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PubMed1997

Gastroduodenal intussusception in a young dog.

A 21-month-old German shepherd crossbreed presented with a nine-month history of intermittent vomiting, anorexia and melaena interspersed with periods of clinical normality. Investigations suggested recurrent pancreatitis and the vomiting resolved with supportive therapy but recurred two weeks later. Abdominal radiographs revealed evidence of an intermittent abdominal mass which, on ultrasonography, had the typical appearance of an intussusception. At laparotomy, a gastroduodenal intussusception was found obstructing the pancreatic and bile duct outflows with perforation of the duodenal wall. The dog was euthanased. Postmortem examination and histology showed no obvious cause for the intussusception but confirmed pancreatic involvement. This is believed to be the first case of gastroduodenal intussusception reported in an animal.

Abdomen↗
PubMed1982

Intussusception--the forgotten postoperative obstruction.

Ten children developed intussusception after laparotomy. The bowel obstruction caused by the intussusception was evident within 8 days of major laparotomy in 8 children and within 39 days in the other two. It developed after the usual postoperative laparotomy ileus, and did not respond to normal non-operative treatment not even to a barium enema. There was one palpable abdominal mass and no rectal bleeding. Only at surgery was the correct diagnosis made. Eight of 10 intussusceptions affected only the small-bowel; most of them were ileoileal, but 2 were ileocolic. Seven of the 10 intussusceptions needed only manual reduction. Postoperative recovery was uneventful.

Abdomen↗
PubMed1993

Intussusception in preterm infants.

Two cases of intussusception in infants born at 26 and 30 weeks' gestation are described. The two infants presented in the neonatal period with abdominal distension, intolerance of feeds, and rectal bleeding. An initial diagnosis of necrotising enterocolitis was made and the infants were treated medically. This led to a delay in the diagnosis of the intussusception. Published work on neonatal intussusception is reviewed and attention is drawn to the fact that the presenting signs and symptoms can be similar to those of necrotising enterocolitis. A diagnosis of intussusception should therefore be considered in any preterm infant with suspected necrotising enterocolitis.

Anastomosis, Surgical↗
PubMed2003

Intussusception and the great smog of London, December 1952.

AIM: To discuss the possible significance of the increased incidence of intussusception in children in relation to the "Great Smog" of London in December 1952. METHODS: Cases of intussusception were recorded in two hospitals in East London for the years 1951, 1952, 1953, and 1954. For 1952 the actual dates of admission were recorded. RESULTS: During the year 1952 the total number of cases of intussusception greatly exceeded that in the previous and succeeding years. Immediately during and after the fog there was a clustering of cases, which only occurred during this period. CONCLUSIONS: The increased incidence of cases during 1952 is thought to reflect the annual variation in incidence resulting from changes in the prevalence of viruses capable of causing intussusception. The clustering of cases in relation to the fog may reflect a facilitated entry of virus through the wall of the terminal ileum due to the effect of swallowed irritants such as sulphurous acid and smoke particles.

Child↗
PubMed1995

Intussusception presenting to a paediatric accident and emergency department.

In a retrospective study, 110 patients episodes with intussusception presenting to a paediatric accident and emergency (A&E) department were reviewed, with particular attention being paid to presenting symptoms, time to diagnosis, radiological investigation, management and outcome. Between 1983 and 1993 100 patients presented to this department with 110 episodes of intussusception. Delay in diagnosis of greater than 12 h from initial medical contact was associated with increased morbidity. Associated factors in delayed diagnosis were departure from the classical symptoms (pain, vomiting and blood per rectum) and the presence of diarrhoea. General practitioner (GP) referral was to the medical team (rather than the surgical team) in around 50% of cases. Irrespective of the specialty of the first hospital doctor to see the patient only 42% were diagnosed correctly within 3 h of admission. In this population diarrhoea is a common symptom of intussusception and should alert the clinician rather than reassure. Because of its many presentations and relative rarity, intussusception remains a difficult condition to diagnose.

Abdomen, Acute↗
PubMedDate not supplied

Intussusception in children: current concepts in diagnosis and enema reduction.

Intussusception cannot be reliably ruled out with clinical examination and plain radiography. However, a contrast material enema study and ultrasonography (US) allow definitive diagnosis of intussusception. The components of an intussusception produce characteristic appearances on US scans. These appearances include the multiple concentric ring sign and crescent-in-doughnut sign on axial scans and the sandwich sign and hayfork sign on longitudinal scans. Indicators of ischemia and irreducibility are trapped fluid at US and absence of blood flow at Doppler imaging. The aim of enema therapy is to reduce the greatest number of intussusceptions without producing perforation. Barium, water-soluble contrast media, water, electrolyte solutions, or air may be used with radiographic or US guidance. The differences in reduction and perforation rates between the various types of enemas are probably due more to perforations that occurred before enema therapy and the pressure exerted within the colon than to the contrast material used. The pressure within the colon is more constant with hydrostatic reduction than with air reduction; this fact may explain the lower risk of perforation with hydrostatic reduction. Radiation exposure is lower with air enema therapy than with barium enema therapy and is absent in US-guided enema therapy.

