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Intestinal intussusception in adults, treat it like a cancer.

Intussusception in adult is a rare condition. Pathologic process is identifiable in 90% of cases. Emergency clinical diagnosis is generally difficult and CT scan typical features are of use. Surgery is always necessary to treat bowel necrosis and to perform pathologic examination. Diagnosis of cancer must be in mind and lymphadenectomy must be done. We present two recent cases of intussusception in adults due to adenomatosis polyposis and Meckel's diverticulum.

Adenomatous Polyps↗

Jejunal inflammatory fibroid polyp presenting as intussusception--a case report with review of the literature.

A 52-year-old woman was presented with intermittent abdominal pain and vomiting for 10 days. Abdominal CT scan disclosed a dilated small bowel loop with a round solid mass in the right anterior supravesical space. The clinical impression was intussusception caused by small bowel tumor. She underwent an exploratory laparotomy. The macroscopic and microscopic findings confirmed an inflammatory fibroid polyp of jejunum causing intussusception. To the best of our knowledge, this was the 5th reported case of such a presentation in English medical literature.

Female↗

Paediatric intussusception in Calabar, Nigeria.

OBJECTIVES: To determine prevalence, clinical presentation, evaluate management methods and outcome of paediatric intussusception in Calabar. DESIGN: A retrospective study. SETTING: University of Calabar Teaching Hospital, Calabar, Nigeria. PARTICIPANTS: All cases of intussusception in children that presented at the children emergency Room and Surgical Outpatient Department of the University of Calabar Teaching Hospital between 1989 and December 1998. RESULTS: The mean age was 7.5 months with a male:female ratio of 1.8:1. The main presenting symptoms were vomiting in 76 (85.3%) patients, general irritability in 69 (77.5%) patients, bleeding per rectum in 47 (52.8%) patients and palpable abdominal mass in 38 cases (42.6%). Majority of the patients presented late to hospital beyond 36 hours since onset of illness and had had enema administration before presentation, a popular phenomenon in the region. Diagnosis of this condition was confirmed clinically in fifty nine patients (66%). Eighty one patients (91%) had laparotomy, the only method of treatment available with simple manual reduction while in eight patients (9%) laparotomy was accompanied with resection and anastomosis for bowel with doubtful viability. CONCLUSION: Time lapse from onset to presentation is not a criterion for choosing between operative and non-operative reduction. The clinical status and abdominal evaluation of the patients are the important features to consider. Operative reduction in most instances involve manual reduction hence should be preceded by conservative methods of reduction.

Developing Countries↗

Intermittent gastroesophageal intussusception in a cat with idiopathic megaesophagus.

An adult female domestic shorthair cat was evaluated for chronic upper respiratory disease and vomiting. A diagnosis of idiopathic megaesophagus with intermittent gastroesophageal intussusception (GEI) was made based on radiographic and endoscopic examinations. The GEI was manually reduced by use of a stomach tube during the endoscopic procedure. An incisional gastropexy was performed to prevent recurrence. Gastroesophageal intussusception is a rare condition in cats. In dogs it is usually associated with rapid progression of clinical signs, culminating in death. In this cat, the condition was associated with chronic signs, probably due to the intermittent nature of the GEI.

Animals↗

Color Doppler ultrasonography in pediatric intussusception.

CDU was used in 11 children with intussusception. Demonstration of vascular images within the "pseudokidney" mass was possible in none of 11 cases. Of them, eight could be treated by hydrostatic reduction. In the remaining case, marked edema of the bowel wall did not allow reduction, and surgery had to be performed: no necrosis was observed in the surgical specimen. Both patients in whom CDU failed to demonstrate vascular signals had necrosis at surgery, and bowel resection was performed. Because of the limited number of patients examined at this time, no firm conclusions can be drawn from our experience. However, CDU seems a promising technique in detecting vascular changes occurring in intussusception, with a possible role as a predictive tool of bowel necrosis.

Child, Preschool↗

Ileocecocolic intussusception in a one-month-old llama.

A 1-month-old female llama was examined because of signs of acute abdominal pain. Physical and ultrasonographic examination revealed a cylindrical mass in the left caudal quadrant of the abdomen. Results of serum biochemical analyses and CBC were within reference ranges. Exploratory laparotomy revealed an ileocecocolic intussusception. Ileocecal resection and end-to-end ileocolic anastomosis were performed. After surgery, fecal examination revealed many coccidial oocysts, although a direct association between coccidiosis and intussusception could not be determined. The cria recovered without serious complications.

Abdomen, Acute↗

Intragastric intussusception--a curiosity.

A case of a 53-year-old man with an intragastric intussuscepted small bowel segment is presented. The patient had previously been operated on for recurrent bleeding gastric ulcers. A discussion is presented on the unusual aspects of the intussusception.

Humans↗

Intussusception among recipients of rotavirus vaccine--United States, 1998-1999.

On August 31, 1998, a tetravalent rhesus-based rotavirus vaccine (RotaShield, Wyeth Laboratories, Inc., Marietta, Pennsylvania) (RRV-TV) was licensed in the United States for vaccination of infants. The Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Academy of Family Physicians have recommended routine use of RRV-TV for vaccination of healthy infants. During September 1, 1998-July 7, 1999, 15 cases of intussusception (a bowel obstruction in which one segment of bowel becomes enfolded within another segment) among infants who had received RRV-TV were reported to the Vaccine Adverse Event Reporting System (VAERS). This report summarizes the clinical and epidemiologic features of these cases and preliminary data from ongoing studies of intussusception and rotavirus vaccine.

