1
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Chang H, Kang J, Pu T, Su R, Chen C, Hu J. Diffuse large B-cell lymphoma-induced intussusception: A case report and literature review. Clin Case Rep 2024; 12:e9046. [PMID: 38895050 PMCID: PMC11183938 DOI: 10.1002/ccr3.9046] [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: 12/20/2023] [Revised: 02/21/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Adult intussusception necessitates early surgical intervention. We emphasis the significance of considering diffuse large B-Cell lymphoma in differential diagnoses for adult intussusception, particularly in the colon, to ensure precise diagnosis and optimal management.
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Affiliation(s)
- Hao‐Cheng Chang
- Department of Surgery, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Jung‐Cheng Kang
- Department of Surgery, Division of Colon and Rectal SurgeryTaiwan Adventist HospitalTaipeiTaiwan
| | - Ta‐Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri‐Service General Hospital Songshan BranchNational Defense Medical CenterTaipeiTaiwan
- Division of Colon and Rectal Surgery, Department of Surgery, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Ruei‐Yu Su
- Department of Pathology, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
- Department of Pathology and Laboratory MedicineTaoyuan Armed Forces General HospitalTaoyuanTaiwan
| | - Chao‐Young Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Je‐Ming Hu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
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2
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Sciberras N, Zammit SC, Sidhu R. Small bowel intussusception - aetiology & management. Curr Opin Gastroenterol 2024; 40:175-182. [PMID: 38190421 DOI: 10.1097/mog.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Adult small bowel intussusception (SBI) differs in incidence, symptomatology and management from the more commonly encountered paediatric intussusception. This review spans across the multitude of causes of adult SBI, and summarises the diagnostic work-up and management options according to recent literature. RECENT FINDINGS There has been an increase in use of small bowel capsule endoscopy and point-of-care ultrasound for the diagnosis of acute adult SBI. SUMMARY A high degree of suspicion of a malignant cause of SBI is required in the adult population. Alarm clinical features include weight loss, history of malignancy, and iron deficiency anaemia. CT remains the gold standard imaging technique as it may identify the lead point and thus aid in endoscopic or surgical management. If malignancy is excluded and no lead point is identified, serology and histology may be helpful to look for inflammatory, infective and autoimmune aetiology.
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Affiliation(s)
| | | | - Reena Sidhu
- Department of Gastroenterology, Sheffield Teaching Hospital NHS Foundation Trust, Department of Infection, Immunity & Cardiovascular Diseases, University of Sheffield, UK
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3
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Fugărețu C, Misarca C. Giant Lipoma of the Bauhin's Valve. Diagnostics (Basel) 2024; 14:562. [PMID: 38473034 DOI: 10.3390/diagnostics14050562] [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: 02/22/2024] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
Lipomas are benign tumors that can affect the digestive tract, everywhere from the hypopharynx to the rectum. Lipomas affecting the large intestine are the second most common benign tumor, after colon adenoma. We present the case of a 46-year-old patient who was initially hospitalized in the Gastroenterology Clinic with a diagnosis of gastrointestinal bleeding. The colonoscopy raised the suspicion of a malignant tumor of the transverse colon, but the computed tomography scan showed the existence of a lipoma that measured 16/11/12 cm that occupied the ascending and transverse colon, though the CT examination could not determinate the origin of the lipoma. After restoring the hydro-electrolytic and fluid balance of the patient, surgery was performed and a huge lipoma of the ileocecal valve was discovered. Extended right hemicolectomy was performed, with good subsequent postoperative recovery of the patient, who was discharged on the fifth day after the surgery. The peculiarity of this case is the huge size of the benign tumor. Lipomas with digestive system localization, although rare, must be considered in patients arriving at the Emergency Department with digestive hemorrhages, intussusception and even intestinal obstruction.
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Affiliation(s)
- Cosmina Fugărețu
- 2nd General Surgery Department, Brașov County Emergency Clinical Hospital, 500326 Brașov, Romania
- Faculty of General Medicine Brașov, Transilvania University, 500019 Brașov, Romania
| | - Catalin Misarca
- 2nd General Surgery Department, Brașov County Emergency Clinical Hospital, 500326 Brașov, Romania
- Faculty of General Medicine Brașov, Transilvania University, 500019 Brașov, Romania
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4
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Masood W, Ahmed R, Fazlani FA, Shakir S, Al Hasibuzzaman M. Multiple intussusceptions secondary to Peutz-Jegher's syndrome in an adult male: a case report from Pakistan. J Surg Case Rep 2024; 2024:rjae008. [PMID: 38304315 PMCID: PMC10832582 DOI: 10.1093/jscr/rjae008] [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: 11/15/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Intussusception is a medical condition characterized by invagination of the intestinal segment, causing obstruction and leading to potential complications such as ischemia, necrosis and perforation. While paediatric intussusception is well documented with a peak in ages between 4 and 36 months, adult intussusception is a rare condition usually involving a lead point. In this article, we present an uncommon case of an adult male with worsening of his long-standing lower abdominal pain for the last 2 months. Radiological test reports revealed target-like lesions demonstrating two intestinal intussusceptions, for which he underwent a small bowel anastomosis, exploratory laprotomy and resection. On receiving the histopathology report, hamartomatous polyps with features favouring Peutz-Jegher's syndrome were identified as a possible lead point.
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Affiliation(s)
- Waniyah Masood
- Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi 75271, Pakistan
| | - Raheel Ahmed
- Department of Surgery, Ruth K. M. Pfau Civil Hospital, Karachi 75271, Pakistan
| | | | - Shaheryar Shakir
- Department of Surgery, Ruth K. M. Pfau Civil Hospital, Karachi 75271, Pakistan
| | - Md Al Hasibuzzaman
- The First Affiliated hospital of Ningbo University, 59 Liuting Jie, Ningbo, 315016, China
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh
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5
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Elkhawaga M, Ross B, Sugo E, Reedman-Hawes C, Balasuriya H. Ileocaecal Intussusception Due to Burkitt Lymphoma: A Surgical and Haematological Emergency. Cureus 2023; 15:e50904. [PMID: 38249231 PMCID: PMC10799675 DOI: 10.7759/cureus.50904] [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: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Intussusception is the protrusion and invagination of a segment of the bowel, referred to as the intussusceptum, into another adjacent segment known as the intussuscipiens. The age range during which intussusception is most observed in children is between three and 18 months. Unlike intussusceptions in children, where the cause is often idiopathic, a specific underlying factor is discernible in a significant majority of cases among adults. In this article, we will present a case of intussusception in an adolescent caused by Burkitt lymphoma.
