Intussusception Of Small Intestine Research Articles

Small intestinal polyps in adults: complications, diagnosis and treatment problems

A case from practice is presented, demonstrating the development of small-intestinal intussusception in a patient, the pathogenetic cause of which was polyps of the small intestine. Despite the fact that the patient twice, before entering the surgical clinic with acute intestinal obstruction, came to the attention of medical workers (the first time with signs of gastrointestinal bleeding, the second time with abdominal pain), the patient was not properly examined, although, retrospectively, it can be assumed that the arsenal of diagnostic methods that were at the disposal of physicians made it possible to make a correct clinical diagnosis. With a very high degree of probability, it can be argued that in both cases, the cause of the patient's problems was the polyps of the small intestine. During the last hospitalization, the patient, despite the preoperative diagnosis that was not entirely accurate in terms of the wording, but absolutely correct in terms of tactics, was promptly performed an adequate surgical intervention in terms of volume. Particular attention of surgeons is drawn to the mandatory need for careful palpation and visual revision of all parts of the small intestine when performing surgical interventions for completed small intestinal intussusceptions.

Intussusception with partial intestinal obstruction as a rare complication of small intestine tumor (clinical case)

A clinical case of small intestine intussusception with partial intestinal obstruction as a rare complication of small intestine tumor in adults is presented. This case demonstrates a variant of clinical signs of intussusceptions, features of preoperative diagnosis and importance of appropriate investigation of small intestine.

A clinical case of small intestinal intussusception caused by metastatic melanoma

Intestinal obstruction is observed in about 9.0 % of patients with acute surgical pathology of the abdominal cavity. The disease occurs at any age, but more often between 25–50 years. Mixed intestinal obstruction is only 3–7 %. The most common form of mixed intestinal obstruction is intestinal invasion. The most common cause of intussusception in adults is an intestinal tumor. Early diagnosis and the optimal amount of surgical treatment are the main components of successful treatment of the patient.
 Aim: to familiarize practitioners with a rare case of intestinal obstruction in adults and its management strategies in a surgical hospital.
 Materials and methods. The patient was treated in the surgical department of the Communal Non-Profit Enterprise “City Hospital No. 7” Zaporizhzhia City Consul. The patient underwent preoperative preparation and surgical intervention.
 Results. The patient underwent an emergency median laparotomy under total intravenous anesthesia with artificial lung ventilation. During the examination of the abdominal cavity, multiple distended loops of the small intestine were visualized. During the revision, at a distance of 1.5 meters from the ligament of Treitz, a volumetric formation of the small intestine of dense-elastic consistency, represented by small-intestinal invasion, up to 10 cm long, was detected. The proximal sections of the small intestine are distended, light purple in color. The sections of the small intestine that were distal to the site of invasion were inflamed. Manual disinvagination of the small intestine was performed. The visual examination showed that the intestine was viable. There was a tumor was found on the antrumeral margin, measuring 1.8 × 2.5 cm, dense in consistency, finely tuberculated, dark purple heterogeneous in color, infiltrating and deforming the wall of the small intestine. Resection of the invaded area of the small intestine with the tumor was performed with the imposition of a small-small intestinal anastomosis “side to side” with two-row nylon sutures.
 Conclusions. In this clinical case, it was possible to establish the final diagnosis and determine further surgical strategy only intraoperatively. Only early diagnosis of melanoma will allow avoiding the complications identified in this patient.

A retrospective review of small intestinal intussusception in 126 cattle in Switzerland.

Intussusception is a form of ileus of the intestines in which an oral intestinal segment slides into the adjacent aboral intestinal segment, causing obstruction of the bowel. We analysed the medical records of 126 cattle with intussusception of the small intestine. Demeanour and appetite were abnormal in 123 cattle. Non-specific signs of pain occurred in 26.2%, signs of visceral pain in 46.8% and signs of parietal pain in 56.4%. Intestinal motility was decreased or absent in 93.7% of the cattle. The most common findings of transrectal palpation were rumen dilation (37.3%) and dilated small intestines (24.6%). In 96% of the cattle, the rectum was empty or contained little faeces. The principal laboratory findings were hypokalaemia (89.6%), hypocalcaemia (76.5%), base excess (72.9%), hypochloraemia (71.8%), azotaemia (62.1%) and haemoconcentration (61.1%). The main ultrasonographic findings were reduced or absent intestinal motility (98.2%) and dilated small intestines (96.0%). A diagnosis of ileus was made in 87.8% and a diagnosis of ileus attributable to intussusception was made in another 9.8%. Right-flank laparotomy was carried out in 114 cattle. Fifty-six (44.4%) cows were discharged. Clinical findings of intussusception in cattle are often non-specific. Ultrasonography may be required to diagnose ileus.

