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PubMed1987

Enteroenteric intussusception: CT findings in nine patients.

The CT scans in nine proven cases of enteroenteric intussusception were analyzed. Three different CT patterns were observed: a target lesion (n = 5), a reniform mass (n = 2), and a sausage-shaped mass with alternating layers of low and high attenuation (n = 2). Small-bowel series were available within 2-4 days of CT in eight patients and were positive in five. Surgical proof of intussusception was available in seven of the nine patients. Resected small-bowel specimens from patients with the reniform configuration revealed focal ischemic changes. Other objective parameters of ischemia such as acidosis and hyperamylasemia were also present in the two patients with reniform masses. Such changes were not evident in the other patients. This suggests that intussusceptions with reniform configurations warrant more urgent surgical attention. The varying patterns of intussusception on CT should be recognized so that appropriate management can be initiated.

Adult↗
PubMed1992

Plain film diagnosis of intussusception: prevalence of the target sign.

We describe a feature of intussusception seen on plain abdominal films that to our knowledge has not been previously described. The abnormality, termed the "target sign," consists of two concentric, circular, radiolucent lines to the right of the spine superimposed on the kidney. Four observers examined 280 plain abdominal films; 180 were of 94 patients who had had 100 episodes of intussusception and 100 films were of 80 control subjects. The target sign was observed by three or four observers on plain films in 24 (26%) of 94 patients with intussusception and on 4% of radiographs of control subjects. There was no concordance between observers on false-positive findings seen in the control subjects. Our experience suggests that circular radiolucent lines superimposed on the right kidney on plain abdominal radiographs (target sign) constitute a useful diagnostic feature of intussusception.

Child↗
PubMed1993

Gas enema for the reduction of intussusception: relationship between clinical signs and symptoms and outcome.

OBJECTIVE: The aim of this study was to establish the extent to which the clinical features of intussusception can be used to predict successful outcome of gas enema and to determine whether the nonsurgical management of intussusception in children can be improved by refining the criteria used to select patients for gas enema. SUBJECTS AND METHODS: Clinical data on 282 consecutive episodes of intussusception (255 patients) were collected prospectively from January 1987 to July 1991. Gas enema was performed in 273 episodes, in which the clinical signs and symptoms were studied by using logistic regression. Nine patients had primary surgery. RESULTS: Gas enema was successful in 216 (79%) of 273 enemas attempted. Fifty-seven patients had surgery after unsuccessful enema. Univariate analysis showed significant associations between successful enema and duration of signs and symptoms less than 12 hr, no rectal bleeding, absence of small-bowel obstruction, presence of a palpable mass, and normal hydration. Multivariate analysis showed that dehydration, small-bowel obstruction, and duration of signs and symptoms longer than 12 hr were significant predictors of unsuccessful enema; yet, in these groups the rate of success still justified attempted enema. Even in severe dehydration, the successful enema reduction rate was 31%. CONCLUSION: Our data suggest that although the factors identified had some predictive value in determining the outcome of attempted enema reduction, they could not be used to indicate patients in whom enema reduction should not be attempted. All patients with intussusception should have a gas enema if the absolute contraindications to enema (i.e., peritonitis or perforation) are absent.

Child↗
PubMedDate not supplied

[Jejuno-jejunal intussusception in adults secondary to submucosal leiomyoma].

INTRODUCTION: Intussusception is the invagionation of a segment of the intestine into itself. It is a serous condition that most commonly affects infants and children, but can also occur in adults. Intussusception in adults is usually caused by tumors, benign or malignant. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. In older patinets and adolescents the diagnosis can be complicated due to lower incidence and variable subacute symptoms. CASE REPORT: We report a rare case of a 27-year-old patient with increasing abdominal discomfort over several weeks. The patient experienced increasing colics, recurrent vomiting, dehydration and weight loss. Finally he was transferred to the surgical ward of our hospital. Intussusception of the small bowel was diagnosed by CT examination. Laparotomy revealed a jejunojejunal intussusception caused by a small bowel tumor. CONCLUSION: The tumor in the jejunum, almost completely obstructed the intestinal lumen and it was resected and bowel continuity was restored. Histopathological examination revealed a submucosal leiomyoma of the jejunum.

Adult↗
PubMed2001

Adult colonic intussusception: a case report.

