Rare Cause Of Intussusception Research Articles

PEUTZ-JEGHERS POLYP AS A LEAD POINT FOR ILEOCOLIC INTUSSUSCEPTION IN A YOUNG FEMALE: A CASE REPORT

Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. It is common in children, and idiopathic ileocolic intussusception is the most common form. It is rare in adults, and again, hamartomatous polyposis is a rare cause of intussusception in adults. But, this complication is most frequent for patients with Peutz-Jeghers syndrome (PJS). It represents 5% of all intussusceptions and accounts for only 1–5% of intestinal obstruction in adults. PJS is a clinical diagnosis based on any one of the following World Health Organization criteria: three or more histologically confirmed Peutz-Jeghers polyps; any number of PJ polyps with a family history of PJS; characteristic, prominent, mucocutaneous pigmentation with a family history of PJS; or any number of Peutz-Jeghers polyps and characteristic prominent, mucocutaneous pigmentation. Here we report a case of intussusceptions in a 21 y old male with underlying PJ polyp in the intestine and mucocutaneous pigmentation.

Lipoma of the Ileum: A Rare Cause of Intussusception in Adults

Bowel intussusception is a rare entity in adults. Symptoms are nonspecific and most of diagnoses are made by computed tomography scan. We report the case of an adult with bowel obstruction due to an ileoileal intussusception caused by a lipoma.A 44-year-old male patient with colicky epigastric pain since the day before, bilious vomiting, abdominal distension and epigastrium tenderness. Plain abdominal radiography revealed dilation of small bowel with gas-fluid levels and computed tomography scan suggested an ileoileal intussusception. We performed bowel resection comprising the lesion, removal of the regional lymph nodes and a primary anastomosis. The histopathology report revealed a lipoma. Patient was discharged on the fifth postoperative day.A lipoma is a rare cause of intussusception, with a challenging diagnosis, because of nonspecific symptoms. An early computed tomography scan is essential for the diagnosis and prompt surgical resection is recommended.

A rare case of jejunal Vanek’s tumor causing intussusception in an adult: a case report and comprehensive literature overview

Abstract Inflammatory fibroid polyp, or Vanek's tumor, is an uncommon benign small bowel tumor and a rare cause of intussusception in adults. This case involves a 62-year-old man with persistent abdominal pain, diagnosed with jejunoileal intussusception. A 4 cm inflammatory fibroid polyp was discovered during surgery, leading to distal jejunal resection. Despite the rarity of adult intussusceptions, they should be considered in abdominal pain diagnoses. The optimal management approach, whether en bloc resection or initial reduction with limited resection, remains debated.

Pediatric case of colonic perivascular epithelioid cell tumor complicated with intussusception and anal incarceration: A case report

BACKGROUNDPerivascular epithelioid cell tumor (PEComa) represents a group of rare mesenchymal tumors. PEComa can occur in many organs but is rare in the colorectum, especially in children. Furthermore, PEComa is a rare cause of intussusception, the telescoping of a segment of the gastrointestinal tract into an adjacent one. We describe a rare case of pediatric PEComa complicated with intussusception and anal incarceration, and conduct a review of the current literature.CASE SUMMARYA 12-year-old girl presented with abdominal pain and abdominal ultrasound suggested intussusception. Endoscopic direct-vision intussusception treatment and colonoscopy was performed. A spherical tumor was discovered in the transverse colon and removed by surgery. Postoperative pathologic analyses revealed that the tumor volume was 5.0 cm × 4.5 cm × 3.0 cm and the tumor tissue was located in the submucosa of the colon, arranged in an alveolar pattern. The cell morphology was regular, no neoplastic necrosis was observed, and nuclear fission was rare. The immunohistochemical staining results were as follows: Human melanoma black 45 (HMB 45) (+), cluster of differentiation 31 (CD31) (+), cytokeratin (-), melanoma-associated antigen recognized by T cells (-), smooth muscle actin (-), molleya (-), desmin (-), S-100 (-), CD117 (-), and Ki67 (positive rate in hot spot < 5%). Combined with the results of pathology and immunohistochemistry, we diagnosed the tumor as PEComa. Postoperative recovery was good at the 4 mo follow-up.CONCLUSIONThe diagnosis of PEComa mainly depends on pathology and immunohistochemistry. Radical resection is the preferred treatment method.

