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PubMed1988

Enema reduction of intussusception by hydrostatic pressure under ultrasound guidance: a report of 377 cases.

Three hundred seventy-seven pediatric intussusception patients were treated by normal saline hydrostatic enema under ultrasound guidance from October 1985 to April 1987. Before reduction, the rate of correct diagnosis by ultrasonography was 100%, and the rate of successful reduction was 95.5% in this group. With this technique there is no risk of x-ray exposure to the patient. The definite criteria for reduction are discussed. Clear echogram was shown during reduction and the ileo-ileo-coli intussusception can be diagnosed. Intestinal perforation, if any, can be accurately recognized at once. This technique is believed to be one of the most promising methods in nonoperative treatment of pediatric intussusception.

Enema↗
PubMed1996

A comparison of colo-colic and ileo-colic intussusception.

There are many differences in the clinical features of intussusception between African and temperate countries. The records of 192 patients with intussusception who presented to the Pediatric Surgical Service at King Edward VIII Hospital, Durban, South Africa during a 10-year period were reviewed. Compared with temperate countries, the patients were older (median, 1 year 7 months), presented later (median, 4.2 days), had a higher proportion of colo-colic lesions (17%), had absence of primary bowel pathology, and had a high surgical rate (82%). To define clinically important differences, the clinical and pathological features of 158 cases of ileo-colic intussusceptions were compared with 34 colo-colic cases. Compared with the ileo-colic group, colo-colic lesions occurred in older children (median, 3.8 years) (v 1.5 years; P < .001). In the colo-colic group, there were fewer shocked and pyrexial patients, and the rate of successful nonoperative reduction was higher. The groups had a similar incidence of surgical intervention (82%). In the ileo-colic group, there was a higher mortality rate and more complications, but only the higher resection rate (P < .001) was statistically significant.

Age Factors↗
PubMed1996

Perinatal intussusception in premature infants.

Intussusception is common in infants aged 5 to 18 months, but there have been only 12 reports of its occurrence among premature infants. Nine of these previously reported cases with adequate data and one new case are reviewed. Many of the infants were believed to have necrotizing enterocolitis, leading to an average 12-day interval between the onset of signs and the operation. Bilious emesis or nasogastric contents, bloody stool, and intestinal dilation without pneumatosis intestinalis were common. A contrast enema showed the intussusception in only 1 of 7 cases. Most cases were diagnosed in the operating room and underwent successful primary anastomosis, with no recurrences. A pathological lead point was identified in 2 of the 10 cases. The overall mortality rate was 23%; the one death since 1970 was secondary to attempted hydrostatic reduction. These cases may represent what, in the absence of premature delivery, would have been the intrauterine development of intussusception likely leading to small bowel atresia.

Anastomosis, Surgical↗
PubMed1999

Intussusception: the accuracy of ultrasound-guided saline enema and the usefulness of a delayed attempt at reduction.

BACKGROUND/PURPOSE: The aim of this study was to evaluate the therapeutic value of ultrasound (US)-guided saline enema for intussusception and the usefulness of a delayed attempt after at least 30 minutes when reduction has not been complete. METHODS: One hundred ninety-five cases of intussusception were diagnosed with ultrasonography. US-guided saline hydrostatic reduction was performed in 194 with an additional attempt after at least 30 minutes in those cases in which only partial resolution had been achieved. The method was changed (the volume of the reservoir bag and the caliber of the catheter were increased) so we analyze two different periods; 85 cases are included in the first period and 110 in the second. RESULTS: The global rate of successful reduction was 81.9% (159 of 194 cases), and it raised to 88.2% (97 of 110 cases) in the second period. In 15.5% cases (30 of 194) reduction was achieved in a delayed attempt at least 30 minutes after the initial partial resolution. The rate of recurrence was 9.7%. No perforation was seen. CONCLUSIONS: The accuracy of US-guided saline enema in achieving intussusception reduction is high, similar to other methods, avoiding radiation exposure. A delayed attempt after a period of rest increases the rate of reductions.

Child↗
PubMed1989

Hydrostatic reduction of ileocolic intussusception: a second attempt in the operating room with general anesthesia.

Over a 3-year-period, standard treatment with hydrostatic pressure from a contrast enema failed to reduce ileocolic intussusception in 31 of 62 children. With the child anesthetized in the operating room, a second contrast enema was given before laparotomy. Of the 31 intussusceptions, 21 (68%) were reduced without complication, thereby avoiding the discomfort, longer hospitalization, complications, and expense of surgery. Nine of the remaining 10 intussusceptions were difficult to reduce manually during surgery or required resection. The overall nonoperative reduction rate for the 3-year period was 84%; for the last 2 years it was 90%. Success with the second enema may be related to the effects of general anesthesia. In addition, partial reduction with the first enema may improve blood flow from the intussusceptum so that it becomes smaller and easier to reduce with the second enema. Because it can easily be added to standard management protocols without increased risk, routine use of this second enema with anesthesia is recommended.

Anesthesia, General↗
PubMed1990

Two children with lethargy and intussusception.