Acute Intestinal Invagination in Adults Revealing GIST: Case Report

Acute intussusception is a pathology of infants and young children. Its occurrence in adults is rare. It is of various etiology. In the vast majority of cases, it is secondary to a tumor which can be benign or malignant. We report the case of a 77-year-old patient, admitted to the emergency department of our structure for an acute intestinal obstruction, an abdominal CT scan showed acute small intestine intussusception on a small intestine tumor complicated by perforation. Treatment was open surgical resection. The anatomopathological and immunohistochemical study of the surgical specimen concluded to a small intestine GIST. From this new case and after analysis of the literature, we discuss the clinical and diagnostic characteristics and the therapeutic possibilities of this rare pathology.

An adult case of small bowel intussusception caused by hemangioma presenting with intestinal obstruction: A case report

Both small bowel intussusception in adults and small bowel hemangioma are rare benign mass lesions. Moreover, a secondary effect of intussusception caused by hemangioma is extremely rare. A 87-year-old female suffered from intussusception and intestinal obstruction caused by hemangioma located in the small bowel (February 14, 2020), reporting abdominal distention without nausea and vomiting. Emergency abdominal and pelvic computed tomography showed an intussusception with the evidence of associated small bowel obstruction. Histological analysis revealed as small intestinal hemangioma accompanied by mesenteric ulcer. The patient underwent segmental resection of intussusception of intestine instead of invalid conservative treatment. Although the postoperative pathological results were inconsistent with preoperative imaging examination, the old woman recovered well. The literature on intussusception of small intestine has described several possible causes including hemangioma, which more likely results in gastrointestinal bleeding or abdominal pain. Yet we experienced a rare case presenting as abdominal distention without nausea and vomiting, Therefore, preoperative diagnosis and localization of these lesions is of great importance. We recommend high resolution contrast-enhanced computed tomography and magnetic resonance imaging should be considered in diagnosis while capsule endoscopy is not available owing to the intestinal obstruction, as long as in facilitating surgical excision.

Jejunal intussusception due to an atypical lipomatous tumor: a rare case report.

Intussusception in adults is rare, and the clinical symptoms of intussusception are subtle, making the diagnosis quite challenging. Gastrointestinal lipomas are rare benign tumors and are essentially adipose growths, most frequently found within the small intestine wall or mesentery. Limited up-to-date evidence exists regarding such lipomas. Intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity, and the diagnosis of duodenal lipoma mainly depends on endoscopy examination, supplemented by computed tomography and magnetic resonance imaging. The present report describes a case of jejunal intussusception in an adult with a history of intermittent colicky abdominal pain located in the left upper quadrant over the last month. Contrast-enhanced computed tomography of the abdomen showed the typical target sign of a small intestinal intussusception along the left upper quadrant and a well-defined, low-density tumor in the intussusception. Exploratory laparotomy revealed jejuno-jejunal intussusception secondary to a lipoma, which was successfully treated with segmental intestinal resection.

A suspected intermediate syndrome and intussusception following propoxur toxicity in a dog

AbstractAn 8‐month‐old, mixed breed dog was referred because of vomiting, generalised muscle tremors and miosis. A few hours before the presentation, the owners saw the dog eating something during the daily walk. The dog was initially treated with fluids, atropine, dexmedetomidine, maropitant and midazolam. Complete blood exams showed a marked reduction of cholinesterase activity. Blood toxicology tests revealed the presence of propoxur. Twenty‐four hours after the presentation, the dog developed a small intestinal intussusception. After an initial improvement, the dog developed weakness and respiratory difficulties. The neurological examination showed obtundation, severe generalised muscle weakness of neck and limbs, reduced flexor reflexes in the four limbs and a short and shallow respiratory pattern, suggesting suspected intermediate syndrome. The dog's neurologic conditions progressively improved, and he was discharged 5 days after presentation with only mild impairment of the neck strength.

