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PubMed2001

Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects.

OBJECTIVE: The aim of this study was to provide measurements for the defecographic diagnosis of rectal intussusception and rectal prolapse. MATERIALS AND METHODS: Four hundred thirty-seven consecutive patients with defecation and micturition disorders and gynecologic complaints were studied by means of defecography (120 patients), colpodefecography (17 patients), or cystocolpodefecography (300 patients). As a control group, 43 asymptomatic subjects underwent defecographic examination. RESULTS: Thirty-five patients were found to have rectal intussusception and 18, to have rectal prolapse. Anterior and posterior rectal wall folding thickness, intussuscipiens diameter, intussusceptum lumen diameter, and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were measured in all patients. The findings were compared with those obtained in 13 of 43 asymptomatic subjects with rectal outline changes mimicking intussusception. Rectal folding thickness and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were significantly greater in subjects with rectal intussusception and rectal prolapse than in asymptomatic subjects with rectal mucosa folding. CONCLUSION: Our findings suggest that dynamic evacuation radiology contributes to making a differential diagnosis between rectal intussusception and mucosal folds in the rectum.

Case-Control Studies↗
PubMed2001

Intussusception during enteral nutrition: a case report.

We report a case of intussusception during enteral nutrition after esophagectomy. The case was a 60-year-old patient who underwent subtotal esophagectomy via the right thoraco-abdominal approach, reconstructed with esophagogastrostomy. He underwent tube feeding through gastrostomy after surgery. The tip of the feeding tube was emplaced in the jejunum. He complained of intermittent abdominal pain and the drainage volume through the gastric decompression tube was increased on the 2nd week from surgery. There was no abnormal finding on abdominal CT or or radiography of the digestive tract, and so a diagnosis of intussusception was made and laparotomy was performed. There was descending intussusception with the jejunum where the feeding tube was emplaced. Enterectomy was not necessary in this case. Adult intussusception is rare. The surgery is sometimes the cause for intussusception. Another cause is use of a long intestinal tube. Since enteral nutrition has priority for nutritional support after esophagectomy, it is important to make an early decision whether surgical intervention is required or not, using abdominal examination by CT, ultrasound and contrast radiography, when bowel obstruction occurs during enteral nutrition through a feeding tube.

Enteral Nutrition↗
PubMedDate not supplied

The "Ibadan intussusception"; now a myth? A 10 year review of adult intestinal obstruction in Ibadan, Nigeria.

Caecocolic intussusception was a significant cause of adult intestinal obstruction in Ibadan where it earned itself the appellation "Ibadan Intussusception". Recently, it has been noticed that there is a significant drop in the cases of adult intussusception. A retrospective review of the intra-operative diagnoses of adult patients who presented to the University College Hospital, Ibadan with intestinal obstruction between June 1990 and June 2000 was carried out. The most common cause of adult intestinal obstruction was obstructed groin hernias followed by adhesions. There was a significant paucity of cases of intussusception, hence the paper queries the veracity of the appellation "Ibadan intussusception" in the present day.

Adolescent↗
PubMed1999

Intussusception in infants: an emergency in diagnosis and treatment.

Intussusception is an important cause of intestinal obstruction and bowel necrosis in infants under 2 years. Most frequently the ileocaecal junction is involved. Various aetiologic factors, such as Meckel's diverticulum and lymphoid hyperplasia have been identified. Hydrostatic reduction of the intussusception should be attempted, but delay in diagnosis frequently leads to surgical intervention, because of failing reduction. We report a case of a 4-month-old boy whose ileocaecal junction was intussuscepted into the rectum, and therefore could be palpated by rectal examination. Unsuccessful hydrostatic reduction and bowel necrosis because of delay in diagnosis, made surgical intervention necessary. A terminal ileostomy was performed. A second case report considers a 10-month-old boy whose ileocaecal junction was intussuscepted into the colon sigmoideum. Because there was no delay in diagnosis, this intussusception could be reduced hydrostatically. The procedure however was difficult because of a dolichosigmoideum. Recent literature is also reviewed.

Abdomen, Acute↗
PubMed1999

Cecal inversion and subsequent colocolic intussusception in a red wolf (Canis rufus gregoryi).