Saline-immersion therapeutic endoscopy (SITE) combined with endoscopic submucosal dissection (ESD) of a rare cause of intussusception: a giant Brunner gland adenoma.

Saline-immersion therapeutic endoscopy (SITE) combined with endoscopic submucosal dissection (ESD) of a rare cause of intussusception: a giant Brunner gland adenoma.

Intussusception secondary to inflammatory myofibroblastic tumor of the small intestine. Case report

Introduction: Intussusception occurs when part of the intestine slides into an adjacent intestinal segment. Inflammatory myofibroblast tumor is a rare cause of this condition, and is observed in 5% -16% cases in adults.Case presentation: A 41-year-old woman presented with abdominal pain and distension. A exploratory laparoscopy was performed, finding ileocolic intussusception into the transverse colon. Due to uncontrollable bleeding, the procedure was converted to laparotomy; resection and latero-lateral ileocolic anastomosis were performed. Histopathology reported inflammatory myofibroblastic tumor, with a favorable postoperative evolution. The patient was discharged on the sixth postoperative day.Discussion: When located in the small intestine, 57% of the tumors that cause intussusception are benign, including the myofibroblastic tumor in this patient. The symptoms and signs associated with this neoplasm are cramp-like abdominal pain, nausea and vomiting. Although imaging studies may lead to suspect this diagnosis, in most cases it is made intraoperatively. Surgical resection of the affected intestinal segment is curative, with favorable prognosis.Conclusions: This case is considered as a rare cause of intussusception. It had a benign course and is still under study since its pathophysiology has not been fully understood.

A5269 - Biliopancreatic blind limb as a rare cause of intussusception at the jejunojejunostomy after Roux-en-Y gastric bypass

A5269 - Biliopancreatic blind limb as a rare cause of intussusception at the jejunojejunostomy after Roux-en-Y gastric bypass

Tu1756 Laparoscopic Treatment of a Giant Colonic Lipoma Presenting As Transverse Colon Intussusception and Lower Intestinal Bleeding: A Case Report

Introduction: Intussusception in adults accounts for 5% of bowel intussusceptions and of 1% of bowel obstructions. Most adult intussusceptions have a demonstrable lead point. Colonic lipomas are a rare cause of intussusception. They are usually small and asymptomatic, with only 30% reaching more than 2 cm at which point they develop symptoms which include anemia, abdominal pain, constipation, diarrhea, bleeding and intussusception. Giant lipoma has been defined as >5 cm in diameter. We present a case of a 6 cm lipoma in the transverse colon causing gastrointestinal bleeding and colo-colonic intussusception. Case: A 31 year-old male patient presented to the emergency room with a one month history of melena and hematochezia, colicky abdominal pain and in the previous 24 hours nausea, vomiting and abdominal distention. Contrast-enhanced CT scan showed a colo-colonic invagination of transverse colon telescoping into the descending colon (Fig. 1). An enema with hidrosoluble contrast was performed with resolution of the intussusception, and an intraluminal oval pediculated mass of 65x41x37 mm with a density of -21 HU was observed at the splenic angle. Colonoscopy reported a submucosal mass with a blood clot causing obstruction of the bowel lumen 55 cm from the anal verge; its proximal and distal margins were marked with blue dye. The patient was taken to surgery and a laparoscopic segmental transverse colectomy was performed. The histopathological report revealed a 6x5x4 cm submucosal lipoma (Fig. 2). The postoperative evolution was uneventful and the patient was discharged on the fifth postoperative day. Discussion: Colonic lipomas are benign nonepithelial tumors which present most commonly in females within the fifth and sixth decades of life. They are most commonly located in the ascending colon (61%), followed by the descending colon (20%), transverse colon (15%) and rectum (3.4%). Symptoms appear in lipomas >2 cm: anemia, colicky abdominal pain, constipation, bleeding and intussusception. Diagnostic methods include CT scan, contrast-enhanced enema, and colonoscopy. CT scan will reveal a regular, well-delimited spherical or ovoid mass of adipose density (-40 to -120 HU). If associated with intussusception it will show a target lesion, a sausage-shaped mass with layers or a mass caused by edema, mural thickening and vascular compromise. Contrast enhanced enema may aid in the reduction of an intussusception and additionally demonstrate a filling defect. Colonoscopy will reveal a submucosal lesion with three characteristic signs: cushion sign, tenting effect, and naked fat sign. Treatment for symptomatic lipomas includes endoscopic excision or surgical resection, with size being the delimiting factor. Segmental colectomy is the gold standard and may be performed laparoscopically.