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Affiliation(s)
| | - Bryony Ross
- The Children's Cancer and Haematology Service, John Hunter Children's Hospital, Newcastle, AUS
| | - Ella Sugo
- Anatomical Pathology, John Hunter Hospital, Newcastle, AUS
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6
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Raj R, Francis MA, Francis DT, Kaur P, Chima R, Jamil NA. A Rare Case of Small Bowel Intussusception in an Elderly: A Case Report and Literature Review. Cureus 2023; 15:e44204. [PMID: 37767247 PMCID: PMC10521763 DOI: 10.7759/cureus.44204] [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: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Intussusception, a rare cause of bowel obstruction in adults, is even less common in the elderly population. Unlike pediatric cases, adult intussusception is primarily associated with pathologic diseases acting as lead points, often requiring surgical intervention. We present a case of an 84-year-old male with a medical history significant for multiple comorbidities, who was diagnosed with a large segment jejunojejunal intussusception resulting in small bowel obstruction. Surgical management was recommended, and an exploratory laparotomy with bowel resection was performed, including the excision of the leading point. This case highlights the challenges in diagnosing adult intussusception and the importance of surgical intervention due to the high incidence of associated pathologic diseases.
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Affiliation(s)
- Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | - Maya Ann Francis
- Internal Medicine, Windsor University School of Medicine - St Kitts and Nevis, Cayon, KNA
| | - Deepa Treesa Francis
- Internal Medicine, Windsor University School of Medicine - St Kitts and Nevis, Cayon, KNA
| | - Parvinder Kaur
- Internal Medicine, Crimean State Medical University, Simferopol, UKR
| | - Rupert Chima
- Internal Medicine, Cardiocare Multispeciality Hospital Abuja, Abuja, NGA
| | - Niyaz A Jamil
- Surgery, Windsor University School of Medicine, Cayon, KNA
- Surgery, Combined Military Hospital, Nowshera, PAK
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7
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Palle LRA, Inban P, Akuma O, Akuma CM, Srirama HA, Thakkar K, Hanafi IS, Dahal R, Yousuf MA, Khan AM, Kelechi AE. Intussusception in an elderly female and its management: A case report and literature review. Clin Case Rep 2023; 11:e7745. [PMID: 37575458 PMCID: PMC10415582 DOI: 10.1002/ccr3.7745] [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: 05/26/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Intussusception is the telescoping or invagination of the proximal part of the gastrointestinal tract into an adjacent section. It is rare in adults, accounting for 1% of adult bowel obstruction. Adult presentation of intussusception is variable, with nonspecific, vague symptoms like abdominal pain, nausea, vomiting, and rectal bleeding. Abdominal computed tomography (CT) scans have the highest sensitivity in the diagnosis of intussusception. The classical findings of intussusception are the target sign and mesenteric vessels lined within the bowel lumen. An abdominal CT scan can reveal a cloverleaf figuration, fluid-filled ileal loops, superior mesenteric venous (SMV) occlusion, and concerns about ongoing sealed perforation or fistulization. Our patient is an 86-year-old female who was diagnosed with a jejunal-jejunal long-segment intussusception, gastro-enteric fistula, and SMV occlusion with distal reconstitution. The patient responded well to conservative treatment and was discharged for follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | - Rojaj Dahal
- Manipal College of Medical Sciences (MCOMS)PokharaNepal
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8
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Jang Y, Park DH, Kong JS. [Isolated Small Bowel Metastasis of Endometrial Carcinoma with Resultant Jejunojejunal Intussusception: A Case Report]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1380-1384. [PMID: 36545417 PMCID: PMC9748457 DOI: 10.3348/jksr.2021.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/26/2022] [Accepted: 05/28/2022] [Indexed: 12/24/2022]
Abstract
Endometrial carcinoma is a common gynecologic malignancy; however, metastasis to the small bowel is rare. Metastatic endometrial carcinoma usually occurs through local extension rather than distant metastasis. Isolated small bowel metastasis is extremely rare; further, intussusception with resultant intestinal obstruction is not common. We report the imaging findings of a patient with isolated small bowel metastasis of endometrial carcinoma with resultant jejunojejunal intussusception.
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9
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Rodríguez-González P, Pérez-Quintero R, Cisneros-Cabello N, Balongo-García R. Invaginación sigmoidea en un adulto. ¿Está indicada la reducción endoscópica preoperatoria? REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La invaginación intestinal o intususcepción es el deslizamiento de una parte del intestino dentro de otra adyacente. Es la causa más común de obstrucción intestinal en niños entre 3 meses y 6 años de edad, con una baja incidencia en adultos, correspondiente al 1 % del total de los cuadros obstructivos en el adulto. Su localización en colon es poco frecuente, pero conviene prestar especial atención por su asociación a lesiones malignas.
Caso clínico. Varón de 39 años que acude a Urgencias con cuadro de obstrucción intestinal secundario a una invaginación en sigmoide. Se intenta reducción endoscópica, sin éxito, por lo que se indicó cirugía urgente, realizando sigmoidectomía y anastomosis colorrectal. El resultado anatomopatológico informó un adenoma de gran tamaño como causante de la invaginación.
Conclusión. Existen controversias respecto al manejo endoscópico en invaginación intestinal en los adultos, especialmente en el colon, debido al elevado porcentaje de etiología tumoral maligna, recomendándose actualmente la resección en bloque sin reducción, para minimizar el riesgo de potencial siembra tumoral.
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10
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Bhansali PJ, Phatak SV, Unadkat BS, Ghanta PR. Ileal Lipoma as a Leading Point of Ileocolic Intussusception in Adult Patient: Ultrasonography and CT Evaluation. Cureus 2022; 14:e26019. [PMID: 35865448 PMCID: PMC9293257 DOI: 10.7759/cureus.26019] [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] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Intussusception in adults is an unusual finding and is commonly associated with benign or malignant mass as the leading point. A preoperative diagnosis on imaging is helpful in diagnosing intussusception along with pathology causing it and aids in further management. We present a case of ileocolic intussusception with lipoma as the lead point: classic ultrasonography and CT imaging findings are described with its postoperative confirmation.
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11
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Laparoscopic Right Hemicolectomy of a Low-Grade Appendiceal Mucinous Neoplasm Causing an Ileocolic Intussusception: A Case Report. Int Surg 2022. [DOI: 10.9738/intsurg-d-20-00039.1] [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] Open
Abstract
Introduction
Intussusception, although common in the pediatric population, rarely occurs in adults. Furthermore, patients often show nonspecific symptoms. Most adult patients with intussusception have a surgical lead point, a well-defined pathological abnormality, often accurately diagnosed after surgery. A low-grade appendiceal mucinous neoplasm (LAMN), often misdiagnosed as acute appendicitis, is rarely associated with the development of intussusception. Here we report a case of LAMN-related ileocolic intussusception that was histologically diagnosed after laparoscopic right hemicolectomy.
