Small Bowel Intussusception Research Articles

Two simultaneous intussusceptions in a neonate with DiGeorge syndrome: A case report

Background: Double simultaneous intussusception is a peculiar and rare variety of intussusception with only 3 previously reported neonatal cases. Case presentation: A 15-day-old male neonate with respiratory distress was found to have Tetralogy of Fallot and hypoplastic pulmonary stenosis. Small bowel intussusception was diagnosed on ultrasound abdomen following hematochezia on the next day. Emergency laparotomy revealed two intussusceptions, ileocolic and jejunojejunal, with bowel gangrenous requiring resection and anastomosis. No pathological lead point was identified. He recovered with supportive care and was discharged. Conclusion: Simultaneously occurring double intussusceptions are extremely rare in neonates, and thorough examination of the entire small bowel in cases of intussusception is key to the diagnosis.

Metastatic Melanoma Causing Recurrent Intussusception and Perforation of Small Bowel: Case Reports and Literature Review

Aim:To present cases of recurred jejuno-jejunal intussusception and jejunal perforation due to melanoma.Materials & methods:Case 1: A 43-year-old male under treatment for malignant melanoma was presented with abdominal pain and distention. Ten centimeter intussuscepted jejunum was resected. Second exploration was done due to failure to pass gas and stool. The reintussusception was detected and resection of reintussuscepted jejunum was performed. Case 2: A 63-year-old male was presented with abdominal pain. Abdomen computed tomography showed free air in the abdomen suggesting intestinal perforations. Perforated area at 80 cm in the jejunum sutured.Conclusion:We present the seemingly first report of reintussusception of resected segment in a very short time. Surgeons should be aware of both intussusception and perforation in metastatic melanoma.

Small Bowel Intussusception in a Preterm Infant

Intussusception is a common cause of intestinal obstruction in 6-18 months of age. However, in preterm infants, it is an extremely rare disease. The symptoms of intussusception in preterm infants are similar to those of necrotizing enterocolitis (NEC). Most preterm infants can often be clinically diagnosed with NEC. The NEC and small bowel intussusception treatments are different. In case of NEC, antibiotics and nothing per oral should be used, but small bowel intussusception could be resolved by spontaneous reduction or it should be treated with bowel reduction or bowel resection with laparotomy in case of symptomatic patients. Because of different treatments, an accurate and urgent diagnosis following clinical suspicion is critical using abdominal X-ray and ultrasonography. In this report, we present a case of small bowel intussusception in a premature infant with gestational age of 27 weeks and birth weight of 1,070 g who was diagnosed based on rapid clinical suspicion and prompt image studies.

Effect of Strict Lockdown on Pediatric Surgical Services and Residency Programme during COVID-19 Pandemic

OBJECTIVE: To document the measures adopted during the COVID-19 pandemic strict lockdown on pediatric surgical services and residents' training at a tertiary care hospital. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Department of Pediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, from April 2020 to June 2020. METHODOLOGY: Data from the Outpatient Department, Emergency Department, and Operation Theatre records were collected. The number of patients seen in the outpatient department, surgeries performed, index emergency cases dealt with, and the residents' duty roster and teaching methodology were documented. Descriptive statistics were used for reporting. RESULTS: During the strict lockdown period, outpatient services continued;however, elective cases were not operated. A total of 2,930 patients were seen in clinics, and 1,316 surgical procedures were performed. The index cases managed included anorectal malformation (n=35), esophageal atresia with and without tracheoesophageal fistula (n=13), small bowel atresia (n=11), omphalocele (n=6), acute appendicitis (n=35), intestinal obstructions (n=23), intussusceptions (n=18), and intestinal perforations (n=16). On-call days of residents were reduced from every third to the fifth day, and online educational sessions were added. During the pandemic, 13 members of surgical and anaesthesia teams got infected with COVID-19. CONCLUSION: COVID-19 pandemic elective surgical services were restricted;however, emergency cases were managed as per routine. In clinical teaching, virtual technologies were incorporated. Working hours of residents were limited to decrease the exposure to infected persons. Key Words: COVID-19, SARS-CoV-2 pandemic, Healthcare workers, Residency programme.