Intussusception accounts for almost all cases of intestinal obstruction in children. In contrast, intussusception in adults is relatively rare. An 86-year-old Japanese female with rectal bleeding came to our hospital via ambulance. At first, colonoscopy findings revealed the sigmoid colon cancer. Ultrasonography showed a hypoechoic mass with a multiple concentric ring sign. Computed tomography showed a round fluid-filled cystic structure. Colon contrast studies demonstrated stenosis in the rectosigmoid colon. A laparotomy was performed. The sigmoid colon was intussuscepted to the rectosigmoid colon. We employed both rectosigmoid and sigmoid colon resection. The resected specimen showed that the disease was advanced sigmoid colon cancer with ulcer formation due to an ischemic change. Tumor was 4.5 cm x 2.0 cm in size. The disease was histopathologically diagnosed as advanced sigmoid colon cancer, well-differentiated adenocarcinoma. We report here a case of adult intussusception due to the sigmoid colon cancer.

Aged↗
PubMed1995

Treatment of internal rectal intussusception in patients with chronic constipation.

BACKGROUND: The significance of internal rectal intussusception (rectal invagination) in chronic constipation dominated by symptoms of obstructed defecation is not fully clarified. METHODS: Seventeen consecutive patients with chronic constipation and a history of obstructed defecation with internal rectal intussusception demonstrated by defecography were treated by perineal rectopexy. RESULTS: Of 15 patients followed up for more than 2 years defecography showed total disappearance of the intussusception in 12. Five of these claimed substantial improvement (42%; 17-72%). Three of four patients with concomitant anal incontinence became fully or partly continent after the rectopexy. CONCLUSION: In some patients with chronic constipation, dominated by symptoms of obstructed defecation, rectal invagination may be an aggravating factor. The study indicates that rectal invagination does not seem to be the cause but rather a consequence of the obstructed defecation. In selected patients, including those with concomitant faecal incontinence, surgical treatment of the intussusception by a minor procedure may be indicated.

Constipation↗
PubMed1990

The use of butorphanol tartrate for the prevention of canine intussusception following renal transplantation.

Butorphanol tartrate (0.05 mg/kg, im) was included in the preanesthetic medication in 15 out of 29 conditioned female mongrel dogs (22.7-27.3 kg body wt) undergoing renal autotransplants as part of a 48-h kidney preservation study. Four postoperative intussusceptions were noted (3 jejunojejunal, 1 ileocolic) among the 14 dogs without butorphanol, whereas no intussusceptions developed in the 15 dogs receiving butorphanol as part of the preanesthetic protocol. In a prior study, 2 out of 18 dogs undergoing renal autotransplants without the use of butorphanol as part of a 24-h kidney preservation study developed intussusceptions (jejunojejunal). With the exception of butorphanol the anesthetic protocol was the same for all 47 dogs receiving transplants. Throughout these studies the surgical team remained constant, and all dogs were negative for parasites and systemic infectious disease pre- and postoperatively. The results indicate that the use of butorphanol tartrate as part of a preanesthetic protocol is effective in preventing canine intestinal intussusception following renal autotransplantation.

Animals↗
PubMed2004

Childhood intussusception at the Moi teaching and Referral Hospital Eldoret: management challenges in a rural setting.

OBJECTIVE: To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome. DESIGN: A retrospective descriptive study covering the period January 2000 to December 2003. SETTING: Moi Teaching and Referral Hospital, Eldoret. PATIENTS: Thirty six children. RESULTS: Of the 36 children, 28 (78%) were males and eight (22%) females giving a ratio of 3.5:1. Median age was six months with a range of 2-72 months. The duration of symptoms was a mean of 5 days with a range of 1-14 days. Sixty one percent were referrals. Initial diagnosis of intussusception based on signs and symptoms was made in 6 out of 36 (17%) patients. The rest were initially treated for other problems. Decision to refer to surgeons, was based on abdominal distension. Plain x-ray was done in four patients and barium enema in one patient. Seventy five percent of the patients required fluid resuscitation before operation. All patients (100%) were managed operatively. Seventy two percent had ileo-colic intussusception, 8% ile-oileal and 22% colo-colic. Perforation was found in 22% and gangrene in 31%. Sixty seven percent were successfully reduced by "milking" while 33% required resection and anastomosis/or stoma creation. Complications included: anastomatic breakdown, bronchopneumonial renal failure, sepsis, recurrent intussusception and death. Mortality was 14% overall. CONCLUSION: Early diagnosis and presentation coupled with improved peri-operative management are essential in improving outcome.

