Recurrent Intussusception Research Articles

Intussusception in adults.

A review of 25 adult patients with intussusception is reported. Intussusception in adults constituted 16.6% of 150 intussusception cases observed during 1956-1985. The underlying pathologic processes were identified in 23 patients (92%). Etiologically, adult intussusception could be categorized into four groups: (1) tumor-related (13 cases, 52%); (2) postoperative (nine cases, 36%); (3) miscellaneous--Meckel diverticulum (one case, 4%); and (4) idiopathic (two cases, 8%). The tumor-related intussusceptions were caused by benign tumors in five and malignant tumors in eight patients. Postoperative intussusceptions were related to various factors including suture lines, ostomy closure sites, adhesions, long intestinal tubes, bypassed intestinal segments, submucosal edema, abnormal bowel motility, electrolyte imbalance, and chronic dilatation of the bowel. The sites of involvement of intussusception were jejunogastric (one), jejunojejunal (seven), ileoileal (four), ileocolic (10), and colocolic (three patients). Four patients had synchronous multiple (ileoileal and jejunojejunal), four had compound (ileoilealcolic), and two had recurrent intussusceptions. When an intussusception is encountered in adults, an underlying pathologic process usually can and should be determined for proper management.

Late Postoperative Partial Recurrent Retrograde Ileoileal Intussusception

Late Postoperative Partial Recurrent Retrograde Ileoileal Intussusception

Nodular lynphoid hyperplasia of the intestinal tract in infancy and childhood

Over an 18-year period we have diagnosed nodular lymphoid polyposis of the intestinal tract in 6 patients. The site of the polyposis, which was due to prominent lymphoid hyperplasia, was ileal (3), colonic (2), and rectal (1). The diagnosis was made following complications arising from the polyps, which included recurrent intussusception (2), rectal prolapse (1), intestinal or pseudointestinal obstruction (2), and rectal bleeding (1). Immunoglobulin staining was performed on all the bowel specimens and in every case secretory IgA was present on the mucosal surfaces and IgG and IgA were seen in the lamina propria, thus excluding immunodeficiency in these patients. Viral studies were performed in 3 patients and all were positive. In one patient Echovirus II was seen in tissue homogenate from a mesenteric lymph node and in another, adenovirus type II was cultured from lymphoid polyps of the rectum. A further patient had positive serological tests for adenovirus. Thus it appears that nodular lymphoid hyperplasia is part of the generalized lymphoid hyperplasia associated with viral infections in infancy and childhood. Immunodeficiency states as a cause of the lymphoid hyperplasia should always be excluded by estimation of serum immunoglobulins.

A CT sign: The “disappearing mass” as a clue to the diagnosis of intermittent intestinal intussusception in children

During the course of evaluation of a child with recurrent abdominal pain, a mass lesion was noted on computed tomography of the abdomen. This mass lesion was not evident within 30 min of the finding. Child was subsequently diagnosed to have intussusception. A “disappearing mass” lesion may therefore be a manifestation of recurrent intussusception.

Jejunal intraluminal diverticular duplication with recurrent intussusception

Herein reported is a 2-yr-old child who presented with recurrent epigastric pain and occasional vomiting. Upper gastric intestinal series demonstrated an apparent intraluminal jejunal diverticulum with jejunojejunal intussusception. Operative reduction of the intussusception and removal of the diverticulum was curative.

Heterotopic gastric mucosa as a leading point of recurrent intussusception: H. Kuze, H. Ikeda, M. Nishida, et al. Jpn J Pediatr Surg 12:1681–1684, (December), 1980

Heterotopic gastric mucosa as a leading point of recurrent intussusception: H. Kuze, H. Ikeda, M. Nishida, et al. Jpn J Pediatr Surg 12:1681–1684, (December), 1980

Surgical technique for the prevention of recurrent intussusception in childhood: J. D. Burrington. Surg Gynecol Obstet 150:573–574, (April), 1980

Surgical technique for the prevention of recurrent intussusception in childhood: J. D. Burrington. Surg Gynecol Obstet 150:573–574, (April), 1980

Nissen Hiatal Hernia Repair: Problems of Recurrence and Continued Symptoms

The standard Nissen operation is the most effective method of reflux control. However, the procedure can result in continuance of symptoms, particularly dysphagia, which presents considerable diagnostic difficulty. Experience gained in the management of 17 patients with continued recurrent symptoms following standard Nissen repair has allowed more specific definition of the nature of these problems. The anatomical defect has been categorized as follows: (1) tight repair (tight fundoplication or tight diaphragmatic repair); (2) anatomical recurrence with and without reflux; and (3) intussusception recurrence. Each patient has been evaluated by history, manometry, pH reflux, acid perfusion, radiology, and endoscopy. At the time of corrective operation, the previous repair was carefully dissected to allow confirmation of the type of defect. Correlation is made between symptoms, investigative findings, and the anatomical problem at operation.

Recurrent intussusception combined with Schoenlein-Henoch's purpura: S. Matsumoto, et al. J Jpn Soc Pediatr Surg 14:909–913, (October), 1978

Recurrent intussusception combined with Schoenlein-Henoch's purpura: S. Matsumoto, et al. J Jpn Soc Pediatr Surg 14:909–913, (October), 1978

Recurrent Intussusception

The appearances at conventional radiography and barium enema were compared in a series of 35 patients with recurrent intussusception and in the same number of cases with an uncomplicated course. Only minor disparities between the groups could be established. The significance of a sparse amount of intestinal gas pointing to intussusception and the implication of a complete evacuation of the bowel following barium enema are stressed. The latter phenomenon, occasionally combined with persistent mild small bowel meteorism, occurred in approximately one-third of all early relapses. Patients with one manifest relapse run a significantly increased risk of further recurrences although in the majority of cases no significant etiologic factors are encountered.

