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PubMed2001

Laparoscopic-assisted resection of ileal lipoma causing ileo-ileo-colic intussusception.

Adult intussusception is rare, and the majority of cases has an underlying cause that requires surgical resection. We report a case of a 39 yr-old man with ileo-ileo-colic intussusception caused by ileal lipoma that was successfully managed by a laparoscopic-assisted surgical maneuver. Using a three-cannula technique, ileo-colic intussusception was reduced laparoscopically. Then, through a 4-cm transverse incision in the right lower quadrant abdomen, ileo-ileal intussusception was reduced manually, and a resection of the tumor-bearing ileal segment and end-to-end anastomosis was performed extracorporeally. Although the role of laparoscopy in managing intussusception is not clearly defined, laparoscopy may be an alternative approach to the surgical treatment of adult intussusception in selected cases.

Adult↗
PubMed1992

[Reevaluation of US and CT findings in adult intussusception].

Computed tomographic (CT) and ultrasonographic (US) findings of 10 adult patients with 11 intussusceptions were retrospectively analyzed. Through close scrutiny of wall structures of intussusceptums and mesenteric fat, new features of adult intussusceptions were found: 1. The returning walls were thicker than the entering walls in 10 of 11 intussusceptums. 2. The neck of the returning wall was thicker than its head in eight of nine intussusceptums. 3. Longitudinal compression of the wall and venous congestion resulting from an inside out turning of the wall structure were thought to be the cause of thickening of the returning wall. 4. Invaginated mesenteric fat tended to be located at the head (apex) in two of seven intussusceptions, making differentiation from intussusception caused by lipoma difficult. 5. The leading masses were detectable as apical soft tissue density masses in eight of 10 intussusceptions. These findings contradict those of previous reports on adult intussusceptions.

Adult↗
PubMed1991

Antiperistaltic and isoperistaltic intussusception associated with abnormal motility after Roux-en-Y gastric bypass: a case report.

Antiperistaltic and recurrent intussusceptions are extremely rare in the adult. We report a patient with both. The patient developed an antiperistaltic intussusception distal to her Roux enteroenterostomy years after a Roux-en-Y gastric bypass for morbid obesity. The diagnosis was made preoperatively with gastrointestinal contrast radiography and ultrasonography. At surgery, the intussusception was reduced, and 12 inches of nonviable bowel was resected, with a functional end-to-end anastomosis. An isoperistaltic intussusception occurred in the early postoperative period just distal to the anastomosis. Manometric evaluation of the Roux limb after the second operation showed altered gastrointestinal motility, consisting of orad-propagated and aboard-propagated migrating motor complexes, minimal phase 2 activity, and lack of conversion to the fed pattern with a liquid meal. Although manometry was not performed before the development of the intussusception, our findings are consistent with the hypothesis that altered intestinal motility may contribute to the development of intussusception.

Adult↗
PubMed1990

Intussusception: is floating caecum a causative factor? Analysis of 10 cases.

Ten consecutive cases of intussusceptions treated by the authors at the University of Port Harcourt Teaching Hospital (UPTH) in a five year period are analysed. The median age of occurrence was nine months; average 5.2 years; range: one month to 25 years. The male to female ratio was 2:3. Five patients had ileocaecal, two ileoileal, two colocolic and one ileocolic intussusceptions. Of the two patients with ileoileal intussusceptions one had antegrade with Meckel's diverticulum and the other retrograde with lipoma as lead-points. The two patients with colocolic intussusceptions had mesenteric and mesocolic lymph nodes hypertrophy. The remaining six patients had freely mobile caecum anchored to the posterior peritoneum by a long mesocaecum and such arrangement was believed to be the cause of the intussusceptions. In addition to intraoperative reduction in five cases and resection with end to end ileoileal anastomosis in one, each of these six patients had the caecum fixed to the posterior abdominal wall to prevent recurrence of the intussusception.

Adolescent↗
PubMed1978

Colonic intussusceptions in children.

There is a high incidence of primary colonic intussusceptions in infants and children in Africa. The case histories of 37 patients are reviewed. Of the varieties described, the caecocolic intussusception (16 patients) presents as an intestinal upset, often mild, with symptoms of colic and vomiting. In many of these patients there is known to be an intestinal infestation with Ascaris lumbricoides. This often leads to a delay in establishing the correct diagnosis. Colocolic intussusception (13 patients) gives rise to more acute abdominal symptoms. On clinical assessment, signs of intestinal obstruction are found and there is usually an intra-abdominal mass which can be palpated in the left colon. Further confirmatory evidence of intussusception is the finding of occult blood in stools. There is an unusually high incidence of sigmoid intussusceptions in infants (8 patients). The diagnosis of this form of intussusception is often delayed owing to inadequate clinical assessment of prolapsed bowel at the anal orifice. The length of the prolapsed bowel, the curved nature of the prolapse and the possible demonstration of a sulcus between the prolapsed bowel and the anal canal wall, aid in diagnosis.

