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The gastro-intestinal tract is a common site for non-Hodgkin's lymphoma and its involvement leads to a variety of clinical presentations. In adults, intussusception has rarely been associated with gastro-intestinal non-Hodgkin's lymphoma. When it occurs, computerized axial tomography scanning seems to be the diagnostic tool of choice.
Colonic lipomas are rare, benign tumours that rarely produce symptoms. Presented here is a case where a sigmoid lipoma acted as lead point to produce intussusception.
A rare case of cystic lymphangioma of the cecum presenting as a leading point for ileocecal intussusception is described. Local resection is recommended.
OBJECTIVE: To study the role of nitric oxide synthase/nitric oxide pathway in the pathophysiological process of intussusception (IN). METHODS: The IN model of rat was induced by lipopolysaccharide (LPS). The content of NOx in plasma and the NOS activity in colic smooth muscle tissues were measured. The content of cGMP was determined by radioimmunoassay. RESULTS: LPS (10 mg/kg, i.p.) induced IN in up to 40% of the rats 6 hours after treatment with LPS. The incidence of IN was significantly increased by 58.3% (P < 0.05) and by 66.8% (P < 0.01) in L-arginine (L-Arg)-treated rats (2% in drinking water) and in sodium nitroprusside (NSP)-treated rats (1 mg/kg, i.p.), respectively, but it is significantly decreased by 66.8% (P < 0.01) after administration of M-omega-nitro-L-arginine methyl ester (L-NAME, 15 mg/kg, i.p.), an inhibitor of nitric oxide synthase (NOS) activity. Furthermore, LPS increased total NOS activity, NOx production and cGMP levels in plasma or in colic smooth muscle tissues. These parameters in LPS-IN rats were significantly elevated by 38.8%, 50.7%, and 48.7% respectively (P < 0.01) compared with LPS-non-IN rats. CONCLUSION: NOS/NO pathway plays an important role in the process of IN, and inhibition of NO production may serve as a possible approach to prevent IN.
Primary malignant melanoma of the lung (PMML) is an uncommon tumor with very few cases reported in the literature that satisfy the required criteria to establish a primary bronchial origin. We report a case of a 44-year-old man with acute abdominal distress and a right pulmonary roentgenographic opacity. A cranial-thoracic-abdominal CT scan confirmed the presence of a pulmonary nodule with bilateral cerebral metastases and marked dilatation of intestinal loops. At laparotomy an ileal intussusception was noted and an ileal resection was done. The resected intestinal segment contained three endoluminal polypoidal formations. Histological and immunohistochemical analyses showed the presence of multiple sites of melanoma. These lesions as well as the brain lesions clearly appeared metastatic. The patient underwent further evaluation to identify a primary site of melanoma; bronchoscopy was performed with biopsy of the pulmonary nodule. Pathology revealed a neoplastic process of fusiform cells, with focal presence of melanic inter- and extracellular pigment. The immunohistochemical analysis confirmed the diagnosis of PMML. We discuss the criteria for diagnosis and histogenesis of PMML along with this unusual presentation.
An elderly man who presented with colicky abdominal pain had gastric volvulus which was reduced after barium meaL More than a year later the symptoms recurred and at laparotomy a gastroduodenojejunal intussusception was found and its apex was formed by a polypoidal gastric tumour (leiomyoma). The patient did very well without any recurrence after the resection of the tumour.
Non-Hodgkin's lymphoma is infrequently diagnosed during pregnancy and puerperium. A 21-year-old woman, para II, gravida II, on the seventh postpartum day arrived at the Emergency Gynaecologic Clinic complaining of colicky abdominal pain associated with bilious vomiting. A large tender mass of firm consistency was palpated in the midline towards the left hypochondrium. A CT scan of the upper abdomen showed thickened small bowel with halo, specifically at the junction of the jejunum with the ileum, resembling imaging of intussusception. Also, blocks of mesenteric and paraortic lymph nodes and multiple lymph nodes inducing enlargement of the anterior mediastinum were found. These findings rendered a picture of lymphoma in Stage at least III. Subsequent exploratory laparotomy confirmed our preoperative diagnosis. Histopathological examination of the lymph node biopsies established the diagnosis of a primary non-Hodgkin's lymphoma. Judging from the extent of the non-Hodgkin's lymphoma in our patient seven days after delivery the disease probably already existed during the last trimester of pregnancy. This study demonstrates a remarkable delay in diagnosis of non-Hodgkin's lymphoma in pregnancy. The diagnostic dilemmas of non-Hodgkin's lymphoma during pregnancy are emphasized and the literature is reviewed.
Inflammatory fibroid polyp (IFP) of jejunnum is a rare nonneoplastic lesion of gastrointestinal tract. We report a case of a 45-year-old man presenting with small bowel obstruction due to jejuno-jejunal intussusception of an inflammatory fibroid polyp. To the best of our knowledges, this is the eighth reported case with such a presentation in English medical literature. Segmental resection of the jejunum was performed and histopathology confirmed the diagnosis.