Etiologic and therapeutic aspects of intussusception in childhood

Fifty-two instances of intussusception in fortynine patients treated at the Hadassah University Hospital during a fifteen year period were analyzed. Intussusception was reduced with no subsequent complications in 47 per cent of the children who underwent barium enema reductions. Recurrence of intussusception occurred in 6 per cent, all of them successfully reduced again by barium enema. Sixty-five per cent of the patients underwent operation, of whom seven had pathologic lead points (lymphosarcoma, Meckel's diverticulum, leiomyoma, and intestinal polyp). Our experience and the collected evidence in the literature indicate the importance and usefulness of the barium enema examination as an excellent diagnostic and therapeutic modality in intussusception. Only when incomplete or uncertain reduction occurs should operative intervention be undertaken. The only contraindication to barium enema should be very marked intestinal obstruction or peritonitis. Regarding the etiology of idiopathic intussusception, we believe that hypertrophy of the lymphatic tissue in the terminal ileum, reactive to some common diseases of infancy and childhood, is a major causative factor.

Lymphoid hyperplasia of the bowel and its surgical significance in children

Twelve children with abdominal complaints had lymphoid hyperplasia of the bowel presenting in an acute or chronic form. The etiology is obscure. An infectious process is thought to precipitate the acute form of the disease. Parasites were identified in two patients with the chronic disease. The acute form, with involvement of the appendix or terminal ileum, presents commonly as acute appendicitis. Because of its self-limiting nature, appendectomy with perservation of the terminal ileum is appropriate. When intussusception is present, resection of the ileum is advisable. The chronic form, which is also common in the terminal ileum, produces disabling symptoms, recurrent intussusception, chronic anemia, and weight loss and is, therefore, amenable to surgical resection.

Massive enlargement of the ileocecal valve due to lymphoid hyperplasia

Two children with unusual infiltration of the ileocecal valve by lymphoid tissue are described. The large filling defect identified on barium enema may suggest a number of conditions. Operative resection will exclude the possibility of a malignant process and will reduce the chance of recurrent intussusception.

Colonic Juvenile Polyps in a Family

AbstractFour siblings with juvenile polyposis coli are presented–one with bleeding per rectum, another with recurrent intussusception and two asymptomatic.Double contrast barium enema findings are illustrated and comparison is made with the premalignant condition of familial adenomatous polyposis.

Adult intussusception: Case report of recurrent intussusception and review of the literature

An unusual case of lymphoma is presented in which small bowel intussusception due to a lymphomatous nodule caused an acute abdomen, requiring small bowel resection. Four weeks later a second intussusception caused intestinal obstruction, necessitating a second laparotomy and bowel resection. The high incidence of malignant tumor in adult cases leads us to recommend primary resection without manual reduction in all but rectosigmoid and selected small bowel cases.

Recurrent intussusception due to a primary colloid carcinoma of the large bowel in a child

Summary A case of recurrent colo-colic intussusception due to a primary colloid carcinoma of descending colon with widespread lymphatic involvement in a child, is reported. The unusual mode of presentation and lack of awareness were responsible for a delay of 6 months before the final diagnosis was made. Two years after the operation the patient is well and there is no evidence of clinically detectable secondaries.

Leading points in childhood intussusception.

Children whose intussusception is caused by a specific pathologic lesion are harder to diagnose and have a higher morbidity than those with the idiopathic variety. We have collected and analyzed 31 such cases found in a series of over 500 intussusceptions. The average age of these children was greater than is usually found in most cases, and the duration of the signs and symptoms was also longer than is usually seen. Almost 50% presented with a picture of advanced small bowel obstruction. Fewer barium enemas were done (50%) and none was successful in reducing the intussusception. There was a higher number of ileo-ideal intussusceptions in this group. The commonest leading points were Meckel's diverticula, polyps, and duplications. All patients with leading points required operation; three-fourths had a bowel resection performed. This study of 569 cases suggests that older children with intussusception and children with recurrent intussusception do not necessarily have leading points causing their intussusceptions.

Recurrent intussusception in children

Twenty-eight children with 35 recurrent intussusceptions were collected and analyzed from a series of 600 intussusceptions over 17 yr. The overall recurrence rate in the entire series was 5% with 11% recurring after hydrostatic barium enema reduction, and 3% after operative reduction. Twenty-three children had one recurrence each, four children had two recurrences, and one child had four recurrent intussusceptions. More than two-thirds of the patients had a recurrence within 6 mo of their first intussusception, and half of these presented earlier and with fewer signs and symptoms than the previous attack had manifested. Twenty-one of 30 recurrences were reduced with barium enema. Sixteen were operated on, reducing nine manually and resecting four others. Only two leading points were found, and in both instances resection was required. All but two of the intussusceptions were ileocolic. The previous mode of reduction of each intussusception did not set a trend for future treatment of recurrent intussusceptions in the same child. While operative reduction diminishes the chances of a recurrent intussusception and ileocolic resection eliminates it, there does not seem to be any indication for surgery as long as barium enema reduction is successful. We have never observed the hydrostatic reduction of an intussusception caused by a leading point.

Chronic Recurrent Jejunogastric Intussusception — Diagnosed by Gastroscopy

Chronic Recurrent Jejunogastric Intussusception — Diagnosed by Gastroscopy

Recurrent acute intussusception : K. Kenigsberg, J. C. Lee, and H. Stein. Pediatrics 53:269–270 (February), 1974

Recurrent acute intussusception : K. Kenigsberg, J. C. Lee, and H. Stein. Pediatrics 53:269–270 (February), 1974