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PubMed1996

Intussusception.

Intussusception is the invagination of one bowel segment into another. It is an emergent condition that most commonly affects infants between five and nine months of age, but it can also occur in other age groups. The etiology is usually idiopathic in infants five to nine months of age; neonates, older children and adults more commonly have lead points such as a Meckel's diverticulum or a neoplasm. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. It has been reported that patients with intussusception present with abdominal pain, vomiting and bloody stools, but this classic triad is often absent. More commonly, lethargy and irritability are the presenting signs. A rectal examination, with testing for occult blood, is an important part of the evaluation and is frequently positive. Barium enema is the gold standard for diagnosis and also has therapeutic potential for reducing the intussusception. Ultrasound is an accurate, low-risk screening tool when performed and interpreted by an experienced ultrasonographer. Surgical reduction is performed if nonoperative reduction is contraindicated or unsuccessful, or if a lead point is suspected.

Humans↗
PubMed1996

[Yersinia enterocolitica: a cause of acute intestinal intussusception].

OBJECTIVES: Yersinia enterocolitica infection is a rare cause of intestinal intussusception, especially in adults. We report here a case in a 29-year-old man and review the literature on diagnosis and therapy. CASE REPORT: A 29-year-old man presented with a 2-week history of diarrhea and weight loss. Ultrasonography revealed acute intestinal intussusception localized at the site of enlarged mesenteric nodes. At laparostomy, intestinal resection was not required. Histology examination of the mesenteric nodes showed follicular hyperplasia. Serology was positive for Yersinia enterocolitica. Outcome was favorable after treatment with tetracycline for 15 days. DISCUSSION: Yersinia enterocolitica are Gram negative bacilli that grow at low temperature. Food contamination is the most frequent source of infection in man, usually in children. Clinical manifestations include gastroenteritis or pseudoappendicular syndrome. Intestinal intussusception is rare. Operative reduction by taxis is generally sufficient. Histology examination of the lymph nodes excludes lymphoma. The diagnosis is confirmed by serology. A 10 to 15-day antibiotic regimen is needed.

Acute Disease↗
PubMedDate not supplied

Reduction of intussusception by ultrasound-guided saline enema.

There were 59 cases with 62 episodes of sonogram-proven intussusception between July 1990 and November 1995 at the Department of Pediatrics of the Pingtung Christian Hospital. Except 2 episodes transferred and 4 episodes which reduced spontaneously, ultrasound-guided saline enema was performed in 56 episodes. The whole procedure was monitored and adequately controlled by real-time sonography. Fifty-one of 56 episodes of intussusception were successfully reduced with no complication. The overall success rate was 91.1%. Among the five failed cases, reduction with barium enema had been tried in four at another hospital; one had succeeded but three failed. Because of absence of radiation exposure, easy observation of the patient's condition during the procedure, as well as high success rate, ultrasound-guided saline enema may be one of the most promising methods useable in nonoperative treatment of intussusception.

Child↗
PubMed1995

Intussusception due to inflammatory fibroid polyp of the ileum. A report of two cases from Turkiye.

Intussusception due to inflammatory fibroid polyps is a very rare entity. In this article two cases of inflammatory fibroid polyps of the ileum (A 32-year old man and a 50-year old woman) in Turkiye are described. Both patients were admitted to the hospital because of acute intestinal obstruction as a result of an intussusception caused by a polyp. The lesions were characterized by an eozinophil containing loosely structured fibrous tissue comprising an onion-skin like arrangement of reticular fibers with spindle-shaped nuclei localised in the submucosa and the base of the mucosa, and variable proliferation of fibroblasts and small vessels. The aetiology of these polyps remains obscure but they appear to be a reactive process (allergic or foreign body reaction) rather than neoplastic. Nkanze et al reported 12 cases of intussusception due to fibroid polyps in Africa. Our two cases are the first cases in Turkiye.

Adult↗
PubMed1996

[Intussusception: barium vs. pneumatic reduction].