English

Malignant melanomas mostly begin as an oculocutaneous lesion and then metastasise to other sites over time. Gastrointestinal melanomas are rare but primary intestinal melanomas are extremely rare. They account for 1 - 3 % of malignant tumours of GI tract.1,2 Although few cases have been reported, the existence of primary intestinal melanoma is still doubtful. It is difficult to differentiate between primary and secondary intestinal melanomas based on their clinical picture alone. Some authors believe that the metastatic melanoma into the intestine manifest symptoms in the patient after complete regression of some old cutaneous lesion.3,4 But some believe that primary melanoma of small intestine originates from Schwannian neuroblast cells, neural crest melanoblasts, or amine-precursor uptake and decarboxylation (APUD) cells through neoplastic changes.5,6 They are unrecognized until late due to absence of symptoms, but if symptoms occur, they include abdominal pain, gastrointestinal bleeding and sometimes with intestinal obstruction and few present acutely with perforation. By any origin, malignant melanoma is an aggressive tumour with very poor prognosis and low survival rates, even after surgery. Here we report a case of primary intestinal melanoma in a young patient who presented as intussusception of small intestine.

Small intestinal intussusception in horses: Multicentre retrospective report on 26 cases (2009‐2020)

SummaryBackgroundIntussusception is an infrequent cause of equine colic, most commonly encountered in young horses. This condition occurs due to abnormalities of motility and frequently includes the caecum.ObjectivesThe purpose of this study was to review the cases of equine small intestinal (SI) intussusception excluding those with caecal involvement.Study designCase series, analytical retrospective study.MethodsMedical records of all horses that had SI intussusception, not involving the caecum, from three equine clinics between 2009 and 2020 were reviewed. Information obtained included: clinical parameters, surgical or necropsy findings, complications and outcome. The Mann‐Whitney U test was used to compare the outcome and complications with various parameters. Fisher’s exact test was used to compare short‐term survival with categorical variables. Significance was set at p ≤ 0.05.ResultsTwenty‐six horses met the inclusion criteria. Median age of horses was 9 months (interquartile range 2.8 months–6.5 years). Relevant history included diarrhoea and general anaesthesia. Twenty‐two out of 26 horses were diagnosed during surgery and 4 at necropsy. During surgery, 5 horses were subjected to euthanasia, 9 underwent manual reduction and 8 underwent resection and anastomosis. The postoperative complication rate was high at 47% and included ileus, diarrhoea and colic. The prognosis decreased when the involved segment was longer (p = 0.032), lactate levels were higher (p = 0.024) and reflux was present before admission (p = 0.024). Of all horses, 53% survived to discharge and 92% of these survived for >1 year post‐operatively (one case was lost to follow‐up).Main limitationThe retrospective nature of the study and the low number of cases included.ConclusionsSmall intestinal intussusception was diagnosed in horses of a variety of breeds and ages. Alterations of motility can predispose to intussusception, not only due to hypermotility (diarrhoea), but also due to hypomotility (anaesthesia). Prognosis for hospital discharge was fair; however, following hospital discharge, the long‐term survival rate is high and complications are rare.

Small Bowel Intussusception due to Multiple Intestinal Metastases from Lung Adenocarcinoma

