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Intussusception of the small bowel due to Peutz-Jeghers syndrome: a case report.

The Peutz-Jeghers syndrome is an autosomal dominant disorder characterized by hamartomatous polyposis of the gastrointestinal tract, melanin pigmentation of the skin and mucous membranes, and an increased risk for cancer. The incidence of surgical complications in these patients is relatively rare, and correlates with the size and location of the polyps. Herein we report the case of a 27-year-old woman presented with episodes of abdominal pain, abdominal distention and intermittent vomiting. Moreover, multiple pigmentation of the mouth was also noted. A preoperative diagnosis of a double jejunal intussusception and jejunal occlusion was based on the findings of small bowel enema and computed tomography. The diagnosis was confirmed at laparotomy.

Adult↗

Ileal intussusception due to invagination of Meckel's diverticulum.

A middle-aged patient is reported who came to laparotomy after a six months period of abdominal complaints. Extensive investigations couldn't explain his symptoms. At laparotomy he was found to have an ileal intussusception due to an invaginated Meckel's diverticulum. These events are confronted with other collected literature reports. Symptomatology and treatment are discussed.

Humans↗

[Intussusception in children: about 20 cases].

The authors report on a retrospective study 20 cases of intussusception in senegalese children. The diagnosis is essentially clinical. In difficult cases plane abdominal X-rays, barium meal and echography are indispensable exams. In our context the diagnosis is most of the time late and it is due to the unknown nature of the affection and early consultation to the traditional practitionners. The lateness of the diagnosis leads to the lateness of the management. This explains the importance of intestinal necrosis noticed in our serie and the high mortality rate which is 10%. The authors suggest recommendations to ameliorate the prognosis of this ailment which is good elsewhere.

Child↗

Stent-graft treatment of complete acute aortic transection complicated by intussusception and pseudo-coartaction.

Aim of the study was to validate the use of endoluminal stent-graft treatment as an alternative to conventional surgery in patients affected by blunt chest trauma and aortic disruption with multiple associated lesions. We report the case of a young female admitted with diagnosis of descending thoracic aortic transection and multiple traumas following a car accident. Spiral computed tomography revealed circular disruption of thoracic aorta immediately after isthmus region with intussusception of leaflets and pseudo-coartation. Doppler analysis showed a 70 mmHg transaortic gradient. The hemodynamic evaluation confirmed the existence of severe transaortic gradient. A Gore-TAG endoprosthesis (26 x 100 mm) was selected. Intraoper-ative transesophageal echocardiography assessment was performed to monitoring the entire procedure. The final arteriogram showed an optimal sealing at proximal and distal site without endoleak with complete readjustment of intimal leaflets to the aortic wall and disappearance of transaortic gradient related to the pseudo-coartation. No complication was observed in the early postoperative and patient was discharged one month later once complete rehabilitation of associated lesion was obtained. Computed tomography scan performed before discharge revealed persistency of patent lumen of aorta with fibrosis of readjusted circumferential intimal flap. In conclusion endovascular repair of complete aortic transection may result safe and effective particularly in patients with extensive associated injuries. Indeed the severity of coexisting non-aortic lesions could be adversely affected by conventional surgery in consideration of high surgical morbidity due to open thoracotomy. Stent-graft repair allows the patient to timely undergo medical or surgical management of associated lesions and a prompt rehabilitation with shorter hospital stay.

Accidents, Traffic↗

Postoperative intussusception in children.

Postoperative intussusception (POI) is an uncommon cause of postoperative mechanical bowel obstruction in children. Four cases of POI during a period of 15 years (1987-2001) were analysed retrospectively. Symptoms developed after a median period of 2.5 days following the operation. All cases were succesfully treated with operative manual reduction. POI occurs after a wide variety of surgical procedures and is often difficult to diagnose because the symptoms are often obscure. As a conclusion, we state that reaching a diagnose requires a high index of suspicion.

