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Belhadj A, Touati MD, Khefacha F, Zayati MR, Chebbi F, Saidani A. Case report: Rare benign colorectal intussusception due to rectal polyp treated non operatively. Int J Surg Case Rep 2024; 119:109790. [PMID: 38781843 PMCID: PMC11143777 DOI: 10.1016/j.ijscr.2024.109790] [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: 03/28/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intestinal intussusception is rare in adults, involving telescoping of one intestinal segment into another. Commonly associated with colonic lesions, it presents as acute obstruction. Diagnosis relies on CT. We report a rare case of colorectal intussusception due to a polyp, managed by endoscopic polypectomy. CASE PRESENTATION We present a case of a 74-year-old man with chronic constipation, who presented with acute abdominal pain, vomiting, and cessation of bowel movements. Hemodynamically stable, he had a distended abdomen. We diagnosed acute bowel obstruction secondary to colorectal intussusception via CT scan. Surgery was planned after resuscitation. However, after induction of general anesthesia, the procedure was postponed due to a significant diarrheal episode and resolution of the abdominal distension. A subsequent colonoscopy revealed a 10 mm polyp, which was excised endoscopically. The patient's recovery was smooth, with no recurrence after a one-year follow-up. CLINICAL DISCUSSION Intestinal intussusception, rare in adults, primarily affects the small intestine but may involve the colon, often associated with organic lesions or postoperative adhesions. While colocolonic intussusceptions, mostly malignant, may stem from benign causes occasionally, symptoms are nonspecific, with common pain. Diagnosis relies on CT scans, with surgery typically required, except in select cases. CONCLUSION Colorectal intussusception, rare in adults, may necessitate laparotomy. Spontaneous symptom resolution enables conservative management. Clinician awareness is vital to prevent unnecessary and risky surgeries, given its rarity and potential for favorable outcomes sans intervention.
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Affiliation(s)
- Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, Ariana, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, Ariana, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia.
| | - Fahd Khefacha
- General Surgery Department, Mahmoud El Matri Hospital, Ariana, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Mohamed Ridha Zayati
- General Surgery Department, Mahmoud El Matri Hospital, Ariana, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Faouzi Chebbi
- General Surgery Department, Mahmoud El Matri Hospital, Ariana, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, Ariana, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
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Lynch P, Feeney G, Ali N, Hussein A, Cury J. Intestinal intussusception-not just for kids. J Surg Case Rep 2024; 2024:rjad734. [PMID: 38283410 PMCID: PMC10817820 DOI: 10.1093/jscr/rjad734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024] Open
Abstract
Intussusception is a phenomenon commonly associated with the paediatric population. In adults, intussusception is frequently a result of a neoplastic process. We present the case of a 56-year-old gentleman who was diagnosed to the local Emergency Department with a 4-day history of worsening severe, left sided lower abdominal pain. The pain was colicky in nature. Computed tomography identified a long-segment intussusception involving distal small bowel, caecum, ascending colon, the entirety of transverse colon and its associated mesentery. The patient proceeded to theatre where a laparotomy and right hemicolectomy was performed. Histopathological analysis of the specimen identified an ileal myxoma as the lead-point of the intussusception. This report emphasises the value of prompt investigation in atypical clinical presentations.
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Affiliation(s)
- Paul Lynch
- Department of Surgery, University Hospital Limerick, Limerick V94 F858, Ireland
| | - Gerard Feeney
- Department of Surgery, University Hospital Limerick, Limerick V94 F858, Ireland
| | - Nisar Ali
- Department of Surgery, University Hospital Limerick, Limerick V94 F858, Ireland
| | - Akthar Hussein
- Department of Surgery, University Hospital Limerick, Limerick V94 F858, Ireland
| | - Jorge Cury
- Department of Surgery, University Hospital Limerick, Limerick V94 F858, Ireland
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3
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Javed N, Dente M, Ghazanfar H, Jyala A, Ihimoyan A. A Rare Case of Cecal Adenocarcinoma Presenting as Intussusception. Cureus 2023; 15:e48899. [PMID: 38106808 PMCID: PMC10725219 DOI: 10.7759/cureus.48899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Colorectal cancer is widely recognized as one of the most common types of cancer worldwide. The management and outlook for colorectal cancer depend on its specific characteristics and how it presents clinically. Despite the identification of various risk factors and causes, cecal carcinoma, a type of colorectal cancer, is infrequent in Western populations under 50 years of age, and little research has been conducted on its epidemiology. Additionally, intussusception, a medical condition where one part of the intestine slides into another, is relatively rare among younger individuals. In this case report, we present a 36-year-old male who presented with abdominal pain. A physical exam revealed mild right-sided and peri-umbilical tenderness. A computed tomography scan of the abdomen and pelvis with contrast revealed long segment intussusception involving the terminal ileum and cecum. The patient underwent a reduction of intussusception and hemicolectomy. He was diagnosed with invasive cecal adenocarcinoma with metastasis to lymph nodes. He was started on chemotherapy and has been following as an oncology outpatient.
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Affiliation(s)
- Nismat Javed
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Margaret Dente
- Internal Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
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Lahham EE, Iwaiwi BI, Halteh S, Khaled H, AlQadi M. A unique case of inverted Meckel's diverticulum presented as an adult intussusception: a case report. J Surg Case Rep 2023; 2023:rjad288. [PMID: 37220592 PMCID: PMC10200354 DOI: 10.1093/jscr/rjad288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/25/2023] Open
Abstract
Although Meckel's diverticulum (MD) is a relatively common asymptomatic gastrointestinal anomaly, an inverted MD is a rare entity that is challenging to diagnose prior to surgery and presents usually in the pediatric population with bleeding, anemia and abdominal pain. The most frequent adult presentation in non-inverted MD is intestinal obstruction, whereas bleeding and anemia are the most typical presenting complaints in inverted MD. Here, we report our experience with an adult female patient, who presented with 5 days duration of abdominal pain, nausea and vomiting. Imaging revealed signs of small bowel obstruction with bowel wall thickening in the terminal ileum and a double target appearance. This case describes a rare cause of adult intestinal intussusception because of inverted MD, which was successfully managed with surgery. The final pathology report confirms the diagnosis.
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Affiliation(s)
| | | | - Silvia Halteh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hala Khaled
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Mohammad AlQadi
- Department of General Surgery, Beit-Jala Hospital, Bethlehem, Palestine
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Haidaran I, Haidaran AI. Adult intussusception: A case report. Int J Surg Case Rep 2023; 105:107977. [PMID: 36989624 PMCID: PMC10074585 DOI: 10.1016/j.ijscr.2023.107977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Intussusception is a recognised cause of bowel obstruction and is significantly more common in paediatric patients. Adult intussusception is rare and requires a predisposing factor in the vast majority of patients and this may include a benign lesion, a malignant lesion or bowel wall abnormality such as inflammatory bowel disease. PRESENTATION OF CASE We present the case of a patient presenting with upper abdominal pain, nausea, vomiting and weakness. The patient had ongoing mild intermittent abdominal pain for months which was investigated with an oesophagogastroduodenoscopy (OGD) that showed gastritis. There were features of peritonism on clinical examination and this was associated with raised inflammatory markers. A Computed Tomography (CT) scan showed telescoping of the ileum with proximal bowel distension suggesting bowel obstruction. The patient underwent emergency surgical resection. Histopathology assessment did not identify a causative factor for the intussusception. DISCUSSION We present a case of idiopathic entero-enteric intussusception in an adult which is not commonly seen. Clinical history of chronic intermittent abdominal pain and CT abdomen are helpful in establishing the diagnosis. Despite that conservative approach is described in the literature, surgery continues to be the only option in patients who are unstable and show signs of peritonitis. CONCLUSION Adult intussusception is not a common condition and can be difficult to diagnose. Patients with intussusception may report a relatively long period of intermittent abdominal pain that worsen acutely due to complete obstruction. CT is the most useful investigative modality to confirm the diagnosis of intussusception.
