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Doppler ultrasonographic detection of nutcracker syndrome in a young child with intussusception: a case report.

UNLABELLED: We report on a 2-y-old male with intussusception accompanying nutcracker syndrome detected by renal Doppler ultrasound. Renal Doppler ultrasound revealed a significant difference in the peak velocity between the hilar and aortomesenteric portions of the left renal vein. CONCLUSION: Renal Doppler ultrasound has been very useful and effective in detecting nutcracker syndrome in a young child.

Child, Preschool↗

Localised mid-jejunal volvulus following intussusception and enteroplication in a dog.

Ileocolic intussusception was successfully treated surgically by partial enterectomy and enteroplication in an 11-month-old, male neutered German shepherd dog. Segmental intestinal volvulus was identified in the same dog two months later and was managed successfully by a second partial enterectomy. The dog made an uneventful recovery and was free of clinical disease six months after the second surgery. Both conditions are reviewed in this case report and a possible relationship between these two episodes in this dog is discussed.

Anastomosis, Surgical↗

Idiopathic megaoesophagus and intermittent gastro-oesophageal intussusception in a cat.

An eight-month-old domestic shorthair cat was presented with chronic vomiting for three months, with an acute increase in frequency during the past two days. A diagnosis of megaoesophagus was made by chest radiography. Diagnostic work-up for megaoesophagus was performed. A gastro-oesophageal intussusception was identified during endoscopy. Medical and nutritional therapy was instituted with a good response to the treatment.

Animals↗

Molecular epidemiology of adenovirus isolates from patients diagnosed with intussusception in Melbourne, Australia.

Twenty-one intussusception (IS)-associated and 59 temporally linked adenoviral isolates from clinical infections were compared. Species C (15/21 IS- and 32/59 non-IS-associated isolates) dominated. Of these, serotype 2 (AdV-2) (7/15 IS-associated isolates) and serotype 1 (AdV-1) (16/32 non-IS-associated isolates) were the most commonly identified serotypes. DNA restriction analysis of AdV-2 isolates identified six genomic types; of these, type D2 (3/7 IS- and 8/11 non-IS-associated isolates) was the dominant type after BamHI and SmaI digestion. IS-associated isolates are similar to circulating non-IS-associated strains.

Adenovirus Infections, Human↗

Intussusception--current trends in management.

Barium enema reductions were attempted in 65 (90%) of 72 intussusceptions, of which 51 (79%) were successful. This represents a success rate of 70% overall. The average hospital stay was 3 1/2 days. There was no mortality and, apart from a recurrence rate of 10%, no morbidity. It is suggested that barium enema reduction should be the treatment of choice provided that there is an emergency service of a paediatric radiologist and the patient is adequately resuscitated, the only absolute contraindication being evidence of pneumatosis intestinalis or peritonitis. Those patients who presented with shock, rectal bleeding, duration of symptoms longer than 48 hours, and pronounced degree of bowel obstruction had a higher rate of unsuccessful reduction. However, only the last two were significant. Further, provided that the clinical condition remains satisfactory and the reduction has been achieved to the caecum a repeat barium enema after some hours may be successful in achieving reflux of contrast into the ileum, confirming complete reduction.

Age Factors↗

Intussusception in cystic fibrosis.

Two cases of acute intussusception in older children with cystic fibrosis are reported. Both cases presented with symptoms and signs consistent with meconium ileus equivalent, which delayed the final diagnosis. Both cases required abdominal surgery but made full and uneventful recoveries.

Cystic Fibrosis↗

Function of the anal sphincters in patients with intussusception of the rectum.

Patients with intussusception of the rectum--six with anal incontinence and nine continent--were examined with respect to the function of the anal sphincters. Anal pressure was recorded continuously during rest, during maximal voluntary squeezing of the anal muscles, and during gradual expansion of the rectum by means of a balloon inserted into the rectal ampulla. The maximal anal pressure at rest, which is mainly due to activity of the internal anal sphincter, was lower (P less than 0-001) in the incontinent patients (31 mmHg +/- 5-6) than the continent (67 mmHg +/- 4-3) and the former had significantly smaller relaxations of the internal sphincter upon rectal distension (P less than 0-05). The increase in anal pressure during voluntary squeezing, a function of the external sphincter, did not differ significantly compared with healthy subjects in either incontinent or continent patients. On the basis of the above findings, it is concluded that the function of the internal sphincter is impaired in the incontinent patients.