Metastatic small bowel tumors are rare. They often present with small bowel occlusion, bleeding, perforation, or intestinal intussusception. Pulmonary adenocarcinoma with metastasis to the small intestine causing intussusception is exceedingly rare. A 72-yearold male patient with a past medical history of left lung adenocarcinoma, presented to the emergency department with abdominal pain and vomiting. On admission, an X-ray of the abdomen without preparation showed some hydroaeric levels on the small intestine. The abdominopelvic computed tomography (CT) scan revealed an ileo-ileal invagination, with an image of the invagination rod. The patient underwent a surgical resection of the small bowel with the removal of the ischemic areas and immediate anastomosis. Macroscopic examination of the surgical specimen revealed five tumor masses varying in size between 1 and 4 cm. The histological examination of the samples taken from these tumors, coupled with an immunohistochemical study confirmed the diagnosis of intestinal metastases of pulmonary origin expressing cytokeratin 7 (CK7) and thyroid transcription factor 1 (TTF1) but negative for CK20, chromogranin, and synaptophysin. The postoperative course was uneventful, and the symptoms transiently recovered. However, the patient died 3 months later. We should consider multiple metastatic lesions in adult intussusception, especially in patients with a past medical history of lung cancer.

Small Intestinal Intussusception Due to Complicated Giant Jejunal Diverticulosis

Background: Jejunal diverticulosis and jejunal lipomatosis are uncommon conditions. Usually asymptomatic, they may cause severe complications in some cases. Intussusception is unusual in adults, but when diagnosed swiftly it can be treated surgically, usually with good outcome. Case presentation: We present a 60-year-old female patient with a history of chronic malnutrition and anemia, complaining of acute abdominal pain, vomiting and diarrhea. Contrast-enhanced abdominal computed tomography (CT) showed intussusception, multiple giant jejunal diverticula and multiple lipomas. The patient underwent urgent surgery, but radical treatment was not possible due to the extent of the diseases. One month later, another surgery was needed due to ileostomy obstruction caused by lipomas. The patient’s condition deteriorated due to malnutrition and concomitant metabolic disorders, which eventually led to her demise. Conclusions: Radical treatment is not always possible in an extensive jejunal disease. Prolonged malnutrition impairs postoperative healing, and therefore surgical or nutritional treatment should be considered in jejunal diverticulosis before the onset of severe complications requiring urgent surgical intervention.

A case of gastric ulcers and intussusception due to Ascariasis in a 4-months old American Hampshire boar in Sabon Gari Local Government Area, Kaduna State, Nigeria

A Four months old American Hampshire boar weighing about 35kg from a back-yard piggery in Sabon Gari Local Government Area, Kaduna State was presented with the chief complains of restlessness, shivering and pasty perineum. There was no medical history. Physical examination revealed, pale ocular mucus membrane, restlessness, shivering and pasty perineum. The vital parameters were above normal ranges. Faecal sample from the rectum was taken to the helminthology laboratory of the Veterinary Teaching Hospital, Ahmadu Bello University, Zaria, for helminth egg detection and identification. Based on the tentative diagnosis of Ascariasis and enteritis, 35mg of a 17% piperazine adipate solution and 700mg of a 20% oxytetracyline long acting were administered orally and deep intramuscularly, respectively as single doses. The boar died 2 hours after therapy. Post-mortem examination revealed; distended ingesta-filled stomach, ulceration of the stomach mucosal wall with tarry (blackish) haemorrhages, Ascaris suum in the stomach and small intestine, intussusception of the small intestine and empty distal portion of the intussuscepted small intest ne. The helminthology laboratory result indicated eggs of Ascaris suum. Based on the helminthology laboratory result and the post mortem examination findings, it was concluded that the b ar died of gastric ulcer and small intestine intussusception due to Ascariasis. Routine deworming and deworming record keeping in order to know when the next deworming is due were advocated to the farmer.

Adenovirus-associated intussusception in a child

Intestinal intussusception is one of the most common causes of acute abdominal emergencies in children under 2 years of age. We herein describe a case of adenovirus associated small intestinal intussusception in a 5-month-old boy. A brief review on triggers of intussusception in children is provided. Thorough gross and microscopic inspections of resected intussusception specimens are recommended to diagnose subtle predisposing triggers such as viral infections.