Cecal Diseases↗
PubMed1993

[CT findings of invaginated mesentery in adult intussusception].

The CT findings of invaginated mesentery in adult intussusception were analyzed in 12 patients (three patients with four small bowel intussusceptions and nine patients with nine large bowel intussusceptions). In all small bowel intussusceptions, the neck was located near the superior mesenteric artery and vein (SMA & SMV) and showed a medial opening, and the vessels in the neck showed a continuity to the left side of SMA & SMV. In most of the large bowel intussusceptions, the neck was located distant from SMA & SMV, and the vessels in the neck did not show continuity to SMA & SMV. The difference in CT findings between small and large bowel intussusception is attributed to the difference in mesenteric anatomy; the small bowel and its mesentery move freely in the peritoneal cavity, whereas the large bowel is partially fixed to the retroperitoneum.

Adult↗
PubMed1993

A case of intussusception and lymphoid hyperplasia in a patient with AIDS.

Idiopathic intussusception in adults is rare. In tropical climates, enteric infection is causally implicated. Three cases of intussusception in AIDS patients have been reported, two of which were associated with enteric infection. We report the fourth case of ileocolonic intussusception in an AIDS patient in whom lymphoid hyperplasia of the terminal ileum was found but no infection documented. The relationship between lymphoid hyperplasia and intussusception is discussed. The previous cases of AIDS and intussusception are reviewed. Idiopathic intussusception may become more prevalent as the number of AIDS cases increases, and must be considered in the differential diagnosis of abdominal pain in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Adenovirus and intranuclear inclusions in the appendix in children with acute intussusception].

One hundred and five appendices removed at the time of surgical reduction of intussusception in children were studied by light microscopy after routine procedures to search for aetiological factors involved in intussusception. Normal pediatric appendix specimens served as controls (n = 30). Light microscopic examination showed viral inclusions in epithelial cells in 48 of 105 appendices (45%) from the cases of intussusception. No viral inclusion was observed in controls. Immunohistochemistry performed on 21 appendices from intussusception with a monoclonal antibody against adenovirus showed intranuclear positivity in all appendices with viral inclusions. Viral inclusions seen in epithelial cells of appendices from cases of intussusception are caused by virus and in particularly by adenovirus. The etiological factors involved in intussusception without viral inclusion in appendix remain unknown.

Acute Disease↗
PubMedDate not supplied

Neonatal ileoileocolic intussusception associated with ileal polyp: report of one case.

Neonatal intussusception is an uncommon disease. We report a case of neonatal ileoileocolic intussusception led by an ileal polyp in a female neonate. The patient presented with irritable crying, bilious vomiting and frank bloody stool on the 26th day of life. On physical examination, a mobile abdominal mass was palpated. Abdominal sonography demonstrated a long segment intussusception; associated with a low echogenic mass. At laparotomy, ileoileocolic intussusception led by an ileal polyp was found. Pathology confirmed the diagnosis of polyp. Because intestinal obstruction is the primary manifestation, neonatal intussusception is initially indistinguishable from obstructions due to other reasons like intestinal atresia, congenital bands, necrotizing enterocolitis or midgut volvulus. Our experience showed that although uncommon, intussusception should be considered in the differential diagnosis of intestinal obstruction during the newborn period.

Female↗
PubMed1998

Double intussusception in an adult following a laparotomy for trauma: a case report and review of the literature.

Intussusception is an unusual occurrence in adults. Postoperative intussusception may represent a separate pathophysiologic entity from primary intussusception in adults, occurring more frequently in the small bowel and without a specific underlying cause. Surgical resection is not mandatory and in those patients with viable bowel in whom the intussusception can successfully be reduced, manual reduction alone is an appropriate surgical strategy. Intussusception after laparotomy for trauma is a recently recognized phenomenon. For as yet unexplained reasons there seems to be a high association with liver injuries. A case of double intussusception is presented after a penetrating injury to the liver with discussion of the possible etiology and pathophysiology of this entity.

Adult↗
PubMed1996

Intussusceptive microvascular growth in a human colon adenocarcinoma xenograft: a novel mechanism of tumor angiogenesis.

