Presence Of Intussusception Research Articles

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.

Intususcepción intestinal en la población pediátrica vs. población adulta

La intususcepción intestinal se define como la invaginación de un segmento del intestino en un segmento inmediatamente adyacente. Su forma más frecuente en la población pediátrica es la intususcepción idiopática de tipo ileocólica, la cual es considerada una de las urgencias abdominales más frecuentes. Ésta es tratada de manera general por medio de una reducción no quirúrgica, tal como un enema neumático y/o hidrostático. En la población adulta, por su parte, la presencia de intususcepción es poco común y ocurre con mayor frecuencia en el intestino delgado que en el colon. En la mayoría de los casos en esta población, la intususcepción se asocia con un punto pivote patológico que provoca la presencia de síntomas de obstrucción intestinal. Generalmente, la invaginación a nivel de intestino delgado tiene una etiología benigna, aunque cuando es maligna se asocia con mayor frecuencia a una enfermedad metastásica difusa. Por el contrario, la etiología maligna en la invaginación intestinal de tipo ileocólica y colónica se encuentra con mayor frecuencia asociada a un adenocarcinoma primario. De manera general, su diagnóstico se realiza de forma intraoperatoria o mediante imágenes transversales, tales como TAC o RMN del abdomen, permitiendo diagnosticar más fácilmente las intususcepciones asintomáticas y/o transitorias, las cuales pueden observarse adecuadamente sin ninguna intervención. Por su parte, en los casos que este justificada la intervención quirúrgica en la población adulta, se realiza una resección intestinal de tipo oncológico, esto debido a la frecuente asociación con malignidad de la intususcepción en dicho grupo de edad.

Peutz-Jeghers syndrome complicated with intussusception in late pregnancy

A 19-year-old woman who was 34 weeks pregnant presented at The Affiliated Hospital of Southwest Medical University (Luzhou, China) in September, 2018, with a 3-day history of abdominal pain, accompanied by vomiting and constipation. Physical examination revealed hyperpigmented macules on her lips (figure, A), and an abdominal bulge, abdominal tenderness, and hyperactive bowel sounds. A non-contrast CT scan indicated the presence of intussusception (figure, B) and intrauterine late pregnancy. The patient reported that her mother had undergone bowel resection twice because of intussusception and died of intestinal cancer.

2650 Severe Celiac Disease Presenting With Intussusception Without Lead-Point in an Adult Male

INTRODUCTION: Adult celiac disease is an autoimmune disorder that usually presents with abdominal pain and diarrhea. We present the case of an adult man who presents with chronic diarrhea and intussusception, who was diagnosed with severe celiac disease. CASE DESCRIPTION/METHODS: 38 year old male with history of depression, presents with three months of abdominal pain and intermittent watery diarrhea, associated with thirty-pound weight loss, fatigue, nausea, diffuse joint stiffness and mild swelling, and tingling and numbness that started two weeks prior. Physical exam was remarkable for thin body habitus, hyperactive bowel sounds and diffuse abdominal tenderness with guarding. Laboratory testing was significant for microcytic anemia and INR 2.7, work up for infectious causes of diarrhea was negative. Liver and renal function tests were normal. CT of the abdomen showed fluid filled colon as well as entero-enteric intussusception of approximately 10 cm in left mid abdomen. Further investigation included tissue transglutaminase (TTG) antibodies of more than 100 U/mL and IgA 227. Colonoscopy with random biopsies was performed, pathology revealed partial villous atrophy negative for increased intraepithelial lymphocytes, suggestive of celiac disease. Patient was diagnosed with severe celiac disease, associated with multiple vitamin deficiencies secondary to malabsorption and peripheral neuropathy. Patient was managed conservatively and eventually discharged with follow up of Gastroenterology and Rheumatology practices. DISCUSSION: Intussusception is well described in patients with previously diagnosed celiac disease, in which small intestinal lymphoma or adenocarcinoma may represent the “lead point” causing the intussusception. Much rarely seen is intussusception as the presenting symptom of previously undiagnosed celiac disease, particularly in the absence of a lead point. Theories of its development include presence of flaccid, dilated small bowel, fold abnormalities, lymphadenopathies and fluid excess. Intussusception in celiac disease is often multiple, transient and repetitive, so surgical intervention should be avoided. In our case, the presence of intussusception without a lead point was suggestive of celiac disease, confirmed by serologic and histologic testing. Intussusception without a lead point should prompt investigation for celiac disease as it may represent initial presentation, in order to avoid unnecessary surgical intervention.