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Inflammatory fibroid polyp (Vanek's tumor) causing double compound ileo-ileal intussusception in an adult patient, a case report. Int J Surg Case Rep 2022; 93:106947. [PMID: 35318183 PMCID: PMC8935495 DOI: 10.1016/j.ijscr.2022.106947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction and importance Case report Clinical discussion Conclusions Interventions and outcome Methods Intussusception is a condition in which there is telescoping ladder f one bowel segment into another resulting in mechanical bowel obstruction. While intussusception is considered a common condition in infants and young children, it is rare in adults. It is not common to have two lead points (Double intussusception) for the disease, causing symptoms simultaneously. In this case, we report a case of double intussusception in an adult patient, something that has been reported in only handful of cases worldwide.
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Jabi R, Elmir S, Ouryemchi M, Bouziane M. Acute Intestinal Invagination: An Exceptional Method of Revealing Crohn's Disease. Cureus 2021; 13:e18673. [PMID: 34786254 PMCID: PMC8579914 DOI: 10.7759/cureus.18673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/05/2022] Open
Abstract
Crohn's disease presents a public health problem. The clinical presentation is variable with gastrointestinal and extra gastrointestinal manifestations. The management is multidisciplinary while patients with Crohn's disease rarely require surgery. We present a rare case of a 57-year-old patient followed for 10 years for ankylosing spondylitis and admitted for abdominal pain on intussusception caused due to Crohn's disease which was probably symptomatic but not understood by your patient.
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Affiliation(s)
- Rachid Jabi
- Department of General Surgery, Faculty of Medicine and Pharmacy, Mohamed Vi University Hospital, Oujda, MAR
- Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM), Mohammed Ist University, Oujda, MAR
| | - Siham Elmir
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, MAR
| | - Mouad Ouryemchi
- Department of General Surgery, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, MAR
- Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM), Mohammed Ist University, Oujda, MAR
| | - Mohammed Bouziane
- Department of General Surgery, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, MAR
- Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM), Mohammed Ist University, Oujda, MAR
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8
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Kim KH. Intussusception in Adults: A Retrospective Review from a Single Institution. Open Access Emerg Med 2021; 13:233-237. [PMID: 34163260 PMCID: PMC8214106 DOI: 10.2147/oaem.s313307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose Intussusception is uncommon in adults and often manifests as nonspecific symptoms. Owing to its low incidence and the lack of knowledge on the symptoms, causes, and treatment of adult intussusception (AI), many surgeons may have limited experience in the diagnosis and treatment of intussusception. This study aimed to describe the experience of AI and discuss its clinical presentation, etiology, and management. Material and Methods I retrospectively reviewed patients aged 19 years and older who were diagnosed with intussusception at a single institution between March 2010 and December 2019. Results Among 28 patients who were finally analyzed, abdominal pain was the most commonly observed symptom. Ileocolic and ileoileal intussusceptions were the most common locations, and a lead point was observed in 19 cases (68%), of which malignancy was observed in six (21%). Bowel resection was performed in 27 cases. According to the pathological findings of the tissue from the resected section, nine and three cases of small bowel intussusception (SBI) were benign and malignant, respectively, whereas 13 and three cases of colonic intussusception (CI) were benign and malignant, respectively. On comparing SBI and CI, it was observed that most variables did not significantly differ, except for the duration of symptoms. Conclusion SBI had a higher lead point than CI. The rate of malignancy in CI cases in this study was lower than that reported in other studies. En-bloc resection can be considered the first option for the treatment of AI.
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Affiliation(s)
- Ki Hoon Kim
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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9
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Abstract
A 37-year-old woman with no relevant past medical history presented to the emergency department after a 2-day-long period of crampy abdominal pain with an inability for oral intake because of persistent vomiting. The physical examination was unremarkable. Abdominal CT scan with water-soluble oral contrast revealed an ileocecal intussusception (Fig. 1). Because the patient was hemodynamically stable and no abdominal tenderness was found, a delayed surgical intervention was planned with laparoscopic approach. During intervention, the intestinal invagination was reduced, a cecal neoplasm suspected, and a right hemicolectomy with complete mesocolic excision was performed (Fig. 2). Postoperative recovery was uneventful, with discharge on postoperative day 5. The definite pathological report showed well-differentiated colon adenocarcinoma pT2N1aMx, with 1 of 49 positive lymph nodes.
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10
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Tarchouli M, Ait Ali A. Adult Intussusception: An Uncommon Condition and Challenging Management. Visc Med 2021; 37:120-127. [PMID: 33981752 PMCID: PMC8077547 DOI: 10.1159/000507380] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/19/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Intussusception is a rare condition in adults. A pathological lesion is usually found with a significant percentage of malignancy. The optimal treatment is still not universally clear. METHODS This is a retrospective review of adult patients with a diagnosis of intestinal intussusception and surgically treated at our institution from January 2009 to December 2018. Clinical, operative, and histological details were collected and analyzed. RESULTS A total of 26 cases, 16 males and 10 females, were diagnosed with surgically proven intussusception during the 10-year period. The mean age was 45 years (range 21-70). Using ultrasound and/or computed tomography as imaging study, the preoperative diagnosis was made in 21/26 (81%) patients. Five intussusceptions were discovered only upon exploratory laparotomy for intestinal obstruction. There were 19 (73%) cases of enteric and 7 (27%) cases of colonic intussusceptions. All patients underwent surgical exploration. Intestinal resection with immediate anastomosis was the technique of choice for most patients. A single patient underwent stoma for peritonitis secondary to intestinal perforation. An organic cause has been systematically revealed, and no idiopathic intussusception was detected. Etiology was malignant in 9 (35%) cases. CONCLUSION Adult intussusception should be considered in any patient with subacute abdominal pain. Considering the high rate of malignancy, intestinal resection without attempting reduction is highly recommended for colonic intussusceptions. However, a more selective approach can be adopted for enteric intussusceptions.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Surgery, First Medical and Surgical Center, Agadir, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Abdelmounaim Ait Ali
- Department of Visceral Surgery, Mohammed V Military Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Tatsuta K, Sakata M, Sugiyama K, Akai T, Suzuki K, Suzuki Y, Kawamura T, Morita Y, Kikuchi H, Hiramatsu Y, Kurachi K, Takeuchi H. Successful laparoscopic approach for idiopathic adult colo-colonic intussusception: a case report. Surg Case Rep 2020; 6:300. [PMID: 33237497 PMCID: PMC7688730 DOI: 10.1186/s40792-020-01077-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background Adult intussusception is recognized as an abdominal emergency. More than 90% of adult patients with intussusception have distinct causes that are related to benign or malignant tumors. In contrast, idiopathic intussusceptions, which are observed in children, are rare conditions in adult. Especially, colo-colonic idiopathic intussusceptions are rare among them. Surgery is traditionally considered the primary treatment option. Recently, laparoscopic surgery has been reported to be safe and feasible. However, laparoscopic surgical reduction, which is a common procedure in pediatric surgery, is not common in adult intussusception. Case presentation We report a 34-year-old man who presented with sudden abdominal pain. Computed tomography revealed the target sign in the transverse colon. There was no evidence of bowel obstruction, bowel wall edema, or tumor. We diagnosed idiopathic intussusception and selected laparoscopic procedure because of the strong abdominal pain experienced by the patient. There were no signs of perforation, bowel wall ischemia, or tumor in abdominal cavity. We confirmed idiopathic colo-colonic anterograde intussusception. Laparoscopic surgical reduction was achieved by a combination of delicate direct pressure on the anal side of the transverse colon and gentle pulling on the oral side. The patient’s postoperative course was uneventful. Conclusions We achieved successful surgical reduction laparoscopically because of an accurate preoperative diagnosis based on characteristic computed tomography features and appropriate surgical technique. Laparoscopic procedure and surgical reduction is considered to be an effective treatment strategy for adult idiopathic intussusceptions with severe symptoms.