Child, Preschool↗
PubMed2005

Intussusception as a cause of bowel obstruction in adults.

BACKGROUND: Due to its unspecific presentation, intussusception is often diagnosed with delay in adults. METHODS: From 1986 to 2002, ten patients (men/women: 8/2, median age: 53.6 years) were managed for intussusception. Clinical, radiological and surgical management data were retrospectively analyzed. RESULTS: All patients presented with abdominal symptoms (pain: 10/10, nausea and vomiting: 3/10, diarrhoea: 2/10, "red-currant jelly stool": 2/10) during a median time of 8.3 months (2 days - 6 years) and with a trend for longer duration of symptoms for benign compared to malignant underlying disease (2 years vs 1 month). Two cases had developed acute bowel obstruction at the time of surgery. CT-scan was always performed, with correct diagnosis in seven cases. Ultrasonography (4/10), contrast enema (5/10) or coloscopy (4/10) either missed the intussusception or served merely to confirm the CT diagnosis. At surgery, an underlying lesion (six malignant and four benign tumours) was identified and removed in all cases (four small bowel, three right colon, two ileocaecal and one left colon resections). Eight were undiagnosed previously. CONCLUSIONS: Intussusception is rare in adults, but should be considered in cases of chronic or acute bowel obstructions. Early surgical management allows detection and potential cure of underlying tumours.

Abdominal Pain↗
PubMedDate not supplied

Ultrasonographic signs of intestinal intussusception associated with acute enteritis or gastroenteritis in 19 young dogs.

The ultrasonographic pattern of intestinal intussusception was studied in 19 young dogs with acute enteritis or gastroenteritis. The intussusception was observed to be a target-like mass consisting of a hyperechoic or anechoic center surrounded by multiple hyperechoic and hypoechoic concentric rings in transverse sections. In longitudinal sections, the intussusception appeared as multiple hyperechoic and hypoechoic parallel lines, as a tumor-like or pseudokidney mass, and as a trident-like configuration. Ultrasonography may provide a sensitive, specific, and accurate method of diagnosing intestinal intussusception in young dogs.

Acute Disease↗
PubMedDate not supplied

Pylorogastric intussusception in the dog: a case report and literature review.

A 10-month-old, neutered male Saint Bernard presented for evaluation of acute, severe vomiting. A soft-tissue mass was noted within the stomach on survey abdominal radiographs. The diagnosis of pylorogastric intussusception was made during exploratory celiotomy. The intussusception was manually reduced at surgery, the pyloric antrum was enlarged, and the duodenum was permanently affixed to the abdominal wall in an attempt to prevent recurrence of the intussusception. The dog recovered, has gained weight (5 kg), and has had only one isolated episode of vomiting during the one year since discharge from the hospital. This report documents the fourth reported case of pylorogastric (i.e., duodenogastric, gastrogastric) intussusception in the veterinary literature and is the first report that details the surgical management of the disease.

Animals↗
PubMed2006

Intermittent sonographic guidance in air enemas for reduction of childhood intussusception.

OBJECTIVE: The purpose of this study was to prospectively assess the value of intermittent sonographic guidance in nonsurgical air reduction of childhood intussusception. METHODS: The study group included 86 consecutive childhood intussusceptions confirmed on sonography for which we designed an air enema. With intermittent sonographic guidance of our own method, air was gradually injected to the initial intracolonic pressure of 60 mm Hg, which we attempted for 30 seconds on the initial attempt. If the air enema reduction attempts were not successful at a given pressure setting, we repeated the technique at each pressure setting upgraded by increments of 20 mm Hg up to 120 mm Hg. Surgery was performed when even repeated reduction attempts at the maximum intracolonic pressure of 120 mm Hg were unsuccessful. We calculated the successful reduction rate for the intussusceptions at each pressure setting. RESULTS: The overall success rate of sonographically guided air enema reductions was 95% (82/86). The success rates of air enema reductions at 60, 80, 100, and 120 mm Hg showed progressive increases of 53% (42/86), 67% (58/86), 78% (67/86), and 95% (82/86), respectively, with no immediate recurrence and no gross perforation. CONCLUSIONS: The use of intermittent sonographic guidance in air enemas is thought to help safely increase successful reductions of childhood intussusception even with sufficient air enema attempts.

