1
|
Factors associated with surgical treatment in pediatric intussusception. Wien Med Wochenschr 2022; 172:313-316. [PMID: 35896760 DOI: 10.1007/s10354-022-00953-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The study aimed to identify factors related to the need for surgical treatment of intussusception in pediatric patients. METHODS The medical charts of 106 patients diagnosed with intussusception and treated at the Imam Khomeini Medical Center in Ahvaz city between September 2019 and October 2020 were retrospectively reviewed. Patients were compared in terms of risk factor groups treated with surgery (12 pediatric patients) and nonsurgical methods (92 pediatric patients). Size of intussusception, free fluid in the abdomen, and currant jelly stool were compared between the groups. RESULTS The mean age in the group treated with surgery was significantly higher (p = 0.01). The duration of symptoms in patients treated with surgery was significantly higher (p = 0.033). The size of intussusception in the surgical treatment group was significantly larger than in the nonsurgical recovery group (p = 0.042). The rates of presence of free fluid in the abdomen and currant jelly stool were significantly higher in patients treated with surgery (p = 0.001 and p = 0.004, respectively). CONCLUSION Age > 1 year, duration of symptoms > 24 h, currant jelly stool, intussusception > 3.5 cm, and free peritoneal fluid are factors associated with surgical treatment of intussusception in children.
Collapse
|
2
|
Inarejos Clemente EJ, Navarro OM, Navallas Irujo M, Ladera E, Colombo C, Suñol M, Sousa P, Barber Martínez de la Torre I. Omphalomesenteric Duct Anomalies in Children: A Multimodality Overview. Radiographics 2021; 41:2090-2110. [PMID: 34723700 DOI: 10.1148/rg.2021210048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The omphalomesenteric duct is an embryologic structure that connects the yolk sac with the primitive midgut of the developing fetus. Omphalomesenteric duct anomalies include a group of entities that result from failed resorption of the omphalomesenteric duct. These anomalies include Meckel diverticulum, omphalomesenteric fistula, fibrous bands, cysts, and umbilical polyps. Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract and is usually asymptomatic. Symptoms develop when Meckel diverticulum involves complications such as hemorrhage, inflammation, and perforation, or when it causes intussusception or bowel obstruction. Hemorrhage is the most common complication of Meckel diverticulum, and technetium 99m-pertechnetate scintigraphy is the imaging modality of choice for detecting acute bleeding. US and CT are commonly used for the evaluation of patients with other complications such as obstruction and inflammation. Nevertheless, the diagnosis of these complications can be challenging, as their clinical manifestations are usually nonspecific and can masquerade as other acute intraabdominal entities such as appendicitis, inflammatory bowel disease, or other causes of bowel obstruction. There are other umbilical disorders, such as urachal remnants and umbilical granuloma, that may present with symptoms and imaging findings similar to those of omphalomesenteric duct anomalies. An accurate preoperative diagnosis of omphalomesenteric duct anomaly is crucial for appropriate management and a better outcome, particularly when these anomalies manifest as a life-threatening condition. The authors review the anatomy, clinical features, and complications of omphalomesenteric duct anomalies in children, describing the relevant differential diagnoses and associated imaging findings seen with different imaging modalities. ©RSNA, 2021.
Collapse
Affiliation(s)
- Emilio J Inarejos Clemente
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Oscar M Navarro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - María Navallas Irujo
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Enrique Ladera
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Cecilia Colombo
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Mariona Suñol
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Paulino Sousa
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| | - Ignasi Barber Martínez de la Torre
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N.I., E.L., C.C., P.S., I.B.M.d.l.T.) and Pathology (M.S.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; and Departments of Medical Imaging, University of Toronto, and Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada (O.M.N.)
| |
Collapse
|
3
|
Sangüesa-Nebot C, Llorens-Salvador R. Ecografía intestinal en pediatría. RADIOLOGIA 2021; 63:291-304. [DOI: 10.1016/j.rx.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/29/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022]
|
4
|
Sangüesa-Nebot C, Llorens-Salvador R. Intestinal ultrasound in pediatrics. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
5
|
Ultrasound assessment of the bowel: inflammatory bowel disease and conditions beyond. Pediatr Radiol 2017; 47:1082-1090. [PMID: 28779191 DOI: 10.1007/s00247-017-3877-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022]
Abstract
Ultrasound (US) is a versatile imaging study for the evaluation of the bowel in children. US imaging of the bowel can be used as the initial examination or in follow-up for many common pediatric diseases. In this article, we highlight our bowel US technique and describe how US can depict the features of a select group of bowel pathologies relevant to pediatric practice.