After sonographic diagnosis, non-surgical therapy for intussusception in children uses pneumatic or hydrostatic (barium or water soluble) reduction. The purpose of this paper, in the light of our experience, is to answer the questions raised by general radiologists in emergency activity about the technique, indications, sedation and risks.
OBJECTIVES: To investigate the role of endogenous heme oxygenase (HO)/carbon monoxide (CO) system in regulating the process of intussusception (IN) induced by administration of lipopolysaccharide (LPS) in rats. METHODS: IN model of rats were induced by lipopolysaccharide. HO activity was determined by the amount of bilirubin formation which was measured with a double-beam spectrophotometer, and HbCO formation was measured by CO-oximeter. RESULTS: The results showed that LPS (10 mg/kg) caused IN in up to 40% of the rats at 6 h after each treatment of LPS. The incidence of IN were significantly increased by 50% (P < 0.05) and by 83.2% (P < 0.01) in HO substrate (heme-L-lysinate)-treated rats and in exogenous CO-treated rats, respectively; but it was sigificantly decreased by 41.8% (P < 0.05) after administration of ZnDPBG, an inhibitor of heme oxygense (HO) activity. Furthermore, LPS increased HO activity, HbCO formation cGMP content within colic smooth muscle and the plasma level of cGMP, and these parameters were significantly elevated by 62.6% (P < 0.01), 40.0% (P < 0.01), 49.3% (P < 0.05) and 38.9% (P<0.05), respectively, compared with LPS-non-IN rats. CONCLUSION: It is suggested that endogenous HO/CO system plays an important role in the process of IN induced by LPS, and inhibition of HO activity may decrease the formation of IN.
We report the case of a 32-year old female without previous illness. At hospital admission she reported having four days with clinical symptoms such as: intense abdominal pain, gastric vomit, and feces absence. At physical examination, mass in lower quadrant, non-mobile, and painless. Normal laboratory results. Abdominal radiologic studies and ultrasound with 10 x 12 cm mass. The patient was with acute appendicitis diagnosis and laparotomy was done. Transoperatory finding was: ileo-ileal necrotic intussusception. Intestinal resection and anastomosis were performed. Postoperatory evolution was normal. Pathologic study reported: multiple intestinal lipomatosis, mucous erosion, and acute inflammatory process. Frequency of this uncommon pathology is analyzed in the world literature.
Lipomas of the small intestine are usually found incidentally; symptoms occur in less than one-third of affected patients, especially when lipomas are more than 2 cm in size. We report a 32-year-old man in whom intestinal lipomatosis resulted in colo-colic intussusception. These symptoms disappeared following operative resection of about 60 cm of ileum and ascending colon.
In many regions of Africa intussusception is the most common cause of intestinal obstruction next to strangulated hernia. More recent reports seem to indicate a change in the clinical pattern of the disease. This retrospective analysis covering a period of ten years is of 85 patients aged between 11 weeks and 50 years. There were 65 males and 20 females; 69 were children between 1 month and 15 years. The anatomical pattern of the disease has changed from being of the caecocolic type to the ileocolic variety while the pathology of the disease has remained largely unidentified. 32 patients had the ileocolic variety. 20 were ileocaecal, 14 colo-colic, 8 caecocolic, 8 ileo ileal, 2 jejuno jejunal, and 1 jejuno ileal. There were 2 ileal and 4 colonic neoplasms. There was a high rate of bowel resection (54/85) and 8 deaths.
A review of 152 cases of acute intestinal intussusception shows a dramatic evolution in its management within the last 15 years. Ultrasound is the main procedure utilized, and in the hands of a trained-radiologist, it allows a safe non-surgical treatment via barium or pneumatic reduction. Surgery is now limited to the rare cases of failure of the above treatment, and to advanced or complicated cases.
A rare case of solitary intussuscepting capillary hemangioma in the distal ileum with perforation and peritonitis is presented. The diagnosis was made only at surgery for presumed acute intestinal obstruction.
A 39-year-old man was admitted to our Medical Department, because of regular abdominal cramps. At physical examination a palpable mass was detected in the ileocoecal region with tenderness. Examinations proved ileocoecal intussusception. Emergency operation was performed. At histology the cause of small-bowel invagination was Burkitt-lymphoma. After the complex haematological examination chemotherapy was started. Six month after surgery the patient is symptomless.
Adenomyomas are hamartomas of the alimentary tract with exceptionally rare localization at the ileum. The case presented here concerns an infant aged 18 months suffering from adenomyoma of the ileum, which was responsible for the development of ileoileac intussusception. Our paper aims at underlining the particularities of this extremely rare entity, while adding the 13th case reported to the international bibliographic references.
Inflammatory fibroid polyp is a rare polypoid lesion of the gastrointestinal tract, histologically characterized by an admixture of numerous small blood vessels, fibroblasts and edematous connective tissue, accompanying a marked inflammatory cell infiltrate which contains eosinophils. Although it generally presents as a polypoid mass in the gastric antrum, it can be seen throughout the gastrointestinal tract. It is believed to represent a reactive, nonneoplastic condition, but its histogenesis remains controversial. A case of inflammatory fibroid polyp of the ileum presenting clinically as intestinal obstruction due to intussusception is presented here.