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PubMed1982

Computed tomography of entero-enteric intussusception.

Characteristic computed tomographic findings of entero-enteric intussusception were demonstrated with in vitro studies of surgically created intussusceptions in canine small bowel. The signs were effective in detecting intussusception in two patients, one with metastatic melanoma and a second with a plasmacytoma, both of whom had previously nondiagnostic standard oral contrast medium examinations. The findings consist of a dilated loop of bowel (the intussuscipiens) with a thickened wall, within which is an eccentric soft tissue mass (the intussusceptum) and an adjacent crescentic low density mass on the mesenteric side, representing the invaginated mesentery.

Abdominal Neoplasms↗
PubMed1989

Jejunogastric intussusception diagnosis and management.

Jejunogastric intussusception is a rare complication following gastrojejunostomy, Bilroth II partial gastrectomy, and Roux-en-Y gastrojejunostomy. We report a recent patient with a retrograde gastrojejunal intussusception, the most common of the four anatomic variants of jejunogastric intussusception. It may present acutely as a surgical emergency with ischemic small bowel or chronically, with severe postprandial discomfort. Surgical correction is mandatory although controversy exists as to the most appropriate corrective procedure.

Aged↗
PubMed1986

Intussusception of the vermiform appendix: a preoperative diagnosis in an adolescent girl.

Intussusception of the vermiform appendix (IVA) in a 14-year-old girl is reported. The diagnosis was made preoperatively, which is rare: only five other cases have been reported. IVA can present with variable symptoms. This patient presented with episodes of recurrent severe paroxysmal pain and vomiting, each episode being separated by several uneventful weeks. The diagnosis of IVA could be made at the fourth attack of colic by the radiological visualization of a "spiral shell" filling defect at the bottom of the cecum that was reducible by intravenous injection of a spasmolytic. Laparotomy with appendectomy rescued the patient from these distressing episodes. Although IVA is an uncommon condition, one should be aware of its existence and include it in the differential diagnosis of acute abdominal syndromes. When confronted with a clinical picture of intussusception in older children or adolescents, one should especially remember this entity as a differential diagnosis with other causes of intussusception, especially tumors.

Adolescent↗
PubMed1999

Intussusception in a tropical country: comparison among patient populations in Jakarta, Jogyakarta, and Amsterdam.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in young children, and high mortality rates remain a problem in developing countries. The purpose of this study was to describe and elucidate the differences in outcome between groups of children with intussusception in Indonesia, a developing country, and The Netherlands, a developed country. METHODS: In this retrospective review, 176 patients were studied in three types of hospitals. A comparison was made among children treated at a primary care rural hospital in Indonesia, at a secondary care urban hospital in Indonesia, and at a tertiary care urban hospital in The Netherlands. RESULTS: Children in the rural community hospital in Indonesia were more severely ill at arrival and had a significantly longer duration of symptoms, an increased incidence of nonviable bowel, and a mortality rate of 20%, in contrast to a mortality rate of 3% in the urban hospital in Indonesia and no deaths in the Dutch hospital. CONCLUSIONS: The mortality of children with intussusception in rural Indonesia is much higher than in urban Indonesia or in The Netherlands, probably because of delayed treatment, which results in more patients undergoing surgery in worse physical condition.

Child↗
PubMed2002

Incidence of rotavirus diarrhea and intussusception in Hong Kong using standardized hospital discharge data.

Incidence for rotavirus and intussusception was estimated from standardized discharge data for all Hong Kong government hospitals (1997 to 1999). Intussusception incidence in infants (78 to 100 of 100,000) was relatively high. The distinct winter seasonality of rotavirus was not evident for intussusception. During the first 5 years of life an estimated 1 child of 28 is admitted with rotavirus infection (4% of all medical admissions).

Age Distribution↗
PubMed1987

Early coma in intussusception: endogenous opioid induced?

A decreased level of consciousness with little abdominal pain or gastrointestinal symptoms is an uncommon, but well described, presentation of infantile intussusception. Its etiology is unclear. We describe a 10-month-old male who presented with coma and miosis, reversible with bolus injections of naloxone on three separate occasions. No opiates were involved and an intussusception was subsequently found. We speculate that the coma and miosis were induced by an endogenous opioid which could also mask the abdominal pain, thus explaining this presentation of intussusception. If so, miosis would be a valuable clue for diagnosing such children.