Case presentation
A 58-year-old woman visited our emergency department because of intermittent episodes of epigastric pain with periumbilical tenderness. These symptoms persisted intermittently for 2 weeks. The pain was moderate in severity, colicky in nature, and sometimes shifted to the lower abdominal region. Abdominal computed tomography indicated intussusception with ileocecal and mesenteric telescoping into the transverse colon. Complete colonoscopy with reduction of intussusception was performed, revealing a ball-like mass protruding and occupying the entire cecum lumen. Laparoscopic right hemicolectomy was then performed. Macroscopically, a dilated appendix was revealed with mucin content, along with hyalinization and fibrosis of the appendiceal wall. Microscopically, a tumor exhibiting villous and flat proliferation of mucinous epithelial cells with low-grade nuclear atypia was seen. However, there was no infiltration growth of the tumor cells, thereby demonstrating LAMN. Postoperative recovery was uneventful, and the patient was discharged on the 8th postoperative day without surgical complications.
Conclusion
The differential diagnoses of chronic and colicky abdominal pain should be expanded to include intussusceptions as they can be severe, although cases in adults are rare.
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12
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Salemi N, Eshraghi Samani R, Firouzfar A. Colocolic intussusception because of lipoma in a 44-year-old adult. Adv Biomed Res 2022; 11:83. [DOI: 10.4103/abr.abr_32_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/23/2022] [Accepted: 04/16/2022] [Indexed: 11/07/2022] Open
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13
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Ahmed SM, Borz-Baba C, Gokturk S. Trapped in the Bowel. Cureus 2021; 13:e19534. [PMID: 34934553 PMCID: PMC8668146 DOI: 10.7759/cureus.19534] [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: 11/13/2021] [Indexed: 11/05/2022] Open
Abstract
Intussusception in adults is a rare condition and is usually associated with organic disease. It has been implicated for 1% of all bowel obstructions. Clinical presentation can be non-specific and the rarity of the classic triad of abdominal pain, vomiting, and currant jelly stools contributes to late diagnosis and treatment. A 95-year-old lady presented to the emergency department for evaluation of nausea, vomiting, and a two-month history of intermittent diarrhea, which had been worsening for a few days prior to admission. On examination, the abdomen was soft but tender on deep palpation, with audible bowel sounds. No organomegaly or costovertebral angle (CVA) tenderness was appreciated. CT abdomen revealed a long segment of the colon with a loop within loop appearance from the proximal transverse colon to the distal descending colon, consistent with intussusception. The patient was taken to the operating room where local exploration using laparoscopy revealed complete telescoping and intussusception of terminal ileum into the distended ascending and transverse colon and the patient underwent right hemicolectomy. The signs and symptoms of intussusception among the elderly are very non-specific and include nausea, vomiting, change in bowel habits, and gastrointestinal bleeding. Since the classic triad of symptoms (abdominal pain, vomiting, and currant jelly stools) is rarely observed, timely diagnosis and management become a challenge for clinicians. Literature suggests that up to 90% of adults with intussusception present with ongoing abdominal pain. Especially in outpatient settings, patients presenting with intermittent abdominal pain that resolves quickly with simple analgesia should be promptly evaluated. This case illustrates that the rarity of incidence and non-specific clinical presentation are potential barriers towards timely diagnosis and treatment of intussusception among adults, especially the elderly population. Keeping a low threshold for prompt evaluation using appropriate imaging modalities can help overcome this challenge and help reduce the surgical burden.
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Affiliation(s)
| | | | - Suut Gokturk
- Internal Medicine, Saint Mary's Hospital, Waterbury, USA
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14
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Intussusception in a child with Acute Lymphoblastic Leukemia: a remarkable presentation with literature review - a case report. J Egypt Natl Canc Inst 2021; 33:18. [PMID: 34324074 DOI: 10.1186/s43046-021-00079-z] [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: 05/20/2021] [Accepted: 07/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastrointestinal complications are not uncommon in patients of Acute Leukemia. Intussusception as a complication in leukemia, although described, is exceedingly rare. Also, it is usually seen after chemotherapy and not as a part of the native disease process. This case report aims to highlight such a rare association which warrants clinical and pathological attention. CASE PRESENTATION A 14 year old male presented with an acute abdomen. Initial routine investigations revealed a deranged blood picture. On further examination of bone marrow aspirate, biopsy and detailed immunohistochemical studies a diagnosis of B-Acute Lymphoblastic Leukemia (B-ALL) was made. Concurrent ultrasound of the abdomen to find a cause for severe abdominal pain revealed an Ileo-colic intussusception. The patient was started on steroids; however he succumbed to his illness after two days, before surgery could be attempted. CONCLUSION Rare presentations of relatively common diseases are a hurdle for timely and effective medical intervention. Although a rare condition in itself in leukemic patients, the occurrence of Intussusception in this particular patient, especially when no chemotherapy was initiated, is a very rare event. This case report was made to add to the relatively scarce literature available on this particular association. As it is a surgically treatable condition and since delay in diagnosis may lead to poorer prognosis, possibility of co-existence of ALL and intussusception should be borne in mind by all treating physicians and hematopathologists for effective patient care.
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15
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Panzera F, Di Venere B, Rizzi M, Biscaglia A, Praticò CA, Nasti G, Mardighian A, Nunes TF, Inchingolo R. Bowel intussusception in adult: Prevalence, diagnostic tools and therapy. World J Methodol 2021; 11:81-87. [PMID: 34026581 PMCID: PMC8127421 DOI: 10.5662/wjm.v11.i3.81] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
Intussusception is defined as invagination of one segment of the bowel into an immediately adjacent segment. The intussusception refers to the proximal segment that invaginates into the distal segment, or the intussusception (recipient segment). Intussusception, more common occur in the small bowel and rarely involve only the large bowel. In direct contrast to pediatric etiologies, adult intussusception is associated with an identifiable cause in almost all the symptomatic cases while the idiopathic causes are extremely rare. As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. In this review, we discuss the symptoms, location, etiology, characteristics, diagnostic methods and treatment strategies of this rare and enigmatic clinical entity in adult.
