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PubMed2003

[Ileocoecal intussusception of the terminal ileum caused by a carcinoid tumor].

Intussusception of the intestine is a frequent reason for intestinal obstruction in infants; the course is acute but the causes are often not recognizable. In adults intussusception is the cause for bowel obstruction in only 1% of cases. The course is subacute and in over 90% a benign or malignant process in this part of the intestine is found. We report the case of a 45-year-old male with abdominal discomfort, increasing over weeks. The preoperative ultrasonography and computed tomography of the abdomen revealed the typical finding of ileocoecal intussusception. An ileocoecal resection was performed. The histopathological workup showed a small carcinoid tumour of the terminal ileum.

Carcinoid Tumor↗
PubMed2003

Ileoileal intussusception caused by a Ewing sarcoma tumour. An unusual case report.

Intussusception typically occurs in childhood, presenting with a well-known medical history and clinical symptoms. Pathologically, a "leading point" may be attributed to lymphadenomatosis, polyps, or a tumour. In older patients and adolescents, the diagnosis can be complicated due to the lower incidence and variable subacute symptoms. We report on an 18-year-old patient with increasing abdominal discomfort over several weeks. External diagnostics showed no pathological signs or were misinterpreted as a malfunction of intestinal motility. The patient experienced increasing colics, recurrent vomiting, dehydration and weight loss. Finally he was transferred to our paediatric surgical department and laparotomy had to be performed for the clinical and radiological signs of an ileus. An ileoilealic intussusception was found, caused by a small bowel tumour, which almost completely obstructed the intestinal lumen. It was resected and bowel continuity was re-established. Histopathology revealed a very rare, highly malignant mesenchymal Ewing sarcoma, infiltrating the complete bowel wall. After the postoperative course, the patient was transferred to our oncological department for chemotherapy. In older children or young adults, intestinal malignancies are extremely rare. Nevertheless, if these patients suffer from unspecific complaints of chronic intestinal obstruction, a tumour must be ruled out. A Ewing sarcoma may be responsible for an intussusception.

Adolescent↗
PubMed2004

A case of inflammatory fibroid polyp causing small-bowel intussusception in which retrograde double-balloon enteroscopy was useful for the preoperative diagnosis.

We showed a newly developed method, retrograde double-balloon enteroscopy, to be useful for preoperative diagnosis in a case of inflammatory fibroid polyp accompanied by small-bowel intussusception. A 64-year-old woman was admitted to our hospital with small-bowel intussusception. Results of radiographic and ultrasonographic examination were suggestive of a small-bowel mass. Retrograde double-balloon enteroscopy was performed in an attempt to make a preoperative diagnosis. Endoscopic observation, in combination with histological findings derived from endoscopic biopsy, was suggestive of an inflammatory fibroid polyp. The patient then underwent laparotomy with minimal incision, which revealed a polypoid mass leading to a jejunojejunal intussusception, without bowel necrosis, and a partial small-bowel resection was performed. The pathological diagnosis was an inflammatory fibroid polyp.

Endoscopy, Gastrointestinal↗
PubMed2004

[Capillary hemangioma of the colon as a rare cause of intussusception in adults].

HISTORY AND ADMISSION FINDINGS: A 39-year-old patient presented with a history of constipation, abdominal pain and nausea. Magnetic resonance imaging showed a colonic tumour. Biopsy of the tumour did not reveal the diagnosis. INVESTIGATION: The abdomen was tense on palpation and inflammation parameters were elevated. On abdominal x-ray signs of obstructive colonic ileus could be seen. Endoscopic investigation revealed a tumorous stricture of the transverse colon presenting as intussusception with cockade phenomenon during sonography. TREATMENT AND CLINICAL COURSE: Because of obstructive ileus laparotomy was performed with extended right hemicolectomy and end-to-end ileotransversostomy. Histology showed the rare finding of colonic intussusception due to a capillary hemangioma. Post-operative clinical course was normal without any further signs or symptoms of systemic disease. CONCLUSION: Intussusception in adult patients can be a rare complication due to gastrointestinal hemangioma. Endoscopy and radiologic imaging may help to establish diagnosis. Surgical resection of the involved bowel segment seems to be a safe and effective treatment. Nevertheless congenital disease must be excluded to prevent further complications.