The cases of two patients with lethargy as the predominant symptom of intussusception are described. The first patient was admitted to the pediatric ICU with unexplained lethargy. The diagnosis of intussusception was made after he developed right lower quadrant abdominal tenderness and heme-positive stool. The second patient was diagnosed after presenting to the emergency department with intermittent lethargy, right lower quadrant abdominal tenderness, and heme-positive stool. The presence of gastrointestinal symptoms or signs in association with lethargy should alert the physician to the possibility of an intussusception.

Abdominal Pain↗
PubMed2001

Data mining in the US Vaccine Adverse Event Reporting System (VAERS): early detection of intussusception and other events after rotavirus vaccination.

The Vaccine Adverse Event Reporting System (VAERS) is the US passive surveillance system monitoring vaccine safety. A major limitation of VAERS is the lack of denominator data (number of doses of administered vaccine), an element necessary for calculating reporting rates. Empirical Bayesian data mining, a data analysis method, utilizes the number of events reported for each vaccine and statistically screens the database for higher than expected vaccine-event combinations signaling a potential vaccine-associated event. This is the first study of data mining in VAERS designed to test the utility of this method to detect retrospectively a known side effect of vaccination-intussusception following rotavirus (RV) vaccine. From October 1998 to December 1999, 112 cases of intussusception were reported. The data mining method was able to detect a signal for RV-intussusception in February 1999 when only four cases were reported. These results demonstrate the utility of data mining to detect significant vaccine-associated events at early date. Data mining appears to be an efficient and effective computer-based program that may enhance early detection of adverse events in passive surveillance systems.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

CT findings of intussusception in adults.

Intussusception is rare in adults, in contrast to its frequent occurrence in infants. The clinical presentation is variable, consisting mainly of abdominal pain that may be chronic, intermittent, or acute. The classic triad of nausea and vomiting, bloody diarrhea, and an abdominal mass typically present in children with intussusception does not usually appear in adults. This diagnosis is, therefore, rarely included in the differential diagnosis of adult patients with vague abdominal complaints. However, with increasing use of CT scanning in the evaluation of patients with abdominal pain, the diagnosis of intussusception can be readily suggested by the radiologist because of its virtually pathognomonic appearance on CT.

Abdominal Pain↗
PubMedDate not supplied

Transient colocolic intussusception.

We present the CT findings of a transient colocolic intussusception, related to an underlying colonic tumor, but remote from it. The resolving nature of intussusception was clearly demonstrated on delayed images and may explain the characteristic chronic clinical symptoms of intussusception in adult.

Abdominal Pain↗
PubMed2006

Jejunojejunal intussusception following jejunostomy.

Jejunojejunal intussusception is a rare complication of jejunostomy, and its preoperative diagnosis and surgical treatment have not been reported. A 78-year-old man suffered from vomiting off and on after emergency exploratory laparotomy with omentoplasty for perforated duodenal ulcer. He also received Witzel jejunostomy for early feeding. Ileus developed postoperatively and plain X-ray of the abdomen showed distended small bowel loop with scanty colon gas. Small bowel series performed with water-soluble contrast medium revealed substantial fluid retention in the stomach, duodenum and proximal jejunum. Infusion of contrast medium into the feeding tube revealed normal caliber of the distal small bowel. Abdominal sonogram revealed target sign as well as the feeding tube in a dilated jejunum. Abdominal computed tomography confirmed the sonographic impression of jejunojejunal intussusception. Reduction of intussusception was done during exploratory laparotomy. The jejunostomy feeding was continued and the postoperative course was uneventful.

Aged↗
PubMed2003

Fatal intussusception in infancy: an experience in forensic autopsy.

Intussusception, although a common cause of pediatric surgical emergencies, is a rarely fatal condition. A 7-month-old infant who was discovered in her cot was unresponsive and pronounced dead after 2 h of uneventful cardiopulmonary resuscitation in an emergency hospital. Forensic autopsy which was performed in order to clarify the circumstances surrounding the death revealed intussusceptions at two sites of the ileum. Although morbidity and mortality rates from the condition have progressively declined in recent decades but avoidable deaths still occur as was experienced in the present case. The forensic pathology significance in this case was the occurrence of 'painless intussusception' whereby the affected child clinically exhibited no discomfort or characteristic features of acute abdomen until death. In summary, the present case has exhibited an uncommon fatal occurrence and demonstrated the importance of forensic autopsy in such unexpected sudden infant deaths.

Autopsy↗
PubMed2006

[Rare cases of intussusceptions in children].

Intussusception is common in children under two years of age. Most of them are idiopathic whereas intussusceptions secondary to focal pathologies are rare. We report of two unusual cases of ileocolic intussusception. In one child a mobile cecum was seen, in the second child a duplication cyst of the ileocecal valve.

Cysts↗
PubMed2000

Acute enteritis or gastroenteritis in young dogs as a predisposing factor for intestinal intussusception: a retrospective study.

