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A 7-month-old white baby girl developed hypovolemic shock requiring resuscitation secondary to an air enema reduction of intussusception. The implications of this case for standardization of the management techniques in this setting are emphasized.
This study illustrates the sonographic findings of inverted Meckel diverticulum acting as a lead point of an intussusception in five patients. In four patients, the inverted diverticulum was seen as a segment of blind-ending, thick-walled bowel projecting for a variable distance from the apex of the intussusceptum. The larger diverticula had a characteristic bulbous shape. The central serosal surface of the inverted diverticulum was filled with fluid in one patient, with fluid and fat in another, and with echogenic fat only in the other two. The presence of fat was confirmed by CT in one patient. The features illustrated in these four patients appear to be specific. In the fifth patient, the sonogram revealed a nonspecific echogenic mass at the apex of the intussusceptum. Recognition of these features on sonography may obviate the need for further investigation.
The finding of a colo-colic intussusception with pneumatosis intestinalis is described with imaging. This was confirmed at surgery together with pathological confirmation of pneumatosis intestinalis. This rare association occurred in an infant with Peters' anomaly who was taking oral steroids.
An 82-year-old male presented to the hospital because of acute exacerbation of abdominal pain and biliary vomiting. Contrast-enhanced computed tomography of the abdomen was performed. A left paraduodenal hernia associated with volvulus, intussusception, and bowel wall ischemia were radiologically diagnosed. Surgery confirmed the diagnostic imaging findings. We present the first case of an association of these acute abdominal conditions.
We report the case of a 29-year-old man with a long-standing history of abdominal pain related to an intermittent colocolic intussusception caused by pneumatosis cystoides coli. To our knowledge, only one similar case has been reported in the English-language literature.
We report a rare case of recurring idiopathic ileoileal intussusception in an adult. Diagnosis was established with abdominal computed tomography (CT) and enteroclysis, which led to a spontaneous reduction of the invagination. After a short period of physical improvement, a follow-up CT showed a recurrence. Surgery proved the diagnosis, but no predisposing factor was found.
We report a case of intestinal angiosarcomatosis manifesting as jejuno-jejunal intussusception.
A 15-year-old girl presented with small bowel obstruction due to ischemic jejunal stricture which developed three weeks after successful surgical reduction of an intussusception with a Peutz-Jeghers-type polyp as a lead point. The reduced jejunum had no macroscopic injury, and the stricture caused complete obstruction requiring jejunal resection.
The etiology of intussusception (IN) remains largely obscure. In lipopolysaccharide (LPS)-induced IN, an experimental model in mice, IN is considered to be the consequence of altered intestinal motility as a result of increased nitric oxide (NO) along various inflammatory mediators. These could be decreased via cyclooxygenase (COX) inhibition by indomethacin. N-omega-nitro- L-arginine methyl ester ( L-NAME) inhibits nitric oxide synthase (NOS) and NO production. Indomethacin is known to prevent IN; however, the reason is unknown. In this study we aimed to determine the role of NO, the effects of inhibition of its production by L-NAME and indomethacin, and whether preventive effects of indomethacin on LPS-induced IN were related to NO inhibition. A total of 113 mice were divided into seven groups. In the control group ( n=6), no procedure was done. In the sham group ( n=6), 1 ml saline was given; in the indomethacin group ( n=6), 10 mg/kg of indomethacin was given; and in the LPS group ( n=30), 12 mg/kg of LPS was administered intraperitoneally (IP). In the LPS+indomethacin group ( n=32), 10 mg/kg of indomethacin was administered IP simultaneously with 12 mg/kg of LPS. In the L-NAME group ( n=6), 20 mg/kg of L-NAME was administered subcutaneously. In LPS+L-NAME group ( n=27), 20 mg/kg of L-NAME was administered subcutaneously with 12 mg/kg of LPS IP. All animals were laparotomized 6 h following injections. Existence of IN was noted and blood specimens were obtained. NO was quantified by measurements of nitrite and nitrate, obtaining a total of NO metabolites (NOx). The results were compared using the Mann-Whitney U-test and Spearman correlation test. A value of p<0.05 was considered significant. A total of 17 mice (one in control, 10 in LPS, four in LPS+indomethacin, and two in LPS+L-NAME groups) were excluded from the study because of death or insufficient blood collection. LPS (12 mg/kg, IP) induced IN at a rate of 30% ( n=6) in the LPS group. Mean NOx levels were statistically higher in the LPS group (186.67+/-20.06) compared with other groups ( p<0.05). Mean NOx levels were significantly higher in the group of mice with IN than in those without in the LPS group of this study (295.46+/-16.42, 140.05+/-15.44, respectively, p<0.05). The mean NOx levels were statistically lower in the LPS+ L-NAME(23.94+/-3.39) group than the LPS+indomethacin (106.77+/-24.54) group, with no IN detected in neither of these two groups. Increased NOx levels induced by LPS correlated well with the occurrence of IN, and decreasing these levels via COX inhibition by indomethacin or NOS inhibition by L-NAME totally prevented IN from forming in this study. By these observations, it could be concluded that NO is probably involved in the pathophysiology of IN in this experimental model of LPS-induced IN.