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Affiliation(s)
- Francesco Panzera
- Department of Endoscopy, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Beatrice Di Venere
- Department of Surgery, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Marina Rizzi
- Department of Endoscopy, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Assunta Biscaglia
- Department of Radiology, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | | | - Gennaro Nasti
- Department of Surgery, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Andrea Mardighian
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Thiago Franchi Nunes
- Department of Radiology, Santa Casa de Campo Grande, Campo Grande 79010-050, Brazil
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
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16
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Sharma A, Thakur A. Ileocolic intussusception due to intestinal lipoma in an adult patient. Clin Case Rep 2021; 9:1524-1528. [PMID: 33768881 PMCID: PMC7981757 DOI: 10.1002/ccr3.3825] [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: 07/20/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 01/01/2023] Open
Abstract
Intestinal obstruction due to intussusception caused by intestinal lipomas is a rare condition in adults that needs urgent treatment. CT (Computerised Tomography) is the radiologic modality of choice for diagnosis. Surgery is the treatment of choice and has excellent outcome.
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17
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Murshed KA, Khawar M, Petkar M. Heterotopic Gastric Mucosa in the Ileum: A Rare Cause for Intussusception in Adults. Case Rep Gastroenterol 2020; 14:609-614. [PMID: 33362448 DOI: 10.1159/000509504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022] Open
Abstract
Intussusception is the leading cause for intestinal obstruction in children. However, it accounts for only 5% of bowel obstructions in adults. Heterotopic gastric mucosa (HGM) can occur anywhere in the gastrointestinal tract; nevertheless, its occurrence in the small intestine is rare unless associated with remnants of vitelline duct (Meckel's diverticulum). Herein, we describe a case of a 33-year-old male who presented with symptoms and signs of intestinal obstruction caused by ileo-colic intussusception, in which polypoid HGM acted as the organic lead point for intussusception. Several cases of intussusception caused by HGM have been reported in pediatric age group; however, this event is exceedingly rare in adults.
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Affiliation(s)
- Khaled A Murshed
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mahwish Khawar
- Department of General Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mahir Petkar
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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18
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Bonouvrie DS, Janssen L, Niemarkt HJ, van Laar JOEH, Leclercq WKG, van Dielen FMH. Small bowel intussusception in pregnant women with a history of a Roux-en-Y gastric bypass: a case series and a systematic review of the literature. Surg Obes Relat Dis 2020; 16:1603-1613. [PMID: 32737008 DOI: 10.1016/j.soard.2020.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/17/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Abstract
Intussusception of the small intestine has been described in pregnant women with a history of a laparoscopic Roux-en-Y gastric bypass. This study provides a systematic review on the characteristics of intussusception in this population. MEDLINE, Embase, Cochrane Library, and our own hospital's electronics health records were searched for eligible studies/cases. Fifteen papers were eligible, containing 17 cases. Our hospital search included 6 cases. Seventeen of 23 intussusceptions were retrograde and were mostly (18/23) located at the jejunojejunostomy. Six patients were treated successfully with manual reduction only and 17 patients required surgical resection. Fifteen (65%) patients had an ischemic segment. Six (26%) patients delivered during the same hospital admission. One fetal death (1 of twins) was reported. Awareness of this rare but serious complication by obstetricians and bariatric surgeons is necessary to limit maternal and fetal complications.
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Affiliation(s)
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands
| | - Hendrik J Niemarkt
- Department of Neonatology, Máxima Medical Center, Veldhoven, the Netherlands
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Sainaba SM, Ganapath AS, Sivakumar A, Gayathri AV, Yadev IP. Adult Intussusception at a Tertiary Care Center: A Retrospective Study. Niger J Surg 2020; 26:63-65. [PMID: 32165839 PMCID: PMC7041356 DOI: 10.4103/njs.njs_38_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/22/2019] [Accepted: 12/02/2019] [Indexed: 01/06/2023] Open
Abstract
Background: In adults, the majority of cases of intussusception are due to malignancy. Aims: The aim of the study is to describe the pattern of intussusception in the adult population diagnosed and treated at a tertiary care center. Subjects and Methods: Study Design: This is a retrospective cross-sectional study based on chart review, and data collection was made from the computer database and inpatient case records. Study Setting: Adult intussusception cases diagnosed and treated at a tertiary care referral center in South India. All inpatient case sheets including investigations and histopathology information on the computer database of all patients diagnosed with intussusception in the period of August 2012 to July 2016 were retracted based on a pretested and standardized form. Demographic data and other baseline data were summarized with descriptive statistics. SPSS software was used for data analysis. Results: Of the 77 patients, 47 (61%) were male. The common presentations were abdominal pain (95%), vomiting (64%), and rectal bleeding (29%). Common examination findings were abdominal tenderness (45%), guarding (39%), and abdominal mass (38%). On ultrasonography, fifty (65%) patients had intussusception with ileocolic (25) as the most common type. Computed tomography abdomen was taken for 28 (36%) patients, in which 23 (82%) had intussusception with ileocolic (9) as the most common type. Surgery was done for 53 (69%) patients, and the most common procedure was right hemicolectomy (25) followed by resection and anastomosis of the small bowel (23). Intraoperatively, 42 (79%) patients had intussusception with ileocolic (23) as the most common type. Intraoperatively, 14 (26%) patients had a bowel gangrene. Biopsy-proven cause for intussusception was present in 46 patients, with malignancy (21) as the most common cause. The patients were on regular follow-up. Recurrence of intussusception occurred in six patients of the small bowel intussusception who had polyposis. Conclusions: Adult intussusception is often associated with malignancy. Hence, a formal resection without reduction is needed and surgery should be done following oncological principles.
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Affiliation(s)
- Sulfekar Meera Sainaba
- Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Aravind S Ganapath
- Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Anoop Sivakumar
- Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - A V Gayathri
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - I P Yadev
- Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
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Lief K, Janakan G, Clark C, Coffey D. Diagnostic challenge of the non-specific presentation of adult intussusception. BMJ Case Rep 2019; 12:e229931. [PMID: 31694825 PMCID: PMC6855870 DOI: 10.1136/bcr-2019-229931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 02/01/2023] Open
Abstract
The following report will discuss the diagnosis and management of non-specific abdominal pain in a 77-year-old woman who presented to a district general hospital in South London. CT imaging demonstrated ileo-colic intussusception with free air and fluid indicating perforation. The images of the specimen clearly show the ileal tumour within the intussusception. Thus, the patient underwent an emergency right hemicolectomy and formation of a double-barrelled ileostomy. Histology subsequently confirmed this was secondary to a colonic adenocarcinoma. This case report is unique as it highlights that intussusception in adults is very difficult to accurately diagnose based on clinical features (due to non-specific findings) and even with radiology can be challenging. This is also the first documented case of the site of perforation not being directly involved with the site of intussusception. The perforation site was in fact distal to the intussusception. At the time of surgery, it was noted that the patient had significantly faecal loading up to her rectum. The resulting closed loop was the cause of her perforation.
