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We report a patient with idiopathic ceco-colic intussusception diagnosed by computed tomography (CT). Due to an unusual set of circumstances, the accepted algorithm of diagnostic investigations was not followed. This led to the inadvertent CT demonstration of an intussusception in an adult as a thick-walled mass containing a multiplicity of barium and gas-filled loops.
An improved technique for reduction of intussusception by rectal inflation is presented. This is done under fluoroscopy by means of a controllable pressure apparatus. Its pressure is controlled by adjusting the height of the mercury column in a U-tube manometer. The rectal inflation reduction technique has been widely practised for about 20 years in thousands of cases in China. An analysis of 2,496 cases in the years from 1978 to 1983 revealed a nonoperative reduction rate of 91% with two perforations but no deaths. It is good for early cases of intussusceptions. The apparatus is described. Its contraindications and criteria of irreducibility are discussed in the text.
Acute jejunogastric intussusception is a rare complication following gastric surgery. Three patients were treated for this condition during the past 15 years. Common presenting manifestations are vomiting, hematemesis, upper abdominal pain, and palpable abdominal mass within the left hypogastrium. The diagnosis is established by gastroscopy or upper gastrointestinal radiographs. Four categories of classification are described. Optimal operative management consists of prompt laparotomy. Manual reduction of the intussusception is followed by resection of compromised bowel. Procedures to prevent recurrence are individualized.
Colonic intussusception is a condition primarily found in infants and young children. In adults, it is usually associated with a colonic neoplasm. The following report illustrates a case of colonic intussusception in an adult uremic patient in whom postmortem examination showed evidence only of intramural colonic hemorrhage.
Intussusception of the defunctionalized intestinal segment following jejuno-ileal bypass for obesity has rarely been reported. Persistent crampy abdominal pain (often accompanied by nausea and vomiting) and normal radiologic evaluation are suggestive of this entity. The routine use of silver clips, although helpful in some instances, cannot exclude this diagnosis. A high index of suspicion and the use of sonography may prove that intussusception of the defunctionalized segment is more common than has been previously reported.
A case of intussusception into the enteroanastomosis associated with a Billroth II gastric resection is presented. The case is discussed in the light of jejunogastric intussusceptions, described for the first time in 1917, about 30 years after the first gastrojejunostomy. For 30 years enteroanastomosis has been a general procedure in connection with the Billroth II type of gastric resection. The aetiology is discussed.
Intussusception involving the excluded small bowel segment is an infrequent complication following intestinal by-pass procedures for morbid obesity. Because the intussusception involves bowel not in continuity with the alimentary stream, the usual diagnostic clinical and radiographic patterns fail to appear and recognition is usually delayed. This paper reports in detail such a patient, who was relieved of prolonged abdominal pain by operation. Previously reported patients are reviewed.
While endometriosis is a commonly encountered surgical problem, involvement of the gastrointestinal tract is infrequent and appendiceal involvement rate. Intussusception of the appendix is more frequent. Accordingly, the concurrence of appendiceal endometriosis and intussusception is remarkable. We treated two such patients. The clinical presentation of these patients is varied, with most having abdominal pain, nausea and diarrhea. Asymptomatic cases may be found at surgery for unrelated problems. Correct diagnosis preoperatively is uncommon and most likely when the patients also have a palpable mass.
Evaluation of medical and surgical treatment of intussusception in children (a revue of 100 consecutive cases). The authors analysed 100 consecutive cases of intussusception hospitalized in the Department of Paediatric Surgery of the Brugmann University Hospital in Brussels. 90 baryum enemas were performed, 43 of which were curative, 57 children were operated upon. Their age varied from 3 months to 10 years, but 77% of the children were less than 2 years old. The authors paid particular attention to the observations of children who had surgical treatment. This study points out the importance of early diagnosis and treatment. After a delay of 24 hours, 81% patients needed surgery compared to 41% of those who presented earlier.
Intussusception of the distal small intestine was observed in a 5-week old ostrich chick. The intussusception occurred at the point of attachment of the yolk sac and was speculated as being a predisposing cause to the problem, as a result of localised infection. Other predisposing causes seen in poultry such as enteritis, tumours, parasites and diet, were not evident in this case.
The appearances at conventional radiography and barium enema were compared in a series of 35 patients with recurrent intussusception and in the same number of cases with an uncomplicated course. Only minor disparities between the groups could be established. The significance of a sparse amount of intestinal gas pointing to intussusception and the implication of a complete evacuation of the bowel following barium enema are stressed. The latter phenomenon, occasionally combined with persistent mild small bowel meteorism, occurred in approximately one-third of all early relapses. Patients with one manifest relapse run a significantly increased risk of further recurrences although in the majority of cases no significant etiologic factors are encountered.
A case of jejuno-jejunal intussusception occurring in a neonate is reported. The distinction between the clinical signs of neonatal and infantile intussusception is emphasised, and the importance of early diagnosis stressed.
Adult intussusception may be difficult to detect. Clinical findings are variable and standard radiographic studies are not always helpful. In a patient with colocolic intussusception complicating carcinoma, the radiographic examination was normal and the definitive diagnosis was established by real-time ultrasonography alone. This procedure is noninvasive, rapid, painless, inexpensive and devoid of complications or contraindications.
220 children with intussusception were treated at Rouen Children's Hospital between 1969 and 1981. The patients are separated in four groups according to the treatment: --primary operation without barium enema, --operation after failure of the barium enema, --surgical control after reduction by barium enema, --barium enema alone. This study shows that in the third group, the operation did not demonstrate neither any "lead-point", nor any intestinal damage requiring resection. A "lead-point" or an intestinal lesion have been found only in intussusceptions which had not been reduced by barium enema. Thus, one can conclude that a surgical control is useless when the barium enema is successful. The technique of the enema is described.
11 cases of intussusception in adults, including 9 treated by operation, are discussed. The cause of the intussusception was a malignant lesion in 7 and a benign lesion in 2 cases. In 2 patients, reposition was achieved with the aid of a barium enema. Aetiology and clinical and radiological features are discussed. In view of the high incidence of pre-existent lesions and the risk of perforation at reposition with the aid of a barium enema, surgical therapy is indicated. The pre-existent lesions found at operation and pathological anatomical examination were: malignant lymphoma (4 cases), caecal adenocarcinoma (2 cases), leiomyofibroma of the ileum (1 case), caecal endometriosis (1 case), carcinoid appendix (1 case) and Meckel's diverticulum (2 cases).
Intussusception secondary to long intestinal tubes is a relatively uncommon but potentially fatal occurrence. From 1976 to 1979 we have studied five patients with this complication. The mercury-filled bag stimulates peristalsis, the tube is drawn forward, and there is resultant telescoping and "pleating" of the proximal small bowel. If these pleats become fixed by adhesions, they may act as a lead point for intussusception, even after tube withdrawal. Early diagnosis is essential for effective therapy.
The main difference between intussusception in children and adults is its mostly chronic course in adult age. Whereas the mechanical ileus is characterized by acuteness the prevailing chronic form will often lead to wrong diagnoses, thus causing a delay of adequate therapy. Sonography, radiologic and endoscopic investigations should be applied for diagnosing this disease. In most cases the indication for surgery does not correspond to the real cause. There are 4 typical symptoms: pain, vomiting, tumour and melena which should induce the diagnostician to pay attention to intussusception also in adult age.
Intramuscular glucagon was used in one patient with ileocolic intussusception when standard therapeutic barium enema reduction failed. Reduction was accomplished following administration of glucagon and a repeat barium enema. Use of the two methods together may improve the success rate of nonoperative reduction of intussusception.