Multiple Intussusceptions Research Articles

A case of Peutz-Jeghers syndrome presenting as multiple intussusception of small bowel – A rare surgical emergency

Peutz-Jeghers syndrome (PJS) is an autosomal dominant genetic disorder characterised by melanin pigment spots on the oral mucosa, lips, nasal alae, palm and soles, as well as hamartomatous polyps in the alimentary canal. Polyps are often a cause of intussusception in the affected patients. Cancers of the gastrointestinal system, uterus, and breast are common in patients with PJS. Long-term follow-up is required to prevent intussusception in children and cancer in adults. We report a classical case of PJS presenting with multiple intussusception of the small bowel in a 20-year-old male patient.

Rapunzel syndrome and small bowel Intussusceptions in a girl: A case report

Trichobezoars are indigestible masses of ingested hair commonly found in the stomach, often presenting with symptoms related to gastric outlet obstruction and severity related to the mass’s size and location. Rapunzel syndrome is caused by gastric trichobezoar with extended tail and small bowel obstruction. Patients with gastric trichobezoar can be asymptomatic until the bezoar increases in size. We report a case of a 8 years old girl who visited the emergency department with abdominal pain. She was finally diagnosed with Rapunzel syndrome that causes multiple small bowel intussusceptions associated with trichophagia. Surgery was needed to reduce the multiple intussusceptions, and to remove the large trichobezoar. This case highlights to consider the possibility of Rapunzel syndrome when diagnosing the main cause of intussusceptions.

Peutz Jeghers syndrome with multiple intussusceptions

Peutz Jegher’s syndrome is a rare autosomal dominant disorder characterized by the development of hamartomatous polyps and mucocutaneous melanin pigmentation. This case report shows the case of an adult Indian female with intestinal obstruction due to multiple intussusceptions that were caused by hamartomatous polyp of Peutz Jegher’s syndrome. A 32-year-old female presented to the surgical emergency with complaints of colicky abdominal pain, vomiting and melena and with a positive family history for Peutz Jegher’s syndrome. On abdominal examination, a mass was palpable in her right lumbar area and per rectal examination showed ballooning and blood staining. She was provisionally diagnosed with Peutz Jegher’s syndrome with intussusception and her ultrasound imaging of the abdomen also showed the features suggestive of intussusception. She underwent an emergency laparotomy with resection and anastomosis of the involved segment of the jejunum and limited right hemicolectomy. Intraoperative findings showed multiple intussusceptions in her both large and small bowels along with multiple polyps which was seen to be hamartomatous polyps in the histopathological studies. The postoperative period was uneventful and during the review she was healthy. Intussusception is the major complication of Peutz Jegher’s syndrome and it can be prevented with regular surveillance in known cases. Intussusception should be kept in mind as the first differential diagnosis when these patients present with acute abdomen. The investigation of choice that’s preferred is a cross sectional imaging of the gastrointestinal tract to confirm with the diagnosis. Periodic surveillance is essential in those patients with known history or those with the mutation of STK11 (LKB1) gene.

Process Management of Intussusception in Children: A Retrospective Analysis in China.

ObjectivesThis was a retrospective analysis of the epidemiological features of pediatric intussusception, the effects of different management strategies and the factors affecting successful reduction.MethodsUsing our hospital database, data on pediatric intussusception from January 2019 to December 2020 were extracted for analysis, including demographic data, size of intussusception, treatment method, and effects.ResultsThe number of children diagnosed with intussusception was 726 (782 episodes). In all, 394 (54.27%) of these children were male. The male to female ratio was 1.19:1. The peak of the onset age was between 3 and 4 years. In the single intussusception group, the successful reduction rate of cleansing enemas was 65.25%, that of air enemas was 95.80%, and that of B-ultrasound–guided hydrostatic enemas (B-USGHEs) was 96.04%. In the multiple intussusceptions group, the successful reduction rate of cleansing enemas was 43.9%, air enemas were 75%, and B-USGHE was 57.6%. There were no significant differences between the air enema and B-USGHE groups. The diameter and length were related factors influencing successful reduction (P ≤ 0.05). Fifty-three (7.53%) children had recurrent intussusception within 4 years, and all of them were following successful enemas. Thirty-one (3.40%) episodes were found to have spontaneously reduced. Five patients (0.7%) underwent surgery after the failure of air enemas or B-USGHE.ConclusionsPediatric intussusception in our region showed a sex ratio difference and age difference of onset. For single intussusceptions and multiple intussusceptions, the successful reduction rate of cleansing enemas means that some children may avoid radiation exposure. The diameter and length of intussusception were related factors influencing successful reduction in cleansing enema. There were no significant differences in successful reduction between air enemas and B-USGHE. Most recurrent intussusceptions can still be reduced, avoiding surgery.

