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PubMed2002

Outcome of acute intussusception in a regional paediatric centre.

It has been suggested recently that acute intussusception should only be managed in a specialised paediatric centre. The aim of this study is to assess the incidence and outcome of acute intussusception in a comprehensive paediatric unit in Waterford Regional Hospital. It is a retrospective medical records study over a ten year period from June 1990 to June 2000. Our results showed that we had 24 cases giving an incidence of 2.4 cases per year. Contrast enema was performed in 23(95%) cases, successfully reduced in 14(61%) cases, unsuccessfully reduced in 7(30%). Surgical intervention was necessary in 7(30%) cases. Three (12.5%) cases were transferred to a specialised paediatric surgical centre. There were no perforation or death. We conclude from this study that management of acute intussusception can be successfully undertaken in a regional paediatric centre. It requires adequate throughput of cases and close co-operation between paediatrician, radiologist, anaesthetist, surgeons and of course a dedicated paediatric nursing staff.

Child, Preschool↗
PubMed2002

Intussusception as the initial manifestation of AIDS associated with primary Kaposi's sarcoma: a case report.

Kaposi's sarcoma (KS) is the most common AIDS-associated neoplasm. It involves the gastrointestinal tract, skin and lymph nodes with about equal frequency. However, most cases of gastrointestinal KS are clinically silent and found incidentally. We report the case of a 31-year-old homosexual man who developed intussusception in association with a primary ileal KS. He was admitted due to abdominal pain lasting 2 hours. Flat abdominal roentgenogram revealed small bowel ileus in the central abdomen. Abdominal sonography and computerized tomography revealed an intraluminal soft tissue mass in the small intestine with an intussusception. Exploratory laparotomy found an ileal tumor mass 90 cm proximal to the ileocecal valve. Pathologic examination of the resected intestine showed KS. HIV-1 infection was confirmed by Western blot. The CD4 T-cell count was 59/mm3. In conclusion, intussusception by enteric KS may present as the initial AIDS-associated neoplasm in patients with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed2002

The morbidity and mortality of right hemicolectomy for complicated intussusception in infants.

Infants with intussusception in tropical Africa frequently present late. Intestinal resection for gangrene or perforation may warrant a right hemicolectomy. Over a period of 11 year, 15 (45.5%) of 33 infants with intussusception required bowel resection, 10 of which were right hemicolectomies. The age range of those who had right hemicolectomy was 3-9 months (median 6 months) and duration of symptoms 3-8 days (median 6 days). In addition to features of intussusception, seven (78%) infants were dehydrated and one was anaemic. Six (67%) of 9 infants developed procedure related complications postoperatively. Four (44%) had anastomotic dehiscence, associated with abdominal wound dehiscence in 2. In 3 of the patients, the anastomosis leaked again following repeat resection and anastomosis, necessitating relaparotomy and stoma formation. One (11%) patient each had wound infection and prolonged ileus respectively. Six (67%) patients died, including the 4 who had anastomotic dehiscence. The cause of death was overwhelming infection in 4 patients and aspiration of vomitus in two patients. Recommendations are made to minimize morbidity and mortality in these infants.

Colectomy↗
PubMedDate not supplied

Jejunogastric intussusception presenting with outlet obstruction.

A 77-year-old man presented with sudden-onset epigastric pain and bilious vomiting following a light breakfast. Vagotomy and gastrojejunostomy for bleeding duodenal ulcer had been done 22 years ago. Barium meal study suggested jejunogastric intussusception. At laparotomy, a retrograde type II jejunogastric intussusception was confirmed and managed by reduction of the intussusception, disconnection of gastrojejunostomy and resection of the jejunum. Postoperative recovery was uneventful.

Aged↗
PubMed1976

Intussusception in adults.

A review of intussusception in adults treated over a 12-year period is presented. In most cases intussusception was ileocolic in type and symptoms were nonspecific. Benign neoplasms and idiopathic causes were more prevalent in small bowel cases while malignant neoplasms were more common when the colon was involved. In 38% of the cases, no obvious cause for the intussusception was found. All cases were treated surgically, usually by reduction or resection or both.

Adolescent↗
PubMedDate not supplied

Modified noble plication for the prevention of intestinal intussusception after renal transplantation in dogs.

