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PubMed2001

Adult intussusception due to a malignant polyp: a case report.

Intussusception is primarily a disease of childhood; only about 5 to 10 per cent of cases occur in adults. In contrast to childhood intussusception 90 per cent of adults have an associated pathologic process, usually a malignant lesion. Adult cases do not have the classical symptoms and diagnosis may be difficult. CT scan and barium studies are the most useful diagnostic methods. We report a very rare case of adult ileocecocolic intussusception caused by a pedunculated malignant polyp of the cecum and review the clinical features of intussusception.

Abdominal Pain↗
PubMed1975

Intussusception in the adult.

Intussusception in the adult is an uncommon condition usually with a chronic history but it may occasionally present as an acute process. The clinical picture is most often that of a large or a small bowel obstruction. When the intussusception begins in the small bowel, a benign causative factor is found most frequently, whereas intussusception of the colon is most often secondary to a malignant lesion. Idiopathic causes occur rarely as compared to the pediatric age group. The treatment of adult intussusception is surgical.

Adolescent↗
PubMed2001

The potential for improvement in outcome of children with intussusception in the South Island.

AIMS: To review the experience in the South Island to predict the extent to which the outcome in intussusception might be expected to improve by the introduction of management guidelines and access to a regional specialist paediatric surgical service. METHODS: Children with intussusception treated in the South Island during an eleven year period until 1998 were identified from hospital coding systems, the Southern RegionalHealth Authority and from departmental audit programmes. Details of management and outcome were analysed. RESULTS: Data proved difficult to obtain. There were 83 children identified with intussusception confirmed on enema or at surgery; 76 had an enema that was successful in 44. Delayed repeat enema and gas enema techniques were not used as frequently as might be expected. The operative rate was higher than that reported by other centres. CONCLUSIONS: Current data, coding and audit systems have significant short comings, which limit availability of reliable outcome data. Increased awareness of the expanded indications for enema reduction, use of air (rather than barium) and delayed repeat enemas, and access to specialist paediatric surgical involvement appears to increase the nonoperative rate. Implementation of guidelines for the management of intussusception might be expected to reduce by more than half the number of children undergoing surgery for this condition in the South Island.

Barium Sulfate↗
PubMed2001

Intussusception in an HIV-infected patient: a case report and review of the literature.

Intussusception, the telescoping of one segment of bowel onto an adjacent segment, is uncommon in adults in the United States. This is in contrast to intussusception in the tropics, where most cases occur in adults with GI infections. HIV-infected patients are at high risk for conditions that predispose to intussusception, namely tumors and infections of the GI system. We describe a case of intussusception in an adult patient with AIDS and review the pertinent clinical and diagnostic features of this condition.

Adolescent↗
PubMedDate not supplied

Adult intussusception: the Jos experience.

Twenty two consecutive cases of adult intussusception managed between January 1990 and December 1998 at Jos University Teaching Hospital formed the basis of this study. Thirteen (59.1%) of the patients were males and 9(40.9%) females, with a male to female ratio of 1:4:1 and a mean age of 49.6 years. Most patients were referred late to our service as a result of poor index of suspicion and misdiagnosis. Laparotomy was done in all the cases and in 5(22.7%) patients no cause could be found, but in the remaining 17(77.3%) definite causes were identified which were mainly polyps in 7(31.8%) patients and colonic malignancies in 4(18%). The ileocolic intussusception was the commonest variety. Sixteen (72.7%) patients had bowel resection for colonic carcinoma, gangrenous bowel and irreducibility of the intussusception while manual reduction was successful in the other 6(27.3%) patients. The morbidity rate was 22.7% and the complications were wound infection and adhesive intestinal obstruction. Two deaths were recorded with a mortality rate of 9.1%. The pattern of adult intussusception as seen in the western world was observed in this tropical highland.

Adult↗
PubMedDate not supplied

The morbidity and mortality of laparotomy for uncomplicated intussusception in children.

Non-operative management by pressure reduction is now the preferred treatment for uncomplicated intussusception in children. However, in many developing countries, laparotomy is routinely performed for such cases. This is a retrospective anlaysis of 24 children who had operative reduction of intussusception. The age range was 3 months--10 years (median 7 months) and duration of symptoms 12 hours--7 days (median 2 days). The main features were abdominal pain, vomiting and rectal bleeding. Ten (42%) patients had varying degrees of dehydration, which were corrected. At laparotomy, the intussusceptions were reduced without difficulty. Thirteen (54%) patients developed 15 procedure related complications including wound infection 6(25%), ileus 2(8%), stitch sinus 2(8%), incisional hernia 2(8%), intestinal obstruction from adhesions resulting in intestinal gangrene 2(8%) and aspiration pneumonia 1 (4%). Mortality was 2( 8%) from aspiration pneumonia and overwhelming infection due to intestinal gangrene from adhesive intestinal obstruction respectively. Laparotomy for uncomplicated intussusception in children is attended by significant morbidity and mortality. Many of such intususceptions, may be successfully managed by pressure reduction and children should not be denied the benefits of this form of treatment.