Intra-operative enteroscopic polypectomy—An innovative hybrid approach using straight sticks

BackgroundPeutz-Jeghers Syndrome (PJS) is an uncommon intestinal polyposis disorder. Bowel obstructions are a recurring problem in PJS and as many as 50% of these patients require surgery. The current standard of care for these patients is to perform a flexible enteroscopic polypectomy. The traditional push-pull enteroscopy however, might be unavailable or unsuitable in an emergency setting. Alternatively, repeated laparotomies with multiple small bowel resections can lead to short bowel syndrome. MethodsIn our series, we describe an innovative technique where a short midline laparotomy permitted sufficient access to reduce the intussusception(s) and perform a bowel walk. Rigid laparoscopic instruments were introduced within the small bowel lumen via enterotomies, to perform polypectomies along the entire small bowel length. This precludes the need for small bowel resections which can thwart the development of short bowel syndrome. ResultsTwo patients with PJS presenting with acute small bowel obstruction underwent surgery using the described approach. Another two patients with PJS having multiple intussusceptions on CT underwent an elective prophylactic polypectomy using the same approach. We were able to run the bowel in its entirety and a maximum of 41 polyps were retrieved from the port site enterotomy. The operating times were modest and no unique complications pertaining to this technique were encountered. ConclusionSmall bowel polypectomy using rigid instrumentation employing a limited midline laparotomy is an attractive option for both emergency and elective settings in patients with PJS.

Laparoscopic-assisted disinvagination and polypectomy for multiple intussusceptions induced by small intestinal polyps in patients with Peutz-Jeghers syndrome: a case report

BackgroundPeutz–Jeghers syndrome (PJS) is a very rare autosomal dominant genetic disorder characterized by hamartomatous polyps in the gastrointestinal tract and hyperpigmentation of the lips, hands, and feet. The hamartomatous polyps in the small intestine often cause intussusception and bleeding.Case presentationA 62-year-old male was hospitalized for treatment of deep vein thrombosis and pulmonary embolism. In the small intestine, computed tomography showed three small polyps with intussusceptions. Since the patient had gastrointestinal polyposis and pigmentation of his lips, fingers, and toes, he was diagnosed with PJS. After an inferior vena cava filter was placed, he underwent laparoscopic-assisted surgery. The polyps causing intussusception were resected as far as possible without intestinal resection, since they had caused progressive anemia and might cause intestinal obstruction in the future. The patient was discharged from the hospital on postoperative day 9 without complications.ConclusionsLaparoscopic-assisted disinvagination and polypectomy is a useful, minimally invasive treatment for multiple intussusceptions caused by small intestinal polyps in patients with PJS.

Multidetector computed tomography diagnosis of small bowel intussusceptions in adults: observations in a 10-year single-center study.

The etiologies of small bowel intussusception (SBI) in adults are varied. To investigate multidetector computed tomography (MDCT) characteristics in adults with neoplastic and non-neoplastic SBI. Clinical data and MDCT images diagnosed with SBI in adults from January 2010 to May 2020 were retrospectively reviewed. The study included a total of 71 patients. Forty-two patients had a combined total of 55 neoplastic intussusceptions, including 29 patients with benign tumors and 13 patients with malignant tumors. Twenty-nine patients had a combined total of 36 non-neoplastic intussusceptions, of which the condition was idiopathic in 23 patients and cased by non-neoplastic benign lesions in six patients. There were no significant differences in patient age or sex ratio in the neoplastic and non-neoplastic groups. In the non-neoplastic group the intussusceptions were shorter in length (3.6 cm vs. 13.2 cm, P<0.05) and smaller in transverse diameter (2.8 cm vs. 4.2 cm, P<0.05), and less likely to be associated with intestinal obstruction (2 vs. 18, P<0.05). The percentage of patients with multiple intussusceptions was greater in the neoplastic group (10/42, 23.8% vs. 4/29, 13.8%). In the non-neoplastic group only one lead point was detected (in a patient with Meckel's diverticulum), whereas lead points were detected in all 55 intussusceptions in the neoplastic group. There are differences in the clinical and MDCT manifestations of adult neoplastic and non-neoplastic SBIs. Whether a lead point is present or not has implications with regard to deciding on the most appropriate treatment and avoiding unnecessary surgery.

