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PubMed1997

Appendiceal intussusception as a manifestation of mucinous cystadenoma of the appendix: an interesting clinical entity.

In children, intussusception is a common cause of intestinal obstruction. In contrast, intussusception in the adult is an infrequent cause of intestinal obstruction and in the majority of instances has some obvious cause such as a tumor forming the lead point of the intussusceptum. Diagnosis is suggested by chronic, intermittent symptoms of intestinal obstruction, the presence of an abdominal mass, and the passage of blood per rectum. In contrast to children, treatment is invariably surgical resection without reduction. We have encountered an appendiceal intussusception as a manifestation of a mucinous cystadenoma of the appendix. There was no evidence of pelvic visceral involvement. This unique presentation is rarely reported. The patient underwent uneventful laparoscopy-assisted segmental ileocolonic resection with stapled anastomosis. An analysis of our diagnostic and therapeutic approach, as well as a review of appendiceal pathology as a cause of intussusception are presented to better understand this rare clinical entity.

Appendiceal Neoplasms↗

PubMed1997

[Hydrostatic reduction of intestinal intussusception in children. Experience in 43 cases].

BACKGROUND: Intestinal intussusception, a medical emergency, is more commonly idiopathic and ileocolic and occurs with higher frequency in children aged 6 months to 2 years. Barium enema confirms the diagnosis and allows its hydrostatic reduction, that is the treatment of choice of this condition. AIM: To report our experience with hydrostatic reduction of intestinal intussusception in children. PATIENTS AND METHODS: Hydrostatic reduction was attempted in 43 children with intestinal intussusception: 20 male, aged 2 to 48 months, that consulted at the Clinical Hospital of the Catholic University in Santiago. RESULTS: Hydrostatic reduction was successful in 33 children (77%) that were discharged from the hospital 24 to 96 hours after the procedure. A partial reduction was achieved in 10 patients (23%) who required surgery and were discharged from the hospital 5 to 8 days after the procedure. CONCLUSIONS: Our results are similar to those reported abroad and allow the recommendation of hydrostatic reduction as the treatment of choice for intestinal intussusception.

Barium Sulfate↗

PubMed1996

[The role of hypergastrinemia in the pathogenesis of intussusception in infants].

From 1988 to 1992 the serum gastrin levels of 124 patients with intussusception and 20 normal infants and 15 patients with intestinal obstruction under 3 years of age were measured. Serum cAMP levels of 10 normal infants and 10 patients with intussusception were determined. In animal experiment study, the pressures of ileum cavity and ileoceal valve were determined before and after injectting pentagastrin into the veins of 8 young dogs. The levels of gastrin (219.9 +/- 100.6 pg/ml) and cAMP (32.4 +/- 7.6 pmol/ml) were higher in patient group than in the control group. (89 +/- 3 pg/ml, P < 0.05 and 22.2 +/- 7.5 pmol/ml P < 0.05). The result of animal experiment showed that the effect of gastrin and etiology of intussusception are identical. The main physiological funcitons of gastrin is to increase the intestinal peristalsis and relax the ileocecal sphincter. Our study showed that hypergastrinemia may be the basis etiologic factor of intussusception. Main clinical feactures were explained by this new theory.

Animals↗

PubMed1976

Acute jejunogastric intussusception.

Our patient represents an example of acute retrograde jejunograstric intussusception with the additional finding of a bleeding jejunal ulcer in the intussusception. The ulcer may have been etiological in precipitating the intussusception, or a consequence of mucosal sloughing in the hemorrhagic intussusception. Early diagnosis and immediate surgical therapy resulted in an uneventful recovery.

Acute Disease↗

PubMed1990

Mucosal intussusception to avoid ascending cholangitis.