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Affiliation(s)
- Kyota Tatsuta
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Mayu Sakata
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kosuke Sugiyama
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Toshiya Akai
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Katsunori Suzuki
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yuhi Suzuki
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Takafumi Kawamura
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kiyotaka Kurachi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Abstract
Intussusception is a rare phenomenon in adults and usually presents with bowel obstruction. Unlike child intussusception, adult intussusception is seldom idiopathic and frequently associated with secondary causes such as benign and malignant tumors. While most cases are treated surgically, emerging data suggest a more conservative management approach for patients with short-segment adult intussusception and without high-risk features such as bowel obstruction, mass seen on imaging, colon involvement, or constitutional symptoms of malignancy. We present a rare case of adult intussusception due to unsuspected adenocarcinoma of the jejunum, treated successfully with surgical resection followed by adjuvant chemotherapy. We favor the surgical rather than conservative approach for adult patients with intussusception to avoid missing unsuspected malignant tumors that are not readily visualized on imaging studies.
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Small bowel intussusception due to inflammatory fibroid polyp: A case report. Radiol Case Rep 2018; 13:801-804. [PMID: 29988929 PMCID: PMC6034136 DOI: 10.1016/j.radcr.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/10/2018] [Accepted: 05/13/2018] [Indexed: 02/07/2023] Open
Abstract
Inflammatory fibroid polyp (IFP), or Vanek's tumor, is a rare benign lesion of the gastrointestinal tract. According to the location and the size of the lesion, patients present with different clinical manifestations. Our case describes a patient who presented with a picture of a small bowel obstruction. Computed tomography revealed ileoileal intussusception without a clear lead point. The patient underwent resection of the intussuscepted small bowel with primary anastomosis. A polypoid mass was identified as the pathologic lead point. Histopathologic analysis revealed an inflammatory fibroid polyp.
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Marsicovetere P, Ivatury SJ, White B, Holubar SD. Intestinal Intussusception: Etiology, Diagnosis, and Treatment. Clin Colon Rectal Surg 2016; 30:30-39. [PMID: 28144210 DOI: 10.1055/s-0036-1593429] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. Idiopathic ileocolic intussusception is the most common form in children and is typically managed with nonoperative reduction via pneumatic and/or hydrostatic enemas. In the adult population, intussusception is uncommon and occurs more often in the small intestine than in the colon. It is associated with lead point pathology in most symptomatic cases presenting as bowel obstruction. When lead point pathology is present in adult small bowel intussusception, it is usually benign, though when malignant it is most frequently due to diffuse metastatic disease, for example, melanoma. In contrast, adult ileocolic and colonic intussusception lead point pathology is most frequently primary adenocarcinoma when malignant. The diagnosis is typically made intraoperatively or by cross-sectional imaging. With increasingly frequent CT/MRI of the adult abdomen in the current era, transient and/or asymptomatic intussusceptions are increasingly found and may often be appropriately observed without intervention. When intervention in the adult population is warranted, usually oncologic bowel resection is performed due to the association with lead point pathology.
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Affiliation(s)
- Priscilla Marsicovetere
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - S Joga Ivatury
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
| | - Brent White
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire
| | - Stefan D Holubar
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
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Kim JS, Lim JH, Jeong JH, Kim WS. [Conservative management of adult small bowel intussusception detected at abdominal computed tomography]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 65:291-6. [PMID: 25998975 DOI: 10.4166/kjg.2015.65.5.291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS The incidence of adult small bowel intussusception detected at CT has increased with advanced imaging techniques and universal utilization of CT scan. We aimed to identify factors that could predict the necessity of surgical intervention in adult patients with small bowel intussusception detected at CT during the past decade. METHODS There were 39 cases of adult small-bowel intussusception detected at CT from January 2004 to June 2014. The data on clinical factors, radiological factors and outcomes were collected by retrospectively reviewing all available medical records. Patients were classified as surgical group and conservative group according to the outcome. Association between predictive factors and outcome was assessed by Fisher's exact test and logistic regression models. RESULTS Among a total of 39 patients, there were 32 patients (82%) in the conservative group and 7 patients (18%) in the surgical group. Spontaneous reduction was confirmed at short-term follow-up studies (abdominal ultrasonography [n=14], single contrast small bowel series [n=14], CT [n=4]) in the conservative group. No recurrence occurred during the median follow-up period of 14.1 months (range, 0-67.5 months). Patients in the surgical group had significantly higher white blood cell (WBC) counts (OR 1.001, p=0.048), more frequent obstruction (n=4 vs. n=4, p=0.022) or leading point (n=5 vs. n=0, p<0.001) and longer intussuception length (OR 1.929, p=0.032). CONCLUSIONS Factors associated with the necessity to resort to surgical intervention in adults with small bowel intussusceptions were higher WBC counts, presence of obstruction or leading point, and longer intussuception length. Conservative management can be considered with short-term follow-up for those without these predictive factors.
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Alventosa Mateu C, Bañuls Marrades M, Ruíz Sánchez L, Ramiro Gandía R, Pacheco Del Rio G, Vázquez Fernández P, Siles Moreno M. [Adult colocolonic intussusception due to adenomatous polyp: An exceptional cause of a rare entity]. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:425-7. [PMID: 26831823 DOI: 10.1016/j.gastrohep.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Carlos Alventosa Mateu
- Servicio de Medicina Digestiva, Hospital Universitario de la Ribera, Alzira, Valencia, España.
| | - Marta Bañuls Marrades
- Servicio de Medicina Digestiva, Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - Lucía Ruíz Sánchez
- Servicio de Medicina Digestiva, Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - Raquel Ramiro Gandía
- Servicio de Radiodiagnóstico, Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - Gemma Pacheco Del Rio
- Servicio de Medicina Digestiva, Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - Paola Vázquez Fernández
- Servicio de Medicina Digestiva, Hospital Universitario de la Ribera, Alzira, Valencia, España
| | - Marisol Siles Moreno
- Servicio de Medicina Digestiva, Hospital Universitario de la Ribera, Alzira, Valencia, España
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Abelson JS, Turbendian H, Pomp A, Afaneh C. Recurrent intussusception in a gastric bypass patient with incidental Meckel's diverticulum: A case report. J Minim Access Surg 2015; 11:271-2. [PMID: 26622119 PMCID: PMC4640028 DOI: 10.4103/0972-9941.158158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Most cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point. Intussusception has been reported in the bariatric literature, typically due to intussusception of the jejunojejunostomy. However, other causes of intussusception should be considered, including a Meckel's diverticulum (MD). Simple diverticulectomy or segmental resection is the preferred treatment since the malignancy rate is low. We present an interesting case of a patient with past surgical history of open Roux-en-Y gastric bypass who presented with intussusception. Intraoperatively, an MD was encountered and treated with diverticulectomy. 4 months later, she re-presented with recurrent intussusception and was subsequently taken back to the operating room for revision of her jejunojejunostomy. The postoperative course was uncomplicated.