Multiple ileo-ileal intussusception associated with duodenal atresia in a 5-day-old infant: case report

BackgroundIntussusception is the most common intestinal obstruction among infants and young children. Most of the pediatric cases are ileo-cecal, while jejuno-jejunal and ileo-ileal combined contribute only 2.5% of the cases.Case presentationA 5-day-old child presented with recurrent non-bilious vomiting since birth. Physical examination revealed a slightly distended abdomen. A plain radiograph revealed a countable bubble appearance. The initial clinical diagnosis was gastric outlet obstruction. During surgery, we discovered multiple ileo-ileal intussusception associated with duodenal atresia. We manually reduced the intussusceptions and bypassed the duodenal atresia using Kimura’s procedure. We did not find any significant morbidity in the post-operative phase.ConclusionMultiple ileo-ileal intussusception rarely associates with duodenal atresia. In our case report, the intussusceptions might be indirectly caused by duodenal atresia through various pathophysiology. Other unusual findings also supported this suggestion.

The longest trichobezoar (59 in.) presented with gastric perforation and multiple small bowel intussusceptions—a unique presentation

A trichobezoar is an old entity which arises out of eating own hairs. These patients are psychiatrically ill, leading them to eat their own hairs. We report a case of a 15-year-old girl with severe pain in the abdomen, tachycardia, chronic malnutrition, and cachexia. On CT scan examination, we found gastric perforation and multiple intussusceptions in the entire small bowel with trichobezoar extending up to the ileum and gastric perforation. We surgically removed the entire trichobezoar intact along with perforation repair and reduction of all intussusceptions. The tail of the trichobezoar was 59 in. long.

Multiple Intussusceptions after Blunt Abdominal Trauma in a 5-Year-Old Boy: Case Report and Review of Nine Cases Reported in the Literature

Multiple traumatic intussusceptions in a preadolescent child are exceedingly rare and have only been reported twice, in 1925 and 1939. We report a case of multiple intussusceptions occurring after blunt trauma to the abdomen in a 5-year-old boy and review the English language literature on the subject.

Bowel Lymphoma Causing Multiple Intussusceptions In Adult- Case Report and Review of Literature

Intussusception in adults is rarer than children and treatment in most cases in adults is surgical. Multiple Intussusceptions in our case with subacute intestinal obstruction and presence of abdominal lymphadenopathy with diffuse bowel wall thickening warrants non-surgical treatment. Presence of multiple intussusceptions is rare findings. We present a case of female aged 35 years presented with palpable abdominal lump associated with loss of weight and appetite. CECT abdomen showed abdominal lymphadenopathy and multisegmental small bowel thickening maximum upto 1.5 cm. Some segments of bowel also show aneurysmal dilatation associated with asymmetrical mural thickening. Telescoping of proximal bowel segment into adjacent distal bowel is seen in at least two places in ascending colon region (colocolic intussusceptions) and another in ileal loops (ileo-ileal). FNAC from the lymph nodes revealed non hodgkins lymphoma.

Management of Intussusception in the Era of Ultrasound-Guided Hydrostatic Reduction: A 3-Year Experience from a Tertiary Care Center.