Collapse
|
6
|
|
7
|
Kim KH, Kang KA, Lim JH, Lee KG, Kwon TJ. Inverted Meckel diverticulum as a lead point of small bowel intussusception: misinterpreting case as a lipoma. Clin Imaging 2016; 40:840-2. [PMID: 27179156 DOI: 10.1016/j.clinimag.2016.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 02/23/2016] [Accepted: 03/16/2016] [Indexed: 11/28/2022]
Abstract
Inverted Meckel diverticulum is an uncommon cause of intussusception in adults. It may be confused for an intraluminal lipoma. We present a case of small bowel intussusception due to inverted Meckel diverticulum with characteristic computed tomography finding potentially distinguishable from lipoma.
Collapse
Affiliation(s)
- Kyung Ho Kim
- Department of Radiology, Myongji Hospital, Seonam University College of Medicine, 55, Hwasu-ro 14beon-gil, Deogyang-gu, Goyang-si, Gyeonggi-do, 10475, Republic of Korea
| | - Kyung A Kang
- Department of Radiology, Myongji Hospital, Seonam University College of Medicine, 55, Hwasu-ro 14beon-gil, Deogyang-gu, Goyang-si, Gyeonggi-do, 10475, Republic of Korea.
| | - Jae Hoon Lim
- Department of Radiology, Myongji Hospital, Seonam University College of Medicine, 55, Hwasu-ro 14beon-gil, Deogyang-gu, Goyang-si, Gyeonggi-do, 10475, Republic of Korea
| | - Kyung Goo Lee
- Department of Surgery, Myongji Hospital, Seonam University College of Medicine, 55, Hwasu-ro 14beon-gil, Deogyang-gu, Goyang-si, Gyeonggi-do, 10475, Republic of Korea
| | - Tae Jung Kwon
- Department of Pathology, Myongji Hospital, Seonam University College of Medicine, 55, Hwasu-ro 14beon-gil, Deogyang-gu, Goyang-si, Gyeonggi-do, 10475, Republic of Korea
| |
Collapse
|
8
|
Bagade S, Khanna G. Imaging of omphalomesenteric duct remnants and related pathologies in children. Curr Probl Diagn Radiol 2015; 44:246-55. [PMID: 25823549 DOI: 10.1067/j.cpradiol.2014.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/23/2014] [Accepted: 12/29/2014] [Indexed: 01/01/2023]
Abstract
The omphalomesenteric duct (OMD) or the vitelline duct (VD) is the embryologic communication between the yolk sac and the primitive midgut. OMD or VD anomalies are a group of defects resulting from failure of involution of the OMD. Meckel diverticulum is the most common anomaly that results from failure of resorption of the OMD. Other less common anomalies seen in children include OMD fibrous band, fistula, sinus tract, cyst, and umbilical polyps. These OMD remnants can have variable clinical manifestations such as umbilical discharge, small bowel obstruction, gastrointestinal tract bleeding, or acute abdomen. This pictorial essay reviews the clinical presentation and imaging findings of the common and not so common complications of OMD remnants in the pediatric population.
Collapse
Affiliation(s)
- Swapnil Bagade
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO.
| | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University, St Louis, MO
| |
Collapse
|
9
|
Bartocci M, Fabrizi G, Valente I, Manzoni C, Speca S, Bonomo L. Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound 2014; 18:205-11. [PMID: 26261462 DOI: 10.1007/s40477-014-0110-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 05/30/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the role of ultrasound in the diagnosis and treatment of pediatric patients with acute abdominal pain caused by intussusceptions. MATERIALS AND METHODS We performed a retrospective study of all pediatric patients with acute abdominal pain caused by intussusceptions and that underwent ultrasound examination at the emergency service of the Radiology Department between November 2007 and June 2013. The role of ultrasonography in the diagnosis of intussusceptions has been assessed by comparing the echographic presumptive diagnosis with the final diagnosis of discharge. Its importance in the treatment has been assessed by determining the value of ultrasound findings in the choice of the best treatment. RESULTS The ultrasound examination was positive in 16/18 patients with a final diagnosis of intussusception. Some sonographic findings seemed to be able to predict the opportunity to resort to non-surgical therapeutic options like hydrostatic or pneumatic reduction of the intestinal segments invaginated. In our casuistry, five children presented characteristics typical of this subgroup and underwent barium enema which provided the reduction of the intestinal segments involved. The future challenge will be to perform non-surgical ultrasound-guided reductions to avoid the exposure of the infants to ionizing radiations. CONCLUSIONS Ultrasonography is essential not only in the diagnosis, but also it adds important elements in the therapeutic choice and could play in the future an important role in non-surgical reduction of intestinal intussusceptions in pediatric patients.
