rare and usually occurs as a complication in patients with organic diseases. It is responsible for 1% of all bowel obstructions, in most of intussusceptions a malignant tumor is involved. Herein, we present an extremely unusual case of intussusception that occurred as a complication at the site of a functional end-to-end anastomosis.Case presentationA 57-year-old female patient was diagnosed with tumors in the ascending and descending colon and was referred to our department. Laparoscopic hemicolectomy and laparoscopic descending colectomy were performed. The mechanical intestinal obstruction occurred on the 9th day postoperatively, and computed tomography scan revealed intussusception at the site of the ileocolic anastomosis. Endoscopic reduction was attempted, but the procedure was challenging. Surgery was then performed and revealed that the site of ileocolic anastomosis firmly adhered to the side wall and right retroperitoneum. However, the intestine in the oral side of the anastomosis was not fixed. Examination of the anastomotic site revealed that the ileum had passed through the anastomosis and prolapsed into the transverse colon. The ileocolic anastomosis was resected. End-to-end anastomosis was performed, and surgery was then completed. No neoplastic lesions were observed in the resected tissue of the lead point of intussusception. The postoperative clinical course was favorable, and the patient was discharged on the 11th day after the second round of surgery.ConclusionsThere are no reports the anastomosis is involved as part of the intussception, as observed in the present case. Intussusception should thus be considered as one of the causes of postoperative mechanical intestinal obstruction.

Dual-phase computed tomography angiography of intestinal carcinoid tumor as a lead point for cecocolic intussusception in a dog.

In an 8-year-old Labrador Retriever with progressive anorexia, constipation, and depression, CT revealed intussusception of the cecum into the ascending colon and a small cecal mass showing strong enhancement on arterial phase. The ileocecocolic junction was surgically resected and histologically diagnosed as cecocolic intussusception with carcinoid tumor. The carcinoid tumor worked as a lead point of intussusception in this case. Dual phasic CT is useful to assess the presence of gastrointestinal tumors as lead points in old dogs with intussusception.

Unique Obstructive Intestinal Manifestations of Metastatic Melanoma: A Case Series

Introduction: Though rare in adults, intussusception can occur anywhere in the gastrointestinal (GI) tract causing variable symptoms. 90% of cases may be due to disorders like neoplasm or postoperative status and may cause 1% of small bowel obstructions (SBO). Metastatic melanoma (MM) may involve the GI tract, and its various manifestations accentuate the need for astute awareness when treating patients with MM for GI symptoms.We report the cases of 3 women with MM diagnosed with partial SBO (pSBO) of varying types due to metastases.Figure: A) Axial fused PET/CT of the pelvis reveals a hypermetabolic focus in the ileum. B) Axial contrast-enhanced CT of the pelvis reveals ileal bowel wall thickening and associated intussusception caused by melanoma metastatic mass functioning as a lead-point (orange arrow). Oral contrast reveals distended small bowel proximal to intussusception indicating secondary partial SBO (yellow arrows).Figure: C) Enhancing partially obstructing mass (orange arrow) within the bowel lumen which expands the small bowel at that level. There is an adjacent distended loop of proximal small bowel which is partially filled with gas.Figure: D) Axial contrast CT with right lower quadrant intussusception, likely ileocolonic. E) Axial contrast CT with small bowel intussusception of the left mid-abdomen.Case Presentations: Case 1: A 55-year-old woman with MM (right inguinal primary lesion) to right axillary lymph nodes post excision and radiation underwent positron emission tomography/computed tomography (PET/CT) to address mild abdominal pain and for surveillance. PET/CT detected hypermetabolic activity in the small bowel (A) concerning for a soft tissue mass acting as a lead-point for intussusception and pSBO (B). Surgical excision of the mass confirmed MM. She received chemotherapy, but CT showed new mesenteric and hepatic masses. Case 2: A 75-year-old woman with MM (right heel primary lesion) throughout her abdomen was admitted for SBO causing left lower quadrant pain and constipation. She underwent prior excisions (several intra-abdominal surgeries) and several courses of chemotherapy. CT showed a left lower quadrant intraluminal enteric mass with proximal bowel distention consistent with a metastatic mass causing intermittent or pSBO (C). She improved with nonsurgical therapy. She was too ill for a novel chemotherapy trial and pursued hospice. Case 3: A 58-year-old woman with MM (periumbilical primary lesion) to the shoulder, lung, kidney, spleen, mesentery and brain presented with bilateral upper quadrant pain, postprandial emesis and decreased stool output. 2 months prior, a SBO resolved with conservative therapy. She had no prior abdominal surgery. In addition to intra-abdominal metastases, CT showed 2 areas of small bowel intussusception (D-E) with likely MM lead points causing pSBO. She improved without surgery and resumed chemotherapy. Discussion: These cases highlight the importance of maintaining high clinical suspicion of metastatic GI masses as culprits for SBO. When GI symptoms exist in patients with known malignancy such as MM, attempting to identify a soft tissue mass on imaging as a lead-point in intussusception or transition point in SBO for timely and accurate diagnosis is imperative to optimize management.

