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PubMed2006

Intussusception of vermiform appendix with microscopic melanosis coli: a case report.

Intussusception of the appendix is a rare occurrence. Due to the similarity of its symptoms with appendicitis, preoperative diagnosis of this condition is extremely difficult. In this report, we present appendiceal intussusception with histological melanosis coli that occurred in a patient on long-term anthranoid laxative use for chronic constipation. Melanosis coli in the appendiceal tissue, as an indicator of chronic laxative intake, may be a clue implying that the appendical exposure to hyperperistalsis for a long time in our case led to the intussusception. We conclude that colonoscopy may help in preoperative diagnosis of appendiceal intussusception in patients with suspicious appendicitis, particularly in those using laxative medication.

Anthraquinones↗
PubMedDate not supplied

Intussusception at the pediatric ward of Dr. Pirngadi Hospital, Medan.

A retrospective study had been conducted on hospitalized infants and children in the Pediatric ward of Dr. Pirngadi Hospital, Medan from January 1, 1987 through December 31, 1988. The purpose is to assess the incidence and clinical manifestations of intussusception. During the same period, there were 6484 infants and children hospitalized, 39 (0.6%) with intussusception, consisting of 23 (58.9%) males and (41.1%) females. Most of the cases (53.85%) were in age group of 4-6 months. Thirty four patients (87.12%) were wellnourished, and 5 patients (12.82%) undernourished. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting (82.05%) and abdominal distention (66.41%). Successful reposition with barium enema occurred in 1 (20%) out of 5 patients. The major symptoms of intussusception were bloody diarrhoea (87.17%), vomiting. Surgical intervention was performed in 22 patients (56.41%). The result was as follows: discharged in good condition in 15 (68.18%) and deaths occurred in the remaining cases (7 cases = 31.82%). Of those 7 cases who died after operation, 2 cases were hospitalized in less than 2 days, 3 cases in less than 3 days and the remaining 2 cases in more than 3 days, after the symptoms developed.

Child, Preschool↗
PubMed1990

[Retrograde jejuno-jejunal intussusception. A rare complication following total gastric resection].

Jejunogastric intussusception is an infrequent complication following simple gastrojejunostomy or Billroth II anastomosis. Jejunojejunal intussusception through enteroenteric anastomosis following total gastrectomy, however, was reported in 2 cases. Here we present a case of a 59-year-old male patient with gastric ulcer who received a total gastrectomy with loop esophagojejunostomy and Braun's anastomosis 10 years previously, then developed retrograde jejunojejunal intussusception through Braun's anastomosis. The patient presented after a day of acute attacks of left upper quadrant pain with bilious vomiting. In-time, an operation was performed with successful results. This complication of retrograde jejunojejunal intussusception has never been reported. Clinical history, diagnosis, and treatment are discussed.

Anastomosis, Surgical↗
PubMed1990

Childhood intussusception.

Intussusception of the intestine continues to be a significant surgical disease of childhood. The currently accepted therapy is to do a barium enema, followed by a laparotomy, if necessary. To evaluate our results in treating this disease, the charts of the last 169 patients admitted to the hospital, with the diagnosis of intussusception, were reviewed. Intussusception was confirmed in 157 patients, 92 of whom underwent successful reduction by barium enema (59 per cent). Sixty-four were treated with laparotomy (41 per cent). Of these 64, 34 were reduced manually (22 per cent) and 30 required resection (19 per cent). Two patients died (1.3 per cent). Our experience is in general agreement with that of other reported series, and we conclude that hydrostatic barium enema reduction is the treatment of choice for intussusception during childhood. Laparotomy should be reserved for those patients in whom the barium enema was unsuccessful.

Barium Sulfate↗
PubMed1989

Duodenal lipoma causing intussusception.

Duodenal intussusception and duodenal lipomas are both rare clinical entities. A case of duodenal intussusception caused by a lipoma is presented. The diagnosis of lipoma may be made endoscopically and radiographically using both upper gastrointestinal series and computed tomographic scan. Intussusception in the duodenum may be partial and cause minimal symptoms, but it has distinctive roentgenographic findings. The treatment of symptomatic lipomas may be endoscopic removal, using snare and cautery, or local excision via duodenotomy. Intussusceptions must be reduced operatively.

Aged↗
PubMedDate not supplied

The pattern of intussusception in Kuwait. A review of 244 cases.

Two-hundred and thirty-three patients with 244 intussusceptions were treated in the Department of Paediatric Surgery, Ibn Sina Hospital, Kuwait, with only one death. Our incidence was around 25 per year. The age for idiopathic intussusception fits that reported in Western countries. Kuwaitis have a lower incidence of intussusception than other nationalities living in Kuwait. Diarrhea seems to precede intussusception in about 19.1% of cases; leading points were found in 8.2%, and recurrences in 4.5% of cases, most of them following barium reduction. Our complications were high, particularly in the operated group. Barium enema has become our first line of management and it has greatly reduced complications and shortened hospitalization times. Those who present early and late are more prone to operative treatment.

