Signs Of Intussusception Research Articles

Диагностика грыж пищеводного отверстия диафрагмы

The purpose — to show the possibilities of the classical X-ray research method for the diagnosis of hernias of the diaphragm esophageal opening. Material and methods. A classical X-ray examination of 138 patients with hiatal hernia was performed. Initially, a study of the chest organs and posterior mediastinum was carried out. A contrast study of the esophagus and stomach with a barium suspension was carried out in a horizontal position of the patient on the back and on the stomach, as well as vertically. Results. Mostly axial hiatal hernias were diagnosed — in 134 patients (97.1%), including 42 (31.3%) with esophageal shortening due to scarring and 92 (68.6%) sliding hernias; signs of intussusception were revealed in 2 cases. In one patient, along with the esophageal shortening, 2 «niches» were identified due to ulceration, which were confirmed by endoscopy. Paraesophageal hernias were found in 4 cases (2.9%), in all four cases the hernias were fixed; in one case, a total hernia with a volvulus of the stomach was diagnosed. In case of 23 (17.1%) patientsaxial hiatal hernias were combined with esophageal or gastric cancer. X-ray findings were confirmed by upper GI endoscopy. Conclusion. The up-to-date, correctly performed X-ray examination made it possible not only to reveal a hiatal hernia, but also to determine its type, to study the function of the esophageal-gastric junction and the presence of complications.

ACUTE ABDOMEN systemic sonographic approach to acute abdomen in emergency department: a case series

BackgroundAcute abdomen is a medical emergency with a wide spectrum of etiologies. Point-of-care ultrasound (POCUS) can help in early identification and management of the causes. The ACUTE–ABDOMEN protocol was created by the authors to aid in the evaluation of acute abdominal pain using a systematic sonographic approach, integrating the same core ultrasound techniques already in use—into one mnemonic. This mnemonic ACUTE means: A: abdominal aortic aneurysm; C: collapsed inferior vena cava; U: ulcer (perforated viscus); T: trauma (free fluid); E: ectopic pregnancy, followed by ABDOMEN which stands: A: appendicitis; B: biliary tract; D: distended bowel loop; O: obstructive uropathy; Men: testicular torsion/Women: ovarian torsion. The article discusses two cases of abdominal pain the diagnosis and management of which were directed and expedited as a result of using the ACUTE–ABDOMEN protocol. The first case was of a 33-year-old male, who presented with a 3-day history of abdominal pain, vomiting and constipation. Physical exam revealed a soft abdomen with generalized tenderness and normal bowel sounds. Laboratory tests were normal. A bedside ultrasound done using the ACUTE–ABDOMEN protocol showed signs of intussusception. This was confirmed by CT-abdomen. The second case was of a 70-year-old female, a known case of diabetes and hypertension, who presented with a 3-hour history of abdominal pain, vomiting and diarrhea. She had a normal physical exam and laboratory studies. Her symptoms mimicking simple gastroenteritis had improved. However, bedside ultrasound, using the ACUTE–ABDOMEN protocol showed localized free fluid with dilated small bowel loop in right lower quadrant with absent peristalsis. A CT abdomen confirmed a diagnosis of intestinal obstruction. These two cases demonstrate that the usefulness of applying POCUS in a systematic method—like the “ACUTE–ABDOMEN” approach—can aid in patient diagnosis and management.Case presentationWe are presenting two cases of undifferentiated acute abdomen pain, where ACUTE ABDOMEN sonographic approach was applied and facilitated the accurate patient management and disposition.ConclusionACUTE ABDOMEN sonographic approach in acute abdomen can play an important role in ruling out critical diagnosis, and can guide emergency physician or any critical care physician in patient management.

Diagnosing Pediatric Intussusception Through Bedside Ultrasound by Novice Emergency Department Sonographers: A Case Report

Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well.

Risk of Intussusception After Rotavirus Vaccination.