Effect of Strict Lockdown on Pediatric Surgical Services and Residency Programme during COVID-19 Pandemic.

To document the measures adopted during the COVID-19 pandemic strict lockdown on pediatric surgical services and residents' training at a tertiary care hospital. Cross-sectional descriptive study. Department of Pediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, from April 2020 to June 2020. Data from the Outpatient Department, Emergency Department, and Operation Theatre records were collected. The number of patients seen in the outpatient department, surgeries performed, index emergency cases dealt with, and the residents' duty roster and teaching methodology were documented. Descriptive statistics were used for reporting. During the strict lockdown period, outpatient services continued; however, elective cases were not operated. A total of 2,930 patients were seen in clinics, and 1,316 surgical procedures were performed. The index cases managed included anorectal malformation (n=35), esophageal atresia with and without tracheoesophageal fistula (n=13), small bowel atresia (n=11), omphalocele (n=6), acute appendicitis (n=35), intestinal obstructions (n=23), intussusceptions (n=18), and intestinal perforations (n=16). On-call days of residents were reduced from every third to the fifth day, and online educational sessions were added. During the pandemic, 13 members of surgical and anaesthesia teams got infected with COVID-19. COVID-19 pandemic elective surgical services were restricted; however, emergency cases were managed as per routine. In clinical teaching, virtual technologies were incorporated. Working hours of residents were limited to decrease the exposure to infected persons. Key Words: COVID-19, SARS-CoV-2 pandemic, Healthcare workers, Residency programme.

Transient small bowel intussusception in a 30-year-old male.

Transient small bowel intussusception in a 30-year-old male.

Multidetector computed tomography diagnosis of small bowel intussusceptions in adults: observations in a 10-year single-center study.

The etiologies of small bowel intussusception (SBI) in adults are varied. To investigate multidetector computed tomography (MDCT) characteristics in adults with neoplastic and non-neoplastic SBI. Clinical data and MDCT images diagnosed with SBI in adults from January 2010 to May 2020 were retrospectively reviewed. The study included a total of 71 patients. Forty-two patients had a combined total of 55 neoplastic intussusceptions, including 29 patients with benign tumors and 13 patients with malignant tumors. Twenty-nine patients had a combined total of 36 non-neoplastic intussusceptions, of which the condition was idiopathic in 23 patients and cased by non-neoplastic benign lesions in six patients. There were no significant differences in patient age or sex ratio in the neoplastic and non-neoplastic groups. In the non-neoplastic group the intussusceptions were shorter in length (3.6 cm vs. 13.2 cm, P<0.05) and smaller in transverse diameter (2.8 cm vs. 4.2 cm, P<0.05), and less likely to be associated with intestinal obstruction (2 vs. 18, P<0.05). The percentage of patients with multiple intussusceptions was greater in the neoplastic group (10/42, 23.8% vs. 4/29, 13.8%). In the non-neoplastic group only one lead point was detected (in a patient with Meckel's diverticulum), whereas lead points were detected in all 55 intussusceptions in the neoplastic group. There are differences in the clinical and MDCT manifestations of adult neoplastic and non-neoplastic SBIs. Whether a lead point is present or not has implications with regard to deciding on the most appropriate treatment and avoiding unnecessary surgery.

