Sonographic diagnosis of adult intussusception

Adult Mid Ileo-Ileal Intussusception Secondary to Inflammatory Myofibroblastic Tumor (IMT): A Case Report and Literature Review

The intestinal intussusception as a cause of bowel obstruction in adult is a rare finding and is a heralder for an underlying lesion. This is in stark contrast to intestinal intussusception in pediatric population where the etiology is always a primary or benign condition and thus bears different outcomes. We hereby present a case of a young female adult, without the presence of any significant comorbidity. She presented with non-specific symptoms of small bowel intussusception. She was diagnosed as a case of adult intussusception with abdominal ultrasonography. The patient underwent complete resection of the tumor, without any reduction attempts, as the best plausible therapeutic approach. Further, in post-operative evaluation, complete pathological analysis of the resected specimen divulged the presence of inflammatory myofibroblastic tumor (IMT) as the underlying lead point of mid-ileo-ileal intussusception.

Use of Ultrasound in the Diagnostic Work-Up of Adult Intussusception - A Multicenter Retrospective Analysis

PURPOSE

 To evaluate the use of ultrasound (US) in the diagnostic work-up of adult intussusception (AI).

METHODS

 This multicenter study includes 26 consecutive patients diagnosed with AI between January 2010 and November 2017. A retrospective chart analysis was conducted with a focus on abdominal US findings and diagnostic accuracy of different imaging modalities (ultrasound, computed tomography (CT), magnetic resonance imaging). If available, surgical and pathological findings served as the gold standard (76.9 %). US examiners certified according to DEGUM grade 2 or 3 were classified as experts. Otherwise, they were regarded to have basic skills.

RESULTS

 During diagnostic work-up, 92.3 % underwent abdominal US. US was the first-line imaging modality in 88.5 % of cases. The accuracy regarding the detection of AI (85 %), correct localization (95 %) and detection of complications (100 %) was excellent and comparable with CT (81 %, 90.5 %, and 91.7 %) when performed by experts. 72.7 % of tumorous lead points were detected by experienced examiners. In contrast, AI was detected in only 45.5 % of cases by examiners with basic skills. AI was diagnosed prior to surgery in all patients.

CONCLUSION

 US is reliable in the diagnostic work-up of AI when performed by experienced examiners with high-quality equipment. US, CT and MRI should be used in a complementary fashion since combination provides excellent sensitivity regarding the detection and correct localization of AI as well as the detection of complications. The impact of real-time imaging is illustrated by supplementary videos.

Spontaneous acute intussusception in a pregnant woman

Acute intussusception in adults is rare and particularly so in pregnant women. Its incidence ranges from 0.067% to 0.0015% (Choi et al., 2005 Choi et al. (2005) [1]). The non-specific presenting symptoms may be attributed to the pregnancy itself, making the diagnosis difficult. When it happens, however, it causes considerable morbidity and mortality for the pregnant woman and the fetus. In adults, such intussusceptions are mainly secondary to an intestinal disease and frequently a tumor. We present the case of a 21-year-old pregnant woman who was diagnosed of spontaneous acute intussusception at nine weeks of gestation and therapeutic management.

Laparoscopic management of small-bowel intussusception in a 64-year-old female with ileoal lipomas

A 64-year-old female patient presented with upper abdominal pain and vomiting. Ultrasonography showed a hyperechoic mass in the right lower abdomen and computed tomography showed a low-density mass with intestinal invagination. An emergency laparoscopic right-hemicolectomy was performed, and the resected specimen was found to contain three tumors, which were identified histopathologically as intestinal lipomas. Adult intussusception is relatively rare and difficult to be diagnosed, since most symptoms of adult intussusception are nonspecific. We report our clinical experience of the diagnosis and emergent laparoscopic surgery for an adult patient with intussusception.

[A rare cause of recurrent small bowel intussusception. Case report and review of the literature]

Small bowel intussusception is a rare cause of abdominal pain in adult patients. Due to varying symptoms and different underlying causes its diagnosis and treatment is challenging for physicians. This case report describes recurrent intussusception in an adult female patient and celiac disease could only be diagnosed as the cause of these symptoms after surgery. In addition a review of the literature regarding adult intussusception is presented.

Adult intussusception secondary to colorectal cancer in a young man: a case report

BACKGROUND

The occurrence of adult intussusception from colorectal cancer in a 27-year-old man is quite uncommon.

OBJECTIVES

To raise awareness of the incidence of intussusception in adults, to educate others about the protean manifestations and high association with malignancy of the disease, and to provide treatment recommendations.

CASE REPORT

We present a case of a 27-year-old man with a non-contributory family history who presented to the Emergency Department multiple times over a 10-month period with vague abdominal complaints. Clinical symptoms ultimately included a 75-lb weight loss, fatigue, mild right-sided abdominal pain, and anemia. Computed tomography scan of the abdomen revealed right-sided colocolic intussusception with a lead point. The patient underwent a right hemicolectomy with ileocolic anastomosis. Pathologic evaluation and staging revealed a stage IIIB poorly differentiated adenocarcinoma. Molecular analysis was negative for genetic causes.

