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PubMed1998

Intussusception: the paediatric radiologist's perspective.

The diagnosis and treatment of idiopathic intussusception of childhood have changed over the last 10 years. Current diagnostic techniques include plain radiographs and ultrasonography. The standard treatment in the absence of peritonitis or free intra-abdominal air is gas enema, followed by surgical intervention if the intussusception remains irreducible. This review, by radiologists for surgeons, describes the current role of imaging in the diagnosis and management of intussusception.

Child↗
PubMed1998

Perforation during gas reduction of intussusception.

Perforation during attempted gas-enema reduction of intussusception is more common than during a barium enema. In a review of 650 consecutive attempted gas enemas, perforation occurred in 7 infants (1.1%). Gross abdominal distension from the pneumoperitoneum may be rapid and cause splinting of the diaphragm, which leads to acute respiratory distress. This complication is readily recognised at the time of the gas enema, and may require immediate intervention by paracentesis using a 14-gauge needle. A review of 7 children with intussusception in whom perforation occurred revealed that all had radiologic evidence of bowel obstruction (air-fluid levels) prior to the enema, and the patients had had a relatively long history since the onset of symptoms. No perforation occurred during a delayed repeat enema reduction. Perforation during gas enema produces minimal peritoneal contamination. No pathological lesion at the lead point of the intussusception was identified in any of the children in whom perforation occurred.

Enema↗
PubMed2002

Postoperative intussusception after incidental appendicectomy.

Postoperative intussusception of the appendiceal stump is a rare complication of appendicectomy. We report an infant who developed an intussusception of the appendiceal stump 2 days following an appendicectomy performed during a right inguinal herniotomy as a day case. The intussusception was diagnosed on ultrasonography and was to be treated laparoscopically, but spontaneous reduction occurred during induction of general anesthesia.

Abdomen↗
PubMed2000

Intussusception of the vermiform appendix: preoperative colonoscopic diagnosis of two cases and review of the literature.

Intussusception of the appendix is an uncommon condition, and the diagnosis is rarely made preoperatively. Making an accurate diagnosis before laparotomy is important in providing the optimal treatment for the patient. We present the clinical and endoscopic features of two cases of intussusception of the appendix and review the literature. Diagnosis was made preoperatively by colonoscopy in these cases and an elective appendectomy was performed. Appendiceal intussusception should be considered in the differential diagnosis of abdominal pain. Colonoscopy can be a valuable tool in establishing this diagnosis and in selecting the appropriate management.

Abdominal Pain↗
PubMed1999

Intussusception in preterm infants: case report and literature review.

UNLABELLED: Intussusception is an extremely rare disorder in preterm infants. An infant of 29 weeks gestational age with this condition is reported and a retrospective analysis of 17 previously reported cases presented. In the reviewed preterm infants, risk factors for intussusception seemed to be multifactorial. Clinical features included severe abdominal distension (17/17), gastric aspirates (13/17), commonly bilious, bloody stools (10/17) and rarely a palpable abdominal mass (5/17). Diagnostic features were signs of small bowel obstruction on the abdominal radiographs. Signs and symptoms were similar to those seen in necrotizing enterocolitis, therefore difficulties in establishing a correct diagnosis led to an average delay of 7 days between the onset of symptoms and abdominal surgery, increasing the risk of developing a compromised bowel. CONCLUSION: The differential diagnosis of an intussusception should be considered in preterm infants with acute abdominal distension and tenderness.

Diagnosis, Differential↗
PubMed2006

Intramural hematoma of the cecum as the lead point of intussusception in an elderly patient with hemophilia A: report of a case.

Hemophilia A is a congenital bleeding disorder characterized by a deficiency of coagulation factor VIII. Intramural hematoma of the colon is a very rare complication of this disease. We report a case of intramural hematoma of the cecum serving as the lead point of intussusception in a 65-year-old man with hemophilia A. The patient presented with right-sided abdominal pain and bloody stool. Palpation of his abdomen revealed a fist-sized mass. Abdominal computed tomography (CT) showed a circular mass with concentric rings, consistent with an intussuscepted intestine. Because his activated partial thromboplastin time (APTT) was prolonged, we gave him a continuous infusion of factor VIII during and after surgery. Laparotomy revealed an irreducible colo-colic intussusception and we identified a cecal hematoma as the lead point. After an unsuccessful attempt at Hutchinson's maneuver, we performed right colectomy. We report this case to illustrate the necessity of monitoring APTT in patients with hemophilia A who undergo surgery.

