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PubMed1993

Exclusion criteria and outcome in pressure reduction of intussusception.

Experience of 53 episodes of intussusception was examined to compare the observed success rate of pressure reduction with potential outcome had stricter exclusion criteria been applied (history > 24 hours, presence of rectal bleeding, radiological signs of intestinal obstruction). With stricter criteria 25 avoidable laparotomies would have been performed. Most infants can be cured of intussusception by pressure reduction and though some must be excluded this decision should be based on clinical assessment by those experienced in its management. Pressure reduction should not be attempted in the absence of a surgeon with regular experience of intussusception.

Humans↗

PubMed2001

Intussusception associated with bacterial meningitis.

Despite its common association with viral illnesses, intussusception has only rarely been found in the presence of bacterial infections. Two infants are described, both of whom were admitted to hospital with bilious vomiting, drowsiness, and dehydration. Both infants required urgent intravenous volume expansion. Intussusception was confirmed, and reduction was achieved by enema in both cases. Recovery was slow, and one infant developed a seizure. Evidence of meningococcal meningitis was found in both, with septicaemia in one. Neurological outcome is normal to date, and there has been no recurrence of intussusception in either case.

Enema↗

PubMed1982

Double intussusception followed by reintussusception in a kitten.

A three-month-old Burmese kitten with diarrhoea developed a double intussusception, with invagination of jejunoileal intussusception into the colon. During surgical repair, about 20 cm of terminal jejunum and ileum were resected and an anastomosis performed 2 cm proximal to the ileocolic valve. A jejunoileocolic intussusception developed three days later and was reduced manually at laparatomy. The cat has grown normally since than and at one year old shows no signs of intestinal dysfunction.

Animals↗

PubMed1989

Caecal intussusception in two ponies.

One case of caecocaecal intussusception (case 1) and one case of caecocolic intussusception (case 2) in ponies are described. Case 1 showed mild abdominal discomfort for seven days followed by sudden death whereas case 2 showed continuous moderate pain for three weeks. At post mortem examination, case 1 showed intussusception of the base of the caecum into the body whereas in case 2, the entire caecum had invaginated into the right ventral colon. Histopathological examination showed that the lesions in both animals had been present for a long time.

Animals↗

PubMed1977

Angiographic diagnosis of small intestinal intussusception.

The outstanding angiographic features of small intestinal intussusception are: (a) abrupt disappearance of mesenteric vessels at the neck of the intussusception with crowding of the vasa recta; (b) appearance of long collateral channels at the neck of intussusception; (c) angulation and retraction of major intestinal branches; (d) reversal of the course and angulation of the invaginated mesenteric vessels; (e) overlapping of the mesentery vessels by branches of the intussuscipiens; (f) abrupt change in the appearance of the vasa rectae of the distended intussuscipiens and the distal nondistended small intestines.

Adult↗

PubMed1980

Intussusception complicated by distal perforation of the colon.

Three cases of perforation of the colon distal to an ileocolic intussusception are presented. Two cases were associated with attempted hydrostatic reduction of the intussusception, while the other was discovered at operation. The mechanism of this complication is not clear. When performing a contrast enhanced examination of the colon and there is a risk of perforation: (a) dilute water-soluble contrast medium should be used; (b) special attention should be paid to the colon distal to the intussusception; and (c) should contrast material be observed in the peritoneal cavity, the enema reservoir should immediately be lowered to the floor to siphon off the liquid from the colon.

Barium Sulfate↗

PubMed1992

Intussusception in children: reliability of US in diagnosis--a prospective study.

To assess the diagnostic value of ultrasound (US) in clinically suspected acute intestinal intussusception in children, the authors prospectively compared US and enema studies in 83 episodes. None of the cases negative at US proved to be intussusception at enema study (negative predictive value = 100%). The sensitivity of US was 100%, and the specificity was 88%. Most of the sonograms were initially obtained and examined by residents. Several unsuspected abnormalities were also found with US. The authors conclude that a few months of training in US appears to be sufficient for high-accuracy investigation of clinically suspected intussusception, enabling selection of those patients in need of an enema.

