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Diagnosis and management of intussusception remain controversial. The authors discuss the evolution of changes and advances in practice and procedures. They advocate sonographic diagnosis and air enema reduction; the abdominal radiograph is reserved for children with clinical evidence of peritonitis and suspected perforation, if clinical findings are unusual, or if the sonographic examination is equivocal.
Brown bowel syndrome is a rare condition characterized by deposition of lipofuscin in the smooth muscle cells of the gastrointestinal tract. The number of reported cases is small, but all are associated with malabsorptive states. Despite these small numbers, there is considerable evidence that vitamin E deficiency is important etiologically. We report here the case of a severely malnourished [body mass index 11.7 kg/m (2): normal range 20-25 kg/m (2)] 31-yr-old black male with a longstanding history of alcohol abuse, who was on anti-tuberculosis therapy. The patient presented with an acute abdomen and was found, at operation, to have a mid-ileal intussusception. Histological examination of the resected specimen demonstrated lipofuscin accumulation consistent with brown bowel syndrome, but no tumor. Subsequent investigations revealed no significant quantities of vitamin E in the blood and pancreatic steatorrhea. However, deficiency of other fat-soluble (vitamin A and D) and water-soluble vitamins (vitamin C and thiamine) also were detected. This report supports the association of brown bowel syndrome with vitamin E deficiency but cannot exclude the compounding effects of protein calorie malnutrition, multiple vitamin deficiencies, and chronic alcohol toxicity.
We describe the case of a 57-year-old woman who presented with colocolic intussusception due to a lipoma. The lesion was removed by laparoscopic right hemicolectomy. Benign colorectal pathology, such as colonic lipoma, is ideally suited for laparoscopic treatment.
A case of ileocaecocolic intussusception caused by a caecum carcinoma is presented. The authors stress the peculiarity of clinical manifestation, without intestinal obstruction despite the presence of a big abdominal mass involving vessels and bowel, revealed by CT scanning and angiography. Endoscopy was not able to identify the nature of the lesion. Laparotomy performed with the idea to find a mesenchymal neoplasia, permitted to achieve the diagnosis.
A unique case of Menetrier's disease of the stomach with long term follow-up is presented to document progression of extent of the disease radiologically and pathologically. This observation provides an insight into the natural history of the condition and suggests that local excision is not necessarily curative. In addition, this case demonstrates the complication of preoperative direct prolapse of involved gastric mucosa through the pylorus, and subsequent postoperative antegrade intussusception of the progressively involved gastric mucosa across a Billroth II gastrojejunostomy.
The authors investigated the data of a six-months old child having gone through a successful reduction. On the basis of these results, they have come to suppose that the enteric adenovirus 41 played a role in the course of the intussusception. The detection of the virus was verified through PCR, the application of hexon primers and by the restrictive enzyme analysis of Taq I and Hha I.
Intussusception of the appendix into the caecum is an uncommon condition and the diagnosis is rarely made preoperatively. Specific anatomic requirements as well as pathological conditions causing irritation or increasing peristalsis should be present for this event to occur. A case is discussed in which the diagnosis was made of an ileocolic invagination, which appeared peroperatively to be an appendicular invagination.
We report the case of an HIV-seropositive patient with non-Hodgkin lymphoma of the small intestine who presented with an ileocolic intussusception. This lesion fulfilled the diagnostic criteria for primary gastrointestinal lymphoma. Such a neoplasm in an immuno-compromised patient is usually more aggressive and less responsive to treatment than in an HIV-seronegative patient.
A case of intussusception in a haemophilic boy is described. The presumed cause was an intramural haematoma, which resulted in an ileocolic intussuception. This appears to be the first reported case which has been reduced by barium enema. It is suggested that this method, together with factor VIII replacement therapy as soon as possible after the development of symptoms, is the treatment of choice.