Intussusceptive microvascular growth refers to vascular network formation by insertion of interstitial tissue columns, called tissue pillars or posts, into the vascular lumen and subsequent growth of these columns, resulting in partitioning of the vessel lumen. While intussusception has been reported in normal developing organs, its existence in solid tumors has not been previously documented. By observing the growth of the human colon adenocarcinoma (LS174T) in vivo for a period of 6 weeks, we demonstrate that intussusception is an important mechanism of tumor angiogenesis. At the leading edge of the tumor, vascular growth was found to occur by both intussusception and endothelial sprouting. In the stabilized regions, intussusception led to network remodeling and occlusion of vascular segments. The formation of some tissue pillars appears to depend on intravascular blood-flow patterns or changes in intravascular shear stress. The rapid vascular remodeling by intussusception could possibly contribute to intermittent blood flow in tumors.

Adenocarcinoma↗
PubMed2000

[Transurethral removal of the ureter by the intussusception method in the treatment of renal pelvic and ureteral tumors].

Between August 1986 and December 1998, 19 patients who had renal pelvic and upper ureteral tumors were treated with nephrectomy and transurethral removal of the ureter using the intussusception method. Removal of the ureter failed in 5 patients because of excessive ablasion of the ureter or insufficient electro-resection around the ipsilateral ureteral orifice. Excluding those patients, the safety of the operation and the intravesical recurrence were compared with the outcome in 12 patients undergoing partial cystectomy for similar tumors. The mean operating time was not significantly shorter with the intussusception method compared with partial cystectomy (190.4 versus 251.3 minutes), but the mean blood loss was significantly smaller (187.5 versus 460.2 ml) and the intussusception method did not require a blood transfusion. The mean term of hospitalization was 20.3 days for patients treated by the intussusception method which was significantly shorter than that for patient undergoing partial cystectomy (25.4 days). Intravesical recurrence was found in seven patients (50%) treated by the intussusception method and the 1- and 5-year recurrence-free rates were 69.2% and 30.8% respectively. There was no significant difference in the recurrence-free rates between the two surgical techniques. These results suggest that the intussusception method is superior to partial cystectomy in decreasing the operating time, blood loss and term of hospitalization. It can be an attractive option in selected cases, without increasing the risk of intravesical recurrence.

Adult↗
PubMed2002

Comparison of intussusception pull-through end-to-side and conventional end-to-side microsurgical vasoepididymostomy: prospective randomized controlled study in male wistar rats.

PURPOSE: Vasoepididymostomy is a technically challenging and complex microsurgical procedure. Recently a new triangulation end-to-side microsurgical technique was reported that allows intussusception of the epididymal tubule into the vasal lumen, resulting in a higher clinical patency rate of 92% with shorter operative time in preliminary clinical studies. We performed a prospective controlled randomized study comparing the patency rate, postoperative sperm granuloma rate and operating time of conventional and intussusception end-to-side vasoepididymostomy in previously vasectomized rats. MATERIALS AND METHODS: We randomized 42, 6-week-old male Wistar rats into 4 groups, including 6 into the sham operation, and 12 each into the control, conventional end-to-side and intussusception end-to-side vasoepididymostomy groups. Bilateral 2-clip vasectomy was performed in all animals except those in the sham operation group. Bilateral intussusception or conventional end-to-side vasoepididymostomy was performed in the assigned animals 2 weeks after vasectomy. Animals in the control group underwent vasectomy only. In the sham operation group the testes were mobilized out of the scrotum and then returned. Rats were sacrificed at 8, 12, 16 and 24 weeks, respectively. The anastomosis and vasectomy sites were inspected for sperm granuloma. To assess patency the abdominal end of the vas was transected and intraluminal fluid was examined microscopically at 400x magnification for the presence of motile sperm. Patency was further confirmed by performing retrograde indigo carmine vasography through the anastomoses. RESULTS: In the intussusception and conventional groups the patency rate was 91.7% and 54.2% (p = 0.004), the sperm granuloma rate was 20.8% and 58.4% (p = 0.035), and average operative time was 65.8 and 67.7 minutes (p = 0.197), respectively. CONCLUSIONS: Intussusception end-to-side vasoepididymostomy is superior to conventional end-to-side vasoepididymostomy with respect to the patency and postoperative sperm granuloma rates. Further investigations are required to confirm such findings clinically in humans.

Anastomosis, Surgical↗
PubMed1994

Recurrent intussusception. Risks and features.