Barium Sulfate↗
PubMedDate not supplied

Intussusception: evolution of current management.

The records of 583 children who were treated for intussusception at the Children's Hospital of Buffalo in the period 1930-1985 were reviewed. Following a change in management in 1970 from operative treatment to hydrostatic reduction of the intussusception by barium enema, two main groups are defined. In earlier years 95% of patients underwent operative reduction whereas in the latter period 92% had barium reduction attempted. The remaining 8% in this group had clinical contraindications for hydrostatic enema attempt. Ten percent had pathological lead points. Recurrent intussusception occurred in 50 cases (8.5%), 66% following barium enema reduction and 33% after surgery. The mortality in the earlier group was 3.9% and 1.3% in the latter group. No deaths occurred in patients treated successfully with barium enema reduction, and there were no deaths in the children with simple uncomplicated intussusception requiring surgery.

Child↗
PubMed1987

Intussusception in Nigerian adults.

Eleven Nigerian adult patients with intussusception were seen at the Lagos University Teaching Hospital, Lagos, Nigeria, between 1973 and 1985. The average age of the patients was 43.2 years ± 13.5 SD. The most common types of intussusception encountered were the ileoileal and cecocolic. The cause of the intussusception was idiopathic in four patients (36.3 percent) and malignant in only one patient (9 percent). Malignancy as a cause of intussusception in Nigerian adults is rare, but resection without reduction still appears to be the safest surgical approach because most patients came late to surgery.

Adult↗
PubMed1987

Intussusception: current management in infants and children.

Intussusception remains a leading cause of bowel obstruction in early infancy and childhood. From 1970 to 1985, 83 patients with intussusception were treated. There were 51 boys and 32 girls ranging in age from 2 months to 22 years. Ten patients had a total of 14 separate recurrences; nine occurred during the initial hospitalization. Symptoms on presentation included abdominal pain (80%), palpable mass (60%), rectal bleeding (53%), and lethargy or sepsis (45%). Fifteen children underwent exploration without contrast studies based on duration of symptoms (greater than 5 days) and evidence of severe obstruction on plain abdominal x-ray films. In the remaining children, diagnosis was confirmed by barium enema and hydrostatic reduction was achieved in only 34 patients (42% success rate). Symptoms were present more than 48 hours in 55% of the reduction failures. At operation, five children had spontaneously reduced and an appendectomy was performed. Manual reduction was possible in 32 patients. The intussusception was irreducible in 26 patients, and 18 required temporary stomas. Pathologic lead points were found in 11 patients. Average length of hospitalization was 1.5 days after barium enema reduction, 9.6 days after manual reduction, and 13.8 days after bowel resection. There were no recurrences of intussusception after surgical reduction. A significant morbidity rate was observed with a delay in diagnosis. Adequate preoperative preparation and prompt surgical intervention are associated with 100% survival.

Adolescent↗
PubMed1986

The significance of small bowel intussusception in acquired immune deficiency syndrome.

The etiology, radiographic diagnosis, and surgical management of small bowel intussusception in adults have been well documented in the literature. It has been shown that unlike the intussusceptions seen in infants, the adult variety is in most cases associated with a focal pathological process and that surgical reductions and often segmental resections are indicated. We have recently examined a patient with acquired immune deficiency syndrome presenting with small bowel intussusception who at surgery showed no evidence of a leading pathological cause. The purpose herein is to underline the potential development of transitory intussusceptions in patients with acquired immune deficiency syndrome, based on the common association of diffuse enteritis. In these patients, a correct interpretation of the radiographic findings may prevent unnecessary surgical explorations.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Organic causes of intestinal intussusception].

Most of the case of intussuception are considered idiopathic, up to 90-95%. In only a small proportion of them an organic cause is identified. The authors reviewed their experience, including 80 cases of intussusception out of which, 14 showed an organic cause. Six cases were lymphomas, four lymphoid hyperplasia of the colon, two Meckel's diverticulum, one enteric cyst and one Henoch's purpura. An organic cause should be suspected in a child with intussusception who is older than the typical idiopathic intussusception age (6-8 months). Also in those cases with a history of a chronic intussusception.

Child↗
PubMed1984

The obstructed intussusception in childhood.