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Affiliation(s)
- Kyla Lief
- General Surgery, Lewisham Hospital NHS Trust, London, UK
| | | | - Calum Clark
- General Surgery, Lewisham Hospital NHS Trust, London, UK
| | - Duncan Coffey
- General Surgery, Lewisham Hospital NHS Trust, London, UK
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21
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Chan RH, Chen YP. Intussusception caused by typhlitis: a rare complication in a patient with acute lymphoblastic leukemia after chemotherapy. Int J Colorectal Dis 2019; 34:1815-1818. [PMID: 31512021 DOI: 10.1007/s00384-019-03395-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Intussusception, which is common in pediatric patients but rare in adults with leukemia, usually presents with an intralumenal lesion as a lead point in adults. CASE REPORT We herein report the case of a 38-year-old female who developed right lower quadrant abdominal pain and fever on day 16 of chemotherapy. Abdominal computed tomography showed ileocecal intussusception. The patient underwent surgery, and the definitive pathological diagnosis was typhlitis leading to intussusception. Albeit very rare in adults, typhlitis-induced intussusception should be suspected in those with leukemia presenting with abdominal pain.
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Affiliation(s)
- Ren-Hao Chan
- Division of Colorectal Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, 704, Taiwan.
| | - Ya-Ping Chen
- Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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22
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Dragović S. COLON-COLONIC INVAGINATION CAUSED BY CECUM CANCER – A CASE REPORT. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Zaghrine E, Algaba R, Nicolas G, Koury E, Saliba C, Osman D, Al-Shami J, Sayegh JSAA, Kfoury T. Idiopathic Ileo-Ileo-Cecal Intussuception in a 25-Year-Old Female. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:872-876. [PMID: 31217416 PMCID: PMC6598787 DOI: 10.12659/ajcr.914110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intussusception is defined as the penetration or telescoping of a segment of bowel into a more distal segment. Intussusception is a common cause of small bowel obstruction, especially in children. However, this finding is much less common in adults. Furthermore, when present in adults, intussusception is often found in association with some sort of organic mass, such as a tumor or pancreatic divisum that acts as a lead point, dragging the proximal segment into the distal one. The presence of an intussusception in an adult patient with no obvious lead point is very uncommon. CASE REPORT Here we report a case of ileo-ileo-cecal double intussusception in an adult patient that yielded no lead point on surgical exploration. The patient was a 25-year-old female who presented with symptoms of obstruction and was diagnosed with the intussusception via computed tomography scan. Surgical resection of the bowel was necessary as reduction could not be accomplished. CONCLUSIONS The finding of intussusception in an adult patient is far less common than in children, and even more rare when a lead point is not established. When surgery is required, a thorough exploration should be performed to search any signs of a potential lead point. Laparoscopy is usually preferred to laparotomy; however, in this case the degree of distention determined the surgical approach. Thus, due to severe distention, laparotomy was preferred.
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Affiliation(s)
- Elie Zaghrine
- Department of Emergency, Joseph Bracops Hospital, Bruxelles, Belgium
| | - Roberto Algaba
- Department of Digestive Surgery, Joseph Bracops Hospital, Bruxelles, Belgium
| | - Gregory Nicolas
- Department of Surgery, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Elliott Koury
- Department of Gasteroenterology, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Christian Saliba
- Department of Surgery, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Dani Osman
- Department of Surgery, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | | | | | - Tony Kfoury
- Department of Emergency, Joseph Bracops Hospital, Bruxelles, Belgium
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24
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Missed case of intussusception, a rare cause of abdominal pain in adults: A case report emphasizing the imaging findings and review of the literature. Radiol Case Rep 2019; 14:906-910. [PMID: 31193563 PMCID: PMC6536620 DOI: 10.1016/j.radcr.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 12/27/2022] Open
Abstract
Intussusception, a process whereby a segment of the intestine telescopes into the adjoining intestinal lumen, is a rare source of pain in adults that present with nonspecific abdominal pain. Imaging is the mainstay for diagnosis, which requires prompt and accurate interpretation to prevent complications. The following report details the misdiagnosis of intussusception in a 54-year-old male, whom presented to the emergency department with a 4-day history of nonrelenting abdominal pain, nausea, vomiting, and constipation. Following blood tests, chest, and abdominal imaging, the patient was discharged with a suspected passed renal stone. He soon represented to the General Practitioner, however, with equivalent pain; prompting a review of the images. It was apparent that the initial radiologist failed to recognize the subtle presence of intussusception. This case highlights the necessary consideration of intussusception as a differential diagnosis in adult patients presenting with intermittent abdominal pain. The case further emphasizes that radiologists should be familiar with the subtler signs of intussusception.
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25
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Hong KD, Kim J, Ji W, Wexner SD. Adult intussusception: a systematic review and meta-analysis. Tech Coloproctol 2019; 23:315-324. [PMID: 31011846 DOI: 10.1007/s10151-019-01980-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/01/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Perhaps partly because intussusception in adults is rare, optimal treatment remains controversial. The aim of this study was to determine the appropriate surgical procedure for adult intussusception. METHODS A systematic search was undertaken using PubMed, Embase, and Web of Science from 1/1980 to 12/2016. Adults (> 15 years) with intussusception treated by surgical or conservative measures were included. RESULTS One thousand two hundred twenty-nine patients were identified from 40 retrospective case series. Pooled rates of malignant and benign tumors and idiopathic etiologies were 32.9% (95% CI 28.6-37.4), 37.4% (95% CI 32.7-42.3), and 15.1% (95% CI 11.7-19.3), respectively. Pooled rates of enteric, ileocolic, and colonic location types were 49.5% (95% CI 41.8-57.2), 29.1% (95% CI 23.0-36.1), and 19.9% (95% CI 16.3-24.1), respectively. Pooled rates of malignant tumors in enteric, ileocolic, and colonic intussusception were 22.5% (95% CI 18.3-27.3), 36.9% (95% CI 27.3-47.6), and 46.5% (31.1-62.6), respectively. Metastatic carcinoma was the main cause of malignant tumor in enteric intussusception. Conversely, primary adenocarcinoma was the main cause of malignant tumor in ileocolic and colonic intussusception. Considering the high rate of malignancy of colonic intussusception the majority of the studies surveyed recommend en bloc resection without reduction to avoid potential intraluminal seeding or venous tumor dissemination. Pooled rates of postoperative complications and mortality were 22.1% (95% CI 17.5-27.5) and 5.2% (95% CI 3.7-7.4), respectively. CONCLUSION Whereas enteric intussusception can be managed by reduction followed by resection, colonic intussusception should be resected en bloc. Due to the intermediate forms between enteric and colonic intussusception, a selective approach is recommended. Surgery remains the mainstay in adult intussusception.
