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The authors present a case of postoperative enterogastric intussusception after previous Billroth II-gastrectomy, associated with a Braun's W-anastomosis of the efferent small bowel loop. Loss of viability of the incarcerated jejunal loop required segmental small bowel resection. Total recovery was obtained. Literature is reviewed concerning diagnosis and treatment of adult intestinal intussusception.
Treatment options for intussusception in children range from reduction by barium enema to surgical intervention. The authors describe a case in which a conservative option--a fifth attempt to reduce an ileocolic intussusception by barium enema, this time using general anesthesia--successfully resolved the problem.
A 48-year-old man presented with abdominal pain, constipation and irritability one month after starting phenytoin treatment for a generalized seizure. He was hypertensive, tachycardic (BP 174/98, heart rate (HR) 100 bpm supine) and hypovolaemic. Abdominal CT demonstrated transient jejunal intussusception and infarction of the left kidney. Urinary porphobilinogen levels were increased and genetic analysis confirmed the diagnosis of variegate porphyria. Because of ongoing postural hypotension, the patient underwent further autonomic investigations. Levels of blood pressure (MBP), HR and muscle sympathetic activity (MSNA) were increased during the acute attack compared to recovery (131 versus 105 mmHg, 100 versus 60 bpm, 88 versus 26 bursts min(-1)). HR and MSNA did not increase during phase II Valsalva, whereas stroke volume (SV) decays were exaggerated (deltaMBP-56 versus 0-31 mmHg and SV 25% versus 40% baseline). Baroreflex failure causing increased sympathetic activity, decreased sympathetic and parasympathetic rapid responses, loss of splanchnic capacitance and renal salt wasting were the likely mechanisms for postural hypotension. Increased sympathetic activity may also have caused intussusception and focal renal vasoconstriction, both of which may be underdiagnosed causes of abdominal pain in acute porphyria.
Trichuris trichiura is a worldwide problem affecting millions of people. We report an unusual case of intussusception caused by T. trichiura that mimics acute appendicitis. The literature on T. trichiura associated intussusception is reviewed.
CASE HISTORY: An adult male Birman cat was evaluated for recurrent, intermittent vomiting or regurgitation, occasionally associated with abdominal discomfort. CLINICAL FINDINGS AND DIAGNOSIS: Radiographs, including an oesophogram, indicated an oesophageal obstruction. Prior to treatment, the cat's condition deteriorated and it was euthanised at the owner's request. Post-mortem examination revealed a gastro-oesophageal intussusception, a trichobezoar impacted into the intussusceptum, and a dilated oesophageal hiatus consistent with a chronic hiatal hernia. CLINICAL RELEVANCE: Gastro-oesophageal intussusception is a rare condition in cats. Its aetiology in relation to a pre-existing hiatal hernia and a trichobezoar is discussed.
Sixty-four consecutive cases of intussusception in 48 infants and 16 older children managed at Jos University Teaching Hospital between January 1990 and December 1998 are reviewed. The age range was between 3 months and 15 years (mean 2.2 years) and the male to female ratio was 3.6:1. The quartet of abdominal pain, bloody mucoid stools, abdominal mass and palpable rectal mass was present in 70% compared with the classical triad (abdominal pain, bloody mucoid stools and abdominal mass) which occurred in only 32%. All the children had surgery. In 26 (41%) of the children, no associated cause was found, in three polyps formed the lead point and in five children a buried appendicectomy stump formed the lead point. In 30 (47%) other children, mesenteric lymphadenopathy and inflamed Peyer's patches were noted. Ileo-colic intussusception occurred in 32 (50%) children. Manual reduction was successful in 67%. Bowel resection for gangrene, irreducibility and an iatrogenic colonic tear was done in 30% of patients. Two (3%) had spontaneous reductions. There were four deaths. The commonest complications were wound infection and adhesive intestinal obstruction.
Lipoma is a rare cause of adult intussusception. We present the CT findings of an adult patient with jejunojejunal intussusception secondary to submucosal lipoma as the lead point in this case report.
UNLABELLED: Intrauterine intussusception is one of the rare causes of intestinal atresia. CONCLUSION: A case of ileal atresia due to intrauterine intussusception caused by Meckel's diverticulum is reported.
A 45-year-old man with a history of cyclophosphamide exposure underwent repeated ureteroscopy for positive urine cytology findings after resection of a Grade 2 papillary transitional-cell carcinoma of the bladder. Despite careful technique, an intussusception developed in the left ureter, which was repaired by resection and construction of a Boari flap. To our knowledge, this is the first report of retrograde ureteral intussusception caused by ureteroscopy.