Prognostic value of preoperative plasma l-lactate concentrations in calves with acute abdominal emergencies

Acute abdominal emergencies in calves due to abomasal disorders, gastrointestinal ileus, or peritonitis are characterized by a rapid disease progression and usually require immediate surgical intervention. Those conditions are associated with a guarded prognosis, and the aim of the present study was to assess the prognostic relevance of preoperatively measured plasma l-lactate concentrations (l-LAC) in a large study population of calves with a broad spectrum of acute abdominal emergencies. For the purpose of this study, the medical records of 587 calves admitted to a veterinary teaching hospital over a 10-yr period were analyzed retrospectively. Plasma l-LAC was measured as part of a routinely performed biochemistry panel before initiation of surgical intervention. Hyper-l-lactatemia (plasma l-LAC >2.2 mmol/L) was evident in 75% of calves, and the overall survival rate until hospital discharge was 31%. Calves with a negative outcome were younger (median: 3.4 vs. 6 wk) and had higher plasma l-LAC (median: 4.96 vs. 3.09 mmol/L) than calves with a positive outcome. At the individual diagnosis level, l-LAC was associated with mortality in calves with a diagnosis of mesenteric torsion, right-sided dilated abomasum, small intestinal volvulus, or paralytic ileus, but not in calves suffering from peritonitis, malformations, abomasal volvulus, bloat, or small intestinal intussusceptions. Considering the whole study population, the area under the receiver operating characteristic (ROC) curve for plasma l-LAC was 0.66 [95% confidence interval (CI): 0.61-0.70]. A classification tree analysis indicated that l-LAC >8.84 mmol/L and age categories of <3 wk and <1 wk were independent predictors of mortality. The area under the ROC curve of this model was 0.75 (95% CI: 0.71-0.79) and the resulting sensitivity and specificity for the prediction of nonsurvival at the optimal probability cut-point of 0.62 were 67.7 and 76.6%, respectively. In conclusion, hyper-l-lactatemia is common in calves suffering from acute abdominal emergencies. Markedly increased plasma l-LAC is associated with an increased mortality risk, but it is not possible to reliably predict the outcome of affected calves based on a single, preoperative measurement. However, a clinically important finding of this study was that the ability to predict a negative outcome is improved when the age of the calf is considered in addition to plasma l-LAC.

Multiple colic intussusceptions.

Adult large bowel intussusception represents a small minority of intestinal intussusceptions. Main causes involve primary or secondary bowel malignancies. Although multiple small intestine intussusceptions have already been reported, simultaneous large bowel intussusceptions have not been described in the literature so far.

The Role of Hydrocolonic Sonography in Diagnostics of the Intussusceptions due to Neoplastic Process in Children

Introduction. A nonsurgical reduction is the treatment of choice for intestinal intussusception. A neoplasm-associated intussusception always requires surgery. In case of a tumour it is very important to have the diagnosis determined prior to surgical treatment. The hydrocolonic sonography technique makes it possible to assess the tissue structure and to visualize the lumen of the intestine.Materials and methods. The study presents a retrospective comparative analysis of clinical manifestations and diagnosis methods in all the patients with intussusception (n = 380) treated at the Arkhangelsk Children’sClinicalHospital in 1981–2018. This included all the neoplasm-associated intussusception cases (tumours and polyps). The data was compared to clinical manifestations of intussusception associated with other causes (idiopathic, mesenteric node hyperplasia, diverticulum).Results. Neoplasm-associated intussusception is a rare occurrence (2.3%). If the cause of the intussusception is a tumour the typical recorded manifestations include the combination of the signs of gastrointestinal diseases and loss of weight (8–12%), and a chronic course of development (over one to three months). Polyp-associated small intestinal and ileocolic intussusception, a casuistically rare situation, first manifested as an acute intestinal obstruction with protracted abdominal pain syndrome in anamnesis, or recurrent intussusceptions. Traditional and hydrocolonic sonography made it possible to make the diagnosis of intussusception and to identify a tumour. Non-tumour-associated intussusception presented with an acute course of the disease in every case. It manifested with the typical triad of symptoms (abdominal colic pain, rectal haemorrhage, palpable intussusceptum mass) in every third case. The manifestation of the disease as the dyad of symptoms (vomiting and abdominal colic pain) was significantly more frequent (p = 0.001).Conclusions. Clinical presentation of neoplasm-associated intussusception has certain unique qualities. The ultrasound of abdominal cavity and hydrocolonic sonography make it possible to find the intussusception and to identify the tumour or polyp in the structure of the intussusceptum in 100 % of cases at primary examination. The data obtained is used for the optimisation of the surgical treatment strategy.