Aged↗

Small bowel haemangioma with local lymph node involvement presenting as intussusception.

Gastrointestinal haemangiomas make up 0.05% of all intestinal neoplasms. They are sometimes multiple and usually present with pain, bleeding, and obstruction. An associated haemangiomatous change in regional lymph nodes has not been reported previously. A woman of 21 years presented with abdominal pain and vomiting. Abdominal ultrasound and computed tomography scan showed a lower abdominal mass. Laparotomy revealed a small bowel tumour causing an intussusception together with enlarged mesenteric lymph nodes. Pathological examination revealed a small bowel haemangioma with mesenteric node involvement. The pathogenesis of haemangiomatous involvement of lymph nodes is discussed. Hamartomatous change is the likely cause in this patient.

Adult↗

The decline in incidence of acute intussusception in childhood in north-east Scotland.

The records have been studied of 77 cases of acute intussusception in children which occurred in Aberdeen City, Aberdeenshire, and Banffshire during the 10 years 1967--76. There has been a decrease in age-specific incidence of about a third since a previous study in the same region was carried out between 1950 and 1959. The decline in rates is greater for rural areas than for Aberdeen City and it is more marked for girls than for boys.

Acute Disease↗

Retrograde ileo-ileal intussusception.

A case of retrograde ileo-ileal intussusception in a boy of 16 years is reported. There was no apparent predisposing cause. The patient was treated by resection-anastomosis of the ileum and recovered uneventfully.

Adolescent↗

Amoebic granuloma--an unusual cause of caeco-colic intussusception.

A case of amoeboma presenting as an intussusception, encountered for the first time in this institute, is reported. The diagnosis was only made postoperatively. The importance of awareness of such lesions in the tropics, in view of the efficiency of trial antiamoebic therapy, is discussed.

Adult↗

Intussusception in the adult: clinical, radiological and histological features.

Intussusception in the adult is an unusual cause of bowel obstruction. Unlike in childhood the clinical presentation is not clear cut and there are no distinct pathognomonic features. The radiological features are variable. Five patients presented to Frenchay Hospital over a five month period. The patients' clinical courses demonstrate the differing presenting features. Ultrasound investigation and CT scanning may show characteristic signs. Surgical treatment is mandatory as there is nearly always an underlying pathological abnormality which may be malignant.

Aged↗

Ultrasonographic appearance of adult intussusception.

A gray scale ultrasound evaluation of a case of adult intussusception is presented. The observed "target-like" abdominal mass, with central dense echoes and peripheral sonolucency, may be characteristic of this entity. A primary bowel or intestinal loop process should be considered when a lesion with this appearance is encountered.

Adenocarcinoma↗

Ileocolic intussusception: extensive reflux of air preceding pneumatic reduction.

The use of an air enema for diagnosis and treatment of intussusception has recently gained popularity. The current end point for reduction is the reflux of air into the terminal ileum. The authors report three cases in which air freely refluxed into the terminal ileum without complete reduction of the intussusceptum. Thus, reflux of air alone cannot be relied on as the sole criterion for reduction. Close examination of the cecum for a persistent filling defect is imperative to exclude unsuccessful reduction.

Enema↗

Intussusception: hydrostatic pressure equivalents for barium and meglumine sodium diatrizoate.

The pressures generated by a barium suspension and various solutions of meglumine sodium diatrizoate in water were measured with a manometer. A pressure of 120 mm Hg was produced by a 3.5-foot (105-cm) column of 60% wt/vol barium and a 5-foot (150-cm) column of either a 1:3 or 1:4 solution of meglumine sodium diatrizoate and water. This is the pressure used to reduce an intussusception with air.

Barium↗

Intussusception of invaginated Meckel's diverticulum.

Two middle-aged patients are reported who came to laparotomy with a presumptive diagnosis of small bowel tumour. There was no overt evidence of small bowel obstruction in either case. They were found at laparotomy to have intussusception of an invaginated Meckel's diverticulum. This condition should be considered in the differential diagnosis of ileal tumours.

Angiography↗