Adult↗
PubMed1990

Air reduction for intussusception in infancy and childhood: ultrasonographic diagnosis and management without X-ray exposure.

For the treatment of uncomplicated intussusception in infants and children, we attempted air reduction without x-ray study to avoid the genetic and carcinogenic effects of radiation. Intussusception could generally be diagnosed by ultrasonography in addition to the history and typical clinical signs without using a barium enema. The success of reduction could also be safely evaluated from the disappearance of both the characteristic sonographic target sign and the abdominal palpable mass, and improvement in the general condition 2 or 3 hours after completing this procedure. This simple, cheap and clean reduction method was applied to 127 patients under strict indications and sedation with diazepam. The successful reduction rate was high (90.6%) and equal to that by hydrostatic reduction. Accordingly, this procedure appears to be safely applicable to the management of uncomplicated intussusception in infancy and childhood.

Air Pressure↗
PubMed1981

Altered consciousness as a precocious manifestation of intussusception in infants.

Two infants aged 5 and 8 months respectively who developed a marked alteration in consciousness as a precocious manifestation of ileo-colic intussusception are reported. Previously described abnormalities of central nervous system function accompanying intussusception are reviewed. It is suggested that in the face of acutely altered sensorium without apparent cause in the infant the diagnosis of intussusception should be considered.

Cognition Disorders↗
PubMed1993

Delayed presentation of intestinal atresia and intussusception--a case report and literature review.

Neonatal intussusception is a rare phenomenon. We report a case where intestinal obstruction became evident after eight days in an infant of 32 weeks gestational age and 0.94 kg birth weight. Laparotomy revealed a type 2 ileal atresia, present as a result of ischaemic injury secondary to intra-uterine intussusception. Resection of the intussuscepted segment was carried out with primary anastomotic repair leading to a good outcome. A period of eight days passed before clinically evident abdominal distension was noted. We address reasons why this may have occurred.

Anastomosis, Surgical↗
PubMed1995

Myoepithelial hamartoma of the ileum: a rare cause of intestinal intussusception in children.

Herein we present a case report of a 2-year-old male child who suffered an ileocecal intussusception not reduced by pneumoenema. At the apex of the intussusception there was a 2 cm tumor. The pathologic diagnosis was myoepithelial hamartoma. In a review of the literature we could find no previous reference to myoepithelial hamartomas located in distal ileum causing intussusception in children.

Child, Preschool↗
PubMed2000

Isolated heterotopic pancreas causing intussusception.

Pediatric intussusception is usually idiopathic in origin, and a pathological lesion at the leadpoint is identified in only a small proportion of cases. Meckel's diverticulum is the most common location when such a lesion is found. Heterotopic pancreas has been seen most frequently in the stomach or duodenum; however, ileal lesions are rare. In the ileum, heterotopic pancreas is usually associated with Meckel's diverticulum and may cause intestinal obstruction by intussusception. However, isolated heterotopic pancreas in the ileum is distinctly rare and usually discovered incidentally during surgery for other conditions. In a review of English language literature, there were only a few pediatric cases of isolated ileal heterotopic pancreas causing intussusception. We report three additional pediatric cases and discuss the clinical significance of this unexpected rare entity.

Choristoma↗
PubMed1991

Childhood intussusception in Ile-Ife, Nigeria.