Barium Sulfate↗

PubMed1994

Transabdominal manually assisted reduction of pediatric intussusception: reappraisal of this historical technique.

PURPOSE: To determine whether manual manipulation of the abdomen during intussusception reduction improves the success rate or affects morbidity. MATERIALS AND METHODS: A retrospective study was performed in 38 cases of intussusception in 35 children over a 33-month period at a pediatric hospital. In all cases, pneumostatic pressure was used as the initial method of treatment. A comparative review of the intussusception literature was also performed. RESULTS: Reduction was achieved with pneumostatic pressure alone in 22 cases (an initial success rate of 58%). Transabdominal manual manipulation was used in 10 cases after initial pneumostatic reduction failed; seven of these 10 cases were treated successfully. These seven additional successes, attributed to manual assistance, significantly improved the success rate from 58% to 76% (P < .016). No perforation or other complication occurred. CONCLUSION: These results and findings of the literature review indicate that transabdominal manual assistance during reduction is a potentially useful technique that has been shunned without scientific basis for longer than 40 years.

Air Pressure↗

PubMed1996

Air enema for reduction of intussusception in children: risk of bacteremia.

PURPOSE: To evaluate the incidence of bacteremia in children undergoing air enema for the diagnosis and reduction of intussusception. MATERIALS AND METHODS: Twenty-seven children who underwent air enema for the diagnosis and treatment of intussusception were evaluated to identify the incidence of transient bacteremia and fever associated with the procedure. Blood cultures were obtained prior to the manipulation (point 0), immediately after completion of the procedure (point 1), and 2 hours later (point 2). RESULTS: The results of six of 81 sets of blood cultures were positive for bacterial pathogens. Three of them that were obtained at point 0 and two at point 1 grew common skin contaminants. A sixth blood culture drawn at point 1 was positive for Staphylococcus aureus. No patient had more than one positive blood culture result, and all recovered without antimicrobial therapy. Five patients had temperature elevations to > or = 38 degrees C following the enema. Only one of the patients was febrile at admission, and none had positive blood culture results. CONCLUSION: The risk of bacteremia from enteric pathogens following air enema for reduction of intussusception in children appears to be low.

Air↗

PubMed1998

Intussusception in children: reduction with repeated, delayed air enema.

PURPOSE: To evaluate the efficacy of pneumatic reduction of intussusception with an emphasis on repeated, delayed trials. MATERIALS AND METHODS: Seventy-one patients with intussusception were treated with air enemas. Before 1993, one trial of air reduction was performed; since 1993, up to three trials of air reduction were performed. The patients were categorized according to the duration of signs and symptoms: less than 12 hours (group A), 12-24 hours (group B), and longer than 24 hours (group C). RESULTS: The success rate for air reduction was 83% overall (59 of 71 patients), 89% in group A (25 of 28 patients), 83% in group B (20 of 24 patients), and 74% in group C (14 of 19 patients). The success rate was 70% (19 of 27 patients) before 1993 and 91% (40 of 44 patients) since 1993 (P < .05). When patients in whom air reduction was successful were compared with patients in whom it was unsuccessful, there was a statistically significant difference in radiographic signs of intestinal obstruction and duration of signs and symptoms but no important difference in age or rectal bleeding. There were no episodes of complications. CONCLUSION: Repeated, delayed pneumatic reduction of intussusception improves the outcome.

Case-Control Studies↗

PubMed1987

Neonatal intussusception associated with neonatal small left colon syndrome.

A newborn infant with intestinal obstruction resulting from intussusception associated with neonatal small left colon syndrome is described. Differences between neonatal and infantile intussusception are detailed. Chronic loose intussusception in utero is proposed as one cause of the neonatal small left colon syndrome. Consideration should be given to doing a rectal biopsy and a sweat chloride test to differentiate neonatal small left colon syndrome from Hirschsprung's disease and cystic fibrosis, respectively, when the clinical diagnosis is not readily apparent.

Adult↗

PubMed1997

Intussusception: agonal phenomenon or cause of death?

