Postoperative Intussusception Research Articles

Postoperative intussusception in children operated for primary intussusception - A very rare entity

Postoperative intussusception (POI) after abdominal and non-abdominal operations is a rare but recognized condition discussed several times in literature. There are scarce reports regarding POI in children operated primarily for intussusception. We discuss three such cases that were seen in our institution in the last two years. The patients showed symptoms of atypical ileus that failed to resolve two to eight days following primary surgery. Ultrasound reported intussusception and surgical intervention was sought. All patients had ileoileal intussusception. Manual reduction was successful in two cases. One had intestinal necrosis and underwent resection and anastomosis. Recovery was satisfactory without recurrence. POI should be suspected in patients who show signs of intestinal obstruction in early postoperative period. A second POI should be kept in mind after surgical reduction of the first intussusception. Ultrasound should be performed to aid diagnosis followed by urgent surgical intervention.
 doi: https://doi.org/10.12669/pjms.40.5.8276
 How to cite this: Chaudhary MA, Chandni, Jamil A, Burki SA. Postoperative intussusception in children operated for primary intussusception - A very rare entity. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8276
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Postoperative intussusception after congenital diaphragmatic hernia repair: a report of 2 cases

Postoperative intussusception after congenital diaphragmatic hernia repair: a report of 2 cases

Intussusception of the distal bowel after ileostomy

Postoperative intussusception (POI) in preterm infants is very rare; intussusception at the distal end of the stoma is not seen. A 13-day-old premature infant was referred from peripheral hospital with history of necrotizing enterocolitis(NEC), which after the surgery of enterostomy. No typical symptoms appeared during treatment. Distal intestinal intussusception found during closed enterostomy. The patient recovered well after excision of the intussusception and intestinal anastomosis.

Intestinal intussusceptions in children population

Intussusception is an invagination of a proximal segment of the bowel into an immediately adjacent, distal portion of the bowel. Ileocolic intussusception is one of the most common causes of bowel obstruction in children. The peak incidence occurs in infants between five and seven months of age. The etiology of intussusception in children is typically idiopathic, approximately 5-10% of patients have a pathological lead point. Postoperative intussusception is one of the rare causes of intussusception. Children with ileocolic intussusception often present abdominal pain, palpable mass, rectal bleeding, fussiness, and emesis. The most effective imaging method for the diagnosis of intussusception is ultrasound. The treatment of ileocolic and ileoileal intussusceptions is different, the first type requires invasive treatment.

Postoperative intussusception in children

The authors present diagnosis and treatment of two children with postoperative intussusception. A 6-month baby with retroperitoneal teratoma developed clinical signs of intestinal obstruction in 2 days after surgery. The child underwent redo laparotomy, and ileocecal intussusception was found. In the second case, a 6-month baby with choledochal cyst underwent laparotomy, cyst excision and Roux-en-Y-hepaticojejunostomy. Six days later, clinical deterioration with signs of bowel obstruction appeared. Redo laparotomy was performed for early adhesive ileus, and ileoileal intussusception was observed. In both cases, postoperative intussusception was diagnosed during relaparatomy that confirms the complexity of diagnosis.

Post-operative Intussusception, a rare case in pediatric, National Center for Paediatric Surgery, Gezira State, Sudan; 2021

Intussusception is defined by Treves in 1899 as invagination of segment of bowel into adjacent segment usually proximal into distal. It’s a common cause of abdominal emergencies especially in children two years of age and younger. It accounts for 1 in 2000 infants and children and results in intestinal obstruction. Post-operative intussusception is one of the rare etiologies of intestinal obstruction that represents 0.01 to 0.25% after laparotomies and 5 -10% of all early postoperative intestinal obstructions. Our case is a ten years old female presented to the National Center for Pediatric Surgery; Gezira state; Sudan; February 2021 complaining of abdominal distention and constipation for 6 days. She had past history of acute appendicitis due to which she underwent emergency opened appendectomy. Her condition started one day after appendectomy. O/E : patient looks ill, febrile, not pale or jaundice; PR:140b/m; RR:25c/m; abdominal examination show: distended abdomen with full flanks, unhealed lanz incision with small amount of pus discharge; no dilated veins or visible peristalsis; hernia orifice were intact; lower abdomen was tense & tender; no palpable mass; DRE: rectum contains impacted hard stool. Emergency explorative laparotomy was done. Findings: Ileocecal intussusception, bowel was healthy and viable. Simple reduction was done. Conclusion and Recommendations: Post-operative intussusception usually associated with bowel ischemia and necrosis which is not consistent with our case. We highly recommended abdominal ultrasonography, CT scan; when there is a high index of suspicion.