Adolescent↗

Double jejunal intussusception in an adult with chronic subileus due to a giant lipoma: a case report.

We present a case of a 40-year-old male with a clinical history of intermittent intestinal occlusion, abdominal pain and moderate weight loss. Physical examination and laboratory tests were unremarkable. Diagnostic imaging including CT, MR and small-bowel barium X-rays provided evidence of a jejunal lesion of an unknown nature downstream of the ligament of Treitz. Only at surgery was it possible to identify a double intussusception due to a giant stalked polyp which the histological examination revealed to be a submucosal lipoma.

Adult↗

Lipohyperplasia of the ileocecal valve as a cause of intussusception.

We present a case of lipohyperplasia of the ileocecal valve causing episodes of intussusception, and visualized by abdominal ultrasound and CT as a "target-like" appearance. At surgery, a large yellow soft mass was in the region of the ileocecal valve, raising the suspicion of lipohyperplasia. Resection of the fatty tissue from the ileocecal valve was performed at operation, after histologic diagnosis on frozen section. Our case suggests that limited resection removing the terminal ileum is effective and preferable to more extensive resection.

Adult↗

Burkitt lymphoma-induced ileocolic intussusception in Wiskott-Aldrich syndrome.

A 12-year-old patient with Wiskott-Aldrich syndrome (WAS) was referred because of recurrent abdominal pain and bloody stools. Ileocolic invagination was diagnosed and resection of the terminal ileum was performed. Pathologic examination identified submucosal tumor as the leading point of intussusception. Immunohistochemistry confirmed the diagnosis of Burkitt lymphoma. The use of chemotherapy with anti-CD20 monoclonal antibody led to complete clinical remission of lymphoma. Non-Hodgkin's lymphoma (NHL) accounts for more than 60% of the tumors in children with primary immunodeficiency, and it is the most common type of malignancy observed in WAS. Burkitt lymphoma represents 40% to 50% of all NHL cases in childhood, but in WAS it has rarely been reported. Mutation analysis of the WASP gene in this patient revealed missense mutation (105 C > T) in exon 1. WAS protein (WASP) of normal size was present at a reduced amount in peripheral blood lymphocytes. Complete lack of expression of WASP carries a greater risk for severe infections, bleeding, or malignancy development in WAS. However, rare patients with residual expression of mutated WASP, like this patient, still may develop lymphomas.

Burkitt Lymphoma↗

[Small bowel intussusception caused by metastasis from anaplastic thyroid carcinoma: case report and literature review].

Symptomatic involvement of the small bowel by metastasis from an extra-abdominal primary malignancy is rare, most commonly resulting from malignant melanoma and lung cancer; very rarely is small bowel involvement as first metastatic site. The Authors report a case of anaplastic thyroid carcinoma with lung metastasis, brain metastasis and an isolated metastasis to the small bowel leading intestinal obstruction due to small bowel intussusception. The Authors review the international literature about frequency, etiopathogenesis, clinical and diagnostic features and therapy of small bowel metastasis by extra-abdominal malignancies, especially by primary anaplastic thyroid carcinoma. Small bowel metastasis from extra-abdominal malignancies are very unusual, especially from anaplastic thyroid carcinoma, and the etiopathogenesis is still unknown. Clinical findings are typical for abdominal urgency, especially by small bowel obstruction from anaplastic thyroid carcinoma. Computed Tomography has an important role in detecting the type of intestinal obstruction despite it is often unable to diagnose an isolated metastasis. Best therapy is surgical resection, that allows the assessment of metastasis and the definitive staging. The prognosis is poor, despite long-term survival has been occasionally reported for isolated small bowel metastasis

Aged↗

A rare cause of haematemesis: retrograde jejunogastric intussusception.