Surgical management of small bowel-small bowel intussusception in Henoch-Schönlein Purpura

Abstract Henoch-Schonlein Purpura (HSP) is the most common vasculitis seen in children. It is characterized by rash, joint pain, and renal disease. Abdominal findings requiring surgical intervention are uncommon. A 13-year-old male presented to the emergency department with abdominal pain, new onset bilious emesis, and rash after three weeks of flu-like symptoms. Five days prior, he received treatment for strep pharyngitis from his primary care provider. A diagnosis of HSP was made after abdominal CT scan revealed signs of duodenal inflammation and a non-obstructing small bowel-small bowel intussusception. His abdominal pain persisted, and repeat ultrasound revealed persistence of the intussusception with concerns for decreased blood flow to the intussuscepted bowel. He was taken to the operating room for reduction of the intussusception. Vasculitic lesions were visualized within the duodenal mucosa and on the serosa of the small and large bowel. These rare operative images are presented below. The intussusception was reduced without need for resection. In HSP, intramural hemorrhage and submucosal inflammation can create lead points that trigger small bowel intussusceptions to occur. These intussusceptions are typically managed supportively and rarely require surgery. We present a case of HSP requiring surgery with depictions of both mucosal and serosal based vasculitis lesions.

A case of dual segment intussusception(ileocolic and jejunal jejunal): Dilemma for surgeons and radiologists

Abstract Intussusception is defined as a process in which a segment of bowel invaginates into the adjoining intestinal lumen, causing bowel obstruction. With early diagnosis, appropriate fluid resuscitation, and therapy, the mortality rate from intussusception in children is less than 1% (Bothara et al., 2018) [ 1 ]. Intussusception is a common surgical emergency in paediatric age group. Typically patients presented with generalized abdominal pain with bloody stool. Initial resuscitation will be the first line management. Ultra-sonography (USG) is an important investigation for diagnosing intussusception [ 2 ]. It has numerous advantages like absence of harmful radiation exposure to the children, lead point identification and ability to diagnose ileo-ileal and other small bowel intussusceptions (1). Radiologist also provide therapeutic approach by fluoroscopic/ultrasound guided contrast or water reduction. The role of surgery only reserved if recurrent intussusception despite multiple reduction radiologically or in case of suspicious of intestinal perforation with peritonitis. Jejunal intussusception is a rare condition. In contrast to the typical case of ileocolic intussusception, a 'lead point” is commonly found that is usually ectopic gastric mucosa.

S2862 Bowel Within the Bowel; A Case of Metastatic Melanoma Presenting as Small Bowel Intussusception

INTRODUCTION: Melanoma is notorious for metastasizing to almost any part of the body. Metastasis to the gastrointestinal tract is most commonly diagnosed on autopsy. A clinical diagnosis is rare and occurs in approximately 2% of cases. We present a rare case of metastatic melanoma to the small bowel that presented as melena and ultimately caused small bowel intussusception. CASE DESCRIPTION/METHODS: 84-year-old male was admitted to the hospital with one-week history of melena and worsening abdominal pain. Past medical history was significant for stage IIB metastatic melanoma. Melanoma was first diagnosed on bottom of right foot 10 years prior to admission and was treated with surgical excision and adjuvant pegylated interferon. Patient had recurrence of melanoma on his back 1 year prior to presentation and underwent surgical excision and was treated with nivolumab. Physical examination revealed two new dermal nodules on the left chest. Laboratory investigations showed a decrease in hemoglobin from 11.5 g/dl three months prior to 9.5 g/dl. Esophagogastroduodenoscopy (EGD) was remarkable for a large, purplish, smooth mass in the third portion of the duodenum which was biopsied. Colonoscopy was unremarkable. Histologic examination revealed neoplastic cells positive for MART-1 and negative for CD3 and CD20. Immunohistochemical staining demonstrated that the malignant cells were positive for S100 which confirmed the diagnosis of metastatic melanoma. The patient was discharged however again presented to the Emergency Department with severe abdominal pain. Computed tomography with contrast showed small bowel intussusception within the left mid abdomen with dilated loops of small bowel proximally and collapsed loops of small bowel distally. Patient was taken for an emergent laparoscopic small bowel resection due to concern of ischemia. He was found to have multiple intra-abdominal lesions studding the small bowel and mesentery. Further metastatic workup revealed lesions in the lungs and the brain suggestive of advanced disease. Decision was made to proceed with palliative ipilimumab chemotherapy and radiation. DISCUSSION: Small bowel tumors are rare, accounting for only 3–6% of all GI tumors. Small bowel melanomas can be primary or metastatic lesions. Clinical presentation of GI metastases includes abdominal pain, overt bleeding, anemia, intestinal obstruction or rarely intussusception. Surgery may not be curative, however is the treatment of choice as it is effective in palliating symptoms and may prolong survival.Figure 1Figure 2