Air↗
PubMedDate not supplied

Ultrasound-guided hydrostatic reduction of childhood intussusception: technique and demonstration.

The authors review the technique of ultrasound-guided hydrostatic reduction of childhood intussusception and illustrate, in real-time fashion, the treatment of three cases with this technique. Two cases of successful reduction of ileocolic intussusception are demonstrated. The third case is an example of the complex fronded appearance of ileo-ileocolic intussusception and failed reduction. This technique is recommended as an alternative method for the treatment of childhood intussusception, as it does not involve ionizing radiation and is a simple and safe procedure.

Enema↗
PubMed1983

The use of glucagon in hydrostatic reduction of intussusception: a double-blind study of 30 patients.

Thirty patients were referred for hydrostatic reduction of ileocolic intussusception. Children with suspected gangrenous bowel or sensitivity to glucagon were excluded from the investigation. A standard protocol for the procedure was used in all patients, including the intravenous administration of glucagon or placebo (0.05 mg/kg) when the intussusception was encountered. Successful reduction was achieved in 53% of both control and glucagon-treated patients. Analysis of the length of the procedure and the ease of reduction of the intussusception indicated no difference in the two groups. This multicenter double-blind study failed to show any therapeutic value of glucagon in hydrostatic reduction of intussusception.

Barium Sulfate↗
PubMed1989

Ileocolic intussusception: new sign on the supine cross-table lateral radiograph.

The ability to detect ileocolic intussusception on the supine cross-table lateral radiograph of the abdomen in infants was prospectively evaluated in 12 cases (including two recurrences) over a 2-year period. The intussusceptions (including one recurrence) were directly depicted on five radiographs as a homogeneous water-density mass producing a convex interface with bowel gas at the anterior part of the abdomen. In another four patients, the intussusception produced an inappropriate craniocaudal separation of gas-filled bowel loops in the upper part of the abdomen, caudal to the liver shadow. The intussusception was prospectively recognized on the supine cross-table lateral radiograph in nine of 12 cases.

Gases↗
PubMed1990

Rectal intussusception and rectal prolapse: detection and postoperative evaluation with defecography.

The authors studied pre- and post-operative defecograms in 20 patients with rectal intussusception and three with rectal prolapse to assess the value of defecography in detection of these conditions. Eleven patients also had solitary rectal ulcers. Two to 3 months after surgery, patients underwent defecography, and results were correlated with postoperative symptoms. In all three patients with rectal prolapse, and 13 of 20 with intussusception, findings on postoperative defecograms were normal and symptoms were gone. Abnormalities and symptoms persisted in two patients and recurred in another two. In five patients, symptoms persisted despite normal defecographic findings. In 11 patients with solitary rectal ulcers, rectal lesions were cured in nine; in two, intussusception and rectal lesions recurred. Thus, presence or absence of solitary rectal ulcer corresponded to postoperative symptoms in all cases. Symptoms and postoperative defecographic findings corresponded in 20. This study suggests that rectal intussusception and prolapse most likely lead to defecation disorders and that defecography is useful in detecting them.

Defecation↗
PubMed1992

Pneumatic reduction of intussusception: 5-year experience.

Pneumatic reduction of 246 intussusceptions was attempted in 219 patients over a 5-year period. The mean age of the patients was 15.4 months. Successful reduction was achieved in 199 cases (80.9%). Bowel perforation occurred in seven cases (2.8%), requiring needle decompression of tension pneumoperitoneum in one case. Recurrence of intussusception occurred in 27 cases (11%). The mean fluoroscopy time was 3.5 minutes +/- 0.2 in successful reductions and 9.3 minutes +/- 0.9 in failed reductions (P less than .001). Logistic regression analysis helped identify four independent predictors of failure, as follows: (a) ileoileocolic intussusception (P less than .001), (b) long duration of symptoms (P less than .001), (c) rectal bleeding (P less than .01), and (d) failed reduction with barium at another institution (P less than .05). Predictors of bowel perforation were a younger age (P less than .05) and long duration of symptoms (P less than .05). Surgery was performed in 48 cases (19.5%), 16 of which required bowel resection. Transmural necrosis of bowel wall was found in nine specimens. The most important predictor of outcome in this series was a long duration of symptoms. Pneumatic reduction is a useful substitute for barium in the management of pediatric intussusception.

Air↗
PubMed1993

Air and liquid contrast agents in the management of intussusception: a controlled, randomized trial.