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Affiliation(s)
- K D Hong
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea
| | - J Kim
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea
| | - W Ji
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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Girón F, Báez Y, Amaya J. Autotrasplante renal por aneurisma de arteria renal en un paciente con riñón funcional único: reporte de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Iyassu S, Abraha M. Case Report: Rare presentation of adult intussusception at Orotta National Referral Hospital, Eritrea. F1000Res 2019; 8:55. [PMID: 33968369 PMCID: PMC8080982 DOI: 10.12688/f1000research.17670.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/25/2022] Open
Abstract
A 38-year-old woman presented at Orotta National Referral Hospital emergency department in May 2017 with pain in the epigastric region and vomiting. Physical examination revealed no pertinent findings. Blood and urine tests were normal, and erect abdominal x-ray revealed a distended small intestine with multiple layers of “air-fluid levels”. CT scan and MRI were not done due to their temporary unavailability. During laparotomy a large mass of 20x20 cm in size was detected in the mid-jejunum of the small intestine. This leading tumor caused intussusception and coiling of the small intestine. As there are no typical symptoms of intussusception, it is very important to do CT scan for patients with long-standing abdominal pain and vomiting to achieve a definitive diagnosis of intussusception.
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Affiliation(s)
- Senay Iyassu
- Department of Surgery, Orotta National Referral Hospital, Asmara, Eritrea
| | - Million Abraha
- Faculty of Medicine, Institute of Social and Preventive Medicine (ISPM), Bern, 3012, Switzerland.,Fairmed, Health for the Poorest, Bern, 3001, Switzerland
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28
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Ahmed M, Habis S, Saeed R, Mahmoud A, Plurad D. Submucosal Lipomas Causing Intussusception and Small Bowel Obstruction: A Case Report. Cureus 2018; 10:e3692. [PMID: 30761244 PMCID: PMC6368428 DOI: 10.7759/cureus.3692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Intussusception is a rare cause of bowel obstruction caused by both benign and malignant pathology. We are presenting the case of an elderly patient who had been diagnosed with irritable bowel syndrome for many years prior to presenting to us with ileocecal intussusception causing a small bowel obstruction. Laparoscopic resection of the terminal ileum and cecum was performed. Pathology revealed multiple submucosal lipomas as the underlying cause.
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Affiliation(s)
- Mohamed Ahmed
- Surgery, Riverside Community Hospital, Riverside, USA
| | - Saba Habis
- Internal Medicine, Riverside Community Hospital, Riverside, USA
| | - Rasha Saeed
- Surgery, Riverside Community Hospital, Riverside, USA
| | - Ahmed Mahmoud
- Surgery, Riverside Community Hospital, Riverside, USA
| | - David Plurad
- Surgery, Riverside Community Hospital, Riverside, USA
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29
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Reardon R, Chua TC, Cross J, Curtin A. Rare differential for large bowel obstruction. ANZ J Surg 2018; 89:962-963. [PMID: 29363257 DOI: 10.1111/ans.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca Reardon
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
| | - Terence C Chua
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
| | - Jane Cross
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
| | - Austin Curtin
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
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30
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Shenoy S. Adult intussusception: A case series and review. World J Gastrointest Endosc 2017; 9:220-227. [PMID: 28572876 PMCID: PMC5437388 DOI: 10.4253/wjge.v9.i5.220] [Citation(s) in RCA: 27] [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] [Received: 10/06/2016] [Revised: 12/22/2016] [Accepted: 03/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To identify factors differentiating pathologic adult intussusception (AI) from benign causes and the need for an operative intervention. Current evidence available from the literature is discussed.
METHODS This is a case series of eleven patients over the age of 18 and a surgical consultation for “Intussusception” at a single veteran’s hospital over a five-year period (2011-2016). AI was diagnosed on computed tomography (CT) scan and or flexible endoscopy (colonoscopy). Surgical referrals were from the emergency room, endoscopy suites and the radiologists.
RESULTS A total of 11 cases, 9 males and 2 females were diagnosed with AI. Median age was 58 years. Abdominal pain and change in bowel habits were most common symptoms. CT scan and or colonoscopy diagnosed AI, in ten/eleven (90%) patients. There were 6 small bowel-small bowel, 4 ileocecal, and 1 sigmoid-rectal AI. 8 patients (72%) needed an operation. Bowel resection was required and definitive pathology was diagnosed in 7 patients (63%). Five patients had malignant and 2 patients had benign etiology. Small bowel enteroscopy excluded pathology in 4 cases (37%) with AI. Younger patients tend to have a benign diagnosis.
CONCLUSION Majority of AI have malignant etiology however idiopathic intussusception is being seen more frequently. Operative intervention remains the mainstay however, certain small bowel intussusception especially in younger patients may be a benign, physiological, transient phenomenon and laparoscopy with reduction or watchful waiting may be an acceptable strategy. These patients should undergo endoscopic or capsule endoscopy to exclude intrinsic luminal lesions.
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31
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Kim JW, Lee BH, Park SG, Kim BC, Lee S, Lee SJ. Factors predicting malignancy in adult intussusception: An experience in university-affiliated hospitals. Asian J Surg 2017; 41:92-97. [PMID: 28131633 DOI: 10.1016/j.asjsur.2016.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Intussusception is one of the common causes of intestinal obstruction in children but is uncommon in adults. Unlike pediatric intussusception, most adult cases have a demonstrable etiology. The purpose of this study was to review our experience of adult intussusception and to identify the predictive factors for malignancy in this disease. METHODS We retrospectively reviewed the medical records of patients who were diagnosed with intussusception and admitted to the six Hallym University-affiliated hospitals between January 2005 and July 2016. RESULTS The 77 patients had a mean age of 50.5 years (range, 18-91 years). Enteric intussusception is the most common type of adult intussusception (33.7%), and 11 patients (14.2%) had no definite lesion at operation. The most common symptom was abdominal pain (90.9%), and 18 (23.3%) presented with chronic symptoms. Computed tomography was the most common diagnostic modality used, with a diagnostic accuracy of 96.9%. The leading point was identified in 62 (80.5%) patients. Malignancy was more frequently present in the colonic type than in the other two types (61.5% vs. 10%, 37.9%). In a multivariate analysis, chronic symptom >14 days (p = 0.031) and colonic intussusception (p = 0.026) were independent predictors for malignancy. CONCLUSIONS Enteric intussusception is the most common type of adult intussusception, and the most common test is computed tomography. Because chronic symptoms and colonic-type intussusception were predictive factors for malignancy, en bloc resection should be considered in patients with chronic or colonic intussusception.