Air↗
PubMed2000

Extramedullary haematopoietic tumor producing small intestinal intussusception in a beta-thalassemia/hemoglobin E Thai boy: a case report.

The authors report a case of beta-thalassemia/hemoglobin E disease with extramedullary haematopoietic tumor which developed at the small intestine and caused intussusception. A 7 year-old boy with homozygous beta-thalassemia/hemoglobin E presented with recurrent abdominal pain. The abdominal ultrasonography showed ileo-ileal intussusception with a solid mass as the leading point. Resection of the ileal segment was performed. Pathological examination revealed an extramedullary haematopoietic tumor forming an intraluminal polypoid mass, being the leading point of the intussusception. Extramedullary haematopoiesis in the intestinal tract is rare. To our knowledge, this is the first case of extramedullary haematopoietic tumor that produced intussusception of the small intestine in a beta-thalassemia/hemoglobin E patient.

Child↗
PubMed2000

[Carcinoma of the cecum presenting as intussusception].

In intussusception a proximal bowel segment (intussusceptum) invaginates into the lumen of a distal bowel segment (intussuscipiens). In adults intussusception represents a rare cause of intestinal obstruction and is usually secondary to an identifiable lesion that requires surgical treatment other than that of the intussusception itself. We present a 57-year-old woman with metastatic colonic carcinoma of the ileocecal valve and intussusception of the ileum into the cecum. Right hemicolectomy was performed.

Adult↗
PubMed2000

Neonatal intussusception due to a cecal duplication cyst.

Intussusception in the first month of life is rare; however, it should be considered a distinct clinical and pathologic entity. Cecal duplication as the cause of intussusception in a neonate is extremely rare. We report a case of a newborn with ileocecocolic intussusception. She presented with vomiting and bloody stools. Abdominal sonography revealed a target lesion with a cystic component. We performed a laparotomy and found an ileocecocolic-type intussusception which was caused by a cecal duplication cyst. Right hemicolectomy with ileocolostomy was performed. She remained well at one year follow-up.

Cecal Diseases↗
PubMed2000

[Medical-surgical experience of intestinal intussusception. Experience of a university institution].

BACKGROUND: Management of intestinal intussusception in children has evolved from exclusively surgical treatments to nonoperative reduction under fluoroscopic monitoring. AIM: To report a 10 year experience in a University Hospital in the management of intestinal intussusception. PATIENTS AND METHODS: Seventy two patients, aged 2 to 72 months of age, with an uncomplicated intussusception, that were treated by barium or air enema, were studied. RESULTS: The success rate was 73% with barium reductions, and 100% with air reductions. In 17 patients (24%), enema reduction was unsuccessful and were subjected to a surgical reduction. CONCLUSIONS: Nonsurgical reduction is safe and effective as the initial treatment of uncomplicated intussusception in children.

Air↗
PubMed2000

[Recurrent bowel intussusception and celiac disease].

We report a 1-year-old girl with acute abdominal pain. Clinical examination revealed distended abdomen with increased intestinal peristalsis without other pathologic signs. Ultrasound of the abdomen showed a small bowel intussusception. Seven days later, after a new episode of sudden acute abdominal pain, ultrasound revealed a new bowel intussusception. Ig A and Ig G antigliadin-antibodies were elevated and intestinal biopsy revealed total villous atrophy. After being placed on a gluten-free diet the girl was free of colicky complaints and on repeated ultrasound there was no sign of intussusception. With recurrent intussusception, celiac disease should be considered as a cause.

Celiac Disease↗
PubMedDate not supplied

Recurrent intussusception of the sigmoid colon caused by a transanal protruding sessile tubulo-villous malignant polyp.

We report a case of a 35 year-old woman with a large malignant sessile tubulo-villous polyp of the proximal end of a dolico-sigmoid colon causing intussusception and transanal prolapsing. The diagnosis presented some difficulties being the intussusception intermittent. The clinical feature had been initially misdiagnosed for a very large bleeding polyp (5 cm in size), protruding out of the anus with a long pedicle in the rectum. The histology of multiple bioptic samples of the lesion revealed malignancy. Conventional radiologic studies (plain x-rays, barium enema) after metal clips had been placed on the head of the polyp before it rose up the colon, led to the correct diagnosis without, nevertheless, documenting intussusception. An elective surgical resection of the dolico-sigmoid colon allowed the correct diagnosis and the curative treatment of the colonic intussusception and the malignancy.

Adult↗