Colonic Intussusception Revealing a Cecal Adenocarcinoma Associated with Silent Crohn's Disease

Bowel intussusception is uncommon during adulthood and represents 1% to 5% of all bowel obstruction mainly involving the small bowel. Although most of small bowel intussusception during childhood remains idiopathic, malignant or benign tumors and post-operative complications are usually the underlined diagnosed beyond the intussusception for adults. Few cases reported bowel intussusception during Crohn’s disease without evidence of any association between the two conditions. We report the case of a colonic intussusception of a young adult secondary to a colorectal cancer revealing a silent Crohn’s disease.

The longest trichobezoar (59 in.) presented with gastric perforation and multiple small bowel intussusceptions—a unique presentation

A trichobezoar is an old entity which arises out of eating own hairs. These patients are psychiatrically ill, leading them to eat their own hairs. We report a case of a 15-year-old girl with severe pain in the abdomen, tachycardia, chronic malnutrition, and cachexia. On CT scan examination, we found gastric perforation and multiple intussusceptions in the entire small bowel with trichobezoar extending up to the ileum and gastric perforation. We surgically removed the entire trichobezoar intact along with perforation repair and reduction of all intussusceptions. The tail of the trichobezoar was 59 in. long.

Jejunal Polyps that Lead to Small Bowel Intussusception in Adults: A Rare Case Report

Small intestine polyps are very rare in adults. Incidental finding of those polyps; sending them for histopathology that comes out to be Peutz-Jeghers syndrome (PJS) is extremely rare. PJS is an inherited disease characterized with typical hamartomas polyps in intestine along with distinctive skin pattern and mucocutaneous pigmentation. Gene mutation is responsible for 93% of PJS cases, among which majority of cases occur due to mutation in STK11 gene. PJS patients have 15-fold higher risk of developing cancer, including intestinal, extra-intestinal, breast, lung, pancreatic and colorectal cancer. Although PJS incidence is very low but its early recognition is very important for lowering morbidity and mortality. In this study, we have reported a very rare case of PJS in adults that was operated for small bowel obstruction secondary to intussusception. These cases are very rare in literature.

Acute intestinal obstruction caused by small bowel intussusception (clinical case)

One of the most difficult to diagnose and rare forms of acute intestinal obstruction is intussusception. This article presents an analysis of a clinical case of acute intestinal obstruction caused by small bowel intussusception in a patient suffering from small-bowel polyposis.

Small bowel intussusception in pregnant women with a history ofaRoux-en-Y gastric bypass: a case series and a systematic reviewoftheliterature.

Intussusception of the small intestine has been described in pregnant women with a history of a laparoscopic Roux-en-Y gastric bypass. This study provides a systematic review on the characteristics of intussusception in this population. MEDLINE, Embase, Cochrane Library, and our own hospital's electronics health records were searched for eligible studies/cases. Fifteen papers were eligible, containing 17 cases. Our hospital search included 6 cases. Seventeen of 23 intussusceptions were retrograde and were mostly (18/23) located at the jejunojejunostomy. Six patients were treated successfully with manual reduction only and 17 patients required surgical resection. Fifteen (65%) patients had an ischemic segment. Six (26%) patients delivered during the same hospital admission. One fetal death (1 of twins) was reported. Awareness of this rare but serious complication by obstetricians and bariatric surgeons is necessary to limit maternal and fetal complications.

MR Enterography Features of Jejunal Lipoma Causing Intussusception: A Unique Case Report

Intussusception usually occurs in children due to benign causes, whereas in adults, it is mostly caused by malign causes in the colon. On the other hand, the causes of small bowel intussusceptions in adulthood are usually benign, such as polyps, lipomas, adenomas, and Meckel’s diverticulum. Intestinal lipomas are an uncommon entity among benign tumors. Here, we present MR enterography features of jejunojejunal intussusception caused by an intramural lipoma.