Various types of intestinal intussusception were diagnosed in 29 of 220 young dogs with acute enteritis or gastroenteritis, due to canine parvovirus (85 cases) or presumably to other infectious agents, inflammation or less common hypermotility and metabolic derangements (135 cases). As the other causes of the disease were excluded, acute enteritis or gastroenteritis was considered to be the most likely predisposing factor for the intestinal intussusception. The most common type of intussusception was found to be the ileocolic. Of the 21 dogs that underwent surgical resection and anastomosis of the intestine, 18 dogs recovered completely and three died due to complications. The high survival rate was due to the effective pre-operative, surgical and post-operative therapy.

Abdomen↗
PubMed2001

Adult intussuscepted Meckel's diverticulum presenting mainly lower gastrointestinal bleeding.

Herein, we report on an adult with intussusception of an invaginated Meckel's diverticulum presenting mainly with acute intermittent lower gastrointestinal bleeding, whereas the common symptom of abdominal pain, indicating intussusception, was absent. Colonoscopy revealed a reducible polypoid lesion in the ileocecal area. Computed tomography led to suspicion of an intussusception. Surgical resection revealed a Meckel's diverticulum containing an aberrant pancreas. The unique clinical symptoms and the methods of diagnosis are discussed.

Adult↗
PubMed1997

Post-cesarean section pain secondary to intussuscepting colonic adenocarcinoma.

The differential diagnosis for lower abdominal and pelvic pain following Cesarean section includes many causes, such as endometritis, abscess, pelvic hematoma, wound complications, pelvic vein thrombophlebitis, gastrointestinal dysfunction and obstruction. Colonic obstruction secondary to intussusception is a rare cause. We present a case of post-Cesarean section pain in a 26-year-old patient due to obstructing colonic intussusception secondary to colonic adenocarcinoma. Review of the literature failed to identify a previous case report of colonic adenocarcinoma with intussusception presenting early in the postpartum period. The diagnosis was initially made by ultrasound, and later corroborated by computed tomography, barium enema and laparotomy.

Adenocarcinoma↗
PubMed1999

Rectal prolapse of an ileocaecal neoplasm associated with intussusception in a cat.

Intussusception associated with lymphoma of the ileocaecocolic junction was diagnosed in a 12-year-old female domestic short-haired cat that presented with a 3-week history of diarrhoea and a protruding anal mass. Surgical exploration revealed an ileocolonic intussusception proximal to the mass at the ileocaecal junction which was excised. A diagnosis of ileocaecocolic lymphosarcoma was made and euthanasia was later performed. This is an unusual case of an ileocaecal junction tumour that manifested as a rectal prolapse associated with intussusception in a cat.

Animals↗
PubMed2001

Air enema for diagnosis and reduction of intussusception in children: clinical experience and fluoroscopy time correlation.

PURPOSE: The objective of this study was to correlate the fluoroscopy time with radiologic outcome in the pneumoreduction of intussusception in children. METHODS: From September 1995 to December 1997, a prospective analysis of 181 cases of pediatric intussusception with pneumoreduction without sedation was done. A receiver operating characteristic curve of fluoroscopy time was drawn for correlation with radiologic outcome. RESULTS: The overall success and failure rates of pneumoreduction were 84% and 16%, respectively. Three patients (1.6%) experienced colon perforation. The mean fluoroscopy time was 2.8 +/- 1.7 minutes in successful procedure and 4.9 +/- 2.8 minutes in failed procedures (P < 0.001). Analysis of the receiver operating characteristic curve of fluoroscopy time indicates that 4 minutes fluoroscopy time was a good critical point in differentiating successful and failed cases. In those 18 patients who had successful reduction with fluoroscopy times of more than 4 minutes, 4 patients had clinical symptoms for more than 1 day and 14 patients less than 1 day. One of those 4 patients required operation 1 day later because of peritonitis caused by necrosis of terminal ileum. Two patients had high fever in the next 2 days and recovered after antibiotic treatment. CONCLUSIONS: Pneumoreduction is a good method in treatment of intussusception with high successful rate. Four minutes is the critical point of procedure. Reduction with greater than 4 minutes in those patients having illness more than 1 day might not benefit and have more complications.

Air↗
PubMed2002

[Intussusception after Billroth II procedure--an uncommon cause of an upper gastrointestinal ileus].

We present a case of a 73-year-old male patient with Korsakow's disease who was admitted with upper gastrointestinal bleeding and recurrent vomiting. He had received partial gastric resection with Billroth II reconstruction 39 years before for recurrent ulcer disease. At gastroscopy erosive gastritis with no active bleeding and a structure-resembling necrotic mucosa suspicious for intussuscepted small bowel was seen. At exploratory laparotomy jejunogastric intussusception of 50 cm of small bowel through Braun's enteroanastomosis into the gastric remnant was found. After reposition the bowel recovered well and resection was unnecessary. As prophylaxis the bowel was partially attached by sutures in terms of a partial Noble's Operation. The patient's recovery was uneventful after surgery. Jejunogastric intussusception is a rare cause of upper gastrointestinal bleeding and ileus.

Aged↗