Adult ileocolic intususception: a case report

Intussusception is defined as the pathology in which a segment of intestine telescopes into the adjoining intestinal lumen. Ileocolic accounts for 75% of all cases of intussusception. The average age of affected adults is between 50 and 60 years old and it occurs more often in women. The higher percentage of intussusception in adults (65%) occurs due to malignant or benign neoplasms. Appendix is part of intussusception of commonest ileocolic type but appendix as lead point for intussusception is rare. Patient details were collected by patient’s IPD file. Complete detailed history, patient vitals, hemogram, ABO, with X-ray Abd erect, USG abdomen and CECT abdomen was done. Post-OP patient was followed by USG review. 60-year-old female diagnosed and operated as for ileocolic intussusception with appendix as lead point. Ileo transverse anastomosis was performed with hemicolectomy involving the terminal ileum along with caecum and ascending colon. Post op patient did well passed stools on 5th day. Intussusception is a pathology in which a segment of intestine telescopes into the adjoining intestinal lumen causing intestinal obstruction. Intussusception are two types antegrade and retrograde. CT scan and colonoscopy, which provide an accurate diagnosis, allowed the best surgical choice in the hands of an experienced surgeon.

Ileo-ileal Intussusception Caused by Primary Monophasic Synovial Sarcoma (SS) of the Ileum

Synovial Sarcoma (SS) is an uncommon neoplasm, very rare in gastrointestinal tract. We report a case of 57 years old man who reported a previous diagnosis of primary left atrial leiomyosarcoma referred for a follow-up CT, that showed findings compatible with ileo-ileal intussusception. The patient underwent surgical resection and pathological analysis showed that the lead point of intussusception were two polypoid lesions referable to SS. The present case report suggests that, although the incidence of SS is rare, it should be considered in the differential diagnosis of any gastrointestinal non-epithelial malignancy. Case Study Cesare et al.; BJMMR, 11(7): 1-7, 2016; Article no.BJMMR.21438 2

One Month Ongoing Intussusception: Case Report

The aim is to present a case operated due to one-month ongoing intussusception and diagnosed as lymphoma. A six years old boy was admitted to our emergency department with complaint of colicky abdominal pain and bilious vomiting for the last month. He was operated due to 3 cm intussusception at ileocecal part. A mass which is about 6 cm in diameter, hard, partly mobile and invaginate the intestine at its posterior aspect was found. Pathology was reported as Burkitt lymphoma. He received two cycles of chemotherapy at post-operative period. He is still event free for the last two years. One must remember that lymphoma can be the lead point in intussusception especially in elderly children.

Isolated Ileal Pancreatic Heterotopia Causing Intussusception with Gangrene

Isolated ileal heterotopic pancreatic tissue as a lead point of intussusception in children is extremely rare. We report a 6-month-old female with ileoileal intussusception and a 4-year-old female with ileocolic intussusception both associated with gangrene. A review of literature suggests a higher prevalence of gangrene probably secondary to the pancreatic exocrine tissue.

