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Computed tomographic evaluation of ileocolic intussusception in an adult is presented. Upper gastrointestinal series with orally administered water-soluble contrast agent suggested obstruction in the lower part of the small intestine, but computed tomography made a definitive diagnosis. Pathognomonic CT findings of ileocolic intussusception are presented.
This paper compares the effects on patients of perforation with barium and with air during attempted intussusception reduction by reviewing the clinical, radiological, surgical and pathological findings and sequelae in seven children who received barium and seven who received air. In both groups perforation occurred in infants under 6 months of age (with one exception) with a long duration of symptoms. All patients with barium enema required resection of bowel whereas only four with air enema required resection. Anesthetic times were longer in those patients with barium perforation in whom the intussusception did not move and there was a large leak. The patients with perforation due to air had a shorter hospital stay with decreased morbidity compared to those with perforation due to barium. Perforation occurred through areas of transmural necrosis in a minority of patients in each group. Perforations through normal bowel and shear injury (with air enema) indicate that increased pressure during the examination is an important factor in some patients. Because perforation with air is so much easier to deal with surgically and the children do better clinically, there is a tendency for some to consider perforation with air an inconsequential situation. However, a potential rare complication with this technique is tension pneumoperitoneum. Keeping this in mind, we continue to use air as the contrast of choice because the procedure in our hands is a safe, quicker and easier technique and we have achieved a substantial improvement in reduction rates. Overall reported perforation rates with air enema compare favourably with those due to barium enema.(ABSTRACT TRUNCATED AT 250 WORDS)
Hydrostatic reduction of intussusception by barium or air enema has been widely accepted. The five-year experience with this procedure at two children's hospitals is reviewed and the results compared to previous studies. Various clinical and radiographic factors are evaluated in relation to the reduction rate. The findings show that the more distal the intussusception is encountered, the lower the rate of reduction. However, 25% are reduced within the rectum with no evidence of increased complications. Small bowel obstruction and prolonged duration of signs and symptoms decreased the rate of reduction statistically but there is no significant increase in complication rate in those attempted, contrary to a previous report. The cresent sign (dissection sign) and age of the patient are not significant factors in reduction as reported by other studies.
Two cases of intussusception with free peritoneal fluid detected by ultrasound are presented. In neither of these cases was the fluid associated with perforation or intestinal compromise. After assessing the findings in these patients, we believe that small amounts of fluid may well be present in uncomplicated intussusception. Furthermore, we feel that its presence should not constitute a contraindication to nonsurgical reduction if no associated clinical findings to suggest perforation or intestinal compromise are present.
Retrograde intussusception is a rare occurrence. We report a retrograde jejunal-duodenal intussusception associated with a jejunal duplication cyst, which presented as intermittent biliary and upper gastrointestinal (UGI) obstruction and a mobile abdominal mass in a newborn infant.
A case of duodenojejunal intussusception secondary to a single multilobulated duodenal lipoma mimicking acute pancreatitis in a 12-year-old boy is presented. Duodenojejunal intussusception is a rare entity because of the somewhat fixed position of the duodenum within the retroperitoneum.
To determine what practices are being utilized in the management of intussusception, a survey was sent to chairpersons of 64 Pediatric Radiology departments in the United States and Canada. There was a 92% response rate. Barium is used in 97% of departments and is the most commonly used contrast-agent in 64%. Water-soluble contrast is used in 83% of departments and air in 50%. In high-risk patients, water soluble contrast is used in 71% of departments, air in 28% and barium in 24%. Glucagon, pre-exam antibiotics, and pre-exam sedation are not used regularly in a majority of departments. The radiologic management of intussusception is more varied than only a few years ago. Use of water-soluble contrast and air have increased, while barium use is less routine.
A case of gastro-oesophageal intussusception was reported in 1840 by Von Rokitanski: this is rare, with only two other cases having been reported. In our patient the gastro-oesophageal intussusception followed Nissen fundoplication.