A 2-yr-old female red wolf (Canis rufus gregoryi) presented with weight loss and diarrhea. Abnormal clinical pathology included low serum calcium, sodium, chloride, globulin, and albumin levels. Differential diagnosis included infectious enteritis, intestinal parasitism, inflammatory bowel disease, hepatic or renal disease, and malnutrition. The wolf was treated empirically, but did not improve. A second examination revealed persistent poor musculature and stool quality. Abdominal palpation revealed a firm mass; contrast radiography confirmed an intussusception. Exploratory laparotomy revealed a colocolic intussusception involving the cecum. Following reduction of the colocolic intussusception, cecal inversion (cecocolic intussusception) was identified. Because the cecal inversion could not be reduced, typhlectomy was performed through a colotomy incision. Bacterial culture of peritoneal fluid yielded two strains of Escherichia coli. Postoperatively, the wolf was placed on antibiotics and a soft diet. The diet was gradually returned to its normal formulation and the wolf progressively gained weight. Physical examination 7.5 mo following initial presentation revealed normal body weight and condition. To our knowledge, this is the first recorded incidence of cecal inversion with concurrent colocolic intussusception.

Animals↗
PubMed1999

[Why is it preferable to use air in the radiological reduction of intestinal intussusception?].

OBJECTIVE: We present our experience describing the radiological findings in the treatment of intestinal intussusception. PATIENTS AND METHODS: A retrospective study of the clinical and ultrasound findings and their treatment in 131 intussusceptions diagnosed in 126 patients was performed. RESULTS: In 102 cases, the pneumatic intussusception reduction under radiological control was possible. Twenty-nine patients underwent surgery and amongst these the pathological changes in the intestinal wall indicated resection in 9. CONCLUSIONS: The pneumatic intussusception reduction under fluoroscopic monitoring is now more accepted than hydrostatic reduction with barium. With the proper equipment and experienced staff, this is the most promising method in the management of intestinal intussusception during infancy.

Air↗
PubMed1999

Intussusception in a child infected with enterovirus: case report.

Most intussusceptions in childhood are idiopathic. The association of viral infection has been suspected for decades. We report a case of ileocolonic intussusception in a child during a course of enterovirus infection. A 20-month-old girl with vomiting and irritable crying of 4 days' duration was found to have intussusception by sonography. She had suffered from herpangina one week earlier. Due to her peritoneal signs, she underwent surgical manual reduction. A cluster of enlarged lymph nodes in the intussuscipiens was noted preoperatively by high resolution ultrasound. Two swollen lymph nodes were removed for pathologic evaluation and examined for a viral genome by polymerase chain reaction (PCR) amplification. Panenterovirus base pairs were confirmed on the electrophoresis print. During postoperative sonographic follow-up, significant shrinkage of previous mesenteric lymphoid hyperplasia was observed. In this article, we present the first case of childhood intussusception in associated with enterovirus infection, in which the panenterovirus genome was identified in the patient's mesenteric lymph nodes. This was also the first evaluation of the role of mesenteric lymph nodes in intussusception by high resolution sonography.

Enterovirus Infections↗
PubMed1999

Ileo-ileo-colic intussusception secondary to an ileal lipoma.

Adult intussusception is extremely uncommon and constitutes approximately 5-16% of all intussusceptions. We describe a case of ileo-ileo-colic intussusception secondary to an ileal lipoma occurring in a 22 year old man who in addition had autosomal dominant polycystic kidney disease. CT scan played a pivotal role in not only demonstrating the cause of intestinal obstruction (intussusception) but also showed that a lipoma was the lead point precipitating the intussusception.

Adult↗
PubMed2000

Mini-laparoscopic reduction of intussusception for children.

The success of mini-laparoscopic cholecystectomy and splenectomy has encouraged the application of this new technique in children with non-complicated intussusception. Here, we report on the use of this technique in two children, aged 21 and 24 months, respectively, who had failed saline enema reduction of ileocolic intussusception. Under a 2-mm videoscopic visualization, the intussuscepted bowel was identified and reduced with the assistance of a 2-mm working port placed at the right lower abdominal area and a 5- to 10-mm working port placed at the supraumbilical area. An intussuscepted lymph node at the ileocecal area, as the lead point, was removed at the time of the procedure in one child. Both patients experienced relief of symptoms the day after operation and resumed a regular diet on the first post-operative day. No recurrence or complications, including abscess and wound infection, occurred. These findings suggest that mini-laparoscopic reduction is a safe procedure for children with uncomplicated intussusception. Moreover, the procedure provides better cosmesis than conventional laparoscopic techniques.