Colonic lipomas are relatively uncommon clinical entity, although they are among the most common nonepithelial benign tumors of the colon. They may produce abdominal pain, diarrhea, constipation, hemorrhage, and intussusception. We report a case of a 56-year-old man who was suffering from abdominal pain and 4 weeks of intermittent diarrhea. Ultrasound examination of the abdomen revealed an abdominal mass in the right upper quadrant. Computed tomography showed a well-circumscribed intraluminal mass in the ascending colon, measuring 5 cm in diameter, with density value equal to fat. During laparoscopic surgery we found a colocolic intussusception, which we reduced laparoscopically, and performed a laparoscopically assisted right colectomy. The resected colon revealed a 6 cm wide lipoma within the ascending colon. Histology confirmed the diagnosis of benign lipoma. Aspects of preoperative diagnosis and treatment are discussed, and we review the literature.
The authors present a case of appendiceal intussusception, a rare finding that can be associated with appendiceal neoplasms. A 74-year-old woman with right lower quadrant abdominal pain was found to have an appendiceal intussusception associated with a villous adenocarcinoma and was managed with a laparoscopic assisted right hemicolectomy. This case is presented along with a review of the symptoms, diagnosis, classification, and appropriate management of this entity via laparoscopy.
A case of Meckel's diverticulum causing intussusception in an 8-year-old boy is presented. The Meckel's diverticulum was detected by using a Tc-99m-labeled antigranulocyte monoclonal antibody MN3 (Leukoscan; Immunomedics, Morris Plains, NJ), which is under clinical evaluation for the detection of atypical appendicitis at the authors' institution. Pathologic evaluation confirmed Meckel's diverticulitis with ileal-ileal intussusception.
We describe an unusual case of major small-bowel bleeding and intussusception due to jejunal metastases from a large-cell type carcinoma of the lung. Review of the surprisingly frequent case reports of small bowel metastases from primary lung tumors indicates that there is only one prior case report of intussusception and that ours is the first description of major intestinal hemorrhage due to metastatic pulmonary carcinoma.
Cyclic vomiting is a psychosomatic syndrome, but it is also a diagnosis of exclusion. Before such a diagnosis can be made, an organic basis for the episodes of vomiting must be ruled out. We describe a case of episodic vomiting in a school-aged girl. Endoscopic examination eventually confirmed a diagnosis of intermittent duodenal intussusception due to an enteric duplication. Removal of the duplication abolished the episodes of vomiting. The differential diagnosis of episodic vomiting is discussed, and the literature on intussusception is reviewed. Endoscopy should be considered in a child with a history of episodic vomiting.
Heterotopic gastric mucosa (HGM) may be found anywhere in the gastrointestinal tract, most often in a Meckel's diverticulum. Approximately 30 cases of HGM, located in the small bowel beyond the ligament of Treitz and not associated with a Meckel's diverticulum, have been reported. They were most often revealed by intestinal intussusception, occasionally by perforation of an intestinal ulcer or intestinal bleeding. We report a 4-year-old boy who had three attacks of acute intestinal intussusception over a 5-month period resulting in surgery. Both physical examination and barium examination of the small bowel and large intestine were found to be normal between attacks. Peroperative palpation of the small bowel was normal during the three laparotomies. During the third operation, he underwent an intraoperative endoscopy (IOE), which revealed a polypoid mass 2 cm in diameter and 0.5 cm in height, 40 cm proximal to the ileocaecal valve. Histologic examination showed HGM with fundic glands, and chief and parietal cells. This case emphasizes the interest of IOE, the main indications of which are the localization of unknown sites of gastrointestinal bleeding and the search for hamartomatous polyps of the Peutz-Jeghers syndrome for polypectomy and/or segmental resection.
This case report describes the clinical presentation and the radiographic, endoscopic, and pathologic findings in a patient with cystic fibrosis (CF) and intussusception of the appendix. This is the first time that intussusception of the appendix has been documented in a patient with CF. This disorder should be considered in the CF patient with cramping lower abdominal pain or rectal bleeding.
The first rotavirus vaccine was associated with a small, albeit statistically significant, risk of intussusception in immunized infants. Before results of new vaccine studies are available, we need to define the real background risk of intussusception in participating countries. A 5-year retrospective study conducted in Panama found an average rate of 1 case per 3300 infants younger than 1 year of age, with substantial yearly variations ranging from 1:2500 to 1:5000.
A three-month-old infant presented with vomiting, lethargy, and hypertension. Abdominal ultrasound suggested the diagnosis of intussusception, which was confirmed by barium enema. Hypertension, previously unreported with intussusception, only resolved after surgical resection of the lesion.