A retrospective review of 41 intussusceptions encountered in 39 children seen over an 8-year period in Ile-Ife, Nigeria is presented. Most cases (61.5%) occurred in infancy. This contrasts with previous reports from Nigeria where intussusception has been presented as being commoner in older children. Vomiting, abdominal pain, excessive crying and passage of bloodstained stools were the main presenting symptoms. An abdominal mass was palpable in only 28.2% of patients. Generally, patients presented late in hospital with only two (5.1%) arriving within 24 hours of the onset of illness. Hydrostatic reduction with barium enema was attempted in these two patients, and it successfully reduced the intussusception in one and caused partial reduction in the other. Nineteen patients (46.3%) required bowel resection. There were nine deaths, giving a mortality rate of 23.1%. The relatively high bowel resection and mortality rates were attributed to the delay in seeking medical treatment.

Adolescent↗
PubMed1992

Intussusception in children under 2 years of age in the State of Qatar : analysis of 67 cases.

Intussusception is one of the leading causes of bowel obstruction in early infancy and childhood. From 1984-1989, 67 patients under 2 years of age with intussusception were diagnosed and treated in our institution. There were 48 boys and 19 girls ranging in age from 2 months to 2 years with a mean of 7.4 months. Presenting symptoms and signs included abdominal pain (96%), vomiting (93%), rectal bleeding (60%) and a palpable mass (67%). Symptoms and signs were present for less than 24 hours in about 80% of cases. Most of the intussusceptions were of the ileocolic type (75%). The overall success rate of hydrostatic barium enema reduction was 49%. The highest rate of reduction by enema was among patients between 9 and 16 months of age (83%). The success rate of barium enema reduction was negligible after 24 hours of cardinal symptoms. Five children underwent surgical exploration without contrast studies because of delayed presentation and signs of an acute abdomen. A pathological lead point was found in only four cases, the commonest being Meckel's diverticulum. The average length of hospitalization was 2.57 days after barium enema reduction and 7.55 days after surgical reduction. There were no deaths. There was no case of perforation during enema reduction. Three children had recurrence within 3 months of initial presentation. The best outcome is associated with early diagnosis and barium enema reduction, or selected surgical intervention when indicated.

Barium Sulfate↗
PubMed2004

Evaluation of anatomic changes in young children with natural rotavirus infection: is intussusception biologically plausible?

BACKGROUND: Several studies have shown an association between vaccination with the rotavirus vaccine and the development of intussusception. We evaluated the plausibility of a causal association between natural rotavirus infection and intussusception. METHODS: We performed ultrasound measurements, in infants with confirmed rotavirus infection and in healthy control subjects, of the ileum wall thickness and mesenteric lymph nodes, at enrollment and 1 month later. RESULTS: Thirteen pairs of patients with rotavirus infection and control subjects were enrolled. The mean distal ileum wall thickness at the first examination was 3.0 mm in patients with rotavirus infection and 2.0 mm in control subjects (P = .037). The maximum lymph node size in patients with rotavirus infection was 11.6 mm at the first examination and 7.4 mm at the second examination (P = .017). Nodal aggregates and free fluid were also observed more commonly among patients with rotavirus infection (54% vs. 9%; P = .033 for both). CONCLUSION: Rotavirus infection was associated with increased distal ileum wall thickness and lymphadenopathy during the illness period. These changes suggest a plausible mechanism by which rotavirus infection could cause intussusception.

Case-Control Studies↗
PubMed2005

A hexavalent human rotavirus-bovine rotavirus (UK) reassortant vaccine designed for use in developing countries and delivered in a schedule with the potential to eliminate the risk of intussusception.

There is an urgent need for a rotavirus vaccine, because up to 592,000 infants and young children <5 years old die each year from rotavirus diarrhea, predominantly in the developing countries. We have developed a tetravalent human-bovine rotavirus (UK) reassortant vaccine with VP7 (G) specificity for serotypes 1, 2, 3, and 4, which has been shown to be safe, immunogenic, and effective in preventing severe rotavirus diarrhea. However, because of the emergence of VP7 (G) serotype 9 as an epidemiologically important serotype and the importance of VP7 (G) serotype 8 in focal areas, we are planning to add human-bovine (UK) reassortants with G8 and G9 specificity to the tetravalent vaccine, thereby formulating a "designed" hexavalent vaccine for universal use. In addition, we propose that the vaccine be administered orally in a 2-dose schedule, with the first dose given at 0-4 weeks of age and the second dose given at 4-8 weeks of age, when infants are relatively refractory to developing intussusception, thereby avoiding the age period when naturally occurring intussusception is most prevalent (i.e., ages 3-4 months through age 9 months). In this way, there may be the potential to eliminate or at least significantly decrease the risk of intussusception associated with rotavirus vaccination.