Location of Intussusception in Adults Predicts Malignant Etiology

Introduction: Intussusception is defined by a proximal segment of the gastrointestinal tract invaginating into a more distal portion of bowel. This results in obstruction or intestinal vasculature compression which can lead to ischemia, infarction, or even perforation. Adult intussusception is a rare, accounting for 1-5% of the total intussusception cases. Identifiable structural lesions or lead points are identified in up to 30% of cases. In adults, close to 30-50% of all the cases are related to malignancy. Celiac disease has also been reported as a possible etiology for adult intussusception. Methods: We reviewed the records of all patients 18 years and older with an ICD-9 code of intussusception between 01/2010 - 05/2018. Patients with a diagnosis of rectal and gastric intussusception were excluded. Data was obtained from a review of patient charts, operative and pathology reports. Age, gender, race, proximal bowel dilation, and presence of celiac disease were recorded. Cases were categorized based on location and etiology (no neoplasm vs neoplasm). Univariate and multivariate regression analysis were conducted to identify predictors of neoplasm in these cases. Results: A total of 67 cases were identified, with 61% male, mean age of 50 years and 70% white. Small intestine was the site of intussusception in 54 cases (81%) as compared to 13 cases (19%) of colonic intussusception (Table-1). Proximal bowel loop dilation was seen in 25% of cases. 3 patients (4.5%) had associated Celiac disease. Neoplasms were the cause of intussusception in 22% of the cases. 77% of colonic intussusception cases were caused by neoplasms as compared to 9% of the small intestinal intussusception. Patients with neoplasms were older (57.7 versus 49 years). In both univariate and multivariate analysis, colonic location of intussusception was a significant predictor of malignancy with odds ratios of 33 (CI: 6.7-166) and 32 (CI: 6.7-159) respectively. Conclusion: Although small intestinal intussusception is more frequent in adults, colonic intussusception is more frequently associated with neoplasms. Patients with advanced age also have a higher incidence of neoplasms as the cause of intussusception. This reinforces the importance of a more comprehensive investigation for older adults who present with colonic intussusception.160 Figure 1 No Caption available.

A Case of Malignant Lymphoma of the Ileum Resected with Laparoscopy-assisted Surgery: A Strategy for Intussusception of Small Intestine

A Case of Malignant Lymphoma of the Ileum Resected with Laparoscopy-assisted Surgery: A Strategy for Intussusception of Small Intestine

Prospective evaluation of abdominal ultrasonographic findings in 35 dogs with leptospirosis.

Despite the emergence of new serovars, a detailed and current abdominal ultrasonographic description of dogs with leptospirosis is lacking. The purpose of this prospective, observational, single cohort study was to illustrate abdominal ultrasonographic findings in 35 dogs with confirmed leptospirosis. At least one ultrasonographic abnormality was seen in all of the dogs. Ultrasound renal abnormalities were found in all the dogs and included increased renal cortical echogenicity (100%), increased medullary echogenicity (86%), reduced corticomedullary definition (80%), cortical thickening (74%), renomegaly (60%), pelvic dilation (31%), and medullary band (14%). Hepatic changes were identified in 83% of the dogs, with diffuse hypoechoic parenchyma (71%) and hepatomegaly (60%). Biliary gallbladder abnormalities were found in 60% of the dogs, with biliary sludge (46%), wall thickening (29%), mucocele (26%), and hyperechoic wall (20%). The other most frequently observed abdominal abnormalities were perirenal (60%) and peritoneal (46%) effusions, small intestinal wall thickening (49%), and lymphadenopathy (38%). Two dogs (6%) presented with a small intestinal intussusception. No association was found between serogroups and the presence of ultrasonographic findings. This study is the first to prospectively and exhaustively describe abdominal ultrasonographic findings in dogs with leptospirosis. Our results should prompt clinicians to systematically perform abdominal ultrasounds on dogs with suspected leptospirosis even in the absence of abnormal physical signs. The presence of a gallbladder mucocele could be a warning sign of leptospirosis in dogs.