In 2013, the German Standing Committee on Vaccination (Ständige Impfkommission, STIKO) recommended rotavirus (RV) vaccination for all infants while stating that this mildly increased the risk of intussusception, a potentially life-threatening event. Since this recommendation was issued, multiple observational studies on this topic designed as self-controlled case series (SCCS) have been published. The SCCS design is particularly suitable for the study of rare adverse effects of medications. We systematically searched the literature for SCCS studies on the risk of intussusception after RV vaccination. Relative risks (RR) corresponding to different doses of vaccine were summarized in a meta-analysis, and attributable risks (AR) were calculated. Of the 16 initially identified studies, 10 with a predominantly low risk of bias were considered in the analysis. The RR for intussusception was 5.71 (95% confidence interval [4.50; 7.25]) 1-7 days after the first dose, 1.69 [1.33; 2.14] after the second, and 1.14 [0.75; 1.74] after the third. The AR for children of the age at which RV vaccination is recommended was 1.7 [1.1; 2.7] additional intussusceptions per 100 000 vaccinated children after the first dose and 0.25 [0.16; 0.40] after the second. If >3-month-old infants are vaccinated, the AR is higher: 5.6 [4.3; 7.2] per 100 000 after the first dose and 0.81 [0.63; 1.06] per 100 000 after the second. RV vaccination is associated with a markedly elevated RR and a mildly elevated AR for intussusception 1-7 days after the first dose. Physicians should begin the series of vaccinations at age 6-12 weeks, as recommended by the STIKO, because the risk of intussusception is higher afterward. Current health insurance company claim data indicate that 11.2% of infants are still receiving the first dose of the vaccine at ages above 3 months. The parents of vaccinated children should be informed about the possible signs of intussusception (colicky pain, bilious vomiting, and red "currant jelly" stool).

Gastrointestinal Manifestations of Henoch-Schoenlein Purpura

A 43-year-old Hispanic male was admitted to the hospital with a 2-week history of epigastric pain, hematochezia, rash, and joint pain in his elbows and knees. The pain was non-radiating, without nausea, vomiting, or exacerbating or alleviating factors. Two weeks prior to the onset of these symptoms he had developed flu-like symptoms that resolved without treatment. His past medical history was significant for hypertension; however, he had no personal or family history of gastrointestinal, hematological, or autoimmune disease. He had been taking hydrochlorothiazide and irbesartan for his hypertension. He did not smoke or drink alcohol. On admission, he was afebrile without any abnormalities in his vital signs or cardiopulmonary examination. Physical examination was notable for palpable petechial and purpuric lesions on his legs, arms, and periumbilical region; epigastric tenderness was elicited upon deep palpation, and his elbows and knees were tender to touch (Fig. 1). Stool occult blood was positive. Laboratory investigations revealed leukocytosis and positive inflammatory markers but without evidence of bacterial, infectious, or autoimmune process. Urine analysis did not reveal hematuria or proteinuria. A skin biopsy was reported as leukocytoclastic vasculitis. Computed tomography, performed at the referring outside hospital, revealed focal thickening of the third and fourth portions of the duodenum and proximal jejunum without signs of intussusception or pancreatic inflammation. An upper endoscopy revealed acute, moderately severe, patchy inflammation, as well as ulcerations and friability of the distal duodenum and jejunum. Duodenal and jejunal biopsies revealed benign small bowel mucosa with acute and chronic inflammation, ulceration and fragments of ulcer bed. Fungal Grocott methenamine silver staining was negative; no granulomas or viral changes were noted. A chest radiograph was normal. Colonoscopy revealed small non-bleeding vasculitic lesions and red erythematous plaques throughout the colon and the terminal ileum (Fig. 2). A small bowel capsule endoscopy, performed to evaluate the extent of gastrointestinal tract involvement, demonstrated scattered areas of erythematous ulcerated mucosa extending from the duodenum to the ileum (Fig. 3). His symptoms began to resolve within 2 days after admission without further treatment. His rash, diarrhea, abdominal pain, and joint pain steadily improved during his hospitalization. At follow-up 2 months later, he remained symptom-free; his urine screen for hematuria remained negative.