Introduction:Ultrasound-guided hydrostatic reduction (HSR) is currently the initial management tool in the treatment of intussusception. HSR is, however, confronted with failures besides there are still a number of patients who primarily undergo surgical intervention for the management of intussusception. We undertook this study to assess the efficacy of HSR and also to look for factors demanding the surgical exploration in patients with intussusception.Materials and Methods:A total of 215 patients with intussusception from June 2014 to June 2017 were prospectively studied. HSR was carried out in 203 patients, which was successful in 187 and unsuccessful in 16. These two groups were compared using the Student's t-test. Significance was set at P < 0.05. Twelve patients undergoing surgery primarily were also assessed for the factors affecting the decision-making.Results:HSR was successful in 187 and unsuccessful in 16. The failed group was more likely to have symptoms over 24 h, appearance of crescent, and ≥10-cm length on ultrasonography (USG). Two of these patients had ischemic bowel, two had ileoileal intussusception, and eight had pathological lead points, whereas no obvious cause could be identified in the rest of the four patients. Among the 12 patients who were primarily operated, four patients had peritonitis and other four patients were neonates. Laparoscopic reduction was done in four patients.Conclusion:HSR is a safe and effective treatment modality for intussusception. However, it is met with higher failure rates in patients with risk factors such as delayed presentation, appearance of crescent on USG, and length >10 cm. The role of HSR is also dubious in situations such as neonatal intussusception, small-bowel intussusception, and multiple intussusceptions and also in preventing the future recurrence. Such patients ought to be managed by laparotomy or where feasible by laparoscopy. Furthermore, before embarking on HSR, peritonitis and bowel ischemia should be ruled out clinically and radiologically. In the suspicious cases of bowel ischemia, USG Doppler may be helpful.

Recurrent Intestinal Obstruction with Multiple Intussusception in a Patient of Peutz-Jeghers Syndrome

Recurrent Intestinal Obstruction with Multiple Intussusception in a Patient of Peutz-Jeghers Syndrome

Early complications after laparoscopic resection of choledochal cyst

PurposeTo investigate the causes and treatments of early complications involving laparoscopic radical resection of choledochal cyst and summarize the experience.MethodsChildren with choledochal cyst treated by laparoscopy in the Department of Pediatric Surgery, Fujian Provincial Maternity and Children’s Hospital, and Guangzhou Women and Children’s Medical Centre, from March 2016 to May 2018, were retrospectively analysed. Demographics, causes and treatments of early complications, liver function analysis and ultrasonography were collected.ResultsIn total, 231 cases were included; 204 were Type I (156 Type Ia and 46 Type Ic) and 27 were Type IV. No mortality was observed, and 224 cases were successfully laparoscopically operated, while 7 cases were converted to open surgery. Fifteen cases of postoperative developed biliary fistula. There were jejunal Roux loop obstruction in 2 cases and multiple intussusception, anastomotic stenosis after hepaticojejunostomy, residual of choledochal cyst and pancreatic fistula in one each. Patients were followed up ranging from 4 months to 48 months (12.6 ± 0.3 months on average). Postoperative ALT, AST, GGT, TBIL and DBIL all returned to normal during this time. Ultrasonography indicated 5 cases of widened Glisson’s sheath and 1 case of intrahepatic hyperdense shadow.ConclusionEarly complications of laparoscopic radical resection of choledochal cyst can be minimized by properly managing preoperative indications and contraindications, carefully interpreting the magnetic resonance cholangiopancreatography results and accumulating experience by the surgeons.

Multiple Epstein-Barr Virus–associated Smooth Muscle Sarcomas of the Gut in a Child Treated for Acute Lymphoblastic Leukemia

A 7-year-old boy with a history of low-risk acute lymphoblastic leukemia developed multiple intussusceptions shortly after the end of maintenance therapy. Explorative laparotomy showed >10 polyps in the small intestine. Histologic examination revealed intestinal smooth muscle sarcomas associated with Epstein-Barr virus. The patient recovered well after partial cuneiform resection of the largest polyps and treatment with sirolimus. This case report indicates that these tumors may arise even after moderate transient immunosuppression and that association with acute lymphoblastic leukemia is possible although rarely described. We discuss the potential benefit of the mTor/Akt signal inhibitors as treatment for these tumors.

Multiple wandering jejunal intussusceptions in an adult patient with celiac disease: Atypical presentation

Intussusception is a rare presentation of celiac disease. In this report, we describe the condition of a 28-year-old Saudi male known case of brucellosis diagnosed and treated 10 months ago. The patient presented to the hospital complaining of diffuse intermittent dull abdominal pain with mild abdominal distention for 1-month duration, which starts gradually with progressive course. Patient also was given history of generalized fatigability for the same duration. These symptoms were associated with a weight loss about 10 kg in the last 6 months. Abdominal examination revealed soft and lax abdomen with mild tenderness at epigastria area. Computed tomography (CT) abdomen showed jejunal loop intussusceptions with diffuse jejunal wall thickening. Gastroscopy was done and showed fissuring of duodenal folds. Biopsy report came later as duodenal villa atrophy with increased intraepithelial lymphocytosis. The patient diagnosed as celiac disease. After establishing the diagnosis, dietary advice was given and he was discharged for outpatient department follow-up. Currently, the patient remains well and repeat CT scan showed persistence of multiple intussusceptions, though at different sites of the jejunum.