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Affiliation(s)
- Jong Wan Kim
- Department of Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Bong Hwa Lee
- Department of Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Sung Gil Park
- Department of Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Byung Chun Kim
- Department of Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Samuel Lee
- Department of Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Sang-Jeon Lee
- Department of Surgery, College of Medicine, Chungbuk National University, Chungbuk, Republic of Korea.
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Almaghrabi AA, Alddin ASS, Alzamzami AK, Salih ME. Adult Intussusception. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:65-66. [PMID: 30787755 PMCID: PMC6298289 DOI: 10.4103/1658-631x.194254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Adult intussusception is rare. We report the case of an elderly female patient with an ileocecal intussusception who underwent resection and ileocolic anastomosis. The histology revealed chronic inflammation of the ileum and cecum and there was no evidence of malignancy. There was no evidence of malignancy. The appendix showed fibrous obliteration of the lumen.
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Affiliation(s)
| | - Aiman Saleh Sirag Alddin
- Department of General Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Mohamed Elamin Salih
- Department of General Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Abstract
Intussusception is primarily seen among children, most often as idiopathic ileocolic intussusception (1, 4), and only 5 to 16% of all intussusceptions are seen in adults (1, 8). In contrast to childhood invagination, in adults underlying pathologic processes are identified in 18 to 90% (1, 8). This report presents 2 cases of colo-colonic intussusception caused by a colonic lipoma. The ultrasonic features of this benign tumour are rather characteristic. A definitive diagnosis can be provided by CT.
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Affiliation(s)
- C. Wulff
- Department of Radiology/Ultrasound, Glostrup Hospital, Glostrup, Denmark
| | - N. Jespersen
- Department of Gastroenterologic Surgery, Glostrup Hospital, Glostrup, Denmark
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34
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Mixed Adenoneuroendocrine Carcinoma Causing Colonic Intussusception. Case Rep Surg 2016; 2016:7684364. [PMID: 27525153 PMCID: PMC4976167 DOI: 10.1155/2016/7684364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 12/18/2022] Open
Abstract
Colonic intussusception is a rare cause of intestinal obstruction in adults and is caused by a malignant lesion in about 70% of cases. Early diagnosis and treatment are essential. We present a 64-year-old male patient with right colonic intussusception caused by a mixed adenoneuroendocrine carcinoma (MANEC), presenting as a giant pedunculated polyp (54 mm of largest diameter). The patient underwent right colectomy with primary anastomosis and adjuvant chemotherapy. The diagnosis of intussusception of the colon in adults is difficult because of its rarity and nonspecific clinical presentation. In this case, the cause was a rare histological type malignant tumor (MANEC).
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35
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Aydin N, Roth A, Misra S. Surgical versus conservative management of adult intussusception: Case series and review. Int J Surg Case Rep 2016; 20:142-6. [PMID: 26859872 PMCID: PMC4818310 DOI: 10.1016/j.ijscr.2016.01.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/16/2016] [Indexed: 11/17/2022] Open
Abstract
Adult intussusception has traditionally been considered an indication for surgery. Transient intussusceptions are now detected with increased use of imaging. In patients with low risk for underlying neoplasm, supportive care is sufficient. Smaller intussusceptions are more likely to resolve with conservative treatment.
Introduction Intussusception is the telescoping of a segment of bowel into its adjacent segment. It is a known cause of abdominal pain in the pediatric population, however, it is rare in the adult. Adults do not always present with the typical symptoms seen in young children, making the clinical diagnosis more difficult. The etiology of adult intussusception can be idiopathic, benign, or malignant. Diagnosis is most accurately made with computed tomography, which is sensitive in detecting intussusception as well as potential lead points. Presentation of cases This study presents four adult patients with intussusception. The first three patients are adults with idiopathic intussusception and no evidence of a lead point. The fourth case involves intussusception secondary to a jejunal carcinoid tumor which was treated surgically. Each case has unique features in terms of length and number of intussusceptions, duration of symptoms, and recurrence. Discussion Surgical treatment was once argued to be universally appropriate for adult intussusceptions; however, with increased use of advanced imaging, newer literature is demonstrating that this is not true in all cases. Idiopathic intussusception presents with nonspecific symptoms and can be managed with supportive care when the history and clinical picture indicate low probability of a neoplasm. Conclusion This study aims to raise awareness to the potential diagnosis and management of intussusceptions, particularly the symptomatic idiopathic type in the young adult.
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Affiliation(s)
- Nail Aydin
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX 79106-1786, USA.
| | - Andrew Roth
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX 79106-1786, USA.
| | - Subhasis Misra
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX 79106-1786, USA.
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36
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Lipoma of the Small Intestine: A Cause for Intussusception in Adults. Case Rep Surg 2015. [PMID: 26295002 DOI: 10.1155/2015/856030.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intussusception as a cause of intestinal obstruction in adults is rare. There is invariably an underlying pathology which leads to intussusception in adults. A case of intussusception in an adult due to a small intestinal lipoma is presented in view of this association. Ultrasound and CECT may help in a preoperative diagnosis. However early surgical intervention is the mainstay of treatment in order to confirm the diagnosis of the underlying pathology, thereby avoiding misdiagnosis of an underlying cancer.
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Yang CK, Liang WS, Liu CK, Hsu HH. Intussusception Caused by Colonic Tumors in Elderly Patients: A Case Series of Seven Patients. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2014.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Law MF, Wong CK, Pang CY, Chan HN, Lai HK, Ha CY, Ng C, Yeung YM, Yip SF. Rare case of intussusception in an adult with acute myeloid leukemia. World J Gastroenterol 2015; 21:688-693. [PMID: 25593499 PMCID: PMC4292305 DOI: 10.3748/wjg.v21.i2.688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/11/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
Intussusception is rarely reported in adult patients with acute leukemia. We report a case of intussusception in a 29-year-old woman with acute myeloid leukemia (AML). She developed right lower quadrant pain, fever, and vomiting on day 16 of induction chemotherapy. Physical examination showed tenderness and guarding at the right lower quadrant of the abdomen. Abdominal computed tomography (CT) showed distension of the cecum and ascending colon, which were filled with loops of small bowel, and herniation of the ileocecal valve into the cecum. We proceeded to laparotomy and revealed ileocecal intussusception with the ileocecal valve as the leading point. The terminal ileum was thickened and invaginated into the cecum, which showed gangrenous changes. Right hemicolectomy was performed and microscopic examination of the colonic tissue showed infiltration of leukemic cells. The patient recovered after the operation and was subsequently able to continue treatment for AML. This case demonstrates that the diagnosis of intussusception is difficult because the presenting symptoms can be non-specific, but abdominal CT can be informative for preoperative diagnosis. Resection of the involved bowel is recommended when malignancy is suspected or confirmed. Intussusception should be considered in any leukemia patients presenting with acute abdomen. A high index of clinical suspicion is important for early diagnosis.
