Presentation Of Intussusception Research Articles

Patent vitello-intestinal duct with a rare presentation of reverse intussusception with appendicular agenesis: A case report

Background: Vitello-intestinal duct (VID) is found in approximately 2% of newborns, with patency in about 6%. Failure of obliteration leads to some anomalies, most commonly Meckel’s diverticulum. Protrusion of the small bowel is one of the rare presentations. Case Presentation: A 10-month-old male infant presented with a prolapsed, irreducible polypoid-shaped loop of intestine protruding from the anterior abdomen. On exploratory laparotomy, patent VID was confirmed with appendicular agenesis and reverse intussusception. Gangrenous bowel was resected, followed by end-to-end ileo-ileal anastomosis, with a favorable outcome. Conclusion: Patent VID with ileal intussusception and prolapse is a rare entity, which can be easily diagnosed clinically. A high index of suspicion is needed for any associated gut anomaly in these cases, like appendicular agenesis.

A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children.

Surgery remains the mainstay in treating intussusception in developing nations. A correspondingly high bowel resection rate exists despite a shift to nonoperative reduction in high-income countries. We aimed to study the clinical profile of the patients with intussusception presenting to our hospital and to assess the clinical and radiological predictors of success or failure of nonoperative management of intussusception. This prospective study was conducted in the Department of Pediatric Surgery over a period of 3 years and included a total of 118 patients who presenting to our emergency division with features suggestive of intussusception and were managed accordingly either with hydrostatic reduction or by surgical intervention. We observed that the majority of the patients were males (65.5%). The mean age was 13.54 months. Intermittent pain was the most common symptom. Both pain and vomiting did not affect the outcome. Lab parameters like raised total leukocyte counts (TLC), C-reactive protein (CRP) and lactate levels were significantly associated with failure of hydrostatic reduction. Patients with air fluid levels on X-ray were more likely to end up in surgery. Ultrasound findings of bowel wall edema, aperistaltic gut loops and a pathological lead point was associated with failure of hydrostatic reduction as well. The overall success rate of hydrostatic reduction was 85.5%. Hydrostatic reduction of intussusception is a safe and effective method of management of intussusception whenever indicated. Factors that might reduce the chance of its success include continuous pain, irritability, tenderness, deranged lab parameters like TLC, CRP and lactate levels, air fluid levels on X-ray, bowel wall edema, aperistalsis and the presence of a lead point. Shah JY, Banday I, Hamdani HZ, et al. A Study of Predictors of Failure of Nonoperative Management of Ileocolic Intussusception in Children. Euroasian J Hepato-Gastroenterol 2024;14(1):81-85.

Clinical presentation and management outcome of pediatric intussusception at Wolaita Sodo University Comprehensive Specialized Hospital: a retrospective cross-sectional study.

To assess the pattern of clinical presentations and factors associated with the management outcome of pediatric intussusception among children treated at Wolaita Sodo University Comprehensive Specialized Hospital, Ethiopia. This retrospective cross-sectional study included the medical records of 103 children treated for intussusception from 2018 to 2020. The data collected were analyzed using SPSS 25.0 (IBM Corp., Armonk, NY, USA). In total, 84 (81.6%) patients were released with a favorable outcome. Ileocolic intussusception was a positive predictor, with a nine-fold higher likelihood of a favorable outcome than other types of intussusception [adjusted odds ratio (AOR), 9.16; 95% confidence interval (CI), 2.39-21.2]. Additionally, a favorable outcome was three times more likely in patients who did than did not undergo manual reduction (AOR, 3.08; 95% CI, 3.05-5.48). Patients aged <1 year were 96% less likely to have a positive outcome than those aged >4 years (AOR, 0.04; 95% CI, 0.03-0.57). Most patients were discharged with favorable outcomes. Having ileocolic intussusception and undergoing manual reduction were associated with significantly more favorable outcomes of pediatric intussusception. Therefore, nonsurgical management such as hydrostatic enema and pneumatic reduction is recommended to reduce hospital discharge of patients with unfavorable outcomes.

Un bersaglio quando meno te lo aspetti: la sindrome di Peutz-Jeghers

Peutz-Jeghers Syndrome is a genetic condition that puts affected patients at risk of oncological degeneration and gastrointestinal complications. In most cases, abdominal pain is the acute symptom that leads the patient to the emergency room. This may be due to dangerous medical conditions, such as bleeding polyps and intussusception. The clinical presentation of intussusception might initially be subtle with an intermittent pattern that may be underestimated as the child may alternate intense pain with phases of complete well-being. The paper underlines that intense colic pain associated with emesis must always be included in the differential diagnosis of intestinal intussusception, even if it is a rare pathology in children over 2 years of age. The clinician must conduct a targeted anamnesis to investigate secondary causes in a patient with possible intussusception at a non-typical age.

