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A case of recurrent acute intussusception associated with a palpable abdominal mass which patient reduces with relief of symptoms is presented. Surgery revealed multiple colonic polyps and a total colectomy with ileorectical anastomosis was done and the patient has remained well after 3 years of follow up.
An elderly patient presented with intermittent vomiting. The cause was a gastric tumour causing gastroduodenal intussusception. On excision and histological examination this was found to be a stromal tumour of uncertain malignant potential ('STUMP').
The authors present a case of ileocecocolic intussusception by carcinoma of the caecum. They stress the most peculiar aspects of this condition: rare etiology; complete invagination of caecum appendix and ileum; typical clinical presentation characterized by variable dimensions of the mass and symptoms not ascribing to occlusion, no lesions at endoscopy; evidence of a typical "target mass" visualized at T.C.
There is little incentive to change existing protocols or clinical practices of medical conditions in which the results of treatment are considered already to be satisfactory. Our approach to continuing quality improvement (CQI) demands that, even in these conditions, attempts should be made to improve performance further. This report shows how the management of childhood intussusception has been refined at our institution, producing a measurable reduction in the operation rate and thus reducing the overall morbidity to the child. At each step, audit was followed by an intervention, the effect of which was documented. It is our belief that this approach can be applied to any number of medical conditions, and it is a responsibility of CQI personnel to encourage such processes.
We report a 55-year-old man with angiosarcoma of the cecum who presented with generalized colicky abdominal pain with a mass in the periumbilical region. The lesion at surgery was a colo-colic intussusception extending to the midtransverse colon. A radical right hemicolectomy was done. Metastases to regional lymph nodes were noted in the specimen.
Cecocolic intussusception was detected in a 2-year-old male Standardbred horse with a 3-day history of signs of intermittent colic. The entire cecum, which was located within the lumen of the right ventral colon, was edematous and necrotic, and could not be manually reduced. A colotomy was made, and partial typhlectomy was performed. An ileocolostomy also was performed. To prevent eversion of the cecal base, the site of invagination into the colon was oversewn. Several postoperative complications were treated, including peritonitis, thrombophlebitis, anemia, and hypoproteinemia, and 1 year after surgery, the horse was healthy and in training.
A retrospective study of 69 cases of intussusception treated at the University of Port Harcourt Teaching Hospital, Port Harcourt, in the past seven years from October 1985 to September 1992 is presented. The diagnosis was made clinically and confirmed at operation. Fifty (72.5%) of the 69 patients belonged to the three to nine-month age group. There was a male preponderance, with a male to female ratio of 3.6:1. The classic triad of abdominal pain, vomiting and rectal bleeding occurred in only 11 (15.9%) patients. All 69 patients had laparotomy as reduction using barium enema was not attempted. Of the 35 patients who required resection, 27 (77.1%) had gangrenous bowel and 2 (2.8%) had perforation. Mortality was 11.6%. The high mortality rate appears to be related to the long interval between onset of symptoms and commencement of definitive treatment.
The development of minimally invasive surgery for the management of cholelithiasis has been based on the premise that abdominal exploration during cholecystectomy is unnecessary. In the current study, 575 patients undergoing micro- and modern mini-laparotomy cholecystectomy were evaluated to assess the incidence and significance of undetected intra-abdominal pathology. In one instance an intussusception occurred from an ileal fibroma. This patient required a reoperation on the 20th postoperative day, after the removal of the porcellaneous gallbladder. After the primary resection of the tumor and affected bowel area, the patient recovered completely. During 575 cholecystectomy, performed with the micro- and modern minilaparotomy method, only in one patient (0.17%) was significant pathology not detected.
A 63-year-old man had had repeated episodes of ileo-caecal intussusception, and a pre-operative barium enema revealed appendiceal mucocele as a leading cause. Resection of appendix and part of the caecum were undertaken through exploration. The post-operative course was smooth. This unusual etiology is reported and discussed.
The energy imparted to the children in diagnosing and hydrostatic reduction of intussusception was measured in 45 children by means of an area-dose measurement device and the mean absorbed dose was estimated. The device was provided with data on tube kVp, mAs and shutter positions and the results were presented as dGy x cm2. The device had been calibrated against a 30 cm3 ionisation chamber at the relevant kVp range. The median energy imparted and mean absorbed dose were 10.8 mJ and 0.94 mGy, respectively. 70% of the total dose was delivered during fluoroscopy. The complex irradiation situation with varying field collimation, tube voltage and amount of photon absorbing barium sulphate in the intestines renders organ dose and hazards estimations less reliable. However, even leaving the radiation shielding effect of the barium sulphate out, the radiation load is justifiable for a combined diagnostic and interventional procedure.
2 infants, 3 months old and 8 months, respectively, with restlessness and vomiting were each found to have ileocolic intussusception with barium filling defects. Laparotomy disclosed in each a dome-shaped structure, 2 cm and 0.6 cm in greatest diameter, respectively, on the antimesenteric side of the ileal wall. Histological examination showed cystic duplication of the ileum. It is suggested that manual reduction generally fails when cystic duplication is an etiological factor, and surgery is then mandatory.
One case of chronic intussusception (ileo-ileo colic) is reported. A seven and a half year old male had presented with colicky abdominal pain, vomiting, a palpable abdominal mass, infrequent passage of mucus or blood with stools and weight loss over a period of six weeks. There was delay in diagnosis due to unusual presentation and a low index of suspicion. The patient had been admitted to a peripheral general hospital for four weeks where he was treated for amoebic dysentery without improvement, before his transfer to our hospital where the diagnostic problem continued, until the paediatric surgical unit was called in.
We report a case of a Meckel's diverticulum with pancreatic heterotopia that had intussuscepted into the distal ileum, masquerading as a small bowel tumor and presenting with acute lower gastrointestinal hemorrhage. Laparoscopically assisted resection of the diverticulum was successfully accomplished.
Many reviews have included the salient features of the clinical spectrum of intussusception: abdominal pain, vomiting, bloody stools and abdominal mass. We report a case with atypical presentation of the illness, presenting as altered consciousness. A misdiagnosis and delay of treatment is often associated with increased morbidity. Either plain radiographs, supplemented by ultrasonography of the abdomen, or a barium enema should be performed in infants with unexplained lethargy.
A case of multifocal leiomyosarcoma of the stomach, duodenum and jejunum presenting as an intestinal occlusion for small bowel intussusception is reported. Complete surgical excision of the tumour was not possible due to the wide dissemination. The patient died two months later for haemorrhage from an ulcerated gastric localization. Surgical and prognostic implications of disseminated gastrointestinal leiomyosarcoma are briefly discussed through a literature review.
A brief résumé of the important principles of diagnosis and treatment of intussusception in adults is presented, with 3 illustrative case histories.
MR imaging of an intussuscepted sigmoid cancer misinterpreted as a rectal carcinoma is described. High-resolution technique with pelvic-phased array coils and fast spin-echo was used. The diagnosis is discussed in relation to the MR findings.
We present a case of a child presenting with bilious vomiting due to extrinsic duodenal obstruction by an ileocolic intussusception. The clinical presentation, radiographic findings, and use of sonography are discussed.