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Affiliation(s)
- Jonathan S Abelson
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Harma Turbendian
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Cheguevera Afaneh
- Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
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Huang Y, Li LP, Wang J, Lun ZJ, Li W, Yang Z. Inflammatory pseudotumor of the colon causing intussusception: A case report and literature review. World J Gastroenterol 2015; 21:704-710. [PMID: 25593502 PMCID: PMC4292308 DOI: 10.3748/wjg.v21.i2.704] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/18/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023] Open
Abstract
Inflammatory pseudotumor (IPT) is a rare space-occupying lesion of unknown etiology that can mimic malignancy on clinic-radiological and pathological examination. We describe a rare case of ileocecal intussusception from clinically suspected malignancy of the right colon where the patient underwent right hemicolectomy. Histopathology of the resected specimen confirmed IPT of the colon. This patient was observed to have abnormally elevated total leukocyte count and platelets before and after surgery. In an adult with intussusception associated with an abdominal mass, the possibility of IPT of the colon should be considered. Considering the abnormally high total leukocyte and platelet counts and colonic IPT, it is necessary to prevent postoperative adverse effects due to these changes. Although IPT of the colon is usually a benign process, controversy regarding its management still exists. We consider hemicolectomy as a safe treatment approach for colonic IPT and review the existing literature.
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Shah K, Khiria L, Desai P, Vora H, Bhavsar M. Surgically inverting an incidentally detected Meckel's diverticulum - Wrong method. Int J Surg Case Rep 2015; 6C:289-91. [PMID: 25560057 PMCID: PMC4347832 DOI: 10.1016/j.ijscr.2014.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/10/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Intusussception leading to intestinal obstruction is a known complication of Meckel's diverticulum. Inverting of Meckel's acts as a lead point for intussusception. Causes of inversion are many but surgical inversion leading to intusussception is extremely rare. PRESENTATION OF CASE We hereby report a case of a 14 year adolescent boy operated previously for open appendicetomy presenting to us with intestinal obstruction who on exploration was found to have an surgically inverted Meckel's diverticulum acting as a lead point for ileo-colic intusussception. DISCUSSION To the best of our knowledge, surgically inverting any Meckel's diverticulum is never a treatment option even when the diverticulum is incidentally detected. Diverticulectomy or segmental resection is the procedure of choice for Meckel's diverticulum. CONCLUSION Meckel's divereticulum should never be inverted surgically. Not only it is a wrong method but also increases the risk of complications.
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Bowel intussusceptions in adults: the role of imaging. Radiol Med 2014; 120:105-17. [DOI: 10.1007/s11547-014-0454-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/14/2014] [Indexed: 02/07/2023]
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21
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Intussusception of rectosigmoid colon cancer mimicking a pedunculated tumor. Case Rep Surg 2014; 2014:696403. [PMID: 24963434 PMCID: PMC4053309 DOI: 10.1155/2014/696403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/30/2014] [Indexed: 12/30/2022] Open
Abstract
Intussusception in adults is a rare phenomenon involving the colon in approximately 20% of cases. A 65-year-old man was hospitalized with anorexia, anemia, dehydration, and melena. Digital rectal examination revealed a palpable mass approximately 5 cm from the anal verge. The mass moved between the rectosigmoid colon and the rectum below the peritoneal reflection during radiographic examinations and during sigmoidoscopy. We strongly suspected a rectosigmoid pedunculated tumor and performed a low anterior resection. Intraoperatively we observed intussusception of the rectosigmoid colon with easy manual reduction. The tumor was palpable in the rectosigmoid colon. The postoperative course was uneventful. This case illustrates intussusception of a rectosigmoid type 1 colon adenocarcinoma mimicking a pedunculated tumor.
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Ongom PA, Opio CK, Kijjambu SC. Presentation, aetiology and treatment of adult intussusception in a tertiary Sub-Saharan hospital: a 10-year retrospective study. BMC Gastroenterol 2014; 14:86. [PMID: 24886558 PMCID: PMC4016697 DOI: 10.1186/1471-230x-14-86] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 04/30/2014] [Indexed: 12/13/2022] Open
Abstract
Background Adult intussusception is a rare clinical condition worldwide. It contributes to less than 5% of all cases of intussusception. Few studies have been conducted in low-income countries compared to high-income countries; particularly Sub-Saharan Africa. Based on anecdotal evidence, the authors hypothesized that the condition is not as rare in a Sub-Saharan setting in comparison with western countries. We set out to conduct the first review study of adult intussusception in Uganda. Methods The medical records of 37 (out of a total of 62 cases) adolescent and adult patients with a postoperative diagnosis of intussusception at Mulago National Referral and Teaching Hospital, from January 2003 to December 2012, were analyzed. The clinical features, diagnosis, treatment and pathologic features of lesions for these patients were reviewed. Intraoperative findings were described with reference to: the site of the intussusception, and the triggering lesion (either idiopathic or with a lead point). Results The mean age was 33.6 years, with a range of 13 – 72 years. The male to female ratio was 1.85:1. The mean number of days for which symptoms had been present prior to presentation was 6.3 days, while the median was 4 days. All 37 patients presented with abdominal pain. Only 13 (35.1%) had the classical paediatric triad of abdominal pain, a palpable abdominal mass and bloody stool. Most of the remaining patients presented sub-acutely with non-specific symptoms. A lead point was present in 28 patients (75.7%). Of these, 24 (64.9%) cases involved tumours. Among the tumours, 54.2% were malignant. Treatment did not involve intussusception reduction in 14 patients (37.8%). Some form of operative surgery was conducted in 31 (83.8%) patients; mainly segmental bowel resections and hemi-colectomies. Conclusion Adult intussusception is uncommon in the Uganda, though probably less so than in western countries. It presents sub-acutely or chronically and is often diagnosed at laparotomy. Lead points are the triggering lesion most times and are due mainly to tumours. The bulk of tumours are malignant. Most patients require surgical resection, with prior reduction done in selected cases.
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Affiliation(s)
- Peter A Ongom
- Colorectal Unit, Department of Surgery, School of Medicine, Makerere College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
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Arikanoglu Z, Onder A, Taskesen F, Aliosmanoglu I, Gul M, Gumus H, Tas I, Girgin S. Surgical Alternatives in the Treatment of Intestinal Intussusceptions Resulting from Polyps in Adults. Am Surg 2013. [DOI: 10.1177/000313481307900933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adult intussusception is an uncommon disease requiring surgical intervention. The aim of this study is to discuss the surgical alternatives and share our experience in the treatment of adult patients with intussusceptions formed as a result of polyps. The retrospective study included 16 adult patients who underwent surgery after the diagnosis of intestinal invaginations resulting from polyps between the years 2000 and 2011. Sixteen patients (seven males and nine females; mean age, 48.18 years; range, 18 to 76 years) presented with intestinal intussusceptions. Although a preoperative diagnosis was carried out in 11 (68.75%) patients, the diagnosis was made intra-operatively in five patients (31.25%). Among the patients, seven (43.8%) had undergone emergency surgeries and nine (52.8) had elective surgery. The invagination in 12 patients (75%) was located in the small intestine, in two patients (12.5%) in the colon, and in a further two patients (12.5%), it was ileocecally located. Ten patients (62.5%) had segmental resection 1 anastomosis; three patients underwent (18.8%) segmental resection 1 enterostomy, and three (18.8%) received hemicolectomies. In adults, surgical treatment is always the primary option in intussusceptions resulting from polyps. Although the surgical method of choice in colonically located ones is en bloc resection without reduction, because the polyps located in the small intestine are usually of a benign nature, segmental resection with reduction should be performed in elective surgery and segmental resection without reduction should be performed in emergency cases.