Child, Preschool↗
PubMed2000

Controversy in the treatment of adult long ileocolic intussusception: case report.

Adult intussusception is an unusual cause of intestinal obstruction. In contrast to children, intussusception in adults is usually due to an identifiable cause. We present a case of an 81-year-old female who was diagnosed with a long intussusception on CT scan of the abdomen. Because of the likelihood of neoplasia, a right hemicolectomy was undertaken, after which the patient recovered well. The correct treatment of adult intussusception is not unanimously agreed upon. We present a case of long intussusception in which partial reduction of viable small bowel before the resection was done by applying gentle traction. This provided sufficient small bowel mesentery length, preventing any damage to superior mesenteric vessels and avoiding unnecessary excision of healthy bowel.

Adenoma, Villous↗
PubMed2000

[Intussusception in adults].

The authors report eight cases of intussusception of small and large intestine in adults during five years. 3 of the intussusception caused by simple tumors in five cases by malignant. In three cases were chronic presented long term signs and symptoms. Ileo-ileal invagination was diagnostised at 3 patients, ileo-caecal in one case and ileocolic intussusception also in one case. In 2 cases developed caeco-colic, in one case colo-colic invagination. Resection was strongly indicated in seven cases and wedge resection was done at the last patient. One patient has died of cerebral multiple embilization. They review the etiology and pathology, the signs and symptoms as well as the difficulties during diagnosis and treatment of the intussusceptions according to their own experience and literary datas. The authors draw the attention to the importance of the modern iconographic, tools, particularly the ultrasonography in the diagnosis of intussusception.

Adolescent↗
PubMedDate not supplied

Postoperative intussusception, causal or casual relationships?

Postoperative intussusception (POI) is a recognised but uncommon condition. Primary intussusception has been reported several times from Africa, but there are only two reports of postoperative intussusception. A literature review on POI was performed by searching the Medline between 1966 and 1998 together with relevant references in publications on the subject. Postoperative intussusception occurs within a month of an operation. It differs from primary intussusception. No specific aetiology has been found. Predisposing factors based on disorder of peristalsis have been proposed. At risk are patients with prolonged postoperative ileus after prolonged surgery with extensive dissection or after a postoperative regimen of radiation and/or chemotherapy. The diagnosis requires a high index of suspicion. Contrast radiology is not reliable in the diagnosis. The preferred treatment is operative reduction, but resection may be indicated. There are no reports of recurrence after surgical treatment. Preventive measures include gentle handling and avoidance of drying of intestines at operation. The paucity of reports from Africa may mean that the diagnosis is being overlooked.

Adult↗
PubMed2002

Intussusception: a three-year review.

INTRODUCTION: Intussusception is the commonest cause of intestinal obstruction in infants and young children. MATERIALS AND METHODS: This report reviews the clinical presentation, investigations and outcomes of patients with intussusception treated at the KK Women's and Children's Hospital between 1 May 1997 and 30 April 2000. RESULTS: The study population comprised 160 consecutive patients treated for intussusception at our hospital over this 3-year period. The commonest symptom was vomiting; present in 135 patients (84.4%). A palpable abdominal mass was present in 90 patients (56.3%). The classical features of vomiting, abdominal pain, abdominal mass and rectal bleeding were present together in only 12 patients (7.5%). Abdominal ultrasonography was performed in 155 patients. One hundred and fifty-two patients (98.1%) had the classical target lesion on ultrasonography. Air enema reduction was attempted in all except 6 patients. In the majority of patients (130 or 84.4%), the intussusception was reduced successfully by air enema reduction. There was no association between the duration of symptoms before radiological reduction and the outcome of radiological reduction. CONCLUSIONS: As the four classical features of intussusception were present together in only 7.5% of our patients, a high index of suspicion is necessary when any of the signs and symptoms are present in an infant or young child. Abdominal ultrasonography is the diagnostic investigation of choice. Air enema reduction was successful in 84.4% of patients and the duration of symptoms did not reduce the success rate. Thus, air enema reduction should be attempted in most patients unless they have absolute contraindications.