Cause of Death↗
PubMed1992

Adult intussusception in northern Nigeria: a changing disease?

Intussusception in the tropics and sub-tropics had always been regarded as mainly a disease of adults. This paper reports on both a decrease in frequency of the disease in the adult as well as a reduction in the frequency of large bowel involvement. Sixteen adults were treated for intussusception in Ahmadu Bello University Teaching Hospital, Zaria in 10 years. The correct diagnosis was made in one patient prior to operation. Eight intussusceptions were of small intestinal origin and eight were colonic. One patient in the enteric group and three in the colonic group had benign tumours. One colonic tumour was malignant. Eleven intussusceptions were "idiopathic". Four patients in the enteric group had resection; one for neoplasm and three for irreducibility. Four patients in the colonic group had resection, all for neoplasm. Morbidity was minimal and there was no death. A treatment strategy at variance with that advocated in the Western world is suggested.

Adult↗
PubMed1992

[Intussusception in the Pediatric Hospital of Coimbra. 13-year results].

We present the results from 233 consecutive patients treated for intussusception at the Children's Hospital of Coimbra over a 13-year period (between 1/6/77 and 31/5/90). Males outnumbered females (66.5% vs 33.5%) and 87.9% of the cases occurred within the first year of life. Among the presenting signs and symptoms, abdominal pain occurred in 87.9% and vomiting in 81.5%. The presence of currant-jelly stools was less common, but noted in 67.3%. Hydrostatic barium enema was performed in 94.4% of the patients with the aim being both diagnostic and therapeutic, successful reduction was achieved in 57.7%. One hundred and twenty-one patients were operated on with specific pathologic lesion found in 11.5% of them. Complications occurred only in the group submitted to surgery. Six children were reoperated on. Most intussusceptions were of the ileocecocolic variety. The overall recurrence rate was 3.8% (3% recurrent intussusceptions followed barium enema reduction and 0.8% followed manual reduction). Mortality rate was 2.5% (1.7% related to intussusception).

Child↗
PubMed2003

Intussusception associated with a relapsing nephrotic patient: a case report.

BACKGROUND: Gastrointestinal disturbances are encountered frequently in the course of the nephrotic syndrome but intussusception is a rare association. It may be the result of incoordinate motility and bowel wall edema. OBJECTIVE: To report a case of intussusception associated with relapsing nephrotic syndrome. CASE REPORT: The authors reviewed the case of a 5-year-old boy who had been diagnosed as having nephrotic syndrome at Queen Sirikit National Institute of Child Health for 1 year, who later presented with nephrotic symptoms and an acute abdomen. Abdominal ultrasonography and barium enema were performed which diagnosed ileo-colic intussusception. Resection of the ileum and appendectomy were performed while the relapsing nephrotic syndrome was treated by prednisolone. The patient's recovery was excellent. Percutaneous renal biopsy was done because of the frequent relapsing condition and showed mesangial proliferative glomerulonephritis consistent with IgM nephropathy. Intussusception should be included in the differential diagnosis of relapsing nephrotic syndrome presenting with acute abdominal pain. Abdominal ultrasonography is helpful in confirming this condition.

Child, Preschool↗
PubMedDate not supplied

[Bowel intussusception on the child: clinical therapeutical study].

Intussusceptions is the most common cause of bowel obstruction in children between 5 months and 1 year of age. Intussusceptions occurs when a portion of the bowel folds like a telescope, with one segment slipping inside another segment. This study refers to a group of 72 children, with intussusceptions diagnosis between 1975-2000 in our clinic. The authors are also analyzing these cases from the point of view of frequency on years, seasons, age, sex, residence, clinical forms, time since the intussusceptions occurred until the treatment begun.

Child, Preschool↗
PubMed1992

Intussusception of the appendix. A report of four cases and review of the literature.

The clinical and pathologic features of four cases of intussusception of the appendix are reported and the literature is reviewed. All patients had vague abdominal symptoms. The diagnosis of intussusception of the appendix was not made preoperatively in any of these cases. All four patients were females who ranged from 37 to 70 years of age (mean age, 46 years). Examination of the surgical specimens showed tow appendixes that had completely inverted, one with a polyp attached at the base of the appendix forming the intussusceptum and the other with inversion of the appendiceal tip. Three cases were associated with endometriosis and one with a tubulovillous adenoma. Radiologically and endoscopically, the intussuscepted appendix may mimic a neoplastic lesion. Since intussusception may be caused by both benign and malignant conditions, appropriate management will depend on the associated cause.