Many methods have been devised to prevent ascending cholangitis following Kasai's hepatic portoenterostomy for biliary atresia. To investigate the effectiveness of mucosal intussusception in preventing ascending cholangitis, 20 mongrel dogs were randomized to undergo Roux-en-Y cholecystjejunostomy and common bile duct ligation with or without mucosal intussusception. Aeromonas hydrophila was instilled into the gastrointestinal tract. Bacterial cultures were grown from samples taken from the gallbladders and lower jejunum, and blood chemistry and barium studies were performed. The barium studies showed satisfactory lack of reflux in all ten dogs with mucosal intussusception. Only two of them had positive cultures for Aeromonas from the gallbladder 3 days after bacterial instillation into the jejunum. All ten dogs in the control group had positive cultures for Aeromonas from the gallbladder. Our results showed that the mucosal intussusception group had a significantly lower rate of recovery of organisms from the gallbladder compared with the control group when the organisms were instilled into distal intestine (P less than 0.05). The method is worthy of clinical trial as a means of preventing or treating ascending cholangitis.

Aeromonas↗

PubMed2002

Intussusceptive angiogenesis--the alternative to capillary sprouting.

In contrast to sprouting angiogenesis, which is a well established mode of new blood vessel formation, intussusceptive angiogenesis (IA) is a relatively new concept in vascular biology. It was first discovered in the lung as a means of capillary network growth (intussusceptive microvascular growth). The mechanism consists in the repeated insertion of new slender transcapillary tissue pillars, which subsequently increase in size, thus allowing the capillary network to grow in itself (i.e., by intussusception). It could be shown that IA was present in all organs and species investigated so far, so that it appears to be an ubiquitous phenomenon in vertebrates at least. It was not a surprise therefore to find that IA also played a role in tumour vascularisation. Morphological analysis has yet brought evidence for 6 different modes of pillar formation. They all have in common that, at one time, two endothelial leaflets (e.g. of opposite capillary walls) come into close contact, form new junctional complexes, then thin out to finally give way to the invading interstitial tissue, particularly to fibroblasts, myofibroblasts and pericytes. Once such a transcapillary pillar is formed, it can subsequently grow to the size of a normal intercapillary mesh. The addition of collagen fibrils to the pillar core will stabilize the pillar mechanically. Recent observations allowed to extend the IA concept further: The same structural mechanism of intussusceptive pillar formation was shown to contribute also to the formation of vascular trees (arborisation) and to be involved in vascular remodeling. Although numerous growth factors and receptors have already been suggested as being active in IA, very few hard facts are at present available which would allow to get a comprehensive view of IA regulation.

Animals↗

PubMed1997

Gastroesophageal Intussusception Associated with Pneumonectomy in a Dog.

Gastroesophageal intussusception is a rare condition in dogs. We report a gastroesophageal intussusception in an adult dog which had been subjected to unilateral pneumonectomy as a pup. One year after the surgery, computerized tomography scans indicated megaesophagus in the caudal third of the thorax. However, clinically the dog had experienced only a few episodes of vomiting of bile-stained fluid, which was not associated with eating. At 15 months after surgery, the dog was found dead without prior clinical signs of disease. At that time, gastroesophageal intussusception was identified. The cause of the intussusception is not known, although megaesophagus may be a predisposing factor.

Journal Article↗

PubMed1998

Clinical, urodynamic, and histologic effects of urethral intussusception in clinically normal dogs.