Collapse
Affiliation(s)
- M Bartocci
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy ; Via Monte Nagni n°5, 06034 Foligno (PG), Italy
| | - G Fabrizi
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
| | - I Valente
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
| | - C Manzoni
- Department of Surgical Sciences, Pediatric Surgery Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
| | - S Speca
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
| | - L Bonomo
- Department of Radiological Sciences, Radiology Institute, Catholic University of Rome, A. Gemelli Hospital. L.go A. Gemelli 8, 00168 Rome, Italy
| |
Collapse
|
10
|
Sözen S, Emir S, Gönen A, Aziret M. Intestinal Intussusception Due to Meckel’s Diverticulum. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2012. [DOI: 10.29333/ejgm/82556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
11
|
Yigiter M, Kiyici H, Yucesan S, Hicsonmez A. An unusual cause of acute abdominal pain in a child: an inverted Meckel diverticulum: report of a case. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:314-316. [PMID: 20175110 DOI: 10.1002/jcu.20681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Inverted Meckel diverticulum has been reported as a lead point for intussusception in children. However all cases of isolated inversion of a Meckel diverticulum have involved adults in whom the diagnosis was clinically unexpected. We describe the sonographic appearance of isolated inversion of Meckel diverticulum in a 3-year-old boy with acute abdominal symptoms.
Collapse
Affiliation(s)
- Murat Yigiter
- Baskent Univercity Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey
| | | | | | | |
Collapse
|
12
|
Jun YW, Kye BH, Kim HJ, Cho HM, Yoo C, Hwang SS. Intussusception in an Adult due to Inverted Meckel's Diverticulum with Ectopic Pancreatic Tissue. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.suppl1.s41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ye-Won Jun
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong Hyun Kye
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyung Jin Kim
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyeon-Min Cho
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Changyoung Yoo
- Department of Pathology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seong Su Hwang
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| |
Collapse
|
13
|
Shin HO, Lee SW, Koo H, Hwang JY. Isolated heterotopic pancreas in ileoileal intussusception. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:545-548. [PMID: 19321685 DOI: 10.7863/jum.2009.28.4.545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Hyoung Ok Shin
- Department of Radiology, Medical Research Institute, School of Medicine, Ewha Womans University, Seoul 158-710, Korea
| | | | | | | |
Collapse
|
14
|
Nakamura S, Yanagihara K, Izumikawa K, Seki M, Kakeya H, Yamamoto Y, Miyazaki Y, Suyama N, Kohno S. Severe pulmonary tuberculosis complicating Ileocecal intussusception due to intestinal tuberculosis: a case report. Ann Clin Microbiol Antimicrob 2008; 7:16. [PMID: 18620597 PMCID: PMC2478653 DOI: 10.1186/1476-0711-7-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 07/13/2008] [Indexed: 03/12/2023] Open
Abstract
Adult intussusception is a rare clinical entity that is most often caused by a tumor, such as a lipoma, adenoma, or malignant tumor. A case of adult intussusception due to intestinal tuberculosis of the ileocecal region is reported. There are few cases of intussusception due to intestinal tuberculosis.
Collapse
Affiliation(s)
- Shigeki Nakamura
- Second Department of Internal Medicine, Nagasaki University Graduate School of Medical Science, Nagasaki, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Hollerweger A, Rieger S, Hübner E, Macheiner P. Sonographic diagnosis of an inverted Meckel diverticulum: distinct criteria enable the correct diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1263-6. [PMID: 17715324 DOI: 10.7863/jum.2007.26.9.1263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Hospital Barmherzige Brüder, Kajetanerplatz 1, 5020 Salzburg, Austria.
| | | | | | | |
Collapse
|
16
|
Miller CR. Ultrasound in the Assessment of the Acute Abdomen in Children: Its Advantages and Its Limitations. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cult.2007.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
Tekou H, Akakpo-Numado GK, Gnassingbe K, Tchama R, Attipou K. Les diverticules de Meckel chez l’enfant : à propos de 11 cas. ACTA ACUST UNITED AC 2007; 31:617-20. [PMID: 17646792 DOI: 10.1016/s0399-8320(07)89442-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report 11 cases of Meckel's diverticulum in children admitted to the department of Paediatrics Surgery of Lomé (Togo). None of the cases was identified before surgery. A systematic search during appendectomy identified 3 cases. It was fortuitously discovered four times, and due to complications in four cases. There was one complication related death. Segmental intestinal resection was the only technique used.