At the Hospital Niño Jesús air pressure enema has recently replaced the use of barium as treatment of choice in the reduction of intussusception. The purpose of this study was to review the air enema reductions done from June 1992 to February 1994 in 137 patients (group II) and to compare them with a previous series of 153 patients that underwent barium reduction treatment (group I). The groups were similar with regard to sex, age and presentins symptoms as well as clinical signs. Successful reduction was achieved in 131 patients (85.6%) out of 146 attempts treated with barium enema and in 124 patients (90.5%) out of 134 attempts treated with air enema. Among the unsuccessful reduction cases, operation was performed in 22 cases in group I and in 13 cases of group II. In the group I there were two perforations during the reduction attempt, while in group II we did not have any with the air enema. There were two recurrent intussusceptions following barium enema reduction and nine following air enema reduction in the first 48 hours. Patients treated with air enema stayed less days at hospital (1,6 days) than those treated with barium (3 days). We believe that the air enema treatment is easy to perform, is lower in cost and presents less morbility, and that it should be considered as the treatment of choice in the initial management of intussusception.

Barium↗
PubMed1996

[Ileocolic intussusception].

A case of ileocolic intussusception in a 22-year female patient with ileocecal valve inflammatory process in presented. An absence of the acute gastrointestinal obstruction symptoms has been due to the inflammatory infiltration to the front of intussusception. Diagnostic problems in case of the intestinal intussusceptions in adults caused by non-characteristic clinical course have been emphasized.

Adult↗
PubMed1996

Intussusception caused by primary malignant melanoma of the small intestine.

Whether melanoma develops as a primary tumor in the small bowel remains controversial. A 57-year-old male Japanese presented signs of intestinal obstruction. Ultrasonography and computed tomography disclosed an abdominal mass with multiple concentric rings, characteristic of intussusception. At surgery, a spherical tumor, 3.8 cm in diameter, with scattered pigmentation was found to lead the intussusception. Segmental intestinal resection with regional lymph node dissection was performed. Pathological examination revealed diffuse infiltration of malignant melanoma cells. Nodal metastasis was seen only in the mesenteric node draining from the tumor-bearing intestinal segment. Twelve months after surgery, melanoma recurred in the liver and para-aortic lymph nodes, where a malignancy of the digestive organs frequently metastasizes; however, no extraperitoneal melanoma was found after repeated examinations. Thus, this case suggests that primary malignant melanoma can originate in the small intestine and be a cause of intussusception in the adults.

Humans↗
PubMed1997

Simultaneous ileal intussusception and volvulus after jejunoileal bypass for morbid obesity.

OBJECTIVE: The aim of this work is to consider the mechanical complications of jejunoileal bypass for morbid obesity which can have a serious outcome because of the occult nature of the symptoms. DESIGN: The mechanical complications of jejunoileal bypass are mainly intussusception of the bypassed ileal segment, internal herniation of the ileal loops through the mesenteric defects and laparocele. SETTING AND PATIENTS: A recent case is reported in which, most unusually, intussusception and volvulus were both present, with ischaemia and necrosis of the bypassed segment. Moreover, the general health of the patient remains normal despite the severity of the complication. MAIN OUTCOME MEASURES: Examination of blind loop with CT scan which showed an abdominal mass of uncertain interpretation. INTERVENTION: A laparotomy revealed a volvulus of bypassed ileal loops, probably caused by a simultaneous ileal intussusception and an adhesion. On account of the extensive nature of the process and the degree of advanced ischaemia and gangrene patches in the folds of the ileum, resection of the entire bypassed segment as far as the previous jejunoileal anastomosis was necessary. CONCLUSION: The authors point out the occult nature of the manifestations of this type of complication: aspecific abdominal pains in all quadrants, fever, non vomiting, normal passing of faeces and gas and suggested that simultaneous diverticulitis of the colon (frequently found in the obese) can further complicate and delay diagnosis.

Female↗
PubMed1998

Intermittent intussusception caused by colonic lipoma.

Colonic lipomas are rare, usually small, and occur most often in the right colon, particularly in the cecum. They are most common in elderly women. Intermittent episodes of intussusception are not uncommon in patients with colonic lipoma, but they are usually caused by larger pedunculated lipomas. We report a 43-year-old woman with a large colonic submucosal lipoma that induced intermittent colocolic intussusception. The patient presented with symptoms of peptic ulcer, including intractable upper abdominal pain, which did not resolve with treatment. Abdominal sonography showed typical findings of intussusception caused by a lipoma, but the manifestations on barium enema and computed tomography mimicked a malignant colonic tumor. The patient's abdominal pain disappeared after right hemicolectomy and the tumor was demonstrated to be a lipoma. The postoperative course was uneventful; there was no evidence of recurrence at follow-up 6 months later. Physicians should be aware that surrounding organs should also be evaluated in cases of chronic peptic ulcer with intractable upper abdominal pain.