Infantile myofibromatosis (IM) is a distinct but rare clinicopathological entity occurring in neonates and infants. It probably represents a rare soft-tissue tumour made up of undifferentiated myofibroblasts. Its recognition is important since it can be mistaken for a malignancy when, in fact, it has a generally benign prognosis with spontaneous regression. We describe the first case of an infant with IM presenting with acute intussusception due to gastrointestinal as well as the typical skin involvement.
Premedication with intramuscular dexamethasone may decrease the rate of early recurrent intussusception by amelioration of lymphoid hyperplasia.
Angiomyolipomas are benign mesenchymal tumors, but those that arise from the small intestine are exceedingly rare. We report on a 48-year-old woman who had an ileal angiomyolipoma, who presented clinically with vague abdominal pain and bloody stool. Small-bowel intussusception was shown on an abdominal computed tomography (CT) scan. We discuss the clinical manifestations and clinicopathological and immunohistochemical findings of this benign tumor which appeared in this rare location.
Adenomyoma of the small intestine is an extremely rare entity characterized by a mixture of glandular structures lined by columnar epithelium, with intervening bundles of smooth muscle. We report a case of adenomyoma of the jejunum that caused intussusception in an adult. Histologically, the morphologic features are typical of adenomyoma and are noteworthy for the extensive cystic change.
We report herein the case of a 10-year-old child with small bowel obstruction caused by jejunojejunal intussusception of a juvenile polyp. To the best of our knowledge, this is only the third case reported of a juvenile polyp in the small intestine and the first case to be documented in the English literature.
We present a young woman who was hospitalized for abdominal pain and vomiting. Abdominal CT revealed diagnostic features of ileoileal intussusception with a central hypodense lesion of fat density suggestive of a lipoma as the lead point. This diagnosis was confirmed at surgery, where a small bowel resection was performed and a benign lipoma of the ileum was found.
Jejunogastric intussusception (JGI) is a rare but potentially lethal complication of gastrectomy or gastrojejunostomy. In the acute setting, early diagnosis and prompt surgical intervention are mandatory to avoid mortality. We present a case of JGI in a patient with a history of gastrojejunostomy who had increasing vomiting, hematemesis, and abdominal pain for 1 day.
We describe an extremely rare case of an ileocolic intussusception with an appendiceal mucocele as the lead-point and cause of acute right lower quadrant pain in an adult patient. There are only few reported cases of this entity in the radiologic literature. We describe the multislice (computed tomography) CT features and emphasize the value of multiplanar reformations. We also discuss how specific findings on CT should allow for a correct preoperative diagnosis.
The occurrence of small bowel intussusception due to metastatic lung cancer is very infrequent. We present a case of young man recently diagnosed of non small cell lung cancer that had a unique small intestine metastasis. We discuss the diagnostic and therapeutic issues.