Celiac Disease and Intussusception: A Common Association in Children.

In young childhood, intestinal intussusception (IS) is the most common cause of small bowel obstruction. A lead point such as Meckel diverticulum, polyps, tumors, enlarged lymph nodes, cystic fibrosis, and Schoenlein-Henoch purpura are recognized causes. Association between celiac disease (CD) and IS has been well recognized in adults but rarely in children. Data on causes and outcome of intussusception among Saudi children are lacking in the literature. Our objectives were to characterize the pattern of IS among Saudi children and investigate the frequency, clinical presentation, and outcome of intussusception among children with CD. We searched the hospital's picture archiving and communications system for abdominal imaging studies (ultrasound, magnetic resonance imaging, computed tomography scan, and barium contrast studies), performed between 2008 and 2019, using "intussusception" as a search key word. The hospital medical records of the identified cases of intussusception (aged 0-14 years) were then retrospectively reviewed to collect demographic, clinical, laboratory and imaging findings, management, and outcome. During the study period, 57 cases were identified as confirmed IS (31 boys, median age 1.95 years, range 0.33-11 years). Abdominal ultrasound was the diagnostic imaging study in 93%. An underlying cause (secondary IS) could be identified in 19 (33.3%) cases: CD in 6, malignancy and Henoch-Schoenlein purpura, 5 each, and Meckel diverticulum in 3; the remaining 38 (66.6%) cases of IS were idiopathic (primary IS). The presence of hypoalbuminemia and abdominal distension were significantly associated with secondary IS as compared with primary IS ( P < 0.001, P = 0.006, respectively). All of the 6 cases of IS associated with CD resolved spontaneously, but 3 were recurrent. Secondary causes contributed to a large proportion of IS in our study cohort (33%) as compared with 5% to 10% in the literature. Celiac disease is an underrecognized cause of IS among children. A child with IS and hypoalbuminemia, anemia, or chronic diarrhea needs to be investigated for CD to avoid unnecessary surgery.

The impact of the COVID-19 pandemic on presentation of surgical disease in paediatric patients at a tertiary centre in Cape Town, South Africa.

Children are less susceptible to infection with SARS-CoV-2 and subsequent severe disease, yet especially vulnerable to the indirect effects of the pandemic. A constrained healthcare service, combined with the societal and behavioural changes observed during the pandemic, is likely to have altered the presentation of paediatric surgical disease. The objective was to investigate the impact of the COVID-19 pandemic on the volume of paediatric surgical admissions, the severity of disease and the type of surgical pathology treated at our centre. A retrospective cohort study compared paediatric surgical admissions in an eleven-month period before COVID-19 to the same period during the pandemic. Comparisons in volume and diagnoses were based on the number of admissions. Predetermined criteria for severity of disease using triage scores, intraoperative findings and intensive care admissions were compared. A total of 1 810 admissions were recorded, 1061 in the pre-COVID group and 749 during COVID. Emergency admissions reduced by 9.2%, most notably due to a reduction in trauma, caustic ingestions and constipation. There was an increase in incarcerated inguinal hernias and helminth-related pathologies. Significantly more intussusceptions failed pneumatic reduction requiring surgical intervention with bowel resection. There was a two-fold increase in patients requiring emergency intensive care. Paediatric surgical volumes at our centre decreased during the COVID-19 pandemic. There was evidence of more advanced disease on presentation of inguinal hernias and intussusception and a generalised increased demand for emergency ICU admission.

The success of ultrasound-guided hydrostatic reduction in managing delayed presentation of childhood intussusception: A single center experience

BackgroundChildhood intussusception is a common surgical emergency. The current practice for non-operative management in Sri Lanka is ultrasound-guided hydrostatic reduction (USGHR). This retrospective study aims to demonstrate the efficacy and safety of this procedure even in a setting of delayed presentation. MethodWe explore outcomes of USGHR in the management of intussusception in children presenting to a single tertiary care center in Sri Lanka, between November 2019 and March 2021. Hydrostatic reduction was performed in patients with radiologically confirmed intussusception in the absence of contraindications. In failed attempts or early recurrences, USGHR was repeated for a maximum of 2 more attempts. ResultsOur study included 135 participants. Of the patients for which data on symptom duration was available 31.5% (n = 41) presented delayed (t>48 hrs). Hydrostatic reduction showed an overall success rate of 86.4%. No association was seen between time since onset of symptoms and success of USGHR (p<0.05). In 19 patients (14.1%) operative intervention was required. The rates of operative intervention were comparable between those presenting within (12.4%) and after 48 h (12.2%). One case (0.7%) of bowel perforation and 1 case of peritonitis (0.7%) occurred in those presenting within and after 48 h respectively. ConclusionThe success rate of USGHR was high despite delays in patient presentation. Thus, hydrostatic reduction is a safe, effective procedure to be performed as the first-line management option in childhood intussusception even in a setting of delayed presentation. Overall success increases with repeat reduction. Level of evidenceRetrospective study comparative – level III