Accessory spleen as lead point in intussusception

Accessory spleen as lead point in intussusception

Jejuno-Jejunal Invagination

Intussusception is the telescoping of proximal portion of bowel into an adjacent distal bowel. It is an infrequent cause of abdominal pain or anemia in adults. The lead point of intussusception is usually in the small intestine (enteroenteric). The author presented the case of a 45-year-old pilot with anemia and intermittent hematochezia but no abdominal pain. At double-balloon enteroscopy we found a long and twisted invagination of the jejunum. It is important to differentiate the invagination from a benign polyp because endoscopic resection of an invagination carries a high risk of perforation because the visceral serosa is part of the invaginated bowel. This article is part of an expert video encyclopedia.

Colonic inflammatory myofibroblastic tumours: an institutional review

The aim of the study was to present the largest series of colonic inflammatory myofibroblastic tumour (C-IMFT) in the literature so far and to provide a review of this condition. A retrospective review was carried out of a consecutive series of patients diagnosed with a C-IMFT at a community-based hospital with a specialized gastrointestinal unit between 2002 and 2011. The main outcome measures were success rate and postoperative complications. Using a set of terms we searched the PubMed database for papers published on C-IMFT. We reviewed the data from these studies and case reports. There were seven patients with a histopathologically proven C-IMFT. The patients' mean age was 39 ± 11.3 years. Four presented with clinical features of intestinal obstruction of varying severity and three with symptoms of anaemia. Complete surgical resection with end-to-end anastomosis was performed. The gross morphology included polypoidal myxoid tumours that served as a lead point for intussusception in two cases, a whorled mass in two and a circumferential infiltrative tumour in three. Microscopically, all tumours had typical features of IMFT with a variable expression of anaplastic lymphoma kinase (ALK-1) and tumour-free resection margins. All patients were well without local recurrence or metastasis at a mean follow-up of 46.8 ± 11.9 months. Surgical resection is effective for this rare tumour which mostly behaves in a benign manner. Our review supports the need for patients to be followed up for long periods because of the possibility of metastasis or late recurrence.

Ileoileal Intussusception Secondary to an Ileal Fibroma: A Case Report

Purpose: Intussusception accounts for 1-5% of all cases of intestinal obstruction in adults. A lead point is present in 90% of the cases in adults unlike in children. Ileal fibromas are uncommon benign neoplasm of the small bowel. Case: A 43-year-old woman with prior medical history of dyslipidemia and hypothyroidism presented to our hospital with complaints of intermittent abdominal pain for the last 3 months. She had an upper GI endoscopy performed 2 months earlier for similar symptoms which revealed a hyperplastic polyp of duodenal bulb and Helicobacter pylori gastritis. The patient continued to have occasional nausea with epigastric discomfort and mild constipation, but denied vomiting. She denied any prior surgeries or any significant family history of malignancies. Abdominal examination showed fullness in the epigastric region. CT scan of the abdomen revealed ileoileal intussusception with a lead point which appeared to be a rounded solid mass. Patient underwent exploratory laparotomy with findings of ileoileal intussusception one foot from the ileocecal junction. Upon reduction of the intussusception a small polyp, firm to hard in consistency was found. Resection of the ileal lesion with end-to-end anastomosis was performed with removal of few enlarged mesenteric lymph nodes in the adjacent mesentery. Histologically the polyp was involving the muscular wall of the bowel, consisting of fairly uniform appearing round to oval cells with irregular nuclei with low mitotic activity and low ki-67 index. There was admixture of lymphocytes, eosinophils, mast cells and plasma cells present in the lesion with delicate capillary vasculature. Immunostains were negative for CD 34, SMA, S100, ALK -1, CD 10, DESMIN, CD 117 (KIT), DOG -1, pancytokeratin, EMA, CD 45, CD 20, CD 3, CD 68 (KPI AND PGM), synaptophysin and chromogranin. Diffuse vimentin immuno-reactivity of the tumor cells was noted. Histopathology was consistent with an ileal fibroma. The immunostains helped to distinguish the lesion from inflammatory fibroid polyps and gastrointestinal stromal tumor. Clinical presentation of intussusception is nonspecific. The predominant symptoms are those of partial intestinal obstruction. Surgery remains the mainstay of management since in most cases the etiology involves an underling pathologic process. Conclusion: We report an unusual cause of small bowel obstruction in an adult patient, secondary to a ileal fibroma as the lead point of intussusception.