This paper describes two cases of small intestinal intussusception, one in a child and one in an adult, where the findings at autopsy were atypical. The significance of intussusception in this situation is discussed and the literature related to deaths accompanied by acute small intestinal intussusception in the adult and paediatric population is reviewed. It is concluded that the findings represent a true pathological entity and not an 'agonal' event.

Autopsy↗

PubMed2003

Lessons to be learned: a case study approach. Chronic intussusception in childhood.

Chronic intussusception as a cause of persistent abdominal pain in children is often an overlooked diagnosis. Here we present an eight-year-old boy, who at the age of three years had an acute intussusception reduced hydrostatically with barium and who subsequently had been extensively investigated both in Wales and in Switzerland, for persistent colicky abdominal pain. He was found to have chronic intussusception, with a Meckel's diverticulum being the cause of his symptoms.

Child↗

PubMed1994

Plain film diagnosis in intussusception.

In early childhood intussusception a characteristic gas pattern is often visible on plain radiographs which can be used for diagnosis. To test this hypothesis, radiographs of 163 children with intussusception, and as many controls, were reviewed. By using multivariable analysis, it appeared that five out of seven parameters (reduced amount of gas in the jejunum; lateralization of the ileum; indiscernible caecum; reduced amount of feces in the colon; and visibility of the intussusceptum) had discriminatory value. For each parameter a weighting (in points) was derived and the patients were classified: the higher the score the more likely that an intussusception was present. A sensitivity of 90% and a specificity of 90% were obtained.

Cecum↗

PubMed1997

Transient small bowel intussusception: CT findings in adults.

Transient non-obstructing intussusception is known to occur in adults. While the CT findings in small bowel intussusception have been described in detail, few reports concerning transient cases have been published. We evaluated five patients with non-obstructive jejuno-jejunal invagination. All CT studies showed a target pattern with an intraluminal soft tissue mass, an eccentric mesentery, and a slightly dilated intussuscipiens. Transient intussusception has typical CT features and should be distinguished from more severe forms requiring prompt surgical treatment.

Acute Disease↗

PubMed2004

Intussusception: an uncommon cause of postoperative small bowel obstruction after gastric bypass.

Intussusception of the jejuno-jejunal anastomosis is a rare complication of the Roux-en-Y gastric bypass (RYGBP). There are only 3 previous cases reported in the surgical literature. We describe 2 adults who developed jejuno-jejunal intussusception requiring emergent laparotomy several months after RYGBP. Both patients underwent exploratory laparotomy after the diagnosis was made with abdominal CT scan. Each patient had an uneventful postoperative course after bowel resection and revision of the enteroenterostomy. Small bowel obstruction due to intussusception may occur many months after RYGBP and may present with non-specific symptoms such as crampy abdominal pain, nausea, and vomiting. The diagnosis of this rare entity is typically made via abdominal CT scan. Treatment mandates urgent abdominal exploration with reduction.

Adult↗

PubMed2006

Retrograde intussusception following Roux-en-Y gastric bypass.

A case of retrograde intussusception is presented occurring >1 year following a Roux-en-Y gastric bypass (RYGBP). Presentation may be confusing and lead to a serious delay in diagnosis. Review of the literature shows most intussusceptions following RYGBP are retrograde, and most, if not all, appear to originate in the proximal common channel, as ours clearly did. The average excess body weight loss in these patients is much higher than expected, adding evidence that a dysmotility disorder is involved. A hypothesis is presented regarding the mechanism involved in these retrograde intussusceptions.

Female↗

PubMed2003

Medical treatment of recurrent intussusception associated with intestinal lymphoid hyperplasia.

Intestinal lymphoid hyperplasia (ILH) is an uncommon cause of recurrent intussusception in infants and young children. Surgical treatment has been suggested in the management of this disorder. We report 2 cases in which recurrent intussusception was associated with ILH. A short course of steroids resulted in resolution of both symptoms and hyperplasia. We conclude that when recurrent intussusception occurs in association with ILH, and no other lead point can be identified, it is important that treatment with steroids is considered before resorting to a more radical surgical approach.

Barium Sulfate↗