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Affiliation(s)
| | - Akin Onder
- From the Departments of General Surgery and
| | | | | | - Mesut Gul
- From the Departments of General Surgery and
| | - Hatice Gumus
- Radiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Ilhan Tas
- From the Departments of General Surgery and
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Amoruso M, D'Abbicco D, Praino S, Conversano A, Margari A. Idiopathic adult colo-colonic intussusception: Case report and review of the literature. Int J Surg Case Rep 2013; 4:416-8. [PMID: 23500747 DOI: 10.1016/j.ijscr.2013.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/16/2013] [Accepted: 01/17/2013] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Acute colonic intussusception occurring in the absence of organic cause is uncommon in adults. PRESENTATION OF CASE We report acute colonic intussusception in a 46-year-old female; clinical evidence of a palpable mass, abdominal pain and bloody mucoid stools appeared a few hours after hospital admission. Multislice CT-scan confirmed the clinical diagnosis and surgical exploration revealed right colonic obstruction caused by intussusception of the cecum into the ascending colon. Right hemicolectomy was performed and histopathological examination did not reveal any causative pathology. DISCUSSION Intussusception remains a rare condition in adults, representing 1-5% of bowel obstruction and accounting for 0.003-0.02% of all hospital admissions. Intussusception occurs more frequently in the small (50-80%) than in the large bowel (12-50%). It is estimated that approximately 90% of intussusceptions in adults are secondary to an anatomical or pathological condition, of which more than half are malignant. Idiopathic cases are the exception in adults. The clinical presentation of adult intussusception differs considerably from the classic pediatric presentation of abdominal pain, palpable mass, and blood per rectum, which is rarely seen in adults. A pre-operative CT-scan showed a 10cm intussuscepted segment of right colon. Surgical resection was considered mandatory because of severe bowel obstruction, and the theoretical possibility of occult malignancy. This approach was vindicated by the presence of widespread ischemic lesions in the wall of the resected bowel, without any obvious lead point. CONCLUSION There are few reports in the medical literature of acute colonic intussusception occurring in the absence of organic cause in adults.
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Affiliation(s)
- Michele Amoruso
- Unità Operativa di Chirurgia Generale "Giuseppe Marinaccio" Azienda Ospedaliero Universitaria Policlinico di Bari Piazza Giulio Cesare, 11 70124, Italy.
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Akbulut S. Intussusception due to inflammatory fibroid polyp: A case report and comprehensive literature review. World J Gastroenterol 2012; 18:5745-52. [PMID: 23155316 PMCID: PMC3484344 DOI: 10.3748/wjg.v18.i40.5745] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 07/16/2012] [Accepted: 10/23/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To give an overview of the literature on intussusception due to inflammatory fibroid polyp (IFP).
METHODS: We present a new case of ileal intussusception due to IFP and a literature review of studies published in English language on intussusception due to IFP, accessed via PubMed and Google Scholar databases. For the search, the keywords used were: intussusception, IFP, intussusception and IFP, intussusception due to IFP, and IFP presenting as intussusception. The search covered all articles from 1976 to November 2011.
RESULTS: We present a 38-year-old woman who was admitted 10 d after experiencing abdominal pain, vomiting, and nausea. Ultrasonography demonstrated small bowel intussusception. An ileal intussusception due to a mass lesion 50 cm proximal to the ileocecal junction was found during laparotomy. Partial ileal resection and anastomosis were performed. A diagnosis of ileal IFP was made based on the immunohistochemical findings. In addition, a total of 56 reports concerning 85 cases of intussusception due to IFP meeting the aforementioned criteria was included in the literature review. The patients were aged 4 to 81 years (mean, 49 ± 16.2 years); 44 were women (mean, 51.8 ± 14.3 years) and 41 were men (mean, 46 ± 17.5 years). According to the location of the IFP, ileal intussusception was found in 63 patients, while 17 had jejunal, three had colonic, and two had ileojejunal intussusception.
CONCLUSION: Although IFPs are rare and benign, surgery is the only solution in case of intestinal obstruction. Differential diagnosis should be made via immunohistochemical examination.
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Ileocolic intussusception precipitated by diagnostic colonoscopy: a case report. Surg Laparosc Endosc Percutan Tech 2012; 22:e161-3. [PMID: 22678343 DOI: 10.1097/sle.0b013e31824b230f] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Only 5% of all cases of intussusceptions occur in adults. Intussusception complicating colonoscopy is an extremely rare event. Herein, we present a case of a 58-year-old man who developed ileocolic intussusception after a colonoscopy during which an adenomatous polyp was discovered in the terminal ileum. Eight hours after colonoscopy, the patient developed diffuse abdominal pain associated with vomiting and bloody diarrhea. A contrast-enhanced abdominal computed tomography scan revealed features of mechanical intestinal obstruction and a round soft tissue mass inside the right colon, followed by the wall of the intussusceptum. Emergency laparotomy revealed extended ileocecal intussusception with the polyp incarcerated by the ileocecal valve. A typical right hemicolectomy was performed, and the patient had an uneventful recovery. Histologic examination of the surgical specimen revealed an inflammatory fibroid polyp. Ileocolic intussusception due to an ileal polyp may be precipitated by colonoscopy and should be included in the differential diagnosis of acute abdomen after colonoscopy.
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27
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Adult ileocolic intussusception secondary to infectious enterocolitis: anecdotic cause of an uncommon condition. Open Med (Wars) 2012. [DOI: 10.2478/s11536-011-0157-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
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Namikawa T, Okamoto K, Okabayashi T, Kumon M, Kobayashi M, Hanazaki K. Adult intussusception with cecal adenocarcinoma: Successful treatment by laparoscopy-assisted surgery following preoperative reduction. World J Gastrointest Surg 2012; 4:131-4. [PMID: 22655128 PMCID: PMC3364339 DOI: 10.4240/wjgs.v4.i5.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 10/27/2011] [Accepted: 11/24/2011] [Indexed: 02/06/2023] Open
Abstract
We report a case of adult intussusception caused by cecal adenocarcinoma that was treated by laparoscopy-assisted ileocecal resection following reduction by contrast enema and preoperative colonoscopy. A 68-year-old male with cecal cancer was admitted to our hospital because of colicky abdominal pain after taking a laxative. His abdomen was distended, and a mass was palpable in the right upper quadrant, which appeared as a target- or sausage-shaped lesion by ultrasonograhpy and computed tomography. A contrast enema using water-soluble material showed a cup-shaped filling defect characterized by intussusception in the ascending colon. This round defect with a clear margin was pushed gradually back into the cecum by the enema pressure. Re-occurrence of the intussusception is easily released by colonoscopy. We performed laparoscopy-assisted ileocecal resection of a protruding tumor measuring 6.5 cm × 5.0 cm × 3.5 cm from the cecum, with D3 lymph node dissection. Histological examination revealed a well-differentiated adenocarcinoma that had invaded the serosa without permeating the lymphatic or venous capillaries, as well as lymph node metastasis. The postoperative course was uneventful, and the patient has been well without evidence of disease recurrence for 5 years following the operation. Preliminary reduction of adult colonic intussusception before surgical resection is therefore an option in cases of an early and correct diagnosis of intussusception.