Collapse
Affiliation(s)
- Hubert Tekou
- Service de Chirurgie Pédiatrique du CHU Tokoin, O8 BP 80025, Lomé 8, Togo
| | | | | | | | | |
Collapse
|
18
|
Ko HS, Schenk JP, Tröger J, Rohrschneider WK. Current radiological management of intussusception in children. Eur Radiol 2007; 17:2411-21. [PMID: 17308922 DOI: 10.1007/s00330-007-0589-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 11/21/2006] [Accepted: 01/11/2007] [Indexed: 12/20/2022]
Abstract
Intussusception is the most common abdominal emergency situation in infants and small children. There has been great progress in diagnostic and therapeutic management of intussusception. Ultrasound (US) has been shown to be the first-choice imaging technique in diagnosing intussusception for reasons of high accuracy, simultaneous exclusion of differential diagnoses, and disclosure of additional pathologies. Controversial opinions exist worldwide concerning the nonoperative treatment of intussusception in infants and children. Pneumatic reduction under fluoroscopic guidance and hydrostatic reduction under US monitoring are the preferred techniques. The aim should be a success rate of at least 90% in idiopathic intussusception. This review summarizes different types of intussusception and outlines diagnostic aspects as well as several treatment concepts.
Collapse
Affiliation(s)
- Hyun Soo Ko
- Department of Pediatric Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 153, 69120 Heidelberg, Germany
| | | | | | | |
Collapse
|
19
|
Monedero MD, Ripollés T, Nicolau MJ, Martínez-Pérez MJ. Pancreatic pseudotumor in Meckel diverticulum. ACTA ACUST UNITED AC 2006; 31:688-90. [PMID: 16465569 DOI: 10.1007/s00261-005-8010-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 11/13/2005] [Indexed: 12/14/2022]
Abstract
This report describes the ultrasonic appearance of an ectopic pancreatic rest presenting as a mass within an intussusception due to an inverted Meckel diverticulum. Familiarity with the ultrasound appearance of this entity may be useful to obviate unnecessary imaging workup.
Collapse
Affiliation(s)
- M D Monedero
- Department of Radiology, Hospital Universitario Doctor Peset, Valencia, Spain.
| | | | | | | |
Collapse
|
20
|
Sinha R. Jejunal diverticulosis: sonographic diagnosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:84-7. [PMID: 16547978 DOI: 10.1002/jcu.20206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We report the sonographic appearance of jejunal diverticulosis in 4 cases. Jejunal diverticula appear as multiple peri-intestinal hypoechoic structures on sonographic examination. Many diverticula show communication with the bowel lumen. The diverticular neck formed by the prolapsed mucosal and submucosal layers can be seen as a parallel, echogenic structure traversing the bowel wall. Most diverticula also contain echogenic debris and air-related artifacts. Because jejunal diverticula may be encountered during a sonographic examination, sonologists should be aware of their sonographic appearance to prevent diagnostic errors.