The clinical and imaging features of small-bowel intussusception as a complication of abdominal surgery are not well known. Diagnosis may be delayed because symptoms mimic common postoperative complaints. In pediatric cancer patients, the side effects of chemotherapy and symptoms related to the primary malignancy may also obscure the diagnosis. We report the clinical and radiographic features of eight children undergoing evaluation and treatment for solid tumors who developed small-bowel intussusception following laparotomy. These children represent 2.2% of all children and adolescents who underwent laparotomy at a pediatric cancer research and treatment center during a 13-year period. With prompt diagnosis and intervention, morbidity and mortality from this rare but life-threatening postoperative complication can be avoided.
A 6-month-old female infant presented with intussusception. Post-operatively she was noted to have nephrotic syndrome. The oedematous bowel wall may have been the cause of the intussusception and this has not been previously described. In addition her karyotype was XY suggesting her nephropathy was associated with Drash syndrome.
Gastroduodenal intussusception is a rarely documented condition that occurs secondary to a mobile leading gastric tumor that prolapses into the duodenum. Its typical radiologic presentation includes lumen narrowing, distally converging gastric folds, infolding and outpouching of the gastric wall, gastric intussusceptum presenting as a filling defect, and a leading tumor in the duodenum. The coil spring pattern, characteristic of bowel intussusception, is not a prominent feature. Two cases are presented and discussed.
A retrospective study of sixty consecutive cases of proven intussusception with attempt at contrast enema reduction was performed to evaluate currently proposed contraindications to such reduction. When patient age, duration of symptoms, presence of small bowel obstruction and presence of a dissection sign were considered alone, none of the findings indicated irreducibility. Our overall reduction rate was 72% with a complication rate of 3%. This is similar to previously reported series and we concur with more recent publications that the only contraindications to non-surgical reduction of intussusception are free intraperitoneal air, peritonitis or evidence of infarcted bowel. Only when we encountered a combination of symptoms being present for greater than 48 hours and the presence of both small bowel obstruction and a dissection sign was reduction likely to be unsuccessful. However, the presence of a prognostic indicator occurring alone should not be considered a contraindication.
Intussusception of the duodenum is a relatively rare event, and usually results from the presence of benign tumors. A case of duodenal intussusception secondary to Brunner's gland hamartoma is described and its differential diagnosis discussed.
Hydrostatic reduction of an ileocolic intussusception has not been reported when barium dissects around the intussusceptum as opposed to pushing it retrograde. Consequently, this development is considered an indication to discontinue hydrostatic reduction. We have studied a baby in whom draining the colon caused a seemingly irreversible dissection of barium to disappear so that hydrostatic reduction of the intussusception was easily accomplished when the colon was refilled with barium.
Ultrasonography has been shown to be valuable in the detection of intussusception, but a question arises, as to just when this study should be performed. Should it be a general screening procedure or should it be utilized for specific cases only? Upon reviewing the literature, and the findings in 14 of our patients, we feel that it should be utilized as a general screening procedure. In addition, we offer a different explanation for the typical doughnut and pseudokidney signs seen with intussusception.
A case of caecal duplication in a 36-h-old neonate is described. The patient presented with vomiting and an abdominal mass and the barium enema finding was initially suggestive of intussusception. At laparotomy a duplication cyst completely obstructing the lumen was found. This was considered to have given the radiological picture simulating intussusception.
Pediatric radiologists in 40 children's hospitals in North America were interviewed to determine their choice of contrast media in the diagnosis and treatment of intussusception. The respondents indicated that barium was utilized in the vast majority of instances. Almost all indicated that they would proceed with barium enema even if there is unequivocal evidence of small bowel obstruction on the plain film examination. In over 14,000 cases of intussusception, there were 55 perforations, an incidence of approximately 1 in 250. The perforations in general were well tolerated, although there was one death.
We treated a patient with a complete invagination of the appendix which contained one large laminated calcified fecalithy. Colonofiberscopy showed a dimpling submucosal tumor, which was palpated as a bony hard tumor at laparotomy. This finding suggested that the fecalith caused an intussusception of the appendix and that such an intussusception should be suspected when there is a bony hard dimpling submucosal tumor in the cecum.