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Affiliation(s)
- Tsutomu Namikawa
- Tsutomu Namikawa, Takehiro Okabayashi, Kazuhiro Hanazaki, Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku, Kochi 783-8505, Japan
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Adult intussusception: diagnostic pitfalls, morbidity and mortality in a developing country. J Visc Surg 2012; 149:e211-4. [PMID: 22633569 DOI: 10.1016/j.jviscsurg.2012.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To study diagnostic pitfalls, morbidity and mortality of adult intussusception. PATIENTS AND METHODS Retrospective study of adult patients records operated between 1979 and 2007 with the diagnosis of adult intussusception. RESULTS We found 41 cases of adult intussusception. The mean age was 35.2 years (standard deviation (SD)=7.1). The delay between onset and medical consultation was 15 days. The diagnosis was made pre-operatively in 11 cases. Abdominal ultrasound showed an abdominal mass in 11 cases. Ileo-ileal intussusception was most frequent (16 cases). Intussusception was secondary in 24 cases. There were seven instances of intestinal necrosis. Intestinal resection was performed in 34 cases. Surgical site infection occurred in four patients, three patients died. CONCLUSION The pre-operative diagnosis of acute intestinal intussusception is difficult. Morbidity and mortality rates are high. Improved diagnostic investigations in developing countries could improve the prognosis of this condition.
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Sioka E, Christodoulidis G, Garoufalis G, Zacharoulis D. Inverted Meckel’s diverticulum manifested as adult intussusception: Age does not matter. World J Gastrointest Surg 2011; 3:123-7. [PMID: 22007280 PMCID: PMC3192218 DOI: 10.4240/wjgs.v3.i8.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 03/28/2011] [Accepted: 04/07/2011] [Indexed: 02/06/2023] Open
Abstract
Adult intussusception due to Meckel’s diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report two cases of intussusception due to MD in adults. A diverticulectomy using a TA stapler was performed in the first patient. In the second patient extensive fibrosis of the adjacent mesentery and thickening of jejunal mucosa were observed, so a segmental resection of the small bowel or affected ileal part and a hand-sewn anastomosis was performed. The postoperative period along with the long term follow-up was uneventful for both patients. The decision between diverticulectomy vs bowel resection can be based on the intussuscepted bowel condition. Early surgical intervention may ensure a favorable outcome.
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Affiliation(s)
- Eleni Sioka
- Eleni Sioka, Gregory Christodoulidis, Grigorios Garoufalis, Dimitris Zacharoulis, Department of General Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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(18)F-FDG PET/CT in inflammatory pseudotumor of the colon causing intussusception. Ann Nucl Med 2011; 25:447-50. [PMID: 21479731 DOI: 10.1007/s12149-011-0481-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 01/25/2011] [Indexed: 12/26/2022]
Abstract
Inflammatory pseudotumor is a rare benign lesion mimicking malignancy both clinically and radiologically. An accurate diagnosis is still difficult and is based on the histological examination. Since inflammatory pseudotumor is exceptionally rare in the colon, this unexpected lesion can be mistaken for malignancy. We report the first case of inflammatory pseudotumor in the colon that showed (18)F-fluorodeoxyglucose (FDG) uptake and acted as the lead point causing colocolic intussusception.
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Laparoscopic resection of ileal lipoma diagnosed by multidetector-row computed tomography. Surg Laparosc Endosc Percutan Tech 2011; 20:e226-9. [PMID: 21150408 DOI: 10.1097/sle.0b013e3182002ac4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Intussusception is rare in adults and it is difficult to diagnose on admission. We present the case of a 43-year-old woman with the chief complaint of nausea and upper abdominal pain. Abdominal multidetector-row computed tomography showed ileo-ileal small bowel intussusception with an intraluminal soft tissue mass with attenuation numbers suggestive of a lipoma. The patient was treated with a laparoscopic-assisted extracorporeal partial resection of the small bowel including ileal lipoma, followed by a functional end-to-end anastomosis. Histologic diagnosis of the resected tumor, 2.4×2.0×2.0 cm, was an intestinal lipoma. This case serves as the basis of a review of small bowel intussusception in adults secondary to lipomas. It focuses on the utility of multidetector-row computed tomography and the cosmetic, physical, and economic benefits of laparoscopic surgery as well as the rarity of the disease.
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Harma M, Harma MI, Karadeniz G, Arikan I, Barut A, Bayar U. Idiopathic ileoileal invagination two days after cesarean section. J Obstet Gynaecol Res 2011; 37:160-2. [PMID: 21208337 DOI: 10.1111/j.1447-0756.2010.01331.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Postoperative enteroenteric invagination is rare. The only previously reported case post-cesarean was secondary to colonic adenocarcinoma. A 27-year-old woman with preeclampsia delivered a baby by cesarean section. On the second postoperative day, she had abdominal pain, nausea, vomiting, constipation, and distention. An abdominal x-ray showed air-fluid levels, while free fluid (ascites) was detected by ultrasonography. A computed tomography scan did not show the typical invagination picture. Her condition did not improve after 72 h of conservative treatment, and diagnostic laparotomy was performed. A 10 × 3-cm ileoileal invagination 80 cm proximal to the ileocecal valve was found and manually reduced. The patient was discharged on the fifth postoperative day, and her six-month follow-up was normal.
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Affiliation(s)
- Muge Harma
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey.
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Di Saverio S, Tugnoli G, Ansaloni L, Catena F, Biscardi A, Jovine E, Baldoni F. Concomitant intestinal obstruction: a misleading diagnostic pitfall. BMJ Case Rep 2010; 2010:bcr0820092177. [PMID: 22798445 PMCID: PMC3029525 DOI: 10.1136/bcr.08.2009.2177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A 78-year-old man presented to the casualty department, complaining of recurrent and worsening constipation for the previous 2 months. This was associated with central, colicky abdominal pain and melena. In the last days, the symptoms worsened and the patient became partially obstructed, with nausea, vomiting and passing flatus but not stools for 72 h. The past medical history was unremarkable. The radiological findings of the plain abdominal film were consistent with mechanical small-bowel obstruction. CT scan revealed an intraluminal mass in the small bowel, which drew attention away from gross thickening of the caecal wall that was also present. A careful review of the images should not be omitted. One must be aware of a polymorphous appearance and the multiple causes of intestinal obstruction and avoid underestimating even the minor and less evident radiological findings.
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Affiliation(s)
- Salomone Di Saverio
- Department of Surgery and Emergency, Maggiore Hospital Trauma Center, University of Bologna, Bologna, Italy.