Novel laparo-endoscopic hybrid technique of management of a rare case of duodeno-duodenal intussusception.

We herein report a rare case of duodeno-duodenal intussusception (IS) presenting with obstruction caused by tubulovillous adenoma in an adult with malrotation that was managed by a novel laparoendoscopic hybrid technique. This was done by passing transjejunal nasogastric tube (NG) through one of the ports and manoeuvring it towards the IS. Two hundred and fifty millilitre of saline was flushed by aseptosyringe with pressure connected to the NG. This hydrostatic reduction technique resulted in distension of the jejunal and duodenal loop achieving reduction of IS. Intraoperative endoscopy was performed to exactly localise the mass lesion. The duodenum was kocherised and was delivered through a 4-cm transverse incision. Anterior duodenotomy was performed; the mass was excised; and duodenotomy was closed transversely. An extensive literature search did not show any case report of duodenoduodenal IS being managed by this technique. The combination of novel retrograde decompression and intraoperative endoscopy helped us to manage this rare case by this novel technique.

Small bowel intussusception after Roux-en-Y gastric bypass: A case report

Introduction: Small bowel intussusception after Rouxen-Y gastric bypass is a rare condition, with a reported incidence of 0.07–0.6%, and a multifactorial etiology. The severity of the condition ranges from small bowel edema to ischemia and perforation with peritonitis, and the clinical presentation and blood tests are non-specific. The computed tomography (CT) scan is the best diagnostic tool in an emergency department context. Case Report: The authors present the case of a 41-year-old male patient, with history of Roux-en-Y gastric bypass two years before, who presented in the emergency department with acute onset abdominal pain and nausea. Abdominal exploration showed a tender mass in the left upper quadrant. Blood tests showed an increase in alanine transaminase (ALT) and aspartate transaminase (AST) and abdominal CT scan was compatible with a small bowel intussusception, without other findings. A diagnostic laparoscopy confirmed the diagnosis, and the intussusception was resolved without need of bowel resection. The patient showed no complications in the immediate post-operative period, with clinical and analytical improvement, and was discharged on the sixth post-operative day, without relevant complaints in the follow-up appointments. Conclusion: Due to the non-specific clinical presentation of small bowel intussusception, it is required a high level of suspicion in patients who underwent gastric bypass and present with abdominal pain. In terms of surgical approach, resolution of the intussusception may be enough in many cases, when there is no vascular compromise of the bowel, while the evidence of ischemia requires bowel resection.

COMPLETE RECTAL PROLAPSE WITH CONCOMITANT RECTO-SIGMOIDOANAL INTUSSUSCEPTION - A RARE CASE REPORT

Intussusception is more common in the pediatric age group and very rare in adults. The presentation, etiology and treatment of adult intussusception is different from that in pediatric age group. Adult colonic Intussusceptions account for only 5% of all cases, out of which only 1% present as obstruction. Often the diagnosis in adults is delayed due to vague, chronic and non-specic symptoms that are either ignored or treated symptomatically. Rectal prolapse is more common in geriatric age group compared to younger population. Colonic intussusception can be associated with a rectal prolapse. In children the symptoms of intussusception include palpable abdominal mass, fresh blood in stools and colicky abdominal pain. However, in adults, symptoms consist of bloody stool, constipation or symptoms suggestive of malignancy such as weight loss, altered bowel habits and loss of appetite. We present a case of a complete rectal prolapse with strangulated rectosigmoid intussusception for which sigmoid resection was done with reduction of rectal prolapse, rectosigmoid anastomosis, mesh rectopexy and diverting transverse colostomy

Ileocolonic intussusception presenting as chronic diarrhea in an elderly woman.

Video 1Colonoscopy findings of cecal mass as a lead point causing intussusception.