Coma↗
PubMed1994

Intussusception in association with childhood cocaine intoxication: a case report.

A case report of an 11-month-old infant with cocaine intoxication and intussusception is presented. We present this case because there are no prior reports in the literature of cocaine intoxication associated with intussusception. The diagnosis was not initially considered in this patient. We feel the association is biologically plausible and alert physicians to consider intussusception in the differential diagnosis of the cocaine-exposed child with vomiting and abdominal pain.

Cocaine↗
PubMed2003

Laparoscopic treatment for intussusception of the small intestine in the adult.

The term intussusception refers to a spontaneous invagination of a portion of the intestine into another bowel loop. Its incidence is higher in children, but in adults it causes 1% to 5% of intestinal obstructions. The diagnosis of intussusception in the adult is difficult due to the variability of the symptoms. The condition may be chronic, intermittent, or acute. Surgical intervention is necessary in all cases and in up to 90% of cases an organic lesion inside the invaginated part of the bowel is found to be the lead point. The laparoscopic approach offers both a diagnostic and therapeutic option. Laparoscopy may be used as the final diagnostic or therapeutic tool for intussusception in the adult.

Aged↗
PubMed2004

Asymptomatic small bowel intussusception associated with post-transplant lymphoproliferative disease.

A 2-yr-old boy who had undergone orthotopic liver transplantation for biliary atresia 6 months prior presented with generalized lymphadenopathy. Physical exam revealed lymphadenopathy only; the patient had no gastrointestinal signs or symptoms. CT was used to evaluate the patient's lymphadenopathy. The findings were consistent with PTLD, and an incidental intussusception causing small bowel obstruction was found. The intussusception was successfully managed expectantly, and the patient's PTLD responded to administration of rituximab. The etiology, diagnosis and management of intussusception is discussed.

Antibodies, Monoclonal↗
PubMed2004

Multiplanar reconstruction in adult intussusception: case report and literature review.

We describe the use of computed tomography (CT) with multiplanar reconstruction (MPR) in positive diagnosis of a case of enteric intussusception in an adult. To our knowledge, there have been no previous reports of the use of MPR in this setting. Intussusception in adults is an uncommon cause of bowel obstruction that usually presents with non-specific symptoms. An underlying lesion is found in most cases. Multiplanar reconstruction should be used to confirm the diagnosis of intussusception when suspected on axial views, and should increase the yield of positive diagnoses when used in the assessment of a complex abdominal mass involving the bowel.

Adult↗
PubMed1995

Intussusception of the appendix: a report of three cases with different clinical and pathologic features.

Three cases of intussusception of the appendix (IA) with distinctive pathologic changes were reported. All patients were women with different clinical presentations. Grossly, a complete intussusception was found in one case (case 1), while the others (cases 2 and 3) showed a partial intussusception. In case 1, almost the total segment of the appendix bearing the villous adenoma with focal malignant transformation became completely telescoped into the cecum. In case 2, no underlying appendiceal lesion was disclosed. In case 3, appendiceal endometriosis was found as the point of traction. Awareness of such a rare complication associated with various appendiceal lesions provides a clue for making an accurate diagnosis and selecting appropriate surgical management.

Abdominal Pain↗
PubMed2005

Colonic lipoma with florid vascular proliferation and nodule-aggregating appearance related to repeated intussusception.

A unique case of repeatedly intussuscepted colonic lipoma mimicking an epithelial tumor in a 50-year-old man is reported. The tumor was located in the ascending colon and was approximately 5 cm in diameter. Colonoscopic and barium-enema examinations suggested a huge epithelial tumor because of its nodule-aggregating appearance. In contrast, computed tomography examination showed a fatty element in the core of the lesion. The biopsy specimens suggested a primary angiomatous lesion because of its pronounced vascular proliferation. Because the presumed diagnoses based on the examinations were different, the preoperative diagnosis was not confirmed. The tumor was composed of intramural lipoma with a multiple polypoid mucosa overlay. This lesion was unique in that the lipoma appeared to be within the muscularis propria and the multiple polypoid appearance of its covering mucosa. The mucosal changes including florid vascular proliferation, fibromuscular obliteration and epithelial regeneration suggested a reparative process, with ischemic damage due to the effects of intussusception being the most likely event. It should be kept in mind that even a simple lipoma can have a unique appearance reminiscent of epithelial tumor when it repeatedly experiences intussusception.