A randomized study comparing air and liquid contrast agents for diagnosis and reduction of intussusception involved 101 patients. Fifty received liquid contrast material and 51 received air. Rates of diagnosis were 49% (25 of 51) for air and 54% (27 of 50) for liquid contrast material (P = .62). Rates of reduction were 76% (19 of 25) for air and 63% (17 of 27) for liquid contrast material (P = .31). Air enemas resulted in shorter fluoroscopic times in patients without an intussusception and for examinations by radiologists who had performed four or more air enemas. Air enemas were found to be accurate in demonstration of intussusception and at least as effective as liquid contrast medium for reduction of intussusception. In experienced hands, the shorter fluoroscopic time with resultant lower radiation exposure associated with air is an important benefit. There still may be clinical situations, however, in which a liquid contrast agent is preferred.

Air↗
PubMed2005

Jejunogastric intussusception: an unusual cause of hematemesis.

Jejunogastric intussusception is an uncommon but potentially life-threatening complication of a previous gastrojejunal anastomosis. Although jejunogastric intussusception was first described in 1914, fewer than 200 cases have been reported in the English literature thus far. Awareness of this rare complication would help in early diagnosis and appropriate management. Described here is a case report of a patient who presented with hematemesis due to an acute jejunogastric intussusception associated with gangrene of the intussuscepted jejunum.

Abdomen, Acute↗
PubMed2001

Three cases of small bowel intussusception in relation to a rare lesion: inflammatory fibrous polyps.

BACKGROUND/AIMS: Inflammatory fibrous polyps (IFPs), also known as inflammatory pseudotumors, occur rarely in the gastrointestinal tract. IFPs have variable presentations, often presenting as small bowel obstruction due to intussusception or, less commonly, as an incidental finding on radiological examinations or screening colonoscopies. The diagnosis and management of IFPs will be discussed through a review of the literature and a series of cases from our own institution. METHODS: A retrospective analysis of the diagnosis, management and complications of IFPs was performed by a literature review. This was accompanied by a series of 3 cases of IFPs, 2 of which causing intussusception, diagnosed and treated in our own institution. CONCLUSIONS: IFP is a rare disease and has a variable presentation, from asymptomatic to small bowel obstruction due to intussusception. IFPs cannot be differentiated from malignancy without histological examination. Therefore, whether diagnosed incidentally or in the setting of intussusception, the treatment of IFPs is surgical resection of the involved bowel.

Adult↗
PubMed2002

Jejunal intussusception of a gastric lipoma: a review of literature.

Gastrointestinal intussusception is an uncommon condition caused by a pendunculated, gastric tumor being forced through the pyloric sphincter and into the duodenum. An extremely rare case of gastrojejunal intussusception caused by a giant gastric lipoma is described in this article. The patient presented with anemia and weight loss. Initial gastroduodenal endoscopy failed to establish the diagnosis but abdominal ultrasound and computed tomography revealed signs of intussusception possibly associated with a lipoma of the small bowel. At laparotomy a pendunculated, submucosal, gastric lipoma, measuring 10 x 5 cm was found to have been intussuscepted into the jejunum. It was reduced and removed through a gastrotomy. Recovery was uneventful.

Aged↗
PubMed1984

Intussusception associated with necrotizing enterocolitis.

Two premature infants whose clinical picture initially was that of necrotizing enterocolitis eventually developed intussusception. The symptomatology of these two conditions is similar, and when they coexist, recognition of a complicating intussusception is difficult. The pathogenic relationship between necrotizing enterocolitis and intussusception remains obscure. The possibility that necrotizing enterocolitis can be a leading point in the development of intussusception is discussed.

Enterocolitis, Pseudomembranous↗
PubMed2004

Intussusception in early childhood: a cohort study of 1.7 million children.

OBJECTIVE: To describe incidence and temporal trends of intussusceptions in Danish children during 1980 to 2001. METHODS: A population-based cohort study was conducted of 1.67 million children who were younger than 5 years during 1980 to 2001 and were followed up for 6.66 million person-years. The Danish National Patient Registry was used to identify cases of intussusception in the cohort. Age-specific incidence rates were main outcome measure. RESULTS: A total of 1814 cases of intussusception among children who were younger than 5 years were reported from 1980 to 2001. The incidence rate remained fairly constant during 1980 to 1990 but decreased by 55% (95% confidence interval: 43%-65%) from 1990 to 2001. The reduction was most pronounced among children aged 3 to 5 months. CONCLUSIONS: The incidence of intussusception among Danish children declined significantly during the 1990s, particularly among infants 3 to 5 months of age.

Age Distribution↗
PubMed1984

Computed tomography of adult colonic intussusception: clinical and experimental studies.

The CT features of a case of adult ileocolic intussusception and of experimentally induced ileocolic, cecocolic, and colocolic intussusceptions are presented. Both the clinical and experimental cases demonstrated (1) "target" masses with enveloped, eccentrically located areas of low density and (2) interspersed low- and high-density stripes within the intussusception producing a "layered" or "stratified" pattern. This layered pattern of abdominal masses may be characteristic of intussusceptions regardless of location.

Animals↗