Aged↗
PubMed2000

Appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ: report of a case.

Appendiceal intussusception is an uncommon pathologic condition; however, villous adenoma of the appendix is a distinctly rare entity. We report herein a case of appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ. A 67-year-old man was admitted to our hospital with a 1-year history of lower abdominal pain for investigation. Barium enema showed a filling defect with an irregular surface in the cecum, and colonoscopy revealed a cecal tumor with a granular surface. Pathological examination of biopsy samples revealed tubulovillous adenoma with well-differentiated adenocarcinoma, and a diagnosis of cecal cancer in tubulovillous adenoma was made. Surgery was performed and the resected specimen was found to contain a tumor arising from the appendix. The tumor was 5.5 x 4.5 cm in size in the cecal cavity, and the appendix had invaginated into the cecum at its base. The cut surface of the appendix showed the villous tumor filling the appendiceal lumen and projecting into the cecal cavity. Microscopic examination revealed well-differentiated adenocarcinoma in tubulovillous adenoma. To the best of our knowledge, this is the first report of appendiceal intussusception caused by tubulovillous adenoma with carcinoma of the appendix.

Adenocarcinoma↗
PubMed1999

Burkitt's lymphoma presenting as ileocaecal intussusception in systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) are reported to have an increased risk of malignancy, especially lymphoproliferative disorders. We decribe the occurrence of ileocaecal intussusception secondary to Burkitt's lymphoma in a patient with SLE. A 23-year-old woman, who had been diagnosed with SLE 2 years ago, developed intermittent abdominal pain with a palpable mass. Computed tomography and a double-contrast barium enema showed a lobulated mass with intussusception at the ileocaecal junction. Right hemicolectomy and splenectomy was performed after histopathological examinations on colonoscopic biopsy revealed Burkitt's lymphoma. Fourteen months after chemotherapy, there is no evidence of recurrence of the Burkitt's lymphoma. When a patient with SLE has abdominal complaints, besides serositis, lupus enteritis such as peptic ulcer disease, mesenteric vasculitis with or without complications and pancreatitis, we have to consider intussusception secondary to gastrointestinal lymphoma as one of the differential diagnoses. Therefore, we should thoroughly investigate patients with SLE presenting with abdominal pain and not simply consider it afeature of lupus enteritis until other causes have been ruled out.

Adult↗
PubMed2004

Small bowel intussusception due to metastatic malignant melanoma. A case report.

Small bowel metastatic deposits attributed to malignant melanoma are found in 2-5% of patients with malignant melanoma of the skin. Ileo-ileo intussusception caused by metastatic melanoma is a very rare condition. The prognosis of metastatic melanoma is poor. We report a case of a cutaneous malignant melanoma which metastasised to the small bowel causing enteroenteric intussusception. This case refers to a 66-year-old male patient who underwent surgery for suspected enteric intussusception. This diagnosis was suggested by computer tomography scan. The patient had had previous surgery for a primary malignant melanoma in the eyelid of the right eye. Segmental intestinal resection with regional lymph node dissection and ileo-ileo anastomosis was performed. Metastatic melanoma in the gastrointestinal tract should be suspected in patients with history of melanoma of the skin and acute gastrointestinal symptoms. Immediate laparotomy and excision of the affected bowel segment is the appropriate treatment.

Abdomen, Acute↗
PubMed1986

Postoperative intussusception after vaginal vault suspension.

Postoperative intussusception in the adult is a rarely reported and poorly understood condition. Presented is the case of a patient developing incomplete small bowel obstruction after an uneventful vaginal vault suspension. Jejunojejunal intussusception, requiring resection, was found at celiotomy. Intussusception must be considered in treating patients developing postoperative intestinal obstruction.

Female↗
PubMed1986

Results of air pressure enema reduction of intussusception: 6,396 cases in 13 years.

Intussusception is the most common surgical emergency of childhood in China. Over the past 10 years, the incidence of intussusception has steadily increased world-wide, as well as in China. For example, 279 cases were treated in the Shanghai Children's Hospital in 1974, while 615 were treated in 1984. Twelve cases were treated in a course of a single night during 1985. Over the past 13 years, for which we have good records, 6,396 cases of intussusception were treated at the Shanghai Children's Hospital. Males outnumber females by a ratio of 2 to 1. In 3,872 cases seen over the past 6 years, 35.1% were under 6 months of age, 65.9% less than 1 year of age, and 88.4% less than 2 years of age.