Duodenal intussusception secondary to hamartomatous polyps of the duodenum and a review of the literature

Background: Hamartomas of the duodenum are benign duodenal tumors comprising approximately 5-10% of duodenal tumors. The incidence is < 0.01%. Typically asymptomatic, they may manifest as intestinal obstruction, gastrointestinal hemorrhage, biliary obstruction or intussusception. Intussusception as a manifestation of duodenal hamartoma is rare in itself with less than 200 cases reported in the literature. We present the first case report of duodenal intussusception presenting with a partial mid-gut volvulus and biliary obstruction. In addition, a review of current literature have been performed.

Rare polypoid gastric mucosa induced small bowel intussusception in a toddler

Intussusception is a relatively rare occurrence in the pediatric age group and is typically idiopathic. There are even rarer occurrences of intussusception due to heterotopic gastric mucosa with an incidence of 0.1–13%. Understanding the clinical presentation of intussusception and the potential causes is crucial for appropriate care and management. This is a case report of a pediatric patient who presented with small bowel obstruction due to intussusception from a heterotopic gastric polyp in the jejunum.

Ileo-Ileal Intussusception Presenting as Cullen’s Sign: A Case Report

Intussusception is defined as the telescoping of one segment of intestines into another causing intestinal obstruction. This condition although common in children is considered a rare condition in adults and is usually present secondary to a pathological lead point like a neoplasm in adults. It usually presents with non-specific complaints like abdominal pain and as such peri umbilical ecchymosis (Cullen’s sign) has not been seen as a presenting symptom of intussusception. Here we present a rare case of acute abdominal pain with contrast imaging of abdomen revealing ileo ileal intussusception. The patient had periumblical ecchymosis (Cullen s sign) on abdominal examination.

S1981 Adult Intussusception: Finding a Lead on a Rare Case

Introduction: Bowel intussusception is defined as a telescoping proximal loop within the distal loop of bowel, obliterating the bowel lumen. Although over 95% of cases occur in the pediatric population; intussusception in adults is strongly associated with tumors, with malignancy rates accounting for approximately half of all adult cases. Case Description/Methods: A 37-year-old female with no known past medical history presented to the Emergency Department complaining of suddenly worsening non-localized abdominal pain and distension. She reports a 5-day history of intermittent generalized cramps abdominal pain, which causes her to wake up several times throughout the night. Associated symptoms include anorexia, non-bloody emesis, and constipation, followed by small volume loose stools. Her physical exam was significant for generalized abdominal tenderness. Initial laboratory work-up with CBC, CMP, lipase and CRP were unrevealing except for a low serum bicarbonate (19). CT abdomen with contrast demonstrated a large colonic intussusception from the ascending colon to the splenic flexure, with suggestion of a large polyp or mass in the splenic flexure as a possible lead point (Figure). The patient underwent an exploratory laparotomy with right hemicolectomy and lymphadenectomy. Pathology of the resected colon was consistent with a Plasmablastic neoplasm involving the ileocecal valve. All surgical margins and 27 resected lymph nodes were negative. Discussion: Adult intussusception is a rare cause of bowel obstruction (< 1% on adult causes) that carries a high risk of complications, if not emergently identified and treated. Nonspecific abdominal pain is the most common clinical presentation of Adult Intussusception. The triad of red current jelly stool, colicky abdominal pain, and a palpable sausage-shaped mass; classically seen with children, is rarely present in the adult presentation. Due to high rates of malignancy, adult cases are traditionally treated with a large en-bloc resection. Early diagnosis of intussusception in adults requires a high level of clinical suspicion. Failing to recognize this may lead to complications such as bowel ischemia and perforation. Treatment in adults requires urgent operative management with oncologic resection and further investigation.Figure 1.: Left: Coronal CT revealing large colonic intussusception with lead point (yellow arrow). Right: Sagittal CT demonstrating target sign (green arrow).

Recurrent appendiceal intussusception mimicking ileocecal invagination in a 7-year-old girl

Appendiceal intussusception in children is a rare entity characterized by the invagination of the appendix into the cecum. The early diagnosis and optimal surgical management of appendiceal intussusception have not been achieved because of its rarity. Here, we report a case of a 7-year-old girl with appendiceal intussusception presenting with recurrent ileocecal invagination. She was treated by simple appendectomy without using a stapling device. The imaging findings in patients with appendiceal intussusception were reported, and the optimal surgical treatment for appendiceal intussusception was discussed.

