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A 35-year-old parous woman was treated with abdominal hysterectomy for uterine myomata. The patient developed intussusception in the immediate postoperative period and was managed by laparotomy and manual reduction. The difficulties in diagnosis and management of this rare complication are discussed.
Twenty-one of 25 episodes of ileocolic intussusception were successfully reduced by the barium enema hydrostatic technique supplemented by glucagon. No apparent serious complications occurred from the use of this drug. The comfort of the children and the ease of filling the colon and small bowel seemed enhanced by the glucagon.
An intussusceptive antireflux valve was created in the Roux-en-Y loop at the same time as the hepatic portojejunostomy (Kasai procedure) for the purpose of preventing ascending cholangitis in 14 new cases of biliary atresia and in 6 long-term survivors of the Kasai operation after episodes of ascending cholangitis. Ascending cholangitis did not develop in any of the 13 new patients who showed bile outflow following a modified Kasai procedure with antireflux valve nor in 5 of 6 patients who had secondary valve implementation. Postmortem examination of a patient with a valve who died 2 years 3 months after surgery showed that the structure of the valve was intact and that the valve still was quite effective as an antireflux mechanism.
We report a father and two sons who each suffered from recurrent acute ileocolic intussusception in childhood, suggesting that there may in some cases be a genetic predisposition to the condition. This might have an anatomical basis.
Pneumatic insufflation of the colon for reduction of pediatric intussusception has recently been recognized in the United States as an alternative method for the more traditional hydrostatic reduction with contrast material. The experience with pneumatic reduction in China is extensive; more than 14,000 cases have been reported in the English language literature. In this review, the general technique used in China is summarized, and the international experience with air insufflation is included in a comparison of hydrostatic and pneumatic reduction techniques.
It is now apparent that distinction between the so-called malignant histiocytosis and lymphoma can be made using panels of established immunohistochemical markers and/or genotypic analysis. Many, if not all, of the previously diagnosed cases of malignant histiocytosis have been shown to be of lymphoid, rather than histiocytic, lineage. We report a rare case of colonic histiocytic neoplasm accompanied by a lymphoreticular dissemination that mimicked that of malignant histiocytosis. In addition, barium studies and computed axial tomography confirmed an intussusception that subsequently developed. The histiocytic nature of the neoplastic cells was supported by immunohistochemical, ultrastructural, and cytochemical studies. To our knowledge our case may represent the fifth documented case of a histiocytic malignancy reported in the literature. The relationship among the various cases will be discussed as well as the significance of the focal S-100 immunoreactivity observed in the present case.
Henoch-Schonlein purpura is a clinical diagnosis, based on a presentation including rash, arthralgia/arthritis, and abdominal pain, often with renal complications. A rare complication is intussusception, presumably initiated by an edematous vasculitic leading point in the small bowel's mucosal surface. A case is described involving a 3-year-old male, with a brief review of the literature.
OBJECTIVES: To describe the different pathways of management of intussusception (IS) in infants and children in metropolitan France and to identify paediatric emergency centres that might constitute a surveillance network for IS. MATERIAL AND METHODS: A questionnaire was sent to 273 paediatric emergency centres distributed across France in 2005. Modalities of diagnosis and treatment of IS had to be precised. RESULTS: One hundred and sixty-seven centres (61.2%) responded. The response was given by 131 paediatricians (78.4%) and 36 surgeons (21.6%) working in 38 universitary hospitals (22.7%) and 129 general hospitals (77.2%). The mean number of IS treated in each centre in 2004 was 11+/-13.5 (extr. 0 to 70; median 6). Diagnosis of IS required a collaboration between medical and surgical teams in 51.5% of the centres, but in 40.1% the sole medical team was in charge of the diagnosis. Ultrasonography is used for diagnosis by 98.8% of the centres. Reduction with hydrostatic enema and eventually surgery was performed in the same hospital in 44.3%. Other centres systematically or frequently transferred the patients for reduction, mostly towards universitary hospitals (90%). CONCLUSION: The procedures of IS diagnosis are the same everywhere in France but the pathways of therapeutic management do vary, depending on the availability of surgeons and anaesthetists trained in paediatrics on each site. These disparities will probably change with the implementation of the new plan for sanitary organization in children and adolescents in France. Labellized paediatric emergency centres will gather more surgical patients and could eventually constitute an effective surveillance network for IS.
Ten-percent of all malignancies affecting the HIV(+) patient population are lymphomas. Lymphoma involving the gastrointestinal tract may be more common than anticipated in this select group of patients. Because this patient population is frequently seen by the surgeon for abdominal complaints, the diagnosis of enteric lymphoma should be entertained and the general surgeons should be aware of its frequency. We report a case of intussusception caused by enteric lymphoma in an HIV(+) patient.
