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PubMed1981

[Colo-anal intussusception of the adult. A new case (author's transl)].

Report on a case of intestinal obstruction due to a sigmoido-rectal and afterwards anal intussusception of a malignant tumor : review of the literature. Colo-anal intussusception remain very rare as, since Lataste in 1975 related six cases, this one is unique. On the contrary seven new cases of colo-rectal intussusception have been reported. Diagnosis can be difficult. The variability of the mass revealed by successive examination and the intussusception pictures sometime provided by the barium enema may give the correct direction. In this case, treatment consists in the perineal resection of the sigmoid intussusception and its causal tumor followed by an end to end primary anastomosis with an iliac colostomy. This treatment seems to be more suitable for old and deficient people where carcinologic problem is not of first importance.

Adenocarcinoma↗
PubMedDate not supplied

Chronic intussusception in children: report of one case.

Chronic intussusception is defined as intussusception lasting for 14 days or more. Because the clinical manifestation is different from that of acute intussusception, the diagnosis is usually delayed or missed. Ultrasonography is of diagnostic value. We present a 8-year-old boy who had the complaints of marked body weight loss and intermittent abdominal pain for one month. Hydrostatic reduction failed in this case. Laparotomy revealed an ileo-colic intussusception, the leading point of which was a colonic polyp. We would like to emphasize that chronic intussusception frequently appears a nonacute abdominal condition, usually intermittent abdominal pain, and sometimes marked body weight loss and an abdominal mass. Surgical intervention is usually needed in older children because a high incidence of underlying lesions in them.

Child↗
PubMed1995

Pneumatic reduction of intussusception in children.

Over the past decade, pneumatic reduction has been increasingly accepted as the treatment of choice for pediatric intussusception. However the effectiveness of air compared with the more traditional barium reduction of intussusception continues to be a source of concern and debate. From August 1993 to November 1994, pneumatic reduction was used to treat 75 episodes in 73 patients with proven intussusception at Chang Gung Memorial Hospital, Taoyuan. Two patients underwent air reduction twice because of recurrence following an initial successful reduction. The recurrence rate was 3%. Successful reduction was achieved in 65/75 (87%) episodes. None of the patients experienced any complications following the procedure. In two of the 10 patients in whom reduction failed, one was subsequently found to have a Meckel's diverticulum and the other a duplication cyst as a leading point. This prospective study indicates that air enema is a safe and effective form of treatment for intussusception in infants and children. Pneumatic reduction should be the treatment of choice in the initial management of intussusception.

Child↗
PubMed1996

Functional results after abdominal suture rectopexy for rectal prolapse or intussusception.

OBJECTIVE: To assess the functional outcome after suture rectopexy in patients with rectal prolapse or intussusception. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: 33 patients with rectal prolapse and 19 patients with intussusception treated by abdominal suture rectopexy 1969-1992. MAIN OUTCOME MEASURES: Bowel function evaluated by a questionnaire a median of 97 months after operation. RESULTS: 10/33 patients (30%) reported less constipation after rectopexy in the prolapse group compared with 3/19 (16%) in the intussusception group (p = 0.33). Rectal emptying improved in 14/33 (42%) and 1/19 (5%), respectively (p = 0.005), and incontinence in 12/33 (36%) and 3/19 (16%), respectively (p = 0.20). Seventeen patients (52%) with prolapse and 3 (16%) with intussusception described the result of operation as excellent or good (p = 0.02). CONCLUSION: There is a reasonable chance of improved rectal emptying and continence in patients undergoing suture rectopexy for rectal prolapse, whereas bowel symptoms commonly worsen postoperatively in patients treated for intussusception.

Adult↗
PubMed1997

Enteric intussusception due to metastatic intestinal tumors.