Administration, Oral↗
PubMed2001

Enhancing vaccine safety surveillance: a capture-recapture analysis of intussusception after rotavirus vaccination.

The Vaccine Adverse Event Reporting System (VAERS) is the passive reporting system for postmarketing surveillance of vaccine safety in the United States. The proportion of cases of an adverse event after vaccination that are reported to VAERS (i.e., VAERS reporting completeness) is mostly unknown. Therefore, the risk of such an event cannot be derived from VAERS only. To study whether its reporting sensitivity and risks could be estimated, VAERS was linked to data from a case-control and a retrospective cohort study in a capture-recapture analysis of intussusception after rotavirus vaccination (RV). Cases of intussusception after RV were selected from the common time frame (December 1998 through June 1999) and the common geographic area (19 states) of the three sources. Matching occurred on birth date, gender, state, date of vaccination, and date of diagnosis. Thirty-five matches were identified among a total of 84 cases. The estimated VAERS reporting completeness was 47%. The relative risks of intussusception in the periods 3-7 and 8-14 days after RV (relative risk = 22.7 and 4.4, respectively) were comparable with those reported in the two studies. Linkage of VAERS to complimentary data sources may permit more timely postmarketing assessment of vaccine safety.

Adverse Drug Reaction Reporting Systems↗
PubMed2001

Rotavirus vaccine and intussusception: how much risk will parents in the United States accept to obtain vaccine benefits?

Postlicensure surveillance of a newly licensed rotavirus vaccine suggested an increased risk of intussusception. Little was known about the amount of risk parents would tolerate to obtain the vaccine's benefits or the extent to which risk would reduce the price parents would pay for the vaccine. Parents of infants aged 12 months or younger were asked to accept or reject two hypothetical vaccines associated with varying degrees of risk. Parents chose from a list the amount they would pay for two additional hypothetical vaccines, with and without a risk of intussuception. The authors conducted face-to-face surveys in September 1999 among a convenience sample of parents in three US cities. Of 405 eligible parents, 260 (64%) participated. To achieve a 90% acceptance rate, the vaccine could be associated with no more than 1,794 (95% confidence interval: 1,551, 2,025) cases of intussusception in a fully vaccinated, national cohort of infants. The median willingness to pay for three vaccine doses, when vaccination was associated with 1,400 cases of intussusception, was $36 (95% confidence interval: $28, $46) compared with $110 (95% confidence interval: $96, $126) for the risk-free vaccine. The most important aspect of this study may be the methodology to assess how parents balance the benefits and risks of childhood vaccines.

Adult↗
PubMed1977

Jejunal intussusception following small bowel bypass for morbid obesity.

In 600 patients who have undergone small bowel bypass for the treatment of morbid obesity, we have encountered three patients who developed intussusception in the bypassed intestine. Diagnosis in these cases has been difficult but in two patients with surgical marker clips applied to the transected fixed jejunum as well as to the adjacent mesocolon, diagnosis was made easier by the radiographic finding of separation of these clips. Clinical symptoms are difficult to evaluate and valuable time may be wasted before a diagnosis is arrived at. Once a diagnosis is made, operation with either reduction or resection of the area of intussusception should be carried out with refixation of the bowel to the mesocolon and reapplication of surgical marker clips. These marker clips are of great value in the diagnosis of intussusception occurring in the bypassed loop.

Adult↗