Adult↗
PubMed1998

Hydrostatic reduction of acute intussusception. A prospective study.

Data were collected prospectively on 57 Jamaican children presenting with 62 episodes of acute intussusception over a two year period, for whom operative and hydrostatic methods of reduction were employed. 31 (54%) of 57 episodes were reduced successfully using barium (42), saline (11) and air (4) hydrostatically. Among the 31 other episodes, 15 had ileo-colic intussusception, seven caeco-colic, six ileo-ileo-colic and one ileo-ileal. Two patients had spontaneous reduction discovered at surgery. There were two episodes of barium hydrostatic perforation of the colon leading to death in one patient. Hydrostatic reduction is recommended as the first therapeutic option for acute intussusception because it spares the patient a major operative procedure when successful.

Acute Disease↗
PubMed1998

[Cecal intussusception in calves].

Among the patients admitted to the II. Medical Animal Clinic of the University of Munich from 1986 through 1994, there were 51 calves at an age of up to three months with intussusceptions in the caecal region. The following forms were observed: caecocaecal (n = 12), caecocolic (n = 22), ileocaecocolic (n = 6), ileocaecal (n = 8), and jejunoileocolic (n = 3). In 40 cases, the intussusception occurred in the course of diarrheal disease. The most important signs were scant faeces, that often contained blood and/or mucus, and the finding of a hard viscus upon abdominal palpation. Colic was observed in 27% of patients. In 18 cases, surgical intervention was not attempted because of the advanced stage of the disease or severe accompanying disease. From the remaining 33 calves, eight were cured. The others were either destroyed or died because of extensive peritonitis or other diseases. This report is to draw attention to the fact that (caecal) intussusception should be considered in diarrheal calves when faecal output decreases suddenly, and the general state deteriorates.

Animals↗
PubMed1999

Adult colonic intussusception caused by malignant tumor of the transverse colon.

Adult colonic intussusception is rare and often originates from neoplasms. In emergency situations it can be difficult to diagnose. Our aim was to show how the integration of readily available diagnostic means in emergency situations can help in making a correct diagnosis of this disease. A 68-year old male patient presented with vomiting and abdominal pain. The abdomen was distended, with pain to palpation in the left quadrants without a mass. Plain radiographs of the abdomen showed a large amount of gas in the small bowel and in the right and transverse colon. A barium enema demonstrated an endoluminal filling defect in the descending colon. Abdominal ultrasonography revealed the presence of intraperitoneal fluid and thickened left colonic wall at the site of the lesion, with an aspect of a "double ring" consistent with intussusception. A solid formation was also revealed at a point distal to the thickened colonic wall. At emergency laparotomy an approximately 8-cm-long mass was palpable through the left colon. A colostomy was fashioned, and subsequently colonoscopy revealed the presence of a left colon tumor. At the subsequent operation an invagination of the left transverse colon into the descending colon was confirmed. The left transverse and descending colon were resected with high ligation of the left colic artery. Macroscopic examination of the invaginating head showed a vegetating transverse colon neoplasm. We conclude that in emergency settings the association of readily available diagnostic means such as plain abdominal radiography, water soluble contrast enema and ultrasonography may yield reliable information for diagnosing colonic intussusception.

Adenocarcinoma, Mucinous↗
PubMed1984

Gastrogastric intussuscepting leiomyomas.

Two cases of gastrogastric intussusception of leiomyomas are presented. Intussusception of a fundal mass into the gastric antrum can cause a confusing appearance on the double-contrast barium study. Intermittent intussusception was seen on fluoroscopy in 1 case.

Aged↗
PubMedDate not supplied

Ureteral intussusception due to a polyp.