Isolated ileal heterotopic pancreas in a child: A clinically undetected cause of ileoileal intussusception

Introduction: Pancreatic heterotopia has been described most frequently in stomach and duodenum. Isolated occurrence of heterotopic pancreas in ileum is exceptional and is usually discovered incidentally during surgery. In rare cases, heterotopic pancreas has been reported as a lead point of ileoileal intussusception. case report: A one-year-old boy was presented with recent onset of constipation and abdominal distention. radiologic investigation suggested a diagnosis of midgut volvulus with ileoileal intussusception. resection anastomosis of the intussusception was performed. Histologic examination of the resected specimen showed heterotopic pancreas in the wall of intussusceptum at its tip. No other significant pathology was found. conclusion: Ileal heterotopic pancreas is a rare cause of intussusception at any age and is usually not evident clinically. Hence, careful examination of the lead point of intussusceptum in resection specimens is mandatory to delineate the underlying etiology of these cases.

A Rare Cause of Intussusception in an Adult

Case: A 60-year-old female with no significant past medical history was evaluated in our clinic for persistent mid-abdominal pain, microcytic anemia and abnormal imaging. She reported a year of intermittent post-prandial abdominal discomfort. These episodes were of variable duration and often associated with nausea, vomiting and a sensation of bloat. Her previous work up included an initial CT scan which revealed an approximately 12 cm segment of ileum containing elongated “fat” in its central portion with an associated ileo-ileal intussusception, but without obstruction. Subsequent colonoscopy was notable for a prolapsed ileocecal valve, but a normal appearing ileum up to 15 to 20 cm. A small bowel follow through revealed a long, serpiginous, fixed low density lesion extending through several mid-ileal loops in the right lower quadrant. After evaluation in our clinic, she underwent a retrograde double-balloon enteroscopy. Approximately 50 to 60 cm proximal to the ileocecal valve she was found to have a polypoidal lesion with a very long, thick stalk and overlying ulceration. An endoloop was applied close to the base of the stalk and the lesion was then partially resected with snare cautery. The gross description of the resected specimen revealed a red-tan irregularly shaped polypoid mass measuring 5 x 1.8 x 1.6 cm. Microscopically, there was a mixed proliferation of smooth muscle bundles, nerves and ganglion cells, mature adipose tissue, and numerous thin and some thick walled blood vessels involving the mucosa, submucosa and smooth muscle consistent with a small bowel neuromuscular and vascular hamartoma (NVMH). Discussion: NMVH is a rare benign neoplasm occurring in the small intestine that was first described by Fernando and McGovern in 1982. From our review, there have only been 15 cases reported in the literature since its introduction. NMVH typically occurs in adults and often presents as intermittent intestinal obstruction or as occult gastrointestinal bleeding. In each of the previous cases, surgical resection has led to resolution of the patient's symptoms. From our review, this is the first case in the English literature of attempted endoscopic resection of a NMVH via double-balloon enteroscopy. Other types of small intestinal hamartomas have been reported in the literature as rare causes of intussusception, typically in children. In addition, cecal hamartomas have been reported as a rare cause of colonic intussusception. To our knowledge, there has been no previous report of image-documented intussusception caused by small intestinal NMVH in an adult or child. We would like to support its inclusion in the differential diagnosis of causes of intussusception in adults.