OBJECTIVE: To evaluate clinical and histologic effects of surgically created urethral intussusception and determine whether it creates a high-pressure zone that resists passive urine flow in clinically normal dogs. ANIMALS: 8 healthy adult sexually intact female dogs. PROCEDURE: Urethral pressure profilometry was used to measure maximal urethral closure pressure (MUCP) and functional profile length (FPL) in dogs sedated with xylazine hydrochloride and atropine before and 2, 4, 7, 14, 28, 60, and 90 days after surgery. Cystourethral leak point pressure (CLPP) and cystourethral leak point volume (CLPV) were determined in anesthetized dogs immediately before and after surgery. Dogs were assigned to 4 groups of 2 dogs each; groups were euthanatized 4, 14, 28, and 90 days later, and representative tissues were examined. RESULTS: Dog 1 developed complete postoperative urethral obstruction. The procedure was altered, and all dogs recovered without complication. Mild inflammation attributable to surgical manipulation, but not ischemic damage or reduction of the intussusception, was evident. Comparison of preoperative MUCP and FPL with postoperative values did not yield significant differences. Immediate postoperative CLPP and CLPV were significantly higher than preoperative values, but were not significantly increased at euthanasia. A distinct but nonsignificant pressure spike was observed in postoperative urethral pressure profiles and persisted in 7 of 8 dogs. CONCLUSIONS: Urethral intussusception does not have deleterious effects when performed as described. Urodynamic data do not support the premise that urethral intussusception will create a high-pressure zone in the urethra that will resist passive urine flow long term in clinically normal dogs.

Animals↗

PubMed1976

Intussusception in chronic renal failure.

Spontaneous intussusception in adults is rare. Recently, we managed two patients with chronic uremia in whom intussusception developed. Histologic examination of the resected segments showed intestinal intramural hemorrhage. We postulate that the coagulopathy associated with uremia may allow for intestinal intramural hemorrhage, thus forming a nidus from which intussusception may be initiated.

Adult↗

PubMed1992

Ischemic stricture and perforation. An unusual complication after successful barium reduction of an intussusception.

Intussusception is a common cause of intestinal obstruction in infants. Use of a barium enema affords both diagnostic confirmation and a chance for nonsurgical reduction of the intussusception. While failed hydrostatic reduction is an indication for surgical intervention, delayed complications of hydrostatic reduction have not been described. We present a case of ischemic stricture and perforation developing after the successful reduction of an intussusception.

Barium Sulfate↗

PubMed1976

Chronic intussusception in children.

Three children with chronic intussusception are reported together with a review of the literature. Neither the palpation of a mass nor the passage of blood per rectum was necessary for the diagnosis. Weight loss was seen in each case and 1 child was investigated for malabsorption. In all 3 children there was a delay in diagnosis, and it is suggested that a chronic intussusception should be considered more frequently in children with persistent abdominal symptoms for which no cause can be found. Although a barium enema was helpful diagnostically, it did not result in the reduction of the intussusception. The problem of a recurrence after a reduction and its subsequent management is discussed.

Child, Preschool↗

PubMed2001

Sonographic findings in intussusception caused by a lipoma in the muscular layer of the colon.

Lipomas of the gastrointestinal tract are uncommon tumors. Almost all gastrointestinal lipomas are submucosal or subserosal, and most are asymptomatic, although they may cause abdominal pain, bowel obstruction, and gastrointestinal bleeding. The diagnosis of gastrointestinal lipoma is usually not made before surgery. We present a case of colonic intussusception caused by a lipoma that was located in the muscular layer of the colon and was diagnosed preoperatively by sonography. The descending colon appeared edematous and thick. There was layering within the lumen of the descending colon, mimicking the target sign. At the distal end of the intussusception, there was a 4.7-cm, hyperechoic, rounded lesion with a smooth margin. Surgery revealed a polypoid mass originating from the splenic flexure and causing intussusception of the colon, and pathologic analysis confirmed the diagnosis of lipoma of the muscular layer of the colon.

Aged↗

PubMed2006

Appendiceal intussusception diagnosed with endoscopic sonography.

Intussusception of the appendix vermiformis is an uncommon cause of abdominal pain. Several imaging modalities are of limited value in diagnosing this rare condition, including barium enema, transabdominal sonography, and CT. We report a case of intussusception of the appendix vermiformis with the clinical presentation of intermittent abdominal pain in the right lower quadrant. Colonoscopy revealed an erythematous polypoid lesion at the cecal base. Endoscopic sonography demonstrated a multiconcentric structure and enabled the tentative diagnosis of intussusception of the appendix vermiformis. Laparoscopic surgery with a reduction of the appendix and appendectomy was performed and confirmed the diagnosis.