Post-operative Intussusception, a rare case in pediatric, National Center for Paediatric Surgery, Gezira State, Sudan; 2021

Post-operative Intussusception, a rare case in pediatric, National Center for Paediatric Surgery, Gezira State, Sudan; 2021

Post appendectomy young male proffer intussusception unveiled diffuse large B-cell lymphoma non-Hodgkin lymphoma

Intussusception is the telescoping of the proximal segment of the intestine within the lumen of the adjacent segment. Adult intussusception is rare and its aetiology differs from paediatrics. Surgery is highly recommended and challenging considering the possibility of carcinoma. Post-operative intussusception is a rare and bizarre complication. We report an 18-year old male who had undergone uncomplicated appendectomy outside the institute with missed histopathological examination (HPE) report, presented with abdominal pain for 1 week, vomiting 4 days, obstipation 1 day. On examination ovoid mass of size (12×7 cm) in right hypochondrium. A plain abdomen radiograph shows dilated bowel loops. Contrast-enhanced computed tomography (CECT) abdomen and pelvis showed telescoping of small bowel into the caecum. Suggestive of post-appendectomy intussusception causing intestinal obstruction, emergency laparotomy revealed telescoping of ileum into caecum, acting as the leading point of intussusception, proceeded with right hemicolectomy and ileo-transverse anastomosis. With blindsiding HPE defining high grade diffuse large B cell lymphoma, immunohistochemistry stains nuclear positivity for cluster of differentiation-20 (CD-20) >80%, and Ki-67 >90%. Surgery plus chemotherapy is warranted being a high-grade tumour. Surgery must be restricted to the primary tumour, with mesenteric lymph node involvement based on oncological principles. Laparoscopic approach is preferred nowadays.

Jodhpur disease complicated by postoperative intussusception in St. Mary's Hospital Lacor

Abstract Jodhpur disease, now known as primary acquired gastric outlet obstruction (GOO) during infancy and childhood is a rare entity with less than 100 cases. Heineke mikulicz pyloroplasty (HMP) is the mainstay of treatment while other methods of treatment such as gastrojejunostomy and pneumatic balloon dilatation of pylorus have also been effective in some patients. No study has been done to compare the efficacy of these interventions in the management of Jodhpur disease and therefore the choice of operation has been surgeon dependent. Herein, we described a 2 years and 11 months old female child managed for Jodhpur disease with retro colic gastrojejunostomy after a failed HMP complicated by postoperative intussusception who recovered uneventfully with a 1500 g weight gain one month later. Conclusion A clear grading system for antropyloric stricture severity in Jodhpur disease is lacking making gastrojejunostomy a more effective surgical approach that can alleviate complications of repeated surgery.

Post-operative Intussusception Following Ladd’s Procedure

Post-operative intussusception is a recognised cause of intestinal obstruction in child especially during post-operative period. The diagnosis of post-operative intussusception may be difficult due to inconsistent clinical manifestation. It should be considered in any patient who develops abdominal distension, pain, and vomiting after partial return of gastrointestinal function especially after Ladd’s procedure.