In intussusception in early childhood, reduction by barium enema is the treatment of choice. In late cases when there is air and fluid distension of the small bowel on plain x-ray, barium enema is less useful. Generally 20-25% of childhood intussusception presents in this way. We have reviewed the experience of 65 intussusceptions at the Royal Belfast Hospital for Sick Children over the past 5 years and found only one successful barium enema reduction in 22 obstructed intussusceptions.

Barium Sulfate↗
PubMed1978

Gastroscopic reduction of afferent loop intragastric intussusception.

A case is presented of afferent loop intragastric intussusception diagnosed by gastroscopy 18 years after partial gastrectomy with retrocolic gastrojejunostomy. The intussusception was successfully reduced by means of the gastroscope. The symptoms were instantly relieved, with a symptom-free follow-up of 1/2 year. Provided that the intussuscepted segment appears viable it seems justified to aim initially to reduce jejuno-gastric intussusception with the aid of the gastroscope.

Aged↗
PubMed1995

Colo-colonic intussusception caused by lipoma. Case reports.

Intussusception is primarily seen among children, most often as idiopathic ileocolic intussusception (1, 4), and only 5 to 16% of all intussusceptions are seen in adults (1, 8). In contrast to childhood invagination, in adults underlying pathologic processes are identified in 18 to 90% (1, 8). This report presents 2 cases of colo-colonic intussusception caused by a colonic lipoma. The ultrasonic features of this benign tumour are rather characteristic. A definitive diagnosis can be provided by CT.

Adult↗
PubMed1994

[Videoproctography in the study of rectal intussusception. The authors' own experience].

Videoproctography has proved to be a useful diagnostic technique to investigate anorectal disorders; it can provide morphological and functional information which no other diagnostic method yields. From a series of 898 videoproctographs, the findings of 117 patients with rectal intussusception were retrospectively reviewed. The most common symptoms were an incomplete emptying feeling (93% of cases), obstructed defecation (78%), and a feeling of upright rectal weighting (71%). Of the three known types of rectal intussusception, the most common type was distal intussusception (44%), followed by the rectoanal type (38%) and finally by the proximal type (19%). The three types of intussusception were frequently (42%) associated with other disorders of rectal ampulla and especially with rectocele (15%), mucosal prolapse (8%), and descending perineum syndrome (12%); they had different clinical correlations and proctographic patterns and could be recognized in different defecation phases. In our personal experience, proctography with videorecording was a useful diagnostic tool in the dynamic assessment of this morphofunctional disorder which represents one of its major indications.

Adult↗
PubMed1996

A rare case of multiple intussusceptions: intense segmentary lipomatosis of the ileum.

We report a patient who presented with intestinal obstruction; his small intestine showed intense segmentary lipomatosis associated with unusually situated multiple intussusceptions. Preoperatively, we diagnosed intussusceptions in the ileocecal region by ultrasonography and computed tomographic scan. During surgery, the ileum was dilated and contained numerous movable polypoid masses. One reducible intussusception was encountered in the ileocecal region. In addition, an ileoileal intussusception that could not be reduced was resected with an end-to-end anastomosis. At histological examination, more than 150 submucosal lipomas were found.

Adult↗
PubMed1996

Intussusception in an adult secondary to an inverted Meckel's diverticulum.

Intussusception secondary to an inverted Meckel's diverticulum is considered to be a rare occurrence. The pathophysiology of the disease process results in a complicated clinical picture of chronic abdominal pain, lower gastrointestinal bleeding, and recurrent obstructive symptoms that may lead to an unnecessary delay in diagnosis. A case of an inverted Meckel's diverticulum as a lead point for an ileocolic intussusception in an adult is presented. The methods of diagnosis and the salient concepts in the surgical management of intussusception are discussed. Special features regarding the pathophysiology and treatment of an inverted Meckel's diverticulum acting as an intussusception are also reviewed.

Adult↗
PubMed1997

Ultrasound in the diagnosis and exclusion of intussusception.

Intussusception is a major cause of intestinal obstruction in infancy and childhood. Improved results of treatment have followed the increased use of ultrasound imaging and pneumatic reduction. We prospectively studied the value of ultrasound in both the diagnosis and exclusion of intussusception in a peripheral paediatric unit over a four year period from October 1990 to October 1994. In all, 24 patients had a suspected clinical diagnosis of intussusception of which 19 had typical ultrasound findings. The male to female ratio was 8:11 and age at presentation ranged from 2 to 38 months (mean 11.4 months). There were no false negatives and 2 false positives giving a sensitivity to 100% and specificity of 89%. Thus no intussusception was missed by ultrasound examination. Enema reduction was successful in 76% of cases and factors associated with failure of enema reduction included passage of blood per rectum and symptoms for greater than 24 hours. We conclude that ultrasound should be used as a rapid and sensitive screening procedure in the diagnosis and exclusion.

Child, Preschool↗