Eosinophilic gastroenteritis is a quite uncommon clinical entity usually involving the stomach or small bowel. Occasionally, the colon is involved. We have encountered a case of eosinophilic colitis leading to a left-sided colocolonic intussusception and subsequent large bowel obstruction. This is a unique presentation that, to our knowledge, has not been previously reported. We present our case in detail as well as a review of the literature to better understand this rare clinical entity.
We report a rare case of chronic appendicitis causing recurrent intussusception in a 33-year-old man who had recurrent episodes of right iliac fossa pain diagnosed clinically and confirmed by colonoscopy. This is the first known case with the rare combination diagnosed endoscopically.
Intussusception is one of the most frequent cause of mechanical bowel obstruction in children. On the basis of clinical features and diagnosis operations were conducted on 26 children. In 21, the treatment was manual disinvagination. In 5, pathomorphological changes of the walls of the invaginated portion suggested the intestinal resection. The results of treatment and prognosis are discussed.
Small bowel obstruction is slowly coming to be treated by laparoscopic surgery. There is no doubt that laparoscopic surgery will dramatically change the management of small bowel obstruction. I report an adult case of small bowel intussusception causing relapsing small bowel obstruction in which exploratory laparoscopy made an impressive change in the management and outcome.
Adult intussusception is a rare condition, chronic and recurring in nature, and presenting as intermittent intestinal obstruction. Surgeons generally have limited experience with it. We present 13 cases that have been treated in our department over a period of 19 years. In most of the cases there is an identifiable cause and it is often a malignancy. Awareness, plain abdominal films, barium enema and CT are valuable tools for diagnosis. Resection without reduction is the treatment of choice in most cases. In instances where resection would necessitate a permanent stoma, attempts at manual reduction are justified. Timely treatment, properly carried out, should result in a good prognosis.
We report the case of a 45-year-old woman with an intussusception of the small bowel due to Peutz-Jeghers syndrome. Immediate laparotomy was performed, and approximately 5 cm of the small bowel had to be removed because of ischemic areas. Six other polyps were removed through buttonhole enterotomies. The Peutz-Jeghers syndrome is rare. Treatment is either surgery or a combination of surgery and intraoperative enteroscopy. Bowel resections must be kept to a minimum.
We report a case of lung cancer metastatic to the stomach and the jejunum. Adenocarcinoma of the lingula (T 4 N 2 M 0) was diagnosed in a 45-year-old man, who then underwent chemoradiotherapy. Bowel obstruction later developed due to jejunal metastasis. Another metastasis was detected in the stomach. Laparotomy revealed jejuno-jejuno-jejunal intussusception caused by the two lesions. The jejunal and gastric lesions were identified as metastatic large cell carcinoma arising from the lung. One month postoperatively, the patient died due to disease. The literature has demonstrated that large cell carcinoma of the lung tends to metastasizes. However, the complex bowel invagination and gastric metastasis seen in our case are rare.
A child with biliary atresia experienced severe ascending cholangitis when the exteriorized loop of a portahepatoenterostomy was internalized. Backwash of bowel contents was reduced and further cholangitis was prevented by creation of an on-line intussuscepted Roux-en-Y jejunal loop to provide a nonrefluxing conduit from the porta hepatis. The loop could then be internalized and antibiotic therapy could be discontinued. The success of this procedure in this case encourages us to use this method in similar cases of biliary atresia. It may be of use in all Roux-en-Y loops, such as those used to drain the transplanted liver of patients with biliary atresia and those created to drain the distal part of the transplanted pancreas.
A new method of anastomosis after resection of esophageal or cardiac carcinoma was carried out in 141 patients in Anyang Cancer Hospital from February 1983 to September 1985. After resection of the tumor, the proximal end of the esophagus was intussuscepted into the stomach lumen and extroversion sutures were applied on the esophageal mucosa to prevent bleeding and stenosis. In this series, the operative mortality was 0.7% (1/141) and no anastomotic leakage was found. We consider that this modified operative procedure is fairly easy, simple, and beneficial in reducing surgical complications.