915 Duodenojejunal Intussusception Caused by a Solitary Peutz-Jeghers-Type Polyp

Abstract A solitary Peutz-Jeghers (SPJ) type polyp is a rare hamartomatous polyp that shares similar histological features to polyps found in typical Peutz-Jeghers syndrome (PJS), without the associated mucocutaneous pigmentation or family history. Intussusception is rare in adults and of the six previous reports of intussusception caused by a SPJ type polyp, only two occurred in adults. A 59-year-old female presented with recurrent episodes of colicky abdominal pain lasting a few hours. These episodes were followed by abdominal bloating and belching, but no vomiting. A CT scan of the abdomen and pelvis suggested intussusception of the fourth part of duodenum (D4) into the jejunum and a small bowel mass with D4 involvement. Physical examination did not reveal the associated signs of PJS. Multi-disciplinary team (MDT) recommendation was to resect the area in question. An exploratory laparotomy found a small bowel intussusception. Enterectomy of D4 and proximal jejunum was performed, with primary side to end anastomosis. Macroscopically, the specimen showed intussusception of the distal duodenum into the proximal jejunum, associated with a large duodenal polyp measuring 5×3 x 2 cm. microscopic examination revealed hamartomatous changes suggestive of a Peutz-Jeghers polyp. The resection margin showed normal small bowel tissue with no evidence of dysplasia. A colonoscopy to rule out additional polyps was negative, and the patient recovered well from surgery. This rare case highlights the non-specific presentation of intussusception, shows the need for methodical evaluation of the patient's history, examination, and investigations, and queries the requirement for surveillance and screening.

Pattern, presentation, and management of intussusception at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria

Objectives: Intussusception is the most common cause of intestinal obstruction in infants. In developing countries, presentation is usually late with an attendant high mortality rate. Material and Methods: Records of children managed for intussusception at the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi State from 2013 to 2017 were retrieved. Information including the sociodemographic data, the pattern of presentation, treatment, and treatment outcomes were obtained and analyzed using tables. Results: There were 22 patients, 15 (62%) of whom were male (male-female ratio 2.1:1). Age at presentation ranged from 3 months to 14 years with a peak incidence at 7–8 months. The most common symptoms were vomiting (68%), abdominal pain (59%), and bloody stool (41%). Only 1 patient (4.5%) presented within 24 h of onset of symptoms while 13 (59%) presented after 72 h of onset of symptoms. All patients had open surgery, and ileocolic intussusception was the most common type. Ten patients (45.5%) had a manual reduction, while 12 (55.5%) had resection and anastomosis. Surgical site infection was ranked the highest post-operative complication; the mortality rate was 32%. Conclusion: Intussusception is a common cause of intestinal obstruction in infants and children in our environment; presentation is usually late. A high index of suspicion is necessary for early diagnosis and treatment to reduce the associated high mortality rate.

An unusual cluster of Waugh syndrome as a cause of intestinal obstruction in children - A case series.

Introduction and importanceThe association of intussusception with intestinal malrotation is a rare phenomenon named Waugh syndrome by Brereton et. It is a rare disease entity with less than 100 cases described so far. A cluster presentation is something unusual for rare diseases.Case presentationAll four patients have presented with features suggestive of bowel obstruction as all of them have had colicky abdominal pain. Three patients have vomiting as an additional complaint, so as the diarrhea. Fever has also been reported in one patient. Patients have presented in 6 months period, non-consecutively. Abdominal pain, diarrhea and vomiting are alarming in the pediatric population. When each case presented, an immediate resuscitation was performed including IV lines, nasogastric suctioning, electrolytes correction, and blood and FFP transfusion as necessary. Abdominal ultrasonography was performed revealing target sign. After optimization for surgery, manual reduction of the intussusception was done followed by a Ladd's procedure for the malrotation was performed for all 4 patients with excellent outcomes.Clinical discussionWith the surgery, after case optimization, remains the standard of care; the presence of cluster presentation for Waugh syndrome could suggest that some environmental factors might be implicated and further observations can be carried out to look more into such phenomenon.ConclusionWaugh syndrome, a combined presentation of intestinal malrotation and intussusception, is a rare syndrome that can present in children. Optimization for surgery followed by a 2-step surgical approach is the usual treatment with excellent outcomes described.

Unsuspecting Lead Points Causing Nonobstructing Intussusceptions in Pediatric Patients Presenting with Chronic Pain Abdomen

AbstractIntussusception is one of the common causes of bowel obstruction in pediatric age group and is of idiopathic variety in most of the cases. Nonobstructing intussusception presenting with nonspecific symptoms (or chronic pain abdomen) is rare and usually clinically misdiagnosed/difficult to diagnose. The authors present a pictorial review of 10 cases of pediatric nonobstructing intussusception presenting with acute/chronic abdominal pain which were not suspected clinically but diagnosed with a pathologic lead point radiologically.