Intussusception of the ureter is a rare complication of some ureteral diseases. A 49-year-old man was found to have a ureteral intussusception in the middle part of the right ureter accompanied by a polyp below the invaginated segment of the ureter. Surgery confirmed the diagnostic imaging findings. Here, we present a case of ureteral intussusception associated with a fibroepithelial polyp and discuss the radiological characteristics.

Diagnosis, Differential↗
PubMed2006

Radiological diagnosis and classification of antegrade and retrograde Stanford type A intimal intussusception.

Intimal intussusception is an uncommon variation of aortic dissection, resulting from circumferential detachment and stripping of the intima in the setting of a Stanford type A dissection. The resultant tube of detached intima may prolapse either antegrade into the aortic lumen or retrograde into the left ventricular cavity. We classify these forms of dissection as antegrade and retrograde Stanford type A intimal intussusception. We present two cases with intimal intussusception and a review of the current literature. The majority of previous cases have been reported in the cardiology and cardiothoracic surgical literature, with few previous radiological reports.

Aged↗
PubMed1983

Extended dissection of the portahepatis and creation of an intussuscepted ileocolic conduit for biliary atresia.

This paper introduces a new operation for biliary atresia that establishes successful biliary drainage by extending the portahepatic dissection, and decreases ascending cholangitis by incorporating a nonrefluxing intussuscepted draining conduit. An analysis of the postoperative results is presented. The usual dissection of the portahepatis is extended to include the area between and beneath the branches of the right portal vein to incorporate all potentially usable remnants of the intrahepatic ducts. Ascending cholangitis is decreased by interposing an intussuscepted ileocolic segment between the portahepatis and the abdominal wall. This extended dissection of the portahepatis was performed since 1978 in 15 infants with noncorrectable biliary atresia, and bile drainage was achieved in all. In ten infants an intussuscepted ileocolic conduit was constructed. Ascending cholangitis in these ten infants has been either completely absent or easily controlled by antibiotics. The draining bile was highly concentrated due to the water-absorbing capacity of the interposed colonic segment; therefore, fluid and electrolyte disturbances, which develop frequently in patients having jejunal conduits, have never been encountered.

Bile↗
PubMed1986

Continent catheterizable urinary diversion using the ileocecal segment with stapled intussusception of the ileocecal valve.

A continent ileocecal reservoir was created as an alternative to ileal loop urinary diversion in 7 patients. In 3 patients the bladder neck was closed, the in situ bladder was augmented and a continent stoma was formed by intussusception of the ileocecal valve. In the remaining 4 patients an isolated cecal reservoir with a continent stoma replaced the bladder. Creation of a stoma that was continent and easy to catheterize was achieved by intussusception of the ileocecal valve with stabilization of the intussuscepted nipple using a Marlex collar. In most cases the cecal segment was hyperactive but this was controlled with anticholinergic medication. All 7 patients have a satisfactory capacity and a continent stoma without significant catheterization difficulties.

Humans↗
PubMed2002

Intussusception of the reconstructed bladder neck leads to earlier continence after radical prostatectomy.

INTRODUCTION: Although there is no evidence that the reconstructed bladder neck actively contributes to post-radical prostatectomy continence, we set out to determine whether buttressing sutures, which prevent the bladder neck from pulling open as the bladder fills, would result in the earlier return of urinary control. TECHNICAL CONSIDERATIONS: Forty-five men (mean age 57 years, range 37 to 67) with clinical localized prostate cancer underwent anatomic radical retropubic prostatectomy with standard tennis racket bladder neck reconstruction. The bladder neck was then intussuscepted using two 2-0 Maxon Lembert sutures placed lateral and posterior to the reconstructed bladder neck. Filling of the bladder with saline at this point revealed little leakage. Patient-reported continence at 3 months was compared with the published outcome of 64 men using the same quality-of-life instrument (the UCLA Prostate Cancer Index). At 3 months, 82% of men who underwent intussusception of the bladder neck were continent (no pad/dry pad) compared with 54% in our prior report (P = 0.0035). The occurrence of bladder neck contracture was similar: 7% versus 5%. CONCLUSIONS: Intussusception of the bladder neck led to a significant improvement in urinary control at 3 months postoperatively. Longer follow-up will be necessary to determine whether this approach may eliminate the 2% probability of long-term significant problems with urinary control.

Adult↗