CONCLUSION

This case demonstrates how intussusception and possible colorectal cancer must be included in the differential diagnosis even in young adults who have persistent abdominal complaints.

Adult intussusception secondary to lymphangioma of the cecum: a case report

We report the case of a patient with ileocolic intussusception caused by cecal lymphangioma. A 45-year-old man visited our hospital with a 2-month history of frequent episodes of watery diarrhea (>/= 5 times/day) and intermittent abdominal pain. A cecal submucosal tumor with mucosal ulceration and partial obstruction of the colonic lumen was identified by colonoscopy. He was admitted to our hospital 2 days later due to aggravation of his abdominal pain. Physical examination revealed tenderness over the right abdomen with no peritoneal signs. A double-contrast lower gastrointestinal series showed a right-side colonic lesion with indentation and a peripheral, beak-like sign. Abdominal computed tomography scanning revealed an intra-abdominal mass with the characteristic sausage sign, highly suggestive of intussusception. The patient subsequently underwent right hemicolectomy. The final diagnosis was ileocolic intussusception with cecal lymphangioma, which was confirmed by histopathology. He had an uneventful recovery with follow-up in our hospital. This case highlights the possibility of colonic lymphangioma as the leading point of adult intussusception, and this should be taken into consideration as a possible diagnosis in this uncommon clinical condition.

A rare cause of ileus: invagination due to ectopic pancreas

INTRODUCTION

Invagination is seen rarely as a cause of ileus in adults. The cause of invagination in children differs from that in adults. In adults it is mostly due to organic lesions (tumour).

CASE REPORT

In a 49 years old patient, with 3 months of intermittant abdominal pain, radiologic investigations suspected a of small bowel tumour. The patient was operated on. At exploration, there was an ileo-ileal invagination on the terminal ileum over 40 cm distance A totally necrosed ileum segment was resected and an end-to-end anastomosis was performed. Inside the excised ileal loop their was a polyp-like lesion originating from submucosa, bordered by the wall but not protruding to the lumen. The pathological examination of the lesion revealed ectopic pancreatic tissue between the muscular layers of the bowel wall.

RESULT

Intestinal invagination must be got in mind as a rare cause of ileus in adults. During it's clinical course their is enough time to reach the diagnosis. So unnecessory resections and postoperative complications can be prevented.

Laparoscopy-assisted resection of ileoileal intussusception caused by intestinal lipoma

Intussusception is the second most common abdominal emergency in children. In contrast, it is rare in adults. Adult intussusception represents only 1%-3% of patients with bowel obstruction. Although 95% of intussusception in children is idiopathic, merely 7% of adult intussusception is considered idiopathic. Owing to vague symptoms and signs, the preoperative diagnosis of adult intussusception is difficult. Once adult intussusception is diagnosed, surgical intervention is indicated because about half of both colonic and small intestinal intussusceptions are caused by malignant lesions. In this paper, we describe a case of ileoileal intussusception caused by an intestinal lipoma that was diagnosed preoperatively by computed tomography scans and was treated successfully by laparoscopy-assisted surgery. The patient was discharged uneventfully 4 days after the operation. We recommend laparoscopy-assisted surgery as a feasible therapeutic option for adult intussusception.

Clinical entity and treatment strategies for adult intussusceptions: 20 years' experience

PURPOSE

Intestinal intussusception in adults is rare and the optimal management of this problem remains controversial. The purpose of this study was to determine the causes of intussusceptions in adults and to assess their treatment.

METHODS

A retrospective review of patients older than aged 18 years who were diagnosed with intestinal intussusception at Tri-Service General Hospital between July 1984 and July 2004 was conducted.

RESULTS

During the 20-year period, there were 292 patients with intussusception, 24 (8.2 percent) of which were adults. Abdominal pain was the most common presenting complaint (79.2 percent). The diagnosis of adult intussusception was made preoperatively in 18 cases (75 percent) and intraoperatively in 6 cases (25 percent). Of the 24 patients, 20 (83.3 percent) had a defined lesion; 11 (55 percent) lesions were benign and 9 (45 percent) were malignant. In eight patients (33.3 percent), the intussusception was reduced; perforation occurred in one patient (12.5 percent). Segmental resections were performed on 14 patients (58.3 percent), right hemicolectomies on 6 patients (25 percent), laparoscopic low anterior resection on 1 patient (4.2 percent), appendectomy on 1 patient (4.2 percent), and diverticulectomy on 1 patient (4.2 percent). Intraoperative colonoscopy was performed on three patients (12.5 percent) before reduction (lipomas were noted in 2 of the patients (66.7 percent) with limited resection of the ileum and preservation of the antireflux ileocecal valve. There was one perioperative mortality (4.2 percent) and seven postoperative morbidities (29.2 percent).