Ultrasound guided hydrostatic enema reduction of acute intussusception: guidelines in therapy and review of the institutional experience

Background: In this review, author analyzed the cases of Acute Intussusception that underwent Ultrasound guided hydrostatic reduction during a one-year period. Author reviewed this treatment protocol and guidelines of non-operative and surgical therapy. The procedure followed and guidelines of therapy were reviewed and are detailed in the study.Methods: Retrospective analysis of the hospital data of all patients who were treated for acute Intussusception during the period of January 2017 to December 2017 was done. All records including admission data, investigations, procedure records, preoperative details and operation notes, where applicable, post procedure recovery data and incidence of recurrence were studied. Inclusion criteria included confirmed sonological diagnosis of Intussusception verified by the treating paediatric surgeon, availability of all necessary records and absence of other co-morbidities. Exclusion criteria included age more than 2 years, children who had other major systemic disease, doubtful sonological diagnosis and postoperative intussusception. The paediatric surgeon himself performed the procedure in the dedicated ultrasound suite.Results: The study was done in the mother and child wing of a medical college which is a tertiary referral centre catering to more than 200 cases of Intussusception per year. The records of 194 cases of Intussusception were available for analysis, of which only 176 could be included in the study. The age group included is 3 months to 3 years. The mean age was 11 months. The sex incidence was 94 cases in males and 82 in females.Conclusions: Ultrasound guided hydrostatic reduction is a safe, effective and convenient modality for treatment of acute Intussusception, which can be performed by the treating Paediatric surgeon himself with requisite training and exposure.

INTESTINAL INTUSSUSCEPTION SECONDARY TO JEJUNAL ADHESIONS IN ADULT: A RARE CAUSE OF POSTOPERATIVE OBSTRUCTION

Although intussusception is always seen in children, its occurrence in adults is an exceptional situation. Postoperative intussusception is uncommon and few cases have been reported in the literature. We present the case of a 51-year-old woman with jejunal postoperative intussusception. She underwent gastrojejunal anastomosis for pyloric stenosis two weeks earlier. The symptomatology was a bowel obstruction, which was initially thought to be an early postoperative adhesions. The lack of improvement despite medical treatment led to a surgical exploration that helped to the right diagnosis. Intussusception has been related to jejunal adhesions. Manual reduction was made with removal of adhesions. Postoperative period was uneventful. Adult intussusception is uncommon, often caused by tumors. Early surgical revision is the rule to avoid nutritional impact of a chronic postoperative subocclusion.

Jejuno-jejunal intussusception following open drainage of hepatic abscess

Abstract Postoperative jejunojejunal intussception after surgical drainage of hepatic abscess in a toddler is extremely rare, and reports of this special type of postoperative small bowel intussusception are scarce in the literature. The case of a 2-year-old toddler who developed post-operative intussusception following an open drainage of hepatic abscess was retrospectively reviewed. Clinical features, diagnostic strategy, operative findings and outcome were reviewed. He developed vomiting with crankiness suggestive of abdominal colics on the fifth post-operative day; haven been commenced on oral intake 48 h earlier. Physical examination revealed signs of dehydration, upper abdominal fullness and hyperactive bowel sounds. Plain abdominal x-ray showed multiple centrally located air fluid levels with paucity of gas in the pelvis. A conservative approach of “suck, drip and drain” was initially commenced but with worsening of symptoms laparotomy was done where a jejunojejunal intussception (with viable gut) was discovered. Manual reduction was done and the postoperative management was uneventful. This case highlights the need for a high index of suspicion of post-operative intussusception whenever paediatric patients have significant abdominal colics post laparotomy.

Post-Operative Intussusception in a Child after Pseudo Cyst of Pancreas Excision

Post-Operative Intussusception in a Child after Pseudo Cyst of Pancreas Excision

Postoperative Intussusception in Children after Nissen Fundoplication: A Case Report

Postoperative intussusception is a rare complication after various kinds of operations, the incidence of POI is 0.01–0.25 % of children following laparotomy. We reported and analyzed a case of a patient who developed postoperative intussusception following laparotomy for Nissen fundoplication.Postoperative intussusception differs from the other cases of invagination with respect to the pathogenesis, clinical presentation, localization, and therapeutic approach. Diagnosis must be suspected in patient who had occlusion symptoms after abdominal surgery and ultrasound was highly accurate in diagnosing postoperative intussusception in children.