Intestinal intussusception is a frequent problem after experimental transplantation in dogs. This report describes the safety and efficacy of performing a modified Noble plication for the prevention of intussusception. Heterotopic renal transplantation and plication was performed in 20 dogs. Dogs were killed when the serum creatinine concentration exceeded 7 mg/dL because of acute rejection (19 dogs) or venous occlusion (1 dog). Gastrointestinal signs were commonly observed, but no dog experienced an intestinal intussusception, compared to 3 of 14 dogs (21%) previously treated using a similar immunosuppressive regimen. This study supports the routine use of enteroplication in dogs undergoing renal transplantation.

Alkynes↗
PubMedDate not supplied

Intussusception in southern Indian children: lack of association with diarrheal disease and oral polio vaccine immunization.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in young children and has been reported as a complication of a recently withdrawn tetravalent reassortant rotavirus vaccine. METHODS: We studied the history, clinical presentation, management and outcome of intussusception presenting to a tertiary care hospital in southern India over a 10-year period, in order to assess potential association with diarrheal disease and immunization. RESULTS: Data from 137 index cases and 280 control subjects indicated that the risk of diarrheal disease or oral polio vaccine administration in the month prior to presentation was similar in the index cases and controls. Mean time to presentation to hospital after developing symptoms was 1.8 days, and 77.3% of patients required surgery, with 47.4% undergoing intestinal resection. Mortality was 0.006%. CONCLUSIONS: No association could be demonstrated between gastroenteritis or oral poliovirus vaccine immunization and intussusception in southern Indian children. These children presented later and required operative intervention more frequently than has been reported in other studies, but had a good outcome with low mortality.

Case-Control Studies↗
PubMed1955

Barium reduction of intussusception in infancy.

Barium enema reduction was used as the initial routine treatment in 29 infants with intussusception. In 22 of them the intussusception was reduced by this means. In three of eight patients operated upon the intussusception was found to be reduced. Four of the remaining five patients had clinical or x-ray evidence of complications before reduction by barium enema was attempted.Twenty-one of the patients, all of whom were observed in private practice, were treated without admission to the hospital. After reduction, these patients were observed closely by the clinician. None of these patients showed clinical or x-ray signs of complications before reduction. Certain clinical and roentgen criteria must be satisfied before it can be concluded that reduction by barium enema is complete. If there are clinical signs of complications with x-ray evidence of small bowel obstruction, only a very cautious attempt at hydrostatic reduction should be made. As the time factor is generally a reliable clinical guide to reducibility, the late cases should be viewed with greater caution. Long duration of symptoms, however, is not per se a contraindication to an attempt at hydrostatic reduction.

Barium↗
PubMed1992

Belt loop gastropexy in the management of gastroesophageal intussusception in a pup.

Gastroesophageal intussusception and megaesophagus were diagnosed in a 5-week-old German Shepherd Dog. Exploratory surgery was performed, and belt loop gastropexy was used to maintain proper gastric position after manual reduction of the intussusception. The pup survived surgery and was clinically normal when it was 6 months old. Follow-up contrast radiography revealed resolution of the megaesophagus and apparent permanent gastropexy. Previous reports have indicated extremely high mortality for gastroesophageal intussusception, and resolution of megaesophagus in the dog is unusual.

Animals↗
PubMedDate not supplied

Ultrasonographic diagnosis of inflammatory pseudotumor of the ileum complicating with intussusception: a case report.

Inflammatory pseudotumor is one of the etiologies that may cause small bowel intussusception. Because of its emergency, early diagnosis plays a pivotal role in successful management. Ultrasonography is a safe and handy diagnostic tool without invasiveness and it is advantageous for early preoperative diagnosis. We present a case of ileal intussusception caused by inflammatory pseudotumor, which was diagnosed preoperatively with ultrasonography and was proven by operation. The ultrasonographic feature of the inflammatory pseudotumor was heterogeneously hyperechoic and it should be included in the differential diagnosis of hyperechoic leading lesions of small bowel intussusception in adults.

Adult↗
PubMed1992

Retrograde jejunogastric intussusception caused by a jejunal polyp.

A 70-year-old male presented with epigastric pain, vomiting and upper gastrointestinal bleeding 11 years after a subtotal gastrectomy. Retrograde jejunogastric intussusception was diagnosed by endoscopy and barium meal study and finally confirmed by laparotomy. After reduction of the intussusception, a small polyp was found at 20 cm distal to the anastoma, which served as the leading point of intussusception. The pathophysiology and clinical manifestations of this disease were reviewed.