Inflammatory myofibroblastic tumor is a rare spindle cell lesion of indeterminate malignant potential occurring in both pulmonary and extrapulmonary tissues. This report describes an unusual presentation of an unusual tumor at an unusual location: an intramural ileal case of inflammatory myofibroblastic tumor presenting with intussusception in a 29-year-old woman. We characterize this tumor through microscopic and ultrastructural analysis, extensive immunohistochemical analysis, ploidy analysis, and Epstein-Barr virus in situ hybridization, and we report the finding of an ALK/TPM3 fusion using fluorescence in situ hybridization.
A spectrum of appendiceal diseases, ranging from simple mucous distension to acute perforated appendicitis, are seen in patients with CF. We report a 6 year old boy with CF and recurrent periumbilical pain. During colonoscopy, a fleshy pedunculated mass at the junction of the ascending colon and caecum was mistaken for a polyp and excised. However, histopathological examination suggested it was a segment of inverted appendix. The remnant of the inverted appendix was subsequently found to be associated with an intussusception.
PURPOSE: Cholangitis after Kasai portoenterostomy for biliary atresia (BA) strongly influences outcome, and an intussusception antireflux valve (IAV) in the Roux-en-Y limb has been advocated for the prevention of cholangitis without definitive evidence. The authors report a prospective study to evaluate the effectiveness of IAV in BA. METHODS: Twenty-one consecutive patients with uncorrectable-type BA were the subjects for this study. IAV was included based on informed parental request to give 2 groups: IAV- (n = 11) and IAV+ (n = 10). The incidence/duration of episodes of cholangitis (temperature > 38 degrees C, elevated serum bilirubin level, and leukocytosis) during the first 6 months after Kasai were statistically compared between the 2 groups (P >.05 was regarded as not significant). RESULTS: Technical variations in surgical technique were minimized because the same surgeon supervised all procedures. There were no significant differences between the 2 groups for age and weight at the time of Kasai, mean size of bile ductules at the porta hepatis, and degree of liver cirrhosis present. Protocols for antibiotic and steroid therapy were the same for both groups. The total number of patients who had cholangitis in the IAV- group was 6 of 11 and 5 of 10 in the IAV+ group (P = NS). The total number of episodes of cholangitis was 16 in the IAV- group versus 17 in the IAV+ group (P value, not significant). The mean duration of an episode of cholangitis (number of days per number of episodes) was 12 +/- 6 days in the IAV- group versus 11 +/- 7 days in the IAV+ group (P value, not significant). CONCLUSIONS: IAV does not make any significant impact on the incidence or duration of cholangitis in the early post-Kasai period.
The authors discuss a case of hereditary angioneurotic edema in a child presenting with recurrent episodes of colocolic intussusception, each successfully reduced by air enema. Although additional manifestations of vasogenic edema are potential risks of the procedure, these were not encountered.
PURPOSE: Laparoscopy has recently been used to treat intussusception that cannot be reduced radiologically. The effectiveness and practical nature of this approach has been questioned. METHODS: This study retrospectively analyzed the authors' experience with this laparoscopic approach and compared this to the conventional open laparotomy procedure. RESULTS: Sixteen patients were treated via laparoscopy, with 2 of these requiring conversions to an open procedure (12.5%). Twenty-five patients underwent an open reduction. Operative time was not significantly different (P = .698) between the laparoscopic (49.56 +/- 26.40 minutes) and open groups (45.00 +/- 24.74). Length of stay, however, was significantly reduced (P = .005) in the laparoscopic group (3.00 +/- 1.31 days) compared to the open group (4.52 +/- 1.98). Total hospital charges were lower in the laparoscopic group ($8171 +/- 2595) compared to the open group ($11,672 +/- 5466); this difference was not significant (P = .088). There were no significant differences in intra- or postoperative complication rates (P = .637) between the 2 approaches. CONCLUSIONS: Although there remains a group who will require a conversion to an open procedure, the laparoscopic approach should be considered a safe and effective option for all children who do not respond to a radiological reduction.
A case of jejunal intussusception caused by a multiple polypoid mucosal prolapse of jejunum in a 10-year-old girl is reported. The rarity of the lesion, its location, symptoms, and diagnosis are discussed.
Abstract Appendiceal intussusception and mucosa-associated lymphoid tissue lymphoma are both uncommon entities, and this is the first report of the two occurring concomitantly in an 8-year-old boy. This report of a mucosa-associated lymphoid tissue lymphoma localized in the appendix has not been reported previously.
We present the case of a patient with the acquired immune deficiency syndrome (AIDS) who developed an ileo-ileal intussusception due to lymphoma of the small bowel. The clinical and radiographic findings are described.
A case of ileo-colic intussusception with successful hydrostatic reduction under ultrasound guidance is reported. This has not been described previously in the literature.