A Case Report on Post-Operative Intussusceptions in Adult

Intussusception is the prolapse of one part of the bowel into the lumen of the immediately adjoining part. Intussusceptions in adults are much less common, representing 5% of all intussusceptions, 1% of all bowel obstructions, and 0.08% of all abdominal surgery. Surgery as a possible cause of intussusceptions in children is very rare (0.05%) and in adult, there are very few reports. In a report in a mayo clinic only 73 cases were seen within 23 year. This case report will be one of the few case reports on the subject matter. This is a 30 year old female from rural areas who underwent laparotomy and cystectomy for the diagnosis of left side ovarian cystic torsion after she presented with right side abdominal pain of sixth days duration which was squeezing in type. On the fourth post-operative day she started to have abdominal distention, and vomiting which was non projectile bilious matter 4-5 times/day. She came after 4 days of these symptoms with failure to pass both feces and flatus. On the day of admission she has 3-4 episodes of watery diarrhea which was blood tingled. Physical examination she was acutely sick looking and dehydrated. Abdominally she has centrally distended abdomen with palpable bowel loops and visible peristalsis. We investigated her with abdominal X-ray and ultrasound which suggested SBO 2ry to intussusceptions. After stabilizing the patient we did laparotomy. Intraoperativly we found viable ileo- ileal intussusceptions at two sites with distended bowel loops proximal and collapsed bowel loops distal to the intussusceptions. She had smooth post op course and discharged improved. The case is extremely important for the study of this possible differential in post-operative period because a delayed or incorrect diagnosis of acute intussusceptions can have serious consequences. Moreover it serves as an input for future studies in the area.

Post-operative intussusception: a rare phenomenon

Post-operative intussusception: a rare phenomenon

Use of ultrasound in diagnosing postoperative small-bowel intussusception in pediatric surgical oncology patients: a single-center retrospective review.

Postoperative intussusception can be a complication of abdominal surgery and often poses a diagnostic dilemma. The purpose of this study was to evaluate the utility of ultrasonography in the diagnosis of intussusception in children who had recently undergone resection of a primary solid tumor. We performed a retrospective review of all pediatric surgical oncology patients undergoing laparotomy for excision of an abdominal tumor at our institution from 1995 to 2015. We reviewed those with documented postoperative intussusception. In addition we searched the radiology database for all ultrasound examinations requested to rule out postoperative intussusception during our study interval. We analyzed demographics, primary diagnosis, surgical procedure, presentation, diagnostic investigations and definitive treatment. At our institution 852 laparotomies for abdominal tumor resection were performed during the study period, resulting in 10 postoperative intussusceptions (1.2% of cases), of which half were following neuroblastoma resection and the other half following nephrectomy for Wilms tumor. Postoperative intussusception was suspected if the patient had increasing nasogastric output, abdominal distension or feeding intolerance. Ultrasound was used to diagnose intussusception in 9/10 cases, on postoperative day 6 (standard deviation [SD] 5.6days) on average, with a sensitivity of 89% (8/9; one false negative; 95% confidence interval [CI] 0.52, 1.00) and a specificity of 100% (no false positives; 95% CI 0.96, 1.00). Ultrasound was highly accurate in diagnosing postoperative intussusception in children who underwent resection of retroperitoneal tumors.

Bladder exstrophy and postoperative intussusception due to Meckel's diverticulum: A confluence of congenital anomalies

• We report on a case of an intussuscepted Meckel's diverticulum in a post-operative bladder exstrophy patient.

Postoperative Intussusception: A Case Study

Postoperative intussusception is a known yet very uncommon postoperative complication after abdominal surgeries, including ostomy takedown. Early recognition of the symptoms of postoperative intussusception is important for both bedside nurses and nurse practitioners. Understanding clinical features and how to approach diagnosis and management are imperative for the nurse practitioner and the entire surgical team.