Enteroenteric intussusception caused by metastatic tumors is a very rare condition. Because of its rarity and rather mild abdominal physical presentation, preoperative diagnosis is not easily made. Two cases of enteric intussusception due to metastatic intestinal tumors, with the main symptom of melena, are reported. Intussusception was caused by metastatic liposarcoma in one patient and metastatic melanoma in the other. Both patients had long histories of malignant disease, for 15 and 8 years, respectively. They had undergone repeated surgical treatment for metastatic lesions. The diagnosis of enteric intussusception was initially made by computed tomographic scans and small bowel series and was confirmed by laparotomy and pathologic findings. We suggest that tumor metastasis to the small intestine with intussusception should be considered in patients with recurrent tumors and tarry stools.

Adult↗
PubMed1997

Bilateral incisional gastropexies for treatment of intermittent gastroesophageal intussusception in a puppy.

Intermittent gastroesophageal intussusception was diagnosed in an 8-week-old puppy that had had recurrent regurgitation since it was acquired at 6 weeks old. Abnormalities were not detected on survey radiographs or positive-contrast esophagograms; the intussusception was evident only during endoscopic examination of the esophagus. Treatment consisted of bilateral incisional gastropexies attaching the gastric fundus and body to the left and right body walls, respectively. Clinical signs resolved completely after surgery. Gastroesophageal intussusception is rare in dogs, and most dogs with gastroesophageal intussuception have severe clinical abnormalities, including collapse, respiratory difficulties, and shock. However, for dogs with intermittent gastroesophageal intussusception, the only clinical sign may be recurrent regurgitation. Bilateral incisional gastropexies appear to be useful for preventing recurrence of gastroesophageal intussusception in dogs.

Animals↗
PubMed1998

The role of laparoscopy in the management of intussusception in the Peutz-Jeghers syndrome: case report and review of the literature.

A 15-year-old girl with known Peutz-Jeghers syndrome and with nausea and vomiting of all ingested food was transferred from an outside institution. Physical examination revealed a palpable upper abdominal mobile mass. Upper gastrointestinal series revealed a stacked coin appearance consistent with small bowel intussusception. An abdominal computed tomographic scan showed a left upper quadrant sausage-shaped mass with invagination of bowel into bowel suggestive of small bowel intussusception. The patient was taken to the operating room for a combined upper endoscopy and laparoscopy. Laparoscopy confirmed the radiologic findings and a jejuno-jejunal intussusception was identified and reduced laparoscopically. The endoscope could not be passed to the level of the polyp, thus, this loop of small bowel was resected laparoscopically. The final pathologic diagnosis was multiple hamartomas. We conclude that laparoscopy is a safe and effective method of managing intussusception in the Peutz-Jegher syndrome because the pathologic lead point is a benign hamartoma. A combined endoscopic and laparoscopic approach can be used to treat proximal small bowel intussusception and this could possibly eliminate the need for laparotomy and reduce the post-operative complications associated with multiple reoperations in this patient population.

Adolescent↗
PubMed2000

Intussusceptive arborization contributes to vascular tree formation in the chick chorio-allantoic membrane.

Various reports indicate that the process of intussusceptive microvascular growth (IMG) plays a crucial role in capillary network formation of the chorio-allantoic membrane (CAM). In the present study we demonstrate by methylmethacrylate (Mercox) casting and in vivo time-lapse observations that intussusception, i.e. insertion of transcapillary tissue pillars, is also strongly involved in vascular tree formation, a process we refer to as intussusceptive arborization (IAR). From day 7 to day 14 of incubation, several arterial and venous branching generations arise from the capillary plexus. The process is initiated by pillar formation in rows, which are demarcating future large vessels in the capillary meshwork. In a subsequent step the pillars undergo reshaping to form narrow tissue septa that successively merge, which results in the production of new generations of blood vessels. This is followed by growth and maturation of all vascular components. The process of IAR in the CAM is very active at days 10 and 11 of incubation and takes place in preferentially perfused capillary regions determining "dynamic areas". The process of intussusception may be preceded by endothelial division, but the transcapillary pillar formation itself occurs primarily by rearrangement and attenuation of the endothelial cells without local endothelial cell proliferation. We conclude that after the early sprouting phase, the process of intussusception is the basic mechanism of CAM vascularization. It leads to capillary network growth and expansion (IMG) and, at the same time to feed vessel formation with several branching generations (IAR).