Adult↗
PubMed2004

[Primary malignant fibrous histiocytoma (MFH) of the small bowel presenting as an intussusception causing small bowel obstruction].

Adult intussusception secondary to primary sarcoma is a rare cause of small bowel obstruction. Only a few cases of malignant fibrous histiocytoma (MFH) of small bowel presenting as an intussusception have been reported in the literatures. We report a case of small bowel obstruction associated with jejuno-ileal intussusception caused by MFH. A 75-year-old man was admitted with an one-month history of vomiting and epigastric pain aggravated with meals. He was diagnosed as an jejuno-ileal intussusception based on CT scanning and underwent small bowel resection and anastomosis. Resected specimens revealed a polypoid tumor in the ileum and the histology of the tumor was consistent with MFH.

Aged↗
PubMedDate not supplied

[Intussusception in adults].

Intestinal intussusception in adults is a very rare entity whose etiology differs greatly from its pediatric counterparts. Three adult patients with intestinal intussusception presented with intestinal obstruction and required surgery for its resolution. In each case a pathologic cause was found. They had intestinal polyps, two benign (lipoma and hamartomatous polyps) and one malignant (metastasis). Intestinal intussusception in adults usually has a pathologic cause. About half have a malignant etiology. Intestinal resection without reduction of the intussusception is the preferred surgical procedure.

Adult↗
PubMedDate not supplied

Surgical aspects of intussusception secondary to Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome (PJS) is a familial condition characterized by the presence of pigmented mucocutaneous spots and intestinal polyposis. Intussusception is the most frequent abdominal complication, but it is very rare. In our country, this is the second known report. In this article we present four cases of PJS associated with intussusception. All the patients were female and all underwent a surgical procedure. The intussusception was located in the ileum and colon. There are no more than 20 reported cases in the world where these two entities are associated. Children with PJS have a high risk of suffering from ileo-ileal or jejuno-ileal intussusception that will frequently require a special surgical procedure.

Adolescent↗
PubMed2005

[Hydronephrosis due to retrograde ureteric intussusception].

Ureteric intussusception is exceptional. The authors report a case of hydronephrosis due to retrograde intussusception of the subpelvic ureter in a 3-month-old boy admitted for respiratory distress syndrome associated with fever of 39 degrees C. Imaging revealed the presence of marked dilatation of the left kidney. Surgical exploration demonstrated hydronephrosis secondary to obstruction due to ureteric intussusception. This is the first case of ureteric intussusception reported in a child.

Humans↗
PubMedDate not supplied

Colonoscopic diagnosis of appendiceal intussusception: case report and review of the literature.

Intussusception of the appendix is an extremely rare condition. Although approximately 200 cases of appendiceal intussusception have been reported in the literature, very few have ever been diagnosed preoperatively. We report a case of appendiceal intussusception secondary to endometriosis in an otherwise healthy female. The case was diagnosed preoperatively by colonoscopy and treated surgically at laparoscopy. We review the literature of appendiceal intussusception and discuss the associated conditions, diagnosis, and a classification scheme for this unusual finding.

Appendix↗
PubMed2005

Postoperative intussusception in children: a review of 14 cases.

OBJECTIVE: To search the etiologic factor, clinical diagnosis points and treatment of postoperative intussusception (PI). METHODS: To retrospectively review the clinical materials of 14 cases with PI including the cause of disease and treatment. RESULTS: PI occurred within 10 days (average 4 days) after the primary operation. Bowel obstructive symptoms gradually emerged. One case was diagnosed with intussusception by sonography and received enema reduction of intussusception by hydrostatic pressure. Thirteen cases were performed secondary operation. Small intestine was main site of intussusception. Manual reduction of the lesion was performed in 12 cases and bowel resection and anastomosis was done in 1 case with bowel necrosis. CONCLUSION: PI should be suspected if child presents with the symptoms of ileus in early postoperative period. Abdominal sonography may have some value on diagnosis of PI. Operation is the first choice for the treatment of PI.

Child↗
PubMed2006

Giant lipoma causing a colo-colonic intussusception.

Intussusception is much more common in children than in adults. Unlike in children, intussusception in adults is associated with an identifiable etiology in 90 per cent of cases. Lipomas are the second most common benign tumors of the colon. Small lipomas are usually asymptomatic and are found incidentally during colonoscopy. Giant lipomas are uncommon causes for colonic intussusception. This usually presents as abdominal pain and vomiting and less commonly as diarrhea. Computed tomography is an excellent method to diagnose giant colonic lipomas, by showing a well demarcated, round, low-attenuated lesion in the lumen of the colon. The definitive treatment for symptomatic lipomas is surgical resection. Both laparoscopic and open resections have been described. Endoscopic resection of colonic lipomas is associated with a high complication rate. In this report, we present a patient with a giant colonic lipoma causing colocolonic intussusception.

Colectomy↗