Jejunal tubulovillous adenocarcinoma in adenoma presenting with entero-enteric intussusception.

A 73-year-old male was admitted to our institution with complaints of nausea, vomiting, and abdominal distension. Plain abdominal computed tomography (CT) suggested intussusception in the jejunum. Enhanced abdominal CT revealed the 'target-like' sign and ultrasonography revealed the 'multiple concentric ring' sign; therefore, a diagnosis of entero-enteric intussusception was made. The small intestinal obstruction and cause of the intussusception were not evident. The patient was treated conservatively with fasting and transfusion therapy to prevent intestinal obstruction. However, with no spontaneous resolution of intussusception, surgical treatment was decided. The operative findings revealed a jejunal tumor about 30cm from the Treiz ligament, and the jejunum including the tumor with a 5cm margin were partially resected. The resected tumor was a 35×50mm soft mass spreading laterally with nodules. The pathological examinations revealed tubulovillous adenocarcinoma in the adenoma. Intussusception is rare in adults compared to children. About 45% of cases of intussusception in adults are due to small intestinal tumors such as malignant lymphoma or lipoma, but a tubulovillous adenocarcinoma with adenoma is a rare cause of intussusception. We present a rare case of jejunal tubulovillous adenocarcinoma in adenoma presenting with entero-enteric intussusception.

Inflammatory Pseudotumour of the Jejunum Presenting As Intussusception

Inflammatory pseudotumour is a rare cause of intussusception. It consists of a localized, usually polypoid mass that is composed of inflammed fibrous and granulation tissue. We report a case of 42-year old woman who presented with abdominal pain, vomiting and distention of abdomen since one day. X ray abdomen (erect) did not show air fluid level. CT abdomen showed target sign suggestive of intussusception. Emergency exploratory laparotomy revealed jejuno-jejunal intussusception caused by a polypoidal mass. Resection and end to end anastomosis of jejunum was performed. Subsequent histopathology confirmed the mass to be an inflammatory pseudotumour of jejunum. Inflammatory pseudotumour of jejunum as a cause of intussusception has rarely been reported. Among adults presenting with obstruction, inflammatory pseudotumour should be considered in the differential diagnosis. Surgeons need to be aware of this condition because complete surgical excision is the treatment.

Mantle cell lymphoma as a rare cause of intussusception: a report of 2 cases

Intussusception is uncommon in adults and is only very rarely caused by malignant lymphoma. To our knowledge, there are only 2 previously reported cases of mantle cell lymphoma causing intussusception. We present 2 additional cases of intussusception at the ileocecal valve in patients being treated for mantle cell lymphoma, and a review of the pertinent literature is presented.

Ascaris as a leading point for small-bowel intussusception in an adult: a rare cause of intussusception

Adult intussusception represents 1% of patients with bowel obstructions and requires a surgical approach. Malignancy is associated with 31% of small bowel intussusception and 70% of large bowel intussusception. Intestinal intussusception caused by ascaris, however, is very uncommon. This report describes our experience of this rare cause of intussusception and its clinical findings.

Ileal intussusception as result of intestinal intubation.

The long intestinal tube commonly employed in a wide variety of conditions has been in use for about 20 years. The single lumen tube was introduced in 1944, at which time mercury began to replace air in the tube's bag. 1 The complications of intubation have been discussed by many authors. The particular one reported in this paper is rare. Smith, 2 reporting on 1,000 intubations, failed to observe a single case of intussusception. Nichols, 1 using the Harris tube, had one case. Dunn and Shearburn 3 quote three cases from the literature and add one case of their own. Wangensteen 4 and Cantor and Reynolds 5 mention the long intestinal tube as a rare cause of intussusception. Recently such a complication occurred in one of our patients. We are reporting this case because it clearly visualizes the cause and effect and, to our knowledge, possesses the best illustrations of