Intussusception in an Adult With Chronic Cannabis Use: A Case Report

Intussusception is a rare finding in adults presenting with abdominal pain. In the absence of obstruction, environmental factors should be investigated. Cannabinoid Hyperemesis Syndrome (CHS) and its relationship to intussusception in adults has not been established but should be considered if the clinical course matches the criteria and an obstruction has been ruled out. A recent article in The New York Times identified the syndrome as a commonly missed diagnosis that may affect an estimated 2.7 million Americans that are known to smoke marijuana. Patients present to the emergency department (ED) an average of 7 times before a diagnosis is made, expending up to $100,000 in medical resources. With the recent legalization of marijuana by many states, more patients are suspected to present with this syndrome. This case represents an example of how a delay in making a clinical diagnosis correlates to overtesting and rising medical costs. A 30-year-old female with a history of inhaled cannabis use since adolescence presented to the ED with abdominal pain, nausea, and vomiting. She has a history of multiple visits with similar symptoms in the last 3 years. Symptomatic relief at home was previously achieved with hot showers. The patient was managed for nausea and discharged home. The following day, she returned to the ED with severe abdominal pain and intractable vomiting. Abdominal CT revealed 3 jejunal intussusceptions:1 on the right and 2 on the left. Previous imaging on past presentations showed multiple intussusceptions along the small bowel, but a pathological lead point was never identified. She was admitted to the surgical unit and managed conservatively. On day 3, the abdominal pain subsided and repeat imaging showed resolution of all intussusceptions. Cannabinoid Hyperemesis Syndrome (CHS) is a phenomenon associated with long-term cannabis use. It can be diagnosed clinically by the following criteria: cannabis use, abdominal pain, nausea and vomiting, and symptom relief with hot showers and cannabis cessation. Our patient meets all of the criteria but the correlation to CHS was not previously considered, leading to repeat diagnostic testing and unnecessary hospital admission. In an economy where healthcare costs account for 17.9% of the GDP, reducing medical interventions that add low value to healthcare outcome is critical for the financial sustainability of our health systems. One solution lies in restoring the confidence of making a clinical judgment.3072_A Figure 1. Axial contrast enhanced CT scan of the abdomen showing a target-like mass in the small bowel, pathognomonic of intussusception.3072_B Figure 2. Ring-like configurations in the right and left mid abdomen showing evidence of additional intussusceptions (arrow).3072_C Figure 3. Sagittal contrast enhanced CT scan of the abdomen demonstrating a sausage-like mass, typical of a small bowel intussusception. No obstruction or lead point is identified.

Multiple Intussusceptions Associated with Meconium Plugs: A Case and Literature Review

Multiple Intussusceptions Associated with Meconium Plugs: A Case and Literature Review

Multiple Ileo-ileal Intussusceptions in a 3-Year-Old Child

Intussusception is the most common intestinal obstruction among infants and young children. Most of the pediatric cases are ileocecal. Isolated small bowel intussusception accounts for fewer than 10% of all pediatric cases. We reported a previously healthy 3-year-old child who presented with multiple ileo-ileal intussusceptions. Preoperatively, diagnosis made by ultrasonography. During surgery, edematous and dilated small bowel loops with four intussusceptions were found. Ileocecal junction was normal. Our experience shows that the rare entity of multiple intussusceptions with no obviously causative agent may present in pediatric patients.

A rare case of small bowel adenocarcinoma presenting as multiple intussusceptions: an unexpected diagnosis of intestinal obstruction

The authors talk about a rare case of small bowel adenocarcinoma causing intussusception in a 45-years-old Indian man who had presented with features of intestinal obstruction. Small intestinal malignancies are rare and those presenting as multiple intussusceptions are exceptional. It is rarely diagnosed pre-operatively. It poses a great diagnostic challenge. Hence, often it presents as a surprise intra-operative diagnosis. Exploratory laparotomy represents the diagnostic and definitive therapeutic procedure.