Allantois↗
PubMed1981

The well-nourished infant with intussusception. Fact or fallacy?

To assess the nutritional status of children with intussusception, the weight, length, and weight-for-length percentiles of 100 children with intussusception and 100 children admitted to the hospital for elective surgery was determined and compared with the National Center for Health Statistics standards. Of the children with intussusception, 26% were found to have a weight-for-length ratio below the fifth percentile while only 11% of the children admitted for elective surgery had ratios below the fifth percentile. This difference could not be explained by duration of symptoms, vomiting, or diarrhea. Therefore, although children with intussusception may appear "well nourished" they are no better nourished than the general population and, in fact, a significant number exhibit anthropometric data suggestive of malnourishment.

Body Height↗
PubMed1980

Jejunogastric intussusception.

Jejunogastric intussusception is a rare complication after gastric surgery. Only 16 documented cases have been reported at the Mayo Clinic, Rochester, Minn, during the past 72 years. Jejunogastric intussusception is a difficult condition to diagnose clinically. Essentially all patients have epigastric pain. Patients with intussusception generally have had retrocolic gastrojejunostomy without gastric resection. Intussusception of the efferent limb of jejunum is the most frequent type. Surgery is indicated for all patients with the acute type, whereas the chronic type may or may not require operative intervention, depending on the severity of the symptoms. Confirming the diagnosis at operation is occasionally difficult because of spontaneous reduction. Symptoms may recur after operation, but documented recurrence is rare.

Adult↗
PubMed1966

The changing face of intussusception.

Management of intussusception in a pediatric center shows changing patterns over the past 26 years. Early and subacute cases of intussusception are now ordinarily successfully reduced by hydrostatic pressure (barium enema). A minority, who are in shock, who have evidence of significant blood loss or, in whom small intestinal obstruction is apparent, are treated by emergency laparotomy, with or without confirmatory contrast studies. In the latter group the rate of resection is high (16.4% in the present series). Resected segments are microscopically infarcted; with unnecessary resection a rarity. Advances in surgical management have eliminated a major portion of the mortality formerly associated with resection. The use of hydrostatic pressure reduction makes surgery unnecessary in a high percentage of infants with intussusception, but does not reduce the incidence of infarction requiring resection. Ambulatory or nonhospital management of intussusception subjects the infant to the risk of a significant delay in definitive treatment and is not to be condoned.

Humans↗
PubMed1985

Small bowel tumours causing intussusception in childhood.

In a series of 292 children with intussusception ten (3.5 per cent) were caused by small bowel tumours. The average age of these patients was greater than in idiopathic cases; seven of the ten being older than 2 years. Intussusception due to Peutz-Jeghers hamartomas was jejunojejunal whereas other small bowel tumours causing intussusception were in the terminal ileum. The majority of these intussusceptions were either irreducible or gangrenous and all required resection of bowel. There was only one death in the entire series of 292 patients, and this was a child with lymphosarcoma.

Child↗
PubMed1989

Chronic intussusception in children.

Nine children presented with intussusception lasting for 14 days or more. Their mean age was 8.5 years. Diagnosis of intussusception was delayed considerably, probably due to an unusual presentation. Compared with acute intussusception, symptoms consist of infrequent attacks of abdominal pain, sporadic vomiting and no, or small, changes in defecation. Marked weight loss and an abdominal mass assume diagnostic significance, in contradiction to bloody stools. Ultrasonography can be of diagnostic value. An attempt at hydrostatic reduction is often unsuccessful. A high frequency of organic lesions precipitating intussusception warrants early surgical intervention.