OP28.08: Is abnormal posterior compartment anatomy associated with anal incontinence?

It has been claimed that rectocele and intussusception are associated with anal incontinence, but this has not been studied while controlling for anal sphincter trauma. We aimed to investigate such a potential association in women with intact anal sphincter presenting with pelvic floor dysfunction. This is a retrospective study on 1314 women assessed at a tertiary urogynecological centre for pelvic floor dysfunction between 2014 and 2016. All had undergone a standardised physician-directed interview, clinical examination and transperineal 4D ultrasound (TPUS). The presence of intussusception was recorded during the examination, while descent of the rectal ampulla, rectocele, enterocele and anal sphincter trauma were measured offline. 181 women were excluded due to anal sphincter trauma (n=146) and incomplete data (n=35, leaving 1133. Mean age was 54.1 (17-89) years with mean BMI of 29.4 (15-68) kg/m2. Anal incontinence (AI) was reported by 149 (13%) patients, with a median St Mark's score (SMIS) of 12 (1-23). 638 (56%) patients had abnormal posterior compartment anatomy: 38% (n=425) showed significant descent of the rectal ampulla, 46% (n=527) a true rectocele, 8% (n=89) an enterocele and 2% (n=26) an intussusception. Table 1 shows associations between AI and these abnormalities. On adjusting for potential confounders, only the association between enterocele and AI appeared significant (OR 1.84 (1.07-3.16), p=0.026). In women without anal sphincter trauma, macroscopic anatomical abnormalities of the posterior compartment do not seem to be associated with anal incontinence, with the possible exception of enterocele.

Inflammatory fibroid polyps of the gastrointestinal tract: a 14-year CT study at a single institution.

To investigate the computed tomography (CT) features of pathology-proven inflammatory fibroid polyps (IFPs) in the gastrointestinal tract. This retrospective series study included 27 patients with pathology-proven IFPs in the stomach (n=16), small (n=9), and large (n=2) intestine, who underwent contrast-enhanced CT. Two radiologists reviewed the CT images of the patients to determine in consensus the long diameter, shape, margin, contour, and growth pattern of the lesions, the presence of an ulcer and overlying mucosal hyperenhancement, the lesion enhancement patterns including the homogeneity and the degree of contrast enhancement, and the presence of intussusception and obstruction. The CT results and clinical data of the gastric and intestinal lesions were compared. The IFPs typically manifested as well-defined (89%), round or ovoid (81%), slightly lobulated-contoured (70%) masses with a purely endoluminal growth pattern (96%) and an overlying mucosal hyperenhancement (67%). Lesion homogeneity and the degree of contrast enhancement varied. The intestinal IFPs were significantly larger (3.5 vs. 2cm), more symptomatic (82% vs. 19%), and more frequently associated with intussusception (73% vs. 0%) and obstruction (46% vs. 6%) than the gastric lesions (p≤0.027). The characteristic CT features of IFPs were well-defined, round or ovoid, lobulated-contoured, and endoluminal masses with overlying mucosal hyperenhancement and various enhancement patterns. IFP should be included in the differential diagnosis of patients with a soft-tissue mass in the gastrointestinal tract, especially if a large endoluminal mass in the small intestine is accompanied by intussusception.

Gastrointestinal ultrasonography of normal Standardbred neonates and frequency of asymptomatic intussusceptions.