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Hanan B, Diniz TR, da Luz MMP, da Conceição SA, da Silva RG, Lacerda-Filho A. Intussusception in adults: a retrospective study. Colorectal Dis 2010; 12:574-8. [PMID: 19486100 DOI: 10.1111/j.1463-1318.2009.01865.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Intestinal intussusception in adult patients is rare. In contrast with paediatric patients, it is usually secondary to a definable lesion, often malignant. The purpose of this study was to determine the causes and the management of intussusception in adult patients. METHOD A retrospective review was performed looking at patients over 18 years with intestinal intussusception who were admitted to a tertiary university hospital from 1997 to 2007. RESULT There were 16 patients (out of whom 10 were female subjects) of mean age 49 years (range 19-76). All presented with abdominal pain and in seven (46.6%) patients, this was acute. The diagnosis of intussusception was correctly made preoperatively in eight (50%) patients. Six (37.5%) patients had the lead point for the intussusception at the ileocaecal valve, five (31.25%) in the small bowel and five (31.25%) had a colonic lead point. An anatomical cause was found in 14 (87.5%). In two (12.5%), the intussusception occurred in the postoperative period without any definable lesion. Half the patients had a malignant neoplasm. All patients underwent surgery. In 14 (87.5%) patients, this was by resection and in two (12.5%), a reduction with no resection was carried out. CONCLUSION The features of intussusception may be nonspecific and the diagnosis is often made only during laparotomy. An identifiable organic lesion is present in most cases. En bloc resection is recommended for ileocaecal and colocolic intussusception.
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Affiliation(s)
- B Hanan
- Division of Coloproctology and Small bowel of Alfa Institute of Gastroenterology at Federal University of Minas Gerais Hospital, Belo Horizonte, Brazil
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Obstrucción intestinal en el adulto secundaria a invaginación de un divertículo de Meckel. Cir Esp 2010; 87:252-3. [DOI: 10.1016/j.ciresp.2009.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 04/26/2009] [Accepted: 07/01/2009] [Indexed: 12/27/2022]
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Clinical presentations, diagnosis and treatment of adult intussusception, a 20 years survey. Int J Surg 2010; 8:318-20. [PMID: 20359557 DOI: 10.1016/j.ijsu.2010.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 02/03/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intussusception is a rare cause of intestinal obstruction in adult patients. The etiology of malignant nature has been reported to be more frequent in this group and the diagnosis is usually made at operation. Few reports are published for this clinical entity from Middle East. METHODS The medical records of all adult patients admitted with the diagnosis of intussusception in a tertiary care center between 1989 and 2009 were reviewed. RESULTS There were 15 cases of intussusception in this 20 years period. The mean age of patients was 33.6 years, 8 females and 7 males. In 14 cases the leading point of intussusception was in small bowel. Resection and primary anastomosis was the selected procedure in 13 patients; one patient underwent colostomy and one reduction alone. Malignant cause was detected in only 2 cases. 7 Patients were operated on with diagnosis of intussusception according to imaging findings. The diagnosis was made at operation in the remaining 8 cases. Only one anastomotic leakage occurred in patient on systemic steroids. CONCLUSION The mean age of our patients is relatively low with more benign etiologies in small bowel. The CT scan may be the most helpful imaging modality in suspected cases but decision for operation in acute presentations should not be deferred for definite diagnosis. Resection of the involved bowel segment and primary anastomosis is associated with a good outcome.
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40
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Shi B, Gaebelein G, Hildebrandt B, Weichert W, Glanemann M. Adult jejunojejunal intussusception caused by metastasized pleomorphic carcinoma of the lung: report of a case. Surg Today 2009; 39:984-9. [PMID: 19882322 DOI: 10.1007/s00595-008-3954-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 07/06/2008] [Indexed: 12/21/2022]
Abstract
Adult small-intestinal intussusception is rare and very different from childhood intussusception. Both benign and malignant pathologies can underlie small intestinal intussusception in adults, but malignancy is much less frequent. We report a case of jejunojejunal intussusception caused by an intestinal metastasis of the sarcomatoid component of pleomorphic carcinoma of the right lung. The patient, a 61-year-old man, underwent successful segmental jejunal resection. Adult small bowel intussusception, though an unusual cause of acute abdomen, requires early diagnosis and timely management. To our knowledge, this is the first report of adult jejunojejunal double intussusception caused by metastatic sarcomatoid carcinoma of the lung.
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Affiliation(s)
- Baomin Shi
- Department of General, Visceral, and Transplantation Surgery, Universitätsmedizin Berlin, 13353 Berlin, Germany
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41
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Nylund K, Ødegaard S, Hausken T, Folvik G, Lied GA, Viola I, Hauser H, Gilja OH. Sonography of the small intestine. World J Gastroenterol 2009; 15:1319-30. [PMID: 19294761 PMCID: PMC2658828 DOI: 10.3748/wjg.15.1319] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In the last two decades, there has been substantial development in the diagnostic possibilities for examining the small intestine. Compared with computerized tomography, magnetic resonance imaging, capsule endoscopy and double-balloon endoscopy, ultrasonography has the advantage of being cheap, portable, flexible and user- and patient-friendly, while at the same time providing the clinician with image data of high temporal and spatial resolution. The method has limitations with penetration in obesity and with intestinal air impairing image quality. The flexibility ultrasonography offers the examiner also implies that a systematic approach during scanning is needed. This paper reviews the basic scanning techniques and new modalities such as contrast-enhanced ultrasound, elastography, strain rate imaging, hydrosonography, allergosonography, endoscopic sonography and nutritional imaging, and the literature on disease-specific findings in the small intestine. Some of these methods have shown clinical benefit, while others are under research and development to establish their role in the diagnostic repertoire. However, along with improved overall image quality of new ultrasound scanners, these methods have enabled more anatomical and physiological changes in the small intestine to be observed. Accordingly, ultrasound of the small intestine is an attractive clinical tool to study patients with a range of diseases.
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Israelit SH, Brook OR, Abbou B, Molner R, Duek SD, Krausz MM. Intestinal intussusception in elderly patients. Maturitas 2009; 62:124-6. [PMID: 19118957 DOI: 10.1016/j.maturitas.2008.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 11/05/2008] [Accepted: 11/06/2008] [Indexed: 01/12/2023]
Abstract
Intussusception is the most common cause of bowel obstruction in children, but it is a very rare cause of bowel obstruction in the elderly. Diagnosis is based on a high index of suspicion, complete anamnestic recall, physical examination, and imaging modalities. We find abdominal CT scans to be highly sensitive and accurate for making the diagnosis. Treatment of intussusception in adults is always surgical. Segmental bowel resection must be performed. The extent of resection should include any nonviable bowel as well as the leading point of the intussusception. We present a case of an 82-year-old patient with ileo-cecal intussusception, followed by a discussion of the diagnostic and therapeutic options.
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Affiliation(s)
- S H Israelit
- Departments of Surgery A, Rambam Medical Center, Haifa 31096, Israel
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Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, Vassiliou I, Theodosopoulos T. Intussusception of the bowel in adults: A review. World J Gastroenterol 2009; 15:407-11. [PMID: 19152443 PMCID: PMC2653360 DOI: 10.3748/wjg.15.407] [Citation(s) in RCA: 452] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. However, bowel intussusception in adults is considered a rare condition, accounting for 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction. Eight to twenty percent of cases are idiopathic, without a lead point lesion. Secondary intussusception is caused by organic lesions, such as inflammatory bowel disease, postoperative adhesions, Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasms or even iatrogenically, due to the presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusceptions with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected. Reduction of the intussuscepted bowel is considered safe for benign lesions in order to limit the extent of resection or to avoid the short bowel syndrome in certain circumstances.