Adolescent↗
PubMed1993

Intra-anal intussusception: diagnosis by posteroanterior stress proctography.

Intra-anal intussusception was diagnosed in eight of 39 patients on evacuation proctography. Posteroanterior views revealed prolapse of the infolded rectum into the anal canal on staining in seven of eight patients, associated with splaying open of the anal canal and sudden distal movement of the fold during prolapse. Similar changes were seen in four of 31 patients in whom intussusception had not been diagnosed on lateral evacuation proctography. The pattern of the collapsed rectum was assessed for fold length, thickness, and angulation in relation to the midline of the rectum. Infoldings that prolapsed were closer to the anorectal junction on stress (mean 14.6: 42.4 mm, p < 0.0001) showed greater change in height between rest and strain (28.8: 14.6 mm, p < 0.05) and became more acutely angled during straining (41.9: 5.3 degrees, p < 0.01). Intra-anal intussusception may be missed in 33% (four of 12 patients) on routine evacuation proctography. Posteroanterior stress proctography is a simple supplementary examination to validate intussusception.

Adult↗
PubMed1993

Intussusception caused by a carcinoma of the cecum during pregnancy: report of a case and review of the literature.

A case of intussusception due to a carcinoma of the cecum during pregnancy is reported. A 27-year-old pregnant female was admitted to Shimodate Municipal Hospital because of abdominal pain, nausea and vomiting. Her abdomen was distended, and a relatively hard mass was palpable in the right hypochondrium. Following a diagnosis of intussusception by ultrasonography, a laparotomy was performed. The lesion causing the intussusception was found to be a carcinoma of the cecum, and thus a right hemicolectomy with lymph node dissection was carried out. Histological examination revealed that the tumor was a well-differentiated adenocarcinoma which had invaded the muscularis propria but was superficial to the subserosa. None of the lymph nodes were cancerous. The incidence of colonic cancer above the peritoneal reflection during pregnancy is very low. Only 24 cases have been previously reported; our patient is only the 25th case, as well as being the first case demonstrating Dukes' A. Due to the intussusception, ultrasonography was effective for diagnosis and the patient was able to undergo a curative operation at an earlier stage than other patients.

Adenocarcinoma↗
PubMed1980

Jejunal intussusception in children.

Jejunal intussusception in children is an uncommon form of intussusception often presenting with chronic intermittent abdominal pain and weight loss. Two cases of jejunal intussusception caused by enteric duplication are presented. It is concluded that in the absence of generalized small bowel disease, enteric duplication is the most likely cause of jejunal intussusception in children.

Adolescent↗
PubMed1980

Reliability of the abdominal plain film diagnosis in pediatric patients with suspected intussusception.

In order to reassess the diagnostic reliability of the abdominal plain film examination in suspected intussusception, the findings in 100 consecutive cases of this disorder were analysed. Then, these were compared with the same number of cases in which the diagnosis had been rejected by means of barium enema. It was found that a positive plain film diagnosis of intussusception was possible in 89 patients. In 11 cases inconclusive plain film findings called for supplementary barium enemas to establish the diagnosis. In the reference group intussusception was excluded on the basis of plain film findings alone in 74% of cases. In the remaining 26% of patients a barium enema proved necessary to reject the diagnosis of suspected intussusception.

Barium Sulfate↗
PubMed1986

Proximal jejunal intussusception associated with a long tube.

An intussusception of the small intestine in association with a long tube usually occurs in the vicinity of the mercury-filled bag and can be visualized radiographically by instilling barium directly into the tube. On rare occasions, an intussusception develops in the proximal jejunum and is difficult to recognize. We report the fifth and sixth cases of a proximal jejunal intussusception with a long tube in situ and outline a clinical approach that facilitates a prompt, accurate diagnosis. A proximal jejunal intussusception should be suspected if copious bilious vomiting and abdominal pain occur following intubation of the small intestine with a long tube.

Female↗