Age Distribution↗
PubMed2002

Viral isolates of intussusception in Nigerian infants.

Idiopathic intussusception is associated with viral pathogens of gastrointestinal respiratory and febrile diseases of infancy and early childhood. These agents are known to vary from one region to another. No such specific viruses have, however, been reported from Nigeria. We therefore collected stools from 28 infants with intussusception as well as 20 age- and sex-matched healthy controls and subjected these specimens to viral isolation techniques. Of the 21 viral isolates obtained from the two groups, 17 (81%) were from the intussusception group while 4 (19%) were from the controls. Ten (58.8%) of the 17 isolates from these subjects were identified as adenoviruses using monoclonal antibody. All of them were from the intussusception group. None of the four isolates from the controls significantly reacted with this antibody. We concluded that adenoviruses are strongly associated with primary intussusception in Nigerian infants.

Adenoviridae↗
PubMedDate not supplied

[Intussusception in adults. Case report with uncommon etiology and review of the literature].

OBJECTIVE: To present a case of adult intussusception with uncommon etiology. BACKGROUND: Intussusception is a relatively common cause of intestinal obstruction in children, but is a rare clinical entity in adults, representing less than one per cent of intestinal obstruction in this patient population. METHOD: We report on 72-year old female patient with intestinal obstruction due to ileocolic intussusception related to leiomyosarcoma of the terminal ileum. A synchronic adenocarcinoma in the cecum was identified. The patient underwent right hemicolectomy and terminal ileum resection with primary anastomosis. Her postoperative course was uneventful. The patient is free of all evidence of disease at 2 year of follow-up. A thorough review of the literature of adult intussusception was carried out. CONCLUSION: From this review, the recommendation is to resect all cases of adult intussusception, different from the recommended approach in pediatric population.

Adenocarcinoma↗
PubMed2002

Clinics in diagnostic imaging (80). Ileocolic intussusception.

Intussusception is a common but life threatening gastrointestinal emergency that occurs in the infant or young child. A three-year-old boy presenting with abdominal pain and vomiting was diagnosed to have the target sign on ultrasonography. An ileocolic intussusception was initially reduced using air enema. Recurrent intussusception 12 hours later was reduced by barium enema. In the proper hands, ultrasonography has a high diagnostic accuracy rate for intussusception. For treatment, air enema is usually perferred to barium enema. Air enema is a safe, rapid, and clean procedure that has been shown to achieve a high reduction rate, comparable to that of barium enema. Ultrasonographically-guided hydrostatic reduction of intussusception has also been recently described and is an effective alternative.

Abdominal Pain↗
PubMed2003

Retrograde intussusception of the efferent limb after a pancreaticojejunostomy.

Retrograde intussusception is exceedingly rare and has not been reported after a pancreaticojejunostomy. Recurrent retrograde intussusception has been reported only once before. In adults retrograde intussusception has been associated with gastric resection, gastrojejunostomy, Roux-en-Y gastric bypass, and gastrostomy tube placement. We report a case of retrograde intussusception of the efferent limb into the anastomosis of a revised Roux-en-Y bypass of the pancreas. Two long side-to-side anastomoses with plication were performed to prevent a third episode of intussusception involving this patient's Roux-en-Y.

Adult↗
PubMed1992

[Primary colonic intussusception protruding from the anus in adults. Two cases].

The authors report two cases of colonic intussusception in the adult protruding from the anus--or colon-anal intussusception--, not due to a tumor. The first case was a chronic ileo-caeco-colique intussusception, the second case was an acute colo-rectal intussusception. Colo-anal intussusceptions are very rare: less than twenty cases have been described since 1925 in adults. The absence of a tumor origin in our cases represents a special feature, as only three other similar cases have been described. The surgical treatment in both cases was primary colonic resection without colostomy. The surgical treatment of the first case was subtotal colectomy with ileo-rectal anastomosis. The second case was primarily reduced by barium enema which allowed optimal secondary surgical resection of a prepared colon.

Adolescent↗