Abdominal Pain↗

PubMed2005

Intussusceptions arising from two different sites in a child with cystic fibrosis.

Abdominal pain is common in individuals with cystic fibrosis (CF). We report on a 17-year old boy with CF and two recognized intussusceptions: the first colonic intussusception was presumed due to distal intestinal obstruction syndrome, and the second enteric one due to polypoid lesions containing heterotopic gastric mucosa. The presentation, pathology, management, and a literature review of intussusception in CF are discussed.

Adolescent↗

PubMed2006

Intussusception: a rare cause of abdominal pain in pregnancy.

A 34-year-old woman presented at 19 weeks in her third pregnancy with abdominal pain and hyperemesis. This was her third admission during the pregnancy for similar complaints. A few days after admission an exacerbation in her pain was noted, in particular on eating or lying down, and a firm and mobile epigastric mass could be palpated separate from her uterus. The differential diagnosis was a hernia or a degenerating pedunculated fibroid. Sonography revealed a mass separate from the uterus with an appearance consistent with intussusception. Magnetic resonance imaging confirmed the diagnosis. A limited right hemicolectomy was performed. The final diagnosis was adenocarcinoma of the colon. It is difficult to diagnose intussusception during pregnancy. The presenting symptoms of nausea, vomiting, abdominal pain and constipation are common in pregnancy and the displacement of the bowel by the gravid uterus hampers examination. Intussusception is very rare in adults and generally it is associated with tumors. Preoperative diagnosis is difficult but possible with accurate imaging.

Abdominal Pain↗

PubMedDate not supplied

Nonfluoroscopic reduction of intussusception by air enema.

Intussusception is a common pediatric condition in China. Hydrostatic reduction with barium sulfate or pneumatic reduction using air and fluoroscopy has become the standard method in most centers throughout the world. To avoid radiation exposure, reduction without fluoroscopic confirmation was studied. Between 1981 and 1985 a total of 224 children were diagnosed and treated for intussusception. The diagnosis was made correctly on clinical grounds in 184 cases; in 40 cases ultrasonography confirmed the clinical diagnosis. Pressurized air reduction was successful in 217 patients (96.9%); seven patients required operative reduction. Ultrasonograms of the abdomen supported the diagnosis in 40 patients and confirmed subsequent reduction. This experience demonstrates that childhood intussusception can be reduced using pneumatic pressure without exposing the patient to ionizing radiation.

Air↗

PubMed1988

Non-surgical treatment of jejunogastric intussusception.

Three cases of retrograde jejunogastric intussusception who were managed endoscopically are described. The diagnosis was made by means of endoscopy in one case and contrast radiology of the stomach in the other two. Endoscopic management consisted of reduction of the intussusception, followed by placement of a feeding tube deep in the intussuscepting segment. The patients responded very well and surgery could be avoided in all of them.

Adult↗

PubMed1997

Intussusception in the 1990s: has 25 years made a difference?

To evaluate the current management of the infant and child with intussusception, the medical records of 188 consecutive intussusception patients over 5 years (1985-1990) were reviewed and compared to our series from 25 years ago (1959-1968). The peak months changed from May and June to January and July. Duration of symptoms and signs prior to diagnosis increased by one-third to 35 h with, however, a decrease in the incidence of pain, vomiting, abdominal mass, and rectal blood. Air was the only contrast used for the hydrostatic enema in the present series and was tried in every case with 81% success; this is a major improvement from 45% in the old series. There were three perforations (1.4%) with air-enema attempts compared with 1 (0.2%) 25 years ago. Recently only 19% of patients required operation but 30% needed resection; 55% of the patients in the older series required operation and 20% needed resection. Ten percent of intussusceptions continue to be found spontaneously reduced at operation. There were many less pathologic lead points in the newer series. The recurrences increased from 4% to 7%, but their reduction rate also increased from 31% with barium to 100% with air. There were no deaths in the last 25 years.

Barium Sulfate↗