Aged↗
PubMedDate not supplied

Inflammatory fibroid polyp of jejunum causing jejuno-jejunal intussusception.

Intussusceptions originating in the jejunum are rare. We report a 20-year-old woman who had a chronic jejuno-jejunal intussusception due to an inflammatory fibroid polyp manifesting in the post-partum period as peritonitis. Resection-anastomosis of the intussuscepted segment was done. She is well one year later.

Abdominal Pain↗
PubMedDate not supplied

Adult intestinal intussusception: a case report of a rare clinical entity.

Intussusception in adult is a rare entity that challenges the surgeon opening a wide range of issues in order to define the etiology and therapeutic strategy. Whether to resect or not the bowel is the main question. The answer can be given only after having seen the site of obstruction and the etiology. Colonic intussusception is best treated by resection. Also small bowel intussusception can require resection if a neoplasm is the cause. Peutz Jeghers can be one of these causes as is seen in the case we report.

Age Factors↗
PubMedDate not supplied

Recurrent small bowel intussusceptions: an uncommon presentation of celiac disease in an Arab child.

Causes of recurrent bowel intussusception in infancy are rarely identified and uncommon causes such as gluten sensitive enteropathy are not well recognized. We report a 3 year-old Saudi girl who presented with small bowel intussusception, which was diagnosed by abdominal CT. Investigations for concomitant failure to thrive revealed celiac disease. Her small bowel intussusception resolved completely when she was placed on a gluten free diet.

Celiac Disease↗
PubMed2005

Hyaluronidase assisted reduction of intestinal intussusception; a novel application.

Failed manual reduction of entero-enteric intussusception in adults leads to intestinal resection for benign disease. The case of a twenty-year old male with an eight inch jejuno-jejunal intussusception is presented. The authors resected a hamartomatous polyp from the apex of the intussusceptum and a subsequent attempt at manual reduction was unsuccessful. Hyaluronidase was injected into the neck of the intussusception and dissipation of tissue oedema facilitated reduction within two minutes. To our knowledge, this is the first reported case of this application of Hyaluronidase.

Adult↗
PubMedDate not supplied

Postoperative intussusception in children with enterostomy.

Postoperative intussusception (POI) is an uncommon but important cause of postoperative intestinal obstruction. We describe three cases of intussusception, which developed after major abdominal surgery. Two of the patients were premature newborns whose conditions were complicated by necrotizing enterocolitis and accepted ostomy. The other case involved a patient with Hirschsprung's disease who had had a previous colostomy and accepted Duhamel pull through procedure. Postoperative intussusception is a rare complication of pediatric abdominal surgery and may occur in premature infants. The ostomy may be the predisposing factor of these patients.

Diagnosis, Differential↗
PubMed1992

Ileocecal intussusception corrected by resection within the cecum in two horses.

Irreducible ileocecal intussusceptions pose a difficult surgical problem. Strangulating ileocecal intussusceptions involving the ileum and jejunum were identified in 2 horses undergoing exploratory laparotomy because of colic. Surgical correction in both horses was achieved by amputation of the ileocecal intussusception from within the cecal lumen, via typhlotomy. The inverted ileal stump was blindly stapled near the ileocecal orifice after pulling the intussusceptum into the cecum. A jejunocecostomy was performed to reestablish intestinal continuity.

Animals↗
PubMed2006

Emergency helical CT scan in acute abdomen: a case of intestinal intussusception.

Surgeons are familiar to the nosological entity "partial intestinal obstruction". Intussusception constitutes a rare etiologic factor for this entity but usually remains undiagnosed preoperatively. Several imaging techniques have been proposed as useful in the diagnosis of intussusception but none of these has a remarkable sensitivity and specificity. In the following case of partial intestinal obstruction, we performed an helical CT scan of the abdomen. The method revealed with an excellent accuracy the nature (intussusception) and the location (ascending colon) of the partial intestinal obstruction. Having the extra advantage of the shorter examination time than the classical CT scan, we propose the helical CT as an alternative diagnostic modality for preoperative evaluation of patients with partial intestinal obstruction.

Abdominal Pain↗