CONCLUSIONS

Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. We discuss our 20 years of experience in treatment strategies for dealing with such unusual problems.

Transient small-bowel intussusceptions in adults: significance of ultrasonographic detection

AIM

To investigate the frequency, clinical significance, and outcome of small-bowel intussusceptions in adults detected using ultrasound in an outpatient setting.

PATIENTS AND METHODS

In two different retrospective (January 2001 to April 2003) and prospective (May 2003 to June 2005) periods, 33 small-bowel intussusceptions were found in 32 patients (13 females; mean age: 38.1 years) with known or suspected intestinal disease. Patients underwent diagnostic work-up to assess any organic disease. Patients with self-limiting intussusception were submitted to clinical and ultrasonographic follow-up.

RESULTS

Of the 32 patients with small-bowel intussusception, 25 were identified in the prospective series of 4487 examinations (0.53%) and seven in the retrospective series of 5342 examinations (0.15%; p=0.002). Four patients had persistent and 28 self-limiting intussusceptions. Self-limiting intussusceptions were idiopathic in 11 patients (39%) or associated with organic diseases in 17 (Crohn's disease in 11 patients, celiac disease in three, ulcerative colitis in one patient, and previous surgery for cancer in two). Self-limiting intussusceptions were asymptomatic in 25% of patients.

CONCLUSION

Small-bowel intussusceptions in adults are not rare and are frequently self-limiting, idiopathic, or related to organic diseases, mainly Crohn's disease and coeliac disease.

Intussusception: a rare cause of abdominal pain in pregnancy

A 34-year-old woman presented at 19 weeks in her third pregnancy with abdominal pain and hyperemesis. This was her third admission during the pregnancy for similar complaints. A few days after admission an exacerbation in her pain was noted, in particular on eating or lying down, and a firm and mobile epigastric mass could be palpated separate from her uterus. The differential diagnosis was a hernia or a degenerating pedunculated fibroid. Sonography revealed a mass separate from the uterus with an appearance consistent with intussusception. Magnetic resonance imaging confirmed the diagnosis. A limited right hemicolectomy was performed. The final diagnosis was adenocarcinoma of the colon. It is difficult to diagnose intussusception during pregnancy. The presenting symptoms of nausea, vomiting, abdominal pain and constipation are common in pregnancy and the displacement of the bowel by the gravid uterus hampers examination. Intussusception is very rare in adults and generally it is associated with tumors. Preoperative diagnosis is difficult but possible with accurate imaging.

Sonography of the gastrointestinal tract

OBJECTIVE

The purpose of this presentation is to provide an overview of sonographic manifestations of various gastrointestinal diseases.

METHODS

Patients were scanned with an HDI 3000 or HDI 5000 system (Philips Medical Systems, Bothell, WA) with both a 2- to 5-MHz curvilinear transducer and a 5- to 12-MHz linear transducer. The patients were asked to fast from the previous night. For accurate visualization of the stomach, a cup of water was given to patients thought to have stomach or upper gastrointestinal disease.

RESULTS

A satisfactory sonographic examination could be performed in all patients.

CONCLUSIONS

With recent technical advances, the increasing use of sonography in initial evaluation of patients with abdominal pain may allow earlier detection of bowel disease.

[Diagnostics and surgical therapy of enteric intussusception in adults illustrated by three cases]

The diagnosis of enteric intussusception is rare in adults but not in children. The clinical picture often takes an insidious course. Acute abdomen may also be caused by enteric intussusception. We report on three patients with enteric intussusception and acute abdomen. In two cases, a CT led to the diagnosis of invagination of the small intestine. In one patient, invagination of the terminal ileum was detected during coloscopy. All patients were submitted to limited segment resection and end-to-end anastomosis. In all three cases, the invagination was caused by benign pathological changes. Enteric intussusception in adults always requires surgery. In more than 95% of the cases, pathological findings are obtained intraoperatively, which are benign in the small intestine in 85-95% of the cases.

Adult intussusception: diagnosis and clinical relevance

Intussusception is relatively rare in the adult population and differs substantially from pediatric intussusception. Most adult intussusceptions identified at surgery are caused by a definable structural lesion, a substantial proportion of which are malignant, particularly in the colon. Small bowel intussusceptions, however, have a lower prevalence of malignancy. Diagnosis of adult intussusception can be made reliably with noninvasive imaging techniques. CT is now widely regarded as the modality of choice for diagnosing intussusception in adults, but ultrasound and MR imaging have also been used effectively. Determination of the presence of a malignant lead point remains problematic because an edematous or hemorrhagic intussuscipiens may mimic a mass on each modality. Markers for bowel viability have been described but are not precise. Treatment of the persistent symptomatic intussusception in which neoplasia is suspected is surgical, and preoperative reduction is contraindicated. Transient relatively asymptomatic enteric intussusceptions discovered by imaging may not require intervention.

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