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Schwandt CS. Low-grade or benign intestinal tumours contribute to intussusception: a report on one feline and two canine cases. J Small Anim Pract 2008; 49:651-4. [DOI: 10.1111/j.1748-5827.2008.00607.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mohamud SO, Motorwala SA, Daniel AR, Tworek JA, Shehab TM. Giant ileal inflammatory fibroid polyp causing small bowel obstruction: a case report and review of the literature. CASES JOURNAL 2008; 1:341. [PMID: 19025593 PMCID: PMC2596112 DOI: 10.1186/1757-1626-1-341] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 11/21/2008] [Indexed: 01/02/2023]
Abstract
Introduction There are several types of small bowel pathology that can lead to small bowel obstruction or intussusception. The etiology causing small bowel obstruction varies by age. Benign disease is the typical cause in children and adolescents while malignant or adhesive disease is far more common in older patients. Although cases of adult intussusception caused by benign processes are rare, there are reports of inflammatory fibroid polyps causing adult intussusception of the terminal ileum published in the literature. Case presentation We present the case of a 70-year-old man with a multiple year history of intermittent episodes of bowel obstruction who was found to have a giant ileal inflammatory fibroid polyp causing intermittent small bowel obstruction. The patient underwent operative intervention and has now been symptom-free for three years. Conclusion Small bowel lesions include both malignant and benign etiologies. The malignant etiologies include adenocarcinoma, carcinoid or lymphoma while benign lesions are typically lipomas, inflammatory polyps or adenomas. Inflammatory fibroid polyps are rare, benign lesions that can occur anywhere within the gastrointestinal tract. They are typically an incidental finding, but on rare occasions have been presented as the source of intussusception or obstruction.
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Affiliation(s)
- Sagal O Mohamud
- Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA.
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Karatepe O, Tükenmez M, Hünerli K, Citlak G, Salmaslioglu A, Battal M, Erbil Y. Ascaris as a leading point for small-bowel intussusception in an adult: a rare cause of intussusception. Am J Emerg Med 2008; 26:381.e3-4. [PMID: 18358969 DOI: 10.1016/j.ajem.2007.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 05/07/2007] [Indexed: 02/04/2023] Open
Abstract
Adult intussusception represents 1% of patients with bowel obstructions and requires a surgical approach. Malignancy is associated with 31% of small bowel intussusception and 70% of large bowel intussusception. Intestinal intussusception caused by ascaris, however, is very uncommon. This report describes our experience of this rare cause of intussusception and its clinical findings.
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Affiliation(s)
- Oğuzhan Karatepe
- Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul 34394, Turkey.
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Solís Jiménez J, Montes Lluch M, de la Fuente Gutiérrez C, García Ramírez ME, Castro Javoie C, Rodríguez-Peña D. Mujer de 73 años con dolor abdominal recurrente y pérdida de peso. Rev Clin Esp 2007; 207:213-4. [PMID: 17475188 DOI: 10.1016/s0014-2565(07)73359-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J Solís Jiménez
- Servicio de Geriatría, SANITAS, Clínica Universal, Madrid, Spain
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Karamercan A, Kurukahvecioglu O, Yilmaz TU, Aygencel G, Aytaç B, Sare M. Adult ileal intussusception: an unusual emergency condition. Adv Ther 2006; 23:163-8. [PMID: 16644617 DOI: 10.1007/bf02850357] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Adult intussusception occurs infrequently and differs from the childhood condition in its presentation, cause, and treatment. Nonspecific symptoms can delay diagnosis; most cases are diagnosed at emergency laparotomy. Increased use of computed tomographic scanning to evaluate patients with abdominal pain can enhance reliable preoperative diagnosis. Treatment entails simple bowel resection in most cases. Reduction is controversial, especially in cases of colonic intussusception. This report describes the diagnosis and management of a case of adult ileal intussusception caused by an inflammatory fibroid polyp-a rare lesion of the gastrointestinal tract.
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Affiliation(s)
- Ahmet Karamercan
- Department of General Surgery, Gazi University Medical School, Ankara, Turkey
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Drasković M, Misović S, Kronja G, Krsić J, Tomić A, Sarac M. [Jejuno-jejunal intussusception in adults secondary to submucosal leiomyoma]. ACTA ACUST UNITED AC 2005; 58:405-9. [PMID: 16296586 DOI: 10.2298/mpns0508405d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Intussusception is the invagionation of a segment of the intestine into itself. It is a serous condition that most commonly affects infants and children, but can also occur in adults. Intussusception in adults is usually caused by tumors, benign or malignant. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. In older patinets and adolescents the diagnosis can be complicated due to lower incidence and variable subacute symptoms. CASE REPORT We report a rare case of a 27-year-old patient with increasing abdominal discomfort over several weeks. The patient experienced increasing colics, recurrent vomiting, dehydration and weight loss. Finally he was transferred to the surgical ward of our hospital. Intussusception of the small bowel was diagnosed by CT examination. Laparotomy revealed a jejunojejunal intussusception caused by a small bowel tumor. CONCLUSION The tumor in the jejunum, almost completely obstructed the intestinal lumen and it was resected and bowel continuity was restored. Histopathological examination revealed a submucosal leiomyoma of the jejunum.
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Affiliation(s)
- Miroljub Drasković
- Klinika za opstu i vaskularnu hirurgiju, Vojnomedicinska akademija, Beograd
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Erkan N, Haciyanli M, Yildirim M, Sayhan H, Vardar E, Polat AF. Intussusception in adults: an unusual and challenging condition for surgeons. Int J Colorectal Dis 2005; 20:452-6. [PMID: 15759123 DOI: 10.1007/s00384-004-0713-2] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Intestinal intussusception in adults is a rare entity and there is an ongoing controversy regarding the optimal management of this problem. The purpose of this study was to determine the causes and management of intussusception in adults. PATIENTS AND METHODS A retrospective review of patients more than 18 years of age with a diagnosis of intestinal intussusception between January 1996 and December 2003 was conducted. Data related to presentation, diagnosis, treatment, and pathology were analyzed. FINDINGS A total of 13 patients were operated on due to intestinal intussusception. There were 6 men and 7 women with a mean age of 45 years (range 24--61 years). Abdominal pain was the most common presenting complaint (100%). Eight (61.5%) patients presented with acute symptoms and underwent emergency laparotomy. The diagnosis of gastrointestinal intussusception was made preoperatively only in 4 (30.7%) patients by abdominal ultrasonography and computerized tomography. The lead point of intussusception was located in the small intestine in 10 (76.9%) patients, in the colon in 2 (15.4%), and in the ileocecal valve in 1 (7.7%). A pathologic cause for the intussusception was identified in 12 (92.3%) cases and 1 (7.7%) was idiopathic. Of the cases with a defined cause, 58% of the cases were benign and 42% were malignant. Forty percent of cases of small bowel intussusception and 33.3% of cases of colonic intussusception were due to malignant lesions. All cases of small intestinal intussusception were reduced and no perforation occurred. Segmental intestinal resection was performed in 9 patients and excision of the Meckel's diverticulum was made in 1. In cases of colonic intussusception, reduction was not attempted and en-bloc resection was carried out. No perforation or spillage of the contents of the intussusception was observed. There was no surgical mortality. CONCLUSION Adult intussusception is an unusual and challenging condition that represents a preoperative diagnostic difficulty. We think that colonic intussusceptions should be resected in an en-bloc manner without reduction due to the risk of perforation and spillage of micro-organisms and malignant cells, whereas cases of small intestinal intussusception can be reduced without complications unless there is strangulation.
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Affiliation(s)
- Nazif Erkan
- Department of General Surgery, SSK Izmir Teaching Hospital, Izmir, Turkey.
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