Adverse Drug Reaction Reporting Systems↗

Intussusception in adults.

Intussusception in adults is a rare entity that it is generally caused by definable intraluminal pathology. We report four cases of adult intussusception caused by lymphoma of the terminal ileum (2), an inflamed appendix (1) and a mucosal polyp (1). All presented with a variety of nonspecific and chronic symptoms, including abdominal pain, nausea and vomiting, consistent with partial small bowel obstruction. Only one patient had palpable masses in the abdomen. The most useful diagnostic radiological method was computed tomography (CT), which showed "target" lesions. The presence of the characteristic "target" lesion may obviate the need for further studies, including a barium enema. As in the cases reported here, treatment involves more than simple reduction; surgical resection is usually indicated.

Adult↗

Intussusception after Roux-en-Y gastric bypass.

Intussusception is a common pediatric surgical problem. Its occurrence in adults is rare and usually involves a specific lead point such as a small bowel tumor or other mass. We describe two adults who developed intussusception after Roux-en-Y gastric bypass. Signs and symptoms of small bowel obstruction were seen in both of these patients, but the responsible pathology was unusual. Because of the increasing frequency with which these gastric bypass procedures are being performed, a high index of suspicion must be employed when dealing with these postoperative patients who present with abdominal complaints.

Adult↗

John Hunter, Frederick Treves and intussusception.

Early this century, intussusception in childhood was usually fatal. John Hunter, one of the founding fathers of scientific surgery was amongst the first to accurately describe the clinico-pathological features of the condition and one of the great nineteenth century surgeons, Sir Frederick Treves, suggested a plan of management for intussusception which remains little changed up to the present day.

England↗

Intussusception following jejunoileal bypass: case report and review of the literature.

Jejunoileal bypass carries a number of potential complications, one of which is intussusception of the excluded segment. The incidence of this complication is probably about one to two per cent. The usual symptoms consist of intermittent episodes of colicky abdominal pain. The roentgenographic diagnosis is difficult because the condition occurs at the blind end of the excluded segment and it is not possible to reflux contrast material to this area. If the intussusception is associated with severe gastrointestinal hemorrhage, selective angiography may provide the diagnosis.

Adult↗

CT diagnosed jejunal intussusception revealing metastatic renal cell carcinoma.

We report the case of a 77-year-old woman presenting with a jejunal intussusception as the primary symtom of metastatic renal cell carcinoma. Both lesions were demonstrated by abdominal CT which detected also pancreatic metastasis. This case emphasizes the significance of CT to diagnose intussusception and to characterize its cause.

Aged↗

[Appendico-ileo-caecal intussusception as a cause of mechanical ileus].

The authors present a case of 34 years old male operated on for mechanical ileus caused by intussusception of unchanged appendix, cecum and terminal part of ileum. The paper presents possible mechanism of intussusception, diagnostic difficulties determined by non-characteristic symptoms and imaging examination results.

Adult↗

Adenovirus and ileocecal intussusception.

Intranuclear inclusion bodies were found by light microscopy in epithelial cells in more than one-third of the specimens from children operated on for ileocecal intussusception. Electron microscopic examination done on hematoxylin and eosin-stained slides showed the intranuclear inclusion bodies to be composed of viral particles in large and small crystalline arrays. Adenovirus of serotypes 2, 3, and 5 were isolated from the five cases with inclusions in which isolation was attempted. These findings strongly suggest a pathogenetic role for adenovirus in those cases of intussusception in which intranuclear inclusion bodies are found in the epithelial cells of the appendix or the terminal ileum.

Adenoviridae↗

Chronic intussusception associated with ileocecal lymphosarcoma.

A 1011/12-year-old boy with chronic ileocolic intussusception associated with ileocecal lymphosarcoma was decribed. The patient had abdominal pain of 3 months' duration, vomiting, and a firm mass with smooth surface in the right lower abdomen. Barium enema showed intussusception at the distal part of the ascending colon, which was irreducible by hydrostatic pressure. Barium by mouth revealed markedly distended small intestines, which were displaced to the left abdomen. The tumor was inoperable, and the boy died.

Barium Sulfate↗

Intussusception in the older child.

During its first 6 years of operation a large pediatric unit in a suburban general hospital treated 13 children over the age of 2 years for confirmed intussesception. During the same period 14 infants under the age of 2 years were treated for intussusception. It is suggested that the true age incidence of the disease is reflected more accurately by these figures than by those reported by large children's hospitals. The clinical course was often less acute in the older child and hydrostatic reduction was usually effective (in 11 of 12 attempts). Prompt operation is recommended when the condition recurs more than 1 week after reduction because of the increased risk of an underlying intestinal lesion. Practitioners are urged to keep intussusception in mind when assessing an older child with intestinal colic.

Acute Disease↗

Intussusception up to splenic flexure by cecal carcinoma in an adult: report of a case.

A 73-year-old woman was admitted because of constipation and appetite loss. She was diagnosed as having intussusception caused by a colonic tumor, based on the results of physical examination and imaging such as ultrasonography, computed tomography and barium enema. Operation revealed that right colon from the cecum up to the hepatic flexure of the ascending colon was not fixed to the retroperitoneum, and a circular cecal carcinoma was invaginated to the splenic flexure of the transverse colon. We experienced a rare case of ileocolic intussusception up to the splenic flexure by a cecal carcinoma with mesenterium ileo-colicum commune in an adult.

Aged↗