OBJECTIVE: To determine the risk factors associated with recurrent intussusception (RI) and to characterize the timing, features, and complications of RI. DESIGN: Retrospective chart review. SETTING: Children's Hospital and Medical Center, Seattle, Wash. PARTICIPANTS: All patients with a diagnosis of intussusception who underwent barium enema as treatment for reduction between October 1, 1979 and December 31, 1990. Children with RI (N = 23, seven with two or more recurrent episodes) were classified as the case group; children with a single intussusception (N = 234), controls. RESULTS: There were no statistically significant differences in age, sex, race, symptoms, duration of symptoms, or results of the physical examination between the case group and controls. Reduction of the initial intussusception by a barium enema occurred in 96% of patients in the case group vs 62% of the controls (odds ratio, 13.50; 95% confidence intervals, 2.10 to 563.4; P = .003). Only one of 33 episodes of RI followed an operative reduction. In comparing the first recurrent episode with the initial episode, there was a significant reduction in the proportion of patients presenting with lethargy (0% vs 30%; Fisher Exact Test, P = .009) or blood in the stool (5% vs 52%; P < .002) and a drop in the median duration of symptoms from 20 to 6 hours. CONCLUSIONS: Recurrent intussusception cannot be predicted by presenting features or symptoms; operative reduction due to a failed reduction by a barium enema reduces the risk of RI; and patients with RI have fewer symptoms with a shorter duration.

Adolescent↗
PubMed1999

Five risk factors identify patients with gastroesophageal intussusception.

HYPOTHESIS: Risk factors in patients with gastroesophageal intussusception who have noncardiac chest pain need to be identified and analyzed. DESIGN: Prospective consecutive series of 43 patients with gastroesophageal intussusception. SETTING: Outpatient gastrointestinal endoscopy suite for 42 patients; 1 patient sustained gastroesophageal intussusception during labor and delivery and underwent an emergency laparotomy. INTERVENTION: Upper gastrointestinal tract endoscopy under intravenous sedation with appropriate monitoring of vital signs and photographic documentation in most patients. RESULTS: Gastroesophageal intussusception was documented endoscopically in 42 of 43 patients and was found to occur equally in men and women. Five risk factors have been identified: eating disorders or alcohol abuse, sudden sustained exertion, small-bowel obstruction, acid bile peptic disease, and pregnancy. Fifteen (70%) of 22 men were younger than 35 years; precipitating factors included sustained athletic effort and binge eating and drinking episodes. Fifteen (70%) of the 21 women were older than 35 years and had binge eating, peptic disease, and complications of pregnancy as risk factors. CONCLUSIONS: Five risk factors identify patients with severe vomiting or retching who are most likely to develop gastroesophageal intussusception, the precursor of a Mallory-Weiss tear. Upper gastrointestinal tract endoscopy with photographic documentation is the most accurate method of diagnosis. For most patients, medical management can reverse the cause of the vomiting. If vomiting is caused by mechanical obstruction or massive hemorrhage, surgical intervention may be necessary.

Adult↗
PubMed2002

Intussusception induced by villous tumor of the colon: sonographic findings.

We report a case of intussusception caused by a villous tumor of the ascending colon in an 82-year-old man. Abdominal sonography showed intussusception in the ascending colon, with a transverse scan demonstrating a multiple concentric ring sign. Color Doppler sonography showed blood flow signals in a mass, which was considered to be the lead point of the intussusception. A spontaneous reduction of the intussusception occurred during the examination; sonography then showed a mildly echogenic, mass. The graded compression method revealed that the mass was soft and immobile. Colonoscopy confirmed the diagnosis of villous tumor. Sonography helped to make an early diagnosis, allowing successful conservative management of the tumor and the intussusception.

Adenoma, Villous↗
PubMed1982

A two-part study of the aetiological role of rotavirus in intussusception.

The aetiology of intussusception is ill-defined, with viruses being incriminated as one of many possible aetiological agents. A two-part study was performed by us to investigate the aetiological role of rotavirus in intussusception. Retrospective epidemiological data revealed a negative correlation between the incidence of rotaviral gastroenteritis and the incidence of intussusception. A prospective investigation employing electronmicroscopy, enzyme-linked immunosorbent assay (ELISA), and immunofluorescence studies of faeces and fluorescent antibody studies of sera demonstrated evidence of rotavirus infection in only 2 of 24 children with intussusception. No evidence was forthcoming in this study of an aetiological role of rotavirus in intussusception.

Acute Disease↗
PubMed1994

Pneumatic reduction of intussusception using carbon dioxide.

Pneumatic reduction using air has recently become popular for the initial non-surgical management of intussusception. Since carbon dioxide (CO2) is rapidly absorbed from body surfaces, it should theoretically result in less cramping and distension following reduction. We reviewed our recent experience with the pneumatic reduction of intussusception using CO2 in 26 children. In 22 of these the intussusception was reduced (85%). There was one performation with CO2; the patient did not suffer any postoperative complications. Five additional children who had been treated unsuccessfully with barium had intussusception subsequently reduced with CO2. Following CO2 reduction, most children were fed within hours, and there were no instances of significant abdominal distension or cramping. We conclude that pneumatic reduction of intussusception using CO2 is safe and effective, and has the theoretical advantage of more rapid absorption from the gastrointestinal tract than air.

Carbon Dioxide↗