Retrograde Jejunogastric intussusception is a well-recognised, rare but potentially fatal, long-term complication of gastro-jejunostomy or Billroth-II reconstruction. Only about 200 cases have been reported in literature to date. Diagnosis of this condition is difficult in most of the cases. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. Since gastrojejunostomies with vagotomy are on a declining trend, it is extremely rare to come across such a complication. We report such a case that presented with haematemesis.

Hematemesis↗

[Inflammatory fibroid polyp of the ileum presenting as intussusception: a case report in an adolescent].

Inflammatory fibroid polyp is an uncommon and benign submucosal lesion of the gastrointestinal tract. The maximal incidence is in the fifth and sixth decades. The main histological characteristics are diffuse inflammatory infiltrate with eosinophils and highly vascularized fibrocystic stroma. We report a case of 15-year-old patient who underwent emergency surgery because of acute intestinal obstruction as a result of an intussusception. The macroscopical study after segmental ileal resection showed a nodular lesion 3x2x2 cm, arising from the submucosa with an ulcerated surface. The pathologic diagnosis was ileal inflammatory fibroid polyp. Immunohistochemically, the cells reacted with vimentin and CD34. It has no malignant potential although extensive infiltration may occur. The etiology is unknown. We discuss the clinical, the pathological aspects and the possible etiological factors of the inflammatory fibroid polyp.

Adolescent↗

Retrograde intussusception as a complication of Roux-en-Y anastomosis.

We report a case of a serious complication of a Roux-en-Y reconstruction in which an antiperistaltic jejunojejunal intussusception created a strangulating intestinal obstruction. It is suggested that this complication may be an extreme form of the so-called Roux-en-Y stasis syndrome.

Anastomosis, Roux-en-Y↗

Microsurgical epididymovasostomy by tubule intussusception: a new technique in rat model.

This experimental study on 15 adult male rats with bilateral epididymovasostomies evaluates a new technique of tubule intussusception as an improved form of end-to-end anastomosis. This paper describes in detail the steps in this technique and offers physiological, anatomical, and histological follow-up after 3 months. With this technique there is a 97% patency rate and a 23.3% incidence of macroscopic spermatic granuloma. Complications are discussed in detail.

Animals↗

Postoperative intussusception in adults. A report of 5 cases.

Five cases of postoperative intussusception in adults illustrate the clinical features of this uncommon complication. The diagnosis is usually made at laparotomy after a prolonged period of inappropriate conservative treatment, but can be made radiologically if suspected clinically. Simple reduction is usually effective with no potential for recurrence. Although various theories hav e been proposed and various factors implicated, the precise cause and mechanism in individual patients usually remains unknown.

Adolescent↗

[Intussusception in children and adults].

The authors describe several cases of intussusception in children and one in an adult, paying attention to the underlying pathology, also in children. This must be kept in mind at the radiological examination (so called "leading points") and at the operation. Different causes are Meckel's diverticulum, ectopic pancreatic tissue, tumours. Air insufflation (= chinese method) could be safer and in case of perforation it would be less dangerous. Surgery shall be undertaken in late diagnosis, difficult or impossible reductions by enema and signs of perforation or peritonitis.

Aged↗

[Acute intestinal intussusception: ultrasonic diagnosis and air insufflation].

Sixty-five children with intussusception were diagnosed by ultrasonography. Colonic air insufflation was the principle form of treatment. The diagnosis value of ultrasound was 100% and the success rate of reduction by air insufflation was 93%, after intrarectal injection of midazolam (0.3 mg/kg). The device for insufflation was simple, original and manual, with permanent control of intrarectal pressure. No complications were observed.

Acute Disease↗

[Management of intussusception in infancy by hydrostatic desinvagination under ultrasonic monitoring].

The ultrasonographic diagnosis of intussusception may be a recent complementation of X-ray fluoroscopy controlled hydrostatic desinvagination. Ultrasound is also useful in follow-up of the effectiveness of conservative management. By presenting their experience gathered by successful treatment of one case, the authors' aim is to contribute to the spread of this method.

Catheterization↗