The role of plain radiography in assessing intussusception with vascular compromise in children

IntroductionIntroduction: The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception.Material and methodsThe hospital notes of 1,119 paediatric cases of intussusception who presented between January 2007 and February 2008 were retrospectively analysed. Informed consent was given by the parents before the air enema and this study was approved by the hospital ethics committee. Overall, the plain abdominal X-rays of 190 cases were assessed independently by two experienced radiologists, and disagreements were settled by discussion. Symptom profiles, operative notes and pathological records were compared to plain radiography. SAS V8.1 was used for the analysis.ResultsOf the 190 patients, 30 cases had vascular compromise on plain films, as shown by the “coffee-bean” sign or “banana” sign. There was a paucity of gas in 36 cases, a quadrant-specific gas pattern in 51 cases, and the film showed a mass in 73 cases. Statistical analysis that compared signs on plain radiography signs and symptom onset showed a significant difference. Ninety-five cases were irreducible by air enema and required surgical intervention. The location of these intussusceptions were ileo-ileal-colic (n = 44), ileo-colic (n = 25), ileo-ileal (n = 14), ileo-caecal (n = 10), and ileo-colic-colic (n = 2). Eleven cases had intestinal necrosis and underwent resection of the necrotic bowel.ConclusionsThe signs of intussusception on plain radiography were significant during the clinical assessment of children with secondary ischaemic bowel. The radiological findings were shown to have a high concordance with pathology in the assessment of intussusception.The diagnostic value of colour Doppler sonography for the detection of blood flow in intussusception is questionable. The purpose of this study was to evaluate plain radiography in the assessment of vascular compromise in children with intussusception.

Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam

Intussusception (IS) is the most common cause of acute bowel obstruction in infants and young children. Ultrasonography is being increasingly used as the primary investigation for the diagnosis of IS and to guide air or hydrostatic enema reduction. However the accuracy of ultrasonography outside tertiary care settings in developed countries has not been assessed, particularly in Asia where the incidence of IS based on sonographic diagnosis has been reported as the highest in the world. The aim of this study was to evaluate the accuracy of ultrasonography in the diagnosis of acute IS in infants less than 2 years of age in a paediatric hospital in Vietnam. A prospective study was conducted at the National Hospital for Paediatrics, Hanoi, Vietnam, over a 14-month period recruiting patients <2 years of age with IS. Abdominal ultrasonography was performed on each patient and the accuracy of the diagnosis was evaluated against the final diagnosis provided by air enema and/or surgery. A total of 640 infants <2 years of age presented with clinical symptoms and signs of IS. The diagnosis was confirmed in 533 patients via air enema or surgery. Abdominal ultrasonography was 97.5% (466/478) sensitive and 99% (106/107) specific in the detection of IS. Ultrasonography is an accurate, safe and valuable clinical tool in the diagnosis of IS. The use of ultrasonography as a primary investigation for patients with suspected IS prevents unnecessary radiological or surgical procedures being performed, and reduces radiation exposure while maintaining a high level of diagnostic accuracy. These results validate the use of ultrasonography for the diagnosis of IS in a developing country setting.