BackgroundUltrasonographic appearance of the gastrointestinal (GI) tract of equine neonates has not been completely described.ObjectivesTo describe (1) sonographic characteristics of the GI segments in normal nonsedated equine neonates, (2) intra‐ and interobserver variation in wall thickness, and (3) the sonographic appearance of asymptomatic intussusceptions, and (4) to compare age and sonographic findings of foals with and without asymptomatic intussusceptions.AnimalsEighteen healthy Standardbred foals ≤5 days of age.MethodsProspective, cross‐sectional blinded study. Gastrointestinal sonograms were performed stall‐side. Intraobserver variability in wall thickness measurements was determined by calculating the coefficient of variation (CV). The Bland–Altman method was used to assess interobserver bias. Student's t‐test and Fisher's exact test were used to test the association among presence of intussusceptions, age, and selected sonographic findings.ResultsThe reference ranges (95% predictive interval) for wall thickness were 1.6–3.6 mm for the stomach, 1.9–3.2 mm for the duodenum, 1.9–3.1 mm for the jejunum, 1.3–2.2 mm for the colon, and 0.8–2.7 mm for the cecum. Intraobserver wall thickness CV ranged from 8 to 21% for the 2 observers for 5 gastrointestinal segments. The interobserver bias for wall thickness measurements was not significant except for the stomach (0.14 mm, P < .05) and duodenum (0.29 mm, P < .05). Diagnostic images of mural blood flow could not be obtained. Asymptomatic intussusceptions were found in 10/18 neonates. Associations between sonographic variables or age and the presence of intussusceptions were not found.Conclusions and Clinical ImportanceSonographic characteristics of the GI tract of normal Standardbred neonates can be useful in evaluating ill foals. Asymptomatic small intestinal intussusceptions occur in normal Standardbred neonates.

Retrospective detection by negative contrast electron microscopy of faecal viral particles in free-living wild red squirrels (Sciurus vulgaris) with suspected enteropathy in Great Britain

Transmission electron microscopy identified adenovirus particles in 10 of 70 (14.3 per cent) samples of large intestinal content collected at postmortem examination from free-living wild red squirrels (Sciurus vulgaris) across...

Prevention of lipopolysaccharide-induced intussusception in mice by the COX2 inhibitor rofecoxib

Intussusception (IS), an invagination of a portion of the intestine into itself, has recently attracted considerable interest after the withdrawal of a rotavirus vaccine because of reports on increased risk of IS shortly after vaccination. The present study was designed to shed further light on the mechanism of IS formation and its prevention. Intussusception was induced in adult mice by intraperitoneal injection of lipopolysaccharide (LPS; 8 mg/kg) from salmonella typhimurium. The presence of IS was confirmed at laparotomy. The serum levels TNF-alpha were measured with ELISA. Six hours after LPS injection, 14.5% of the animals demonstrated IS. A total of 65 animals received rofecoxib (20 mg/kg), a selective COX2 inhibitor, 15-30 min before intraperitoneal injection of LPS, and only two (3%) in this group demonstrated IS 6 h later (P < 0.05 vs. control). We confirmed the well-known increase in serum TNF-alpha levels in response to LPS; however, this increase was not blocked by rofecoxib pretreatment. Notably, there was no correlation between the serum TNF-alpha levels and the development of IS. The results show that the occurrence of IS can be significantly decreased by pretreatment with a selective COX-2 inhibitor.

Posterior pelvic floor disorders: a prospective comparison using introital ultrasound and colpocystodefecography

To compare introital ultrasound with colpocystodefecography (CCD) in quantifying the anorectal angle and in the diagnosis of posterior pelvic floor disorders. Forty-three consecutive women with functional impairment of the posterior pelvic floor were enrolled after a clinical evaluation. Using both CCD and introital ultrasound examination, the anorectal angle was measured during squeezing to evaluate the strength of voluntary muscle contraction and during straining to assess pelvic floor relaxation. Rectocele depth and the presence of intussusception were assessed. The performance of CCD and that of introital ultrasound were compared. Good concordance was obtained between introital ultrasound and CCD. The intraclass correlation coefficient was 0.82 (95% CI, 0.69-0.89) for measurement of the anorectal angle during squeezing and 0.67 (95% CI, 0.47-0.81) during straining. Rectoceles > 4 cm on CCD were detected by introital ultrasound in 100% of cases, and there was 91% agreement for rectal intussusception. Cohen's kappa index was moderate for rectocele assessment (0.41, P < 0.01) and excellent for intussusception (0.91, P < 0.001). It was also noted that introital ultrasound could be used to detect pelvic floor dyssynergia. Introital ultrasound is a simple, accurate, non-invasive method with which to assess anorectal dynamics.