Colonic Neoplasms↗
PubMed1987

Intussusception in children: a review of 91 cases.

This is a retrospective study of 91 patients treated for intussusception between 1982 and 1984. Criteria for inclusion in the study were the finding of a classical radiological appearance on Barium enema examination or the presence of an intussusception at operation. The clinical features are described. A protocol of management first reported in 1983 was followed with 90 of 91 patients submitted to a diagnostic and/or therapeutic Barium enema. As a result of recent experience, the protocol has been modified in selected patients at the discretion of the surgeon and the radiologist. A success rate of Barium enema reduction of 78% was achieved, which is higher than in previous Princess Margaret Hospital studies; there was recurrence of the intussusception in 12 patients following hydrostatic reduction. Further Barium enema reduction was successful in 11 and operation in one. There was no mortality and minimal morbidity.

Barium Sulfate↗
PubMed1991

Intussusception in Newcastle in a 25 year period.

The history of intussusception in Newcastle in a quarter of a century is presented by analysis of patient presentation and the results of management. The figures for the early years are incomplete, retrieved from one hospital in the area. For the years 1976-1988, all cases were managed by two paediatric surgeons who kept individual disease indices. One hundred and sixty-five episodes of intussusception in 153 patients were reviewed in this study. There was one death in the series, whereas there had been several in the years preceding it. There has been an improvement in the success of hydrostatic and later pneumatic reduction. These changes are attributed to the development of appropriate skills resulting from concentration of the management of this problem in the hands of paediatric surgeons and radiologists with special training and interest in paediatrics. Enema reduction has been used more aggressively in recent years and has widened criteria. In the series there were 8 patients with causal lead points, none associated with recurrence. The overall recurrence rate within the series was estimated at 8%. There seems to be a high incidence of intussusception in doctors' families.

Abdomen↗
PubMed1994

Childhood intussusception in a regional hospital.

This study reviews all childhood intussusceptions treated over a 6 year period in a regional centre with six visiting general surgeons and two paediatricians. Clinical presentation, management, complications and outcomes were noted and an attempt was made to follow up all cases. There were 20 patients, with a median age of 6 months (range 10 weeks to 17 months). Only one patient had all four classical features of intussusception (pain, vomiting, 'red currant jelly' stools and abdominal mass). Seven patients were managed successfully by barium enema reduction, but 14 required operation, four following failed radiological reduction. There was one intestinal perforation due to attempted barium enema reduction and one patient required a reoperation for ileal gangrene following operative reduction. There were no deaths and there have been no subsequent recurrent intussusceptions although three cases were lost to follow up. There was a delay in diagnosis in some cases (average duration from onset to diagnosis was 34 h). Although delay was incurred by parents in some cases and in peripheral hospitals in others, there is a need for greater awareness by surgeons of the significance of subtle features such as pallor and lethargy in a child with persistent vomiting. Delay in diagnosis is likely to lead to an increased need for primary surgical intervention. Adverse features (age > 3 months or < 2 years; symptoms > 24 h; small bowel obstruction; dehydration > 5%) were predictive of an increased likelihood of surgical resection, and may help avoid inappropriate attempts at radiological reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Barium Sulfate↗
PubMed2001

Sonographic features of small-bowel intussusception in pediatric patients.

OBJECTIVE: Small-bowel intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI. METHODS: The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed. RESULTS: Most of the patients presented with nonspecific symptoms, including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively. CONCLUSIONS: Small-bowel intussusception is often over-looked due to nonspecific clinical presentations. Sonographic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.

Abdominal Pain↗
PubMed1990

Intussusception: factors related to treatment.

To provide guidelines for the choice of treatment of intussusception, 10 factors that are known to be related to the outcome of treatment were studied in a series of 146 children with intussusception. The length of history, vomiting, rectal bleeding, small bowel obstruction, ileoileocolic intussusception, and the presence of a leading point were all significantly related to failure of hydrostatic reduction. Only 'rectal bleeding' and 'duration of symptoms of more than 48 hours' contributed significantly to the prediction of failure of hydrostatic reduction by logistic regression analysis. We believe that as well as the generally accepted contraindications--signs of peritonitis or bowel perforation--the presence of rectal bleeding when symptoms have lasted more than 48 hours is a contraindication to hydrostatic reduction.

Adolescent↗