Comparison Between Small and Large Bowel Intussusception in Children: The Experience of a Large Tertiary Care Pediatric Hospital.

Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to serious sequelae. The objective of this study was to determine the prevalence of ileoileal intussusception and to document and compare clinical outcomes with ileocolic intussusception. A retrospective cohort study of children with an abdominal ultrasound that diagnosed intussusception. Clinical data and diagnostic studies were retrieved, to compare ileoileal with ileocolic intussusception. A total of 488 patients were evaluated with an abdominal ultrasound on suspicion of intussusception; 54 (11%) had ileoileal intussusception and 30 (6%) ileocolic intussusception. The significant features distinguishing the 2 conditions were fever, more common in patients with ileoileal intussusception, and an abdominal mass, which was papable more commonly in ileocolic intussusception. None of the ileoileal intussusception patients required surgical intervention, and all were discharged without complication. With recent advances in abdominal ultrasound, the diagnosis of ileoileal intussusception has become easier than before. Patients presenting with small bowel intussusception may not need any immediate intervention. The presence of fever supports the diagnosis of ileoileal intussusception.

Solitary Peutz–Jeghers polyp of jejunum in 3-month-old girl

Abstract We report the youngest case and extremely rare case of solitary jejunal Peutz-Jeghers polyp. The patient was 3-month-old girl who had been reduced by high-pressure enema for twice a week with episodes of intussusception at a referral hospital and underwent laparoscopic examination for a diagnosis of repeated intussusception. The intussusception was reduced laparoscopically. After reduction of the intussusception, an intraluminal bowel polyp was palpated. The polyp was excised and showed typical histological features of a Peutz-Jeghers (PJ) polyp. The patient presented with neither mucocutaneous pigmentation nor positive family history and was therefore characterized as a case of solitary PJ polyp without genetic investigation. The solitary jejunal PJ polyp is rare. Sone et al. [1] reported in 2000 for the first time. So far, only 5 cases of the solitary jejunal PJ polyp were reported and our case appears to be the sixth and the youngest case. Regular follow-up is essential in young children so that future manifestations of the PJS are not missed. A solitary PJ polyp, though very rare, should be kept in mind as a differential diagnosis in intestinal polyps causing small bowel intussusception.

Common Jejunal Tract Intussusception into the Jejuno-Jejunal Anastomosis as Long-Term Complication after near Total Gastrectomy for Distal Gastric Cancer

Background: Intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB) and extremely rare after near total gastrectomy. Case Presentation: 46-years-old woman (BMI=40 kg/m2 , co-morbidity: hypertension) operated about seven months before of near total gastrectomy (for distal gastric cancer) with a small bowel resection with Roux and Y gastric reconstruction , presented epigastric pain after meals, alvus alterations lasting by a week, vomiting in the last days with leukocytosis and transaminase and amylase increase. The CT scan showed peri-hepatic fluid, gastric, duodenal and jejunal dilatation, a "target like imagine" of jejuno-jejunal anastomosis with small bowel air-fluid levels, normal intestinal loop downstream the jejuno-jejunal anastomosis. During laparoscopy we discovered ischemia of common jejunal tract intussuscepted into the jejuno-jejunal anastomosis. The common ischemic intestinal tract and the anastomosis were resected “enbloc” and jejuno-jejunal anastomosis was performed again. Conclusion: The symptoms of small bowel intussusception after near total gastrectomy are not specifics but the risk of severe complications requires an early diagnosis and treatment. According to literature data, CT-scan is the gold standard for the diagnosis but in unclear cases it is mandatory an early laparoscopic exploration to confirm the clinical suspicion and to perform the appropriate treatment.

Small Bowel Intussusception Secondary to Metastatic Spindle Cell Sarcoma: A Case Report and Review of the Literature

Intussusception of the small or large intestine is defined by the telescoping of a segment of bowel on itself.