Intussusception and spontaneous amputation of the esophagus

J Thorac Cardiovasc Surg 2002;124:205-6

Celiac Disease: An Uncommon Cause of Recurrent Intussusception

Celiac disease, one of the most common causes of intestinal malabsorption in childhood, is a mucosal reaction of the small intestine to gluten (1). The characteristic mucosal lesions, degeneration of epithelium and the cuticular layer, villous atrophy, and lymphoplasmocytic infiltration result in a diminished hydrolytic and resorbent function of the small intestine. Typical symptoms of general malabsorption are failure to thrive, large pungent stools, and a distended abdomen. The results of malnutrition are hypoproteinemia, iron deficiency, coagulopathy, and vitamin D deficiency. The symptoms differ in severity. Whereas constipation or intermittent ileus-like symptoms such as vomiting and stool retention with typical radiologic findings can occur in celiac disease, intussusception is rare (2,3). CASE REPORT A 3½-year-old girl with abdominal distension and diarrhea for 6 months had recurrent colicky abdominal pain for 2 weeks that always stopped spontaneously after several hours. On clinical examination during which the patient felt well, there was distended abdomen with increased intestinal peristalsis without other pathologic signs. Growth and weight were on the 10th percentile. Endomysium-immunoglobulin (Ig)A and IgG-antigliadin-antibodies were elevated (4-6). Other parameters were normal. During ultrasound performed while the patient was in abdominal pain, general thickening of the intestinal wall with high echogenicity (7) was seen as well as increased intestinal peristalsis and multiple presumably ileo-ileal intussusceptions (Figs. 1 and 2). These intussusceptions were seen for several days and reduced spontaneously. The mucosa of the small intestine showed villous atrophy and diminished disaccharidases and fructaldolases. Two weeks after being placed on a gliadin-free diet the girl was free of colicky complaints. Subsequently, on repeated ultrasound there was no sign of intussusception. DISCUSSION In childhood, intussusception usually occurs without obvious cause. Common triggers are: Meckel diverticulum, polyps, tumors, swelling of lymph nodes, cystic fibrosis, and Schoenlein-Henoch purpura. A correlation between intussusception and celiac disease is hardly mentioned in pediatric literature, whereas in adulthood, this combination is repeatedly described (3,8). Typical for intussusception of the small intestine seems to be a transient course with mild symptoms. One cause appears to be a disturbed peristalsis in the hypotonic intestinal loop (8). In this case, the correlation between celiac disease and repeated intussusception in different parts of the small intestine is obvious, especially because the recurrent intussusception stopped after starting the patient on a gliadin-free diet. Particularly in recurrent intussusception, celiac disease should be considered as a cause.FIG. 1.: Ultrasound showing thickening of the intestinal wall with high echogenicity and hyperperistalsis.FIG. 2.: Ultrasound showing three intussusceptions.

Plasma beta-endorphin levels and childhood intussusception

To determine whether childhood intestinal intussusception is associated with elevated plasma beta-endorphin levels, a series of patients was studied prospectively. Fourteen patients (age range between 3 months and 7 years) presented to two university pediatric emergency departments in Chicago with clinical symptoms and signs of intussusception. Venous blood (2cc) was withdrawn for plasma beta-endorphin determination, followed by barium enema. Plasma beta-endorphin levels were measured by radioimmunoassay. The mean beta-endorphin level of the 8 patients with barium enema proven intussusception was 14.1 ± 12.0 pg/ml. Two of these patients presented with marked lethargy and had beta-endorphin levels of 7.5 and 21.2 pg/ml. The mean plasma beta-endorphin level of the 5 patients with negative barium enema studies was 18.1 ± 10.0 pg/ml ( P = 0.56). A sixth control patient had a plasma beta-endorphin level of 1569 pg/ml. In conclusion, childhood intestinal intussusception is not associated with elevated plasma beta-endorphin levels.

Idiopathic Postoperative Intussusception

During the last 11 years idiopathic postoperative intussusception developed in ten children. The incidence was 5.5% of all the intussusceptions. The age ranged from three months to ten years and the interval between two surgical procedures differed from three to eight days. Only one of the patients presented the classical signs of intussusception. In nine of them, the obstructions were in the small bowel. Nine of the ten intussusceptions needed simple manual reduction. Postoperative recovery was uneventful.

PLAIN FILM FINDINGS IN INTUSSUSCEPTION.

1. Plain radiographs of the abdomen of 41 patients with intussusception were interspersed with those of 128 controls. 2. Four radiologists attempted to make a diagnosis of intussusception based solely on the plain film findings which have been described in the literature. 3. With the exception of a soft tissue mass or bowel obstruction, the various signs of intussusception were found generally to be either vague or non-specific and subject to a high degree of personal interpretation. 4. Clinical suspicion of intussusception warrants barium study regardless of plain film findings.

A sign of intussusception.

1. The signs of intussusception (exclusive of those of intestinal obstruction) are recapitulated and demonstrated. 2. A further sign consisting of a crescentic gas shadow capping the apex of the intussusceptum is described in four cases.

Intraluminal lipoma of small intestine producing intussusception: Report of a case

<h2>Summary</h2> A case of intussusception due to an intraluminal lipoma of the terminal ileum is reported. Benign tumors of the small intestine are rare, occurring only slightly more than half as frequently as malignant tumors of the small intestine. The preoperative diagnosis may be made by x-ray and by the symptoms of partial obstruction or intussusception in an adult, and the findings of a palpable, mobile tumor mass within the abdominal cavity. The treatment is surgical and should be done promptly if signs of intussusception or acute intestinal obstruction are present.