Age Factors↗
PubMed1990

The leadpoint in intussusception.

Fifty-six patients with a pathological lesion at the leadpoint of their intussusception were encountered at the Royal Children's Hospital, Melbourne, over a 16-year period. The most common lesions were Meckel's diverticula, followed by small bowel polyps, lymphosarcomas, and duplication cysts. Age at presentation was the only factor discriminating these patients from patients with idiopathic intussusception. Unlike previous studies, duration of symptoms was not useful in identifying a pathological leadpoint. Hydrostatic reduction was successful in reducing the leadpoint in three of 21 attempts. Neither morbidity nor mortality was encountered in a policy of initial enema reduction of intussusception, regardless of age.

Adolescent↗
PubMed1990

Postoperative intussusception in a premature infant.

Intussusception occurs most commonly between the fifth and ninth month of life. Affected infants are usually healthy and born at full gestation age. We describe a case of intussusception occurring in a 10-day-old, 700-g neonate born at 28 weeks' gestation. The diagnosis was made at laparotomy 7 days after colostomy for imperforate anus. There were three associated bowel perforations. This case demonstrates that postoperative intussusception can occur in the premature infant. It also serves to illustrate the difficulty in making the diagnosis preoperatively.

Anus, Imperforate↗
PubMed1994

Ultrasound-guided water enema: an alternative method of nonoperative treatment for childhood intussusception.

Ultrasound-guided water enema (USWE) reduction was performed in 115 patients with intussusception, which was diagnosed by ultrasound between April 1988 and August 1992 at Keimyung University Dongsan Medical Center. The overall rate of successful reduction was 80.9%. The rate was 91.0% for patients with symptoms of < or = 24 hours' duration, and 61.1% for patients with symptoms of more than 24 hours' duration (P < .001). Six patients had recurrence during the study period (recurrence rate, 5.2%). There was no perforation or other complications during and after the water enema reduction. The authors conclude that (1) USWE reduction for childhood intussusception has a higher rate of successful reduction and a lower rate of recurrence than does barium enema and (2) USWE is safe and may be an alternative method in the nonoperative treatment of intussusception.

Child, Preschool↗
PubMed1994

Intussusception: a repeat delayed gas enema increases the nonoperative reduction rate.

The operative rate in intussusception has been significantly reduced by (1) expansion of the indications for attempted enema reduction of intussusception to include all children except those with peritonitis or septicaemia and (2) use of the gas (oxygen) enema rather than barium. This prospective study looked at the value of performing a delayed repeat gas enema in children in whom only partial reduction was achieved during the first enema, and who remained clinically stable. Twenty-one patients (of 156 with proven intussusception) had a repeat delayed gas enema, 30 minutes or more after the first attempt at reduction. This was successful in over 50%, reducing the number of patients requiring surgery at our institution by 24% and saving approximately five children a year from surgery.

Child↗
PubMed1995

Interrupted air column in the large bowel on plain abdominal film: a new radiological sign of intussusception.

Intussusception is a frequent cause of small bowel obstruction in infants and toddlers. Early confirmation and treatment are paramount. We have recognized a fairly consistent radiological finding in plain abdominal x-rays that had not been described previously. The study compares the x-ray findings of patients with proven intussusception with those of patients with colicky abdominal pain related to other causes. In association with the relevant symptoms, this "interrupted air column" in the large bowel should alert one to the possibility of intussusception.

Colic↗
PubMed1983

Intussusception following resection of Wilms tumor.

Postoperative intussusception is a documented complication of pediatric surgical and pediatric urologic abdominal operations. In contrast to "primary" intussusception's triad of crampy abdominal pain, palpable abdominal mass, and "currant jelly" stools, postoperative intussusception is generally characterized by abdominal pain and vomiting. An abdominal mass is not usually palpable, and few children have bloody stools. Proper diagnosis and treatment may be delayed because of similar abdominal symptoms in children who may be receiving radiation and chemotherapy, or with prolonged ileus. Two children operated on for Wilms tumor demonstrate the need for awareness of this potential problem in the postoperative patient.

Child↗