Collapse
Affiliation(s)
- Rakesh Sinha
- Department of Radiology, Derby City General Hospital, Derby DE22NE, United Kingdom
| |
Collapse
|
21
|
Ueberrueck T, Meyer L, Koch A, Hinkel M, Kube R, Gastinger I. The significance of Meckel's diverticulum in appendicitis--a retrospective analysis of 233 cases. World J Surg 2005; 29:455-8. [PMID: 15776296 DOI: 10.1007/s00268-004-7615-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Conflicting reports are found in the literature concerning whether to remove an incidentally discovered Meckel's diverticulum (MD). Between 1.1.1974 and 31.12.2000, at a single center, the perioperative data associated with appendectomy (AE) were recorded consecutively and analyzed retrospectively. All patients in whom an MD was discovered during an AE were included in the study. The clinical presentation, postoperative course, and follow-up in all MDs left in place were analyzed. During the course of 7927 AE, 233 MD (2.9%) were detected. Of these 80.7% (n = 188) were removed and 19.3% (n = 45) were left untouched. In 9% (n = 21) of all detected diverticula pathological changes were found. Ectopic tissue was seen in 12.2% (n = 23) of the MDs removed. The postoperative complication rates did not differ significantly between patients in whom the MD was removed (9.5%; n = 18) and those in whom it was not (17.7%; n = 8); in the latter group the appendicitis was of the more acute type (gangrenous or perforated) (24.4% vs. 4.3%). In 18 patients (40.0%) with non-removed MDs, a follow-up period of 14.1 5.8 years was achieved. Complications associated with a non-removed MD were not observed. If during the course of an AE a MD is detected, the present data, as well as those in the literature, suggest that an individualized approach should be taken. Meckel's diverticulum with obvious pathology should always be removed. In cases of gangrenous or perforated appendicitis, an incidentally discovered MD should be left in place, whereas in an only mildly inflamed appendix it should be removed.
Collapse
Affiliation(s)
- Torsten Ueberrueck
- Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller University, Erlanger-Allee 101, 07747, Jena, Germany.
| | | | | | | | | | | |
Collapse
|
22
|
Martín-Lorenzo JG, Torralba-Martinez A, Lirón-Ruiz R, Flores-Pastor B, Miguel-Perelló J, Aguilar-Jimenez J, Aguayo-Albasini JL. Intestinal invagination in adults: preoperative diagnosis and management. Int J Colorectal Dis 2004; 19:68-72. [PMID: 12838363 DOI: 10.1007/s00384-003-0514-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Intestinal invagination in adults is an uncommon but potentially serious condition that is usually diagnosed during surgery by the presence of a mechanical obstructive syndrome. We report a series of adults with intestinal invagination and discuss preoperative diagnosis and surgical procedures. PATIENTS AND METHODS We analyzed the files of all the seven patients aged over 18 years with a postoperative diagnosis of intestinal invagination and treated at our center between 1996 and 2000. RESULTS Preoperative causal diagnosis was established in six cases by ultrasonography and computed tomography. All the patients received surgery, three as emergency and four programmed. The lesions causing the invagination were: three benign (Meckel's diverticulum, inflammatory pseudotumor, fibroid polyp) and one malignant (degenerative villous adenoma polyp) located in the terminal ileum, two malignant lesions in the cecum (both adenocarcinomas over a polyp), and in the remaining case a double lymphoma of the jejunum and ileum. The intussusceptions were ileoileal in three cases and ileocolic in four. We performed intestinal resection in six cases and one excision of Meckel's diverticulum. CONCLUSION Preoperative diagnosis of intussusception was possible in most cases. Sonography and computed tomography proved the most effective and useful preoperative diagnostic methods. In adults colonic invagination is almost always malignant while small bowel is almost always benign. Invagination in adults must be clarified by surgery, and intestinal resection is the procedure of choice.
Collapse
Affiliation(s)
- J G Martín-Lorenzo
- Department of General Surgery, Hospital General Universitario J.M. Morales Meseguer, C/Marqués de los Vélez s/n, 30008, Murcia, Spain.
| | | | | | | | | | | | | |
Collapse
|
23
|
Fernández-Villa T, Vivas I, González-Crespo I, Jiménez S. Diagnóstico mediante TC de invaginación intestinal sobre un divertículo de Meckel: a propósito de un caso. RADIOLOGIA 2001. [DOI: 10.1016/s0033-8338(01)76967-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
24
|
Pumberger W, Hörmann M, Pomberger G, Hallwirth U. Sonographic diagnosis of intussusception of the appendix vermiformis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2000; 28:492-496. [PMID: 11056028 DOI: 10.1002/1097-0096(200011/12)28:9<492::aid-jcu8>3.0.co;2-l] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We present 2 cases of intussusception of the appendix vermiformis (IAV) in children. Sonographic examination demonstrated a lead point within a characteristic multiconcentric ring sign, and longitudinal sonograms showed the inverted appendix protruding into the cecal lumen. A contrast-enema study, using a water-soluble contrast medium, was performed in each case, and a "coiled-spring" sign or "spiral shell" appearance confirmed the diagnosis. A surgical reduction of the appendix and an appendectomy were performed in each case.
Collapse
Affiliation(s)
- W Pumberger
- Division of Pediatric Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | | | | | | |
Collapse
|