Florid Vascular Proliferation of the Colon Related to Intussusception and Mucosal Prolapse: Potential Diagnostic Confusion with Angiosarcoma

With the exception of angiodysplasia, vascular abnormalities of the intestines are unusual. We describe a florid benign vascular proliferation of the colon in five adult patients, three of whom presented with idiopathic intussusception. In all cases, the proliferation was sufficiently exuberant to raise the possibility of angiosarcoma as a diagnostic consideration. The group included 2 males and 3 females with a median age of 43 years. Two patients were HIV positive. Four patients presented with a colonic mass; other symptoms at presentation included abdominal pain, diarrhea, bleeding, and bowel obstruction. In all cases, a florid lobular proliferation of small vascular channels lined by plump endothelial cells extended from the submucosa through the entire thickness of the bowel wall. The endothelial cells showed minimal nuclear atypia, and mitotic figures were infrequent. The overlying mucosa showed ulceration with ischemic-type changes, and had features of mucosal prolapse. A possible underlying arteriovenous malformation was identified in two cases. All patients were alive and well at last follow-up (interval, 6 months to 5 years). The presence of intussusception or mucosal prolapse in all of the cases suggests repeated mechanical forces applied to the bowel wall as a possible etiologic factor. The role of HIV infection in the pathogenesis of these lesions remains to be determined.

Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography.

To assess the diagnostic usefulness of ultrasonography (US) in intussusception in children and determine whether color Doppler sonography (CDS) can indicate bowel viability and help in prediction of reducibility. US was used to examine 176 children in whom the presence of intussusception was clinically suspected. CDS was performed in 64 patients with 65 cases of intussusception proved with US. The positive US findings were confirmed with air enema; the negative findings, with air enema in 46 patients and clinical follow-up in 66 patients (100% specificity and sensitivity). CDS indicated blood flow in 62 of 65 cases of intussusception; pneumatic reduction was achieved in 58 (94%) of these 62 cases. Four patients (6%) underwent manual reduction of viable bowel; three patients (5%) who had no color Doppler signal underwent segmental resection. The difference in reduction rates based on blood flow was statistically significant (P = .0008). US is sensitive and specific in the diagnosis of intussusception, and CDS is a promising predictor of bowel viability.

Defecographic findings in patients with anal incontinence and constipation and their relation to rectal emptying

The aim of this study was to examine defecographic findings in patients with anal incontinence and constipation and to compare these findings with rectal emptying. One hundred seventy-five preoperative defecographies documented on videotape in patients with either anal incontinence or constipation were retrospectively reviewed. The examinations were evaluated with respect to anatomic abnormalities of the rectum or anal canal. The results were compared with a semi-quantitative assessment of rectal emptying as it appeared on the video sequence after one minute of strain. Anatomic abnormalities were found equally in incontinent and constipated patients, except for failure to open the anal canal, which was found only in constipated patients. Rectal intussusception was the most frequent finding. Abnormal defecograms were found in both sexes. Enteroceles, sigmoidoceles, and large rectoceles were found only in women. The presence of intussusception, lacking relaxation of the puborectalis muscle, and rectocele did not correlate with poor rectal emptying. Poor rectal emptying was also found in 19 of 58 patients with normal defecograms. Anatomic abnormalities of the rectum may be demonstrated independently of the clinical symptoms and are not always correlated to impaired rectal emptying. Since they may also be found in healthy controls, surgical correction of these abnormalities should be considered only with great caution.