Long-standing painless intussusception in adults

Childhood intussusception: Correlation between ultrasound reports and intra-operative findings

Background:

Intussusception, a common cause of intestinal obstruction in children, is usually diagnosed through ultrasound scan. The aim of this study was to evaluate the correlation between the ultrasound report and intra-operating findings in children who had laparotomy for intussusception.

Materials and methods:

This was a retrospective study of children aged 12 months and below who had laparotomy for intussusception between January 2017–December 2019 at the pediatric surgery unit of Enugu State University Teaching Hospital Enugu, Nigeria. Findings at ultrasound and findings at surgery were statistically compared.

Results:

A total of 103 cases of intussusceptions were seen during the study period. Out of this number, 69 patients were treated by laparotomy and formed the basis of this report. There was male predominance and the median age of the patients was 8 months. Abdominal pain was the most common presenting symptom. At presentation, about one-quarter of the patients were anemic while one-half of the patients had electrolyte derangement. Comparing the findings at ultrasound and findings at surgery, ultrasound was found to have an accuracy of 89.9%. Approximately, equal number of patients had manual reduction and bowel resection. Surgical site infection was the most common post-operative complication and mortality occurred in 8 (11.6%) patients.

Conclusion:

Ultrasound has high accuracy rate and is quite reliable for the diagnosis of intussusception.

Filiform Polyposis Secondary to Colonic Tuberculosis Presenting as Acute Colo-Colonic Intussusception

Filiform polyposis represents a rare but recognised manifestation on the varied spectrum of histopathology in colonic tuberculosis. We report a case of filiform polyposis secondary to colonic tuberculosis presenting as colo-colonic intussusception diagnosed on an abdominal computed tomography (CT) scan. The patient required urgent hemicolectomy and defunctioning ileostomy. Examination of the resected bowel lesions revealed filiform polyposis. Induced sputum samples from the patient grew Mycobacterium tuberculosis. The patient recovered well from the surgery and received treatment for tuberculosis. At last follow-up, he was awaiting the reversal of his ileostomy. The protean nature of histological findings in colonic tuberculosis and other current diagnostic challenges are discussed. The importance of maintaining a high index of suspicion for colonic tuberculosis and instituting early treatment is highlighted in this case.

An update on common gastrointestinal emergencies

The evaluation of the child with acute abdominal pain often poses as a diagnostic challenge due to the wide range of diagnoses. Surgical emergencies need to be rapidly identified and managed appropriately to minimize morbidity and mortality. Presenting symptoms, clinical examination, and laboratory findings can guide selection of diagnostic imaging. This article reviews common surgical causes of abdominal pain in children.

Abdominal pain in children

Abdominal pain is one of the most common reasons pediatric patients seek emergency care. The emergency physician must be able to distinguish diagnoses requiring immediate attention from self-limiting processes. Pediatric patients can be challenging, particularly those who are preverbal, and therefore, the clinician must rely on a detailed history from a parent or caregiver as well as a careful physical examination in order to narrow the differential diagnosis. This article highlights several pediatric diagnoses presenting as abdominal pain, including surgical emergencies, nonsurgical diagnoses, and extraabdominal processes, and reviews the clinical presentation, diagnostic evaluation, and management of each.

Chronic intussuception due to ileocaecal tuberculosis in a young adult with severe anemia: Case report with literature review

Context:

Intestinal intussuception in an adult is a rare entity that differs in etiology from its pediatric counterpart owing to underlying pathologic lead points in adults, mostly neoplasms. The main clinical presentation in chronic intussuception in adults remains dull abdominal pain, and acute intussuception is uncommon. Computed tomography (CT) remains the diagnostic modality of choice and surgical resection is the optimal treatment.

Case Report:

We report a case of chronic intussuception in a young adult presenting with severe anemia and chronic abdominal pain in right hypochondrium and lumbar region. Pre operative diagnosis of chronic ileocolocolic intussuception was made on the basis of ultrasound, barium and CT scan findings. Exploratory laparotomy was done and right hemicolectomy with end to end anastomosis was performed. Histopathological examination of resected specimen revealed presence of tuberculosis in the mass along with mesenteric lymph nodes involvement. Postoperative recovery was uneventful and he was put on antitubercular drugs. In follow-up the patient is asymptomatic.

Conclusion:

Chronic ileocolocolic intussuception due to tuberculosis should be considered as a possible cause of intestinal obstruction in young patients presenting with vague abdominal pain and severe anemia even in the absence of any specific medical history.

Intussusception

Intussusception is the most common cause of intestinal obstruction in children between 3 months and 6 years. Intussusception occurs when a more proximal portion of bowel invaginates into more distal bowel. These patients often present with a wide range of non-specific symptoms, with less than one quarter presenting with the classic triad of vomiting, abdominal pain, and bloody stools. Thus, the diagnosis continues to rely on clinical suspicion. This review article discusses the clinical presentation of intussusception and the state-of-the art diagnostic and treatment options, as well as a review of the pertinent literature.

Abdominal tuberculosis presenting as ileocolic intussusception in an infant

Intussusception is the most common cause of intestinal obstruction in children, with a peak in children 5 to 7 months of age. Identifiable causes are found in 90% of adults, whereas in infants and young children the majority are idiopathic. We report a case of abdominal tuberculosis (ATB) presenting as an ileocolic intussusception in an infant. A 6-month-old infant presented with features of acute intestinal obstruction. Peroperatively, ileocolic intussusception was found. Histological examination revealed caseating epitheloid cell granulomas with positivity for acid-fast bacilli. Only 3 cases of ATB presenting as intussusception have been previously reported in the literature, with only 1 case presenting in a child. This appears to be the 2nd case of ATB presenting as an intussusception in a child and also in an infant. Tuberculosis should also be kept in the differential diagnosis of lead point of intussusception, even in the age group in which most cases are idiopathic, especially in endemic areas.

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.

Intestinal invagination in adults: preoperative diagnosis and management

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.

Adult intussuception as a cause of abdominal symptoms: a case report and review of literature

Intussusceptions are frequently encountered in children. In adults, they are uncommon and have a different etiology. Our case is one such example of a rare, pathologically proven, recto-rectal intussusception due to an adenocarcinoma with characteristic CT findings.