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Ozkisacik SK, Erdem AO, Coskun O, Yazici M. Small bowel intussusception together with appendicitis in childhood: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2014.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Vagholkar K, Chavan R, Mahadik A, Maurya I. Lipoma of the Small Intestine: A Cause for Intussusception in Adults. Case Rep Surg 2015; 2015:856030. [PMID: 26295002 PMCID: PMC4532934 DOI: 10.1155/2015/856030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/21/2015] [Accepted: 07/21/2015] [Indexed: 02/07/2023] Open
Abstract
Intussusception as a cause of intestinal obstruction in adults is rare. There is invariably an underlying pathology which leads to intussusception in adults. A case of intussusception in an adult due to a small intestinal lipoma is presented in view of this association. Ultrasound and CECT may help in a preoperative diagnosis. However early surgical intervention is the mainstay of treatment in order to confirm the diagnosis of the underlying pathology, thereby avoiding misdiagnosis of an underlying cancer.
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Affiliation(s)
- Ketan Vagholkar
- Department of Surgery, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra 400706, India
- *Ketan Vagholkar:
| | - Rahulkumar Chavan
- Department of Surgery, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra 400706, India
| | - Abhishek Mahadik
- Department of Surgery, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra 400706, India
| | - Inder Maurya
- Department of Surgery, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra 400706, India
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A rare cause of acute abdomen in an adult burn patient: jejuno-jejunal intussusception. J Burn Care Res 2014; 36:e229. [PMID: 25526177 DOI: 10.1097/bcr.0000000000000127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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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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Kim KH, Namgung H, Park DG. Adult intussusceptions: preoperative predictive factors for malignant lead point. Ann Surg Treat Res 2014; 86:244-8. [PMID: 24851225 PMCID: PMC4024935 DOI: 10.4174/astr.2014.86.5.244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 01/25/2014] [Accepted: 02/04/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose Adult intussusception is uncommon, but an organic lesion is found to be the lead point in 75% to 90% of the cases. This study was designed to review our experience with adult intussusception and to determine if there are any preoperative predictive factors for a malignant lead point. Methods Thirty-three patients over 15 years of age were diagnosed with intussusceptions through operative finding over a period of 20 years. We reviewed the medical records of these patients retrospectively, and preoperative predictive factors of malignant lead points were analyzed. Results The preoperative diagnosis of intussusception had been made correctly in 86% of the cases, and computed tomography could find a lead point in 79%. A causative organic lesion was found in 29 patients (88%) pathologically; 16 cases (48%) were due to benign tumors, and 13 (39%) were due to malignant tumors. A malignant lead point was present in four of 21 enteric (20%) versus nine of 13 colonic intussusceptions (75%). The period from symptom appearance to hospital visit showed a more chronic nature in malignant neoplasm than in benign neoplasm (P = 0.006), and the location of causative organic lesion showed significant difference between benign and malignant groups (P = 0.003). Conclusion Adult intussusceptions are commonly secondary to a pathologic lead point, and a computed tomography is an effective diagnostic tool for finding a lead point preoperatively. The chronic nature of the disease presentation and colonic location of the lead point may suggest a malignant neoplasm.
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Affiliation(s)
- Kil Hwan Kim
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Hwan Namgung
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Dong Guk Park
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
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Afifi I, Al-Thani H, Attique S, Khoschnau S, El-Menyar A, Latifi R. Delayed presentation of intussusception with perforation after splenectomy in patient with blunt abdominal trauma. Case Rep Surg 2013; 2013:510701. [PMID: 24455385 PMCID: PMC3877598 DOI: 10.1155/2013/510701] [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: 09/16/2013] [Accepted: 11/25/2013] [Indexed: 11/18/2022] Open
Abstract
Adult intussusception (AI) following blunt abdominal trauma (BAT) is a rare surgical condition. We present a case of delayed diagnosis of ileocecal junction intussusception with a perforation of small bowel in a 34-year-old male with a history of fall from height. Initial exploratory laparotomy revealed shattered spleen requiring splenectomy. Initial abdominal computerized tomography scanning (CT) scan showed dilated small bowel with no organic obstruction. Patient started to improve with partial distention and was shifted to rehabilitation unit. On the next day, he experienced severe abdominal distention and vomiting. Abdominal CT showed characteristic intussusception at the distal ileum. Secondary exploratory laparotomy revealed severe adhesions of stomach and small bowel to the anterior abdominal wall with dilated small bowel loops and intussusception near the ileocecal junction with perforation of small bowel. The affected area was resected and side-to-side stapled anastomosis was performed. Though small bowel intussusception is a rare event, BAT patients with delayed symptoms of bowel obstruction should be carefully evaluated for missed intussusception.
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Affiliation(s)
- Ibrahim Afifi
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Sajid Attique
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Sherwan Khoschnau
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Section of Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, P.O. Box 24144, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, P.O. Box 24144, Doha, Qatar
- Department of Surgery, Arizona University, Tucson, AZ 245005, USA
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Abstract
Intussusception occurs when a proximal segment of the gastrointestinal tract, called intussusceptum, telescopes into the lumen of an adjacent segment, also known as intussuscipiens. Although common in early childhood, intussusceptions are very rare in the adult population. Most intussusceptions in adults are due to a lead point, which is an identifiable pathological abnormality, in opposition to children which there are no identifiable pathological lead points. In contrast to childhood intussusception, in adults it is associated with malignant lesions, particularly in the large bowel rather than in the small bowel. Its preoperative diagnosis and treatment in adults is difficult because of nonspecific abdominal symptom and because it rarely presents with the classic triad of vomiting, abdominal pain and passage of blood per rectum. We present a 63-year-old female with an adenocarcinoma tumor being the lead point in a colocolic intussusception, who was diagnosed preoperatively with computed tomography and had a colonoscopy to rule out obstruction. She underwent right hemicolectomy with side-to-side ileocolic anastomosis and did well postoperatively. In addition, we also review the literature and discuss the value of radiological modalities, location and surgical management to try to improve the preoperative diagnosis. Computed tomography scanning with intravenous contrast is maybe the most accurate modality for diagnosis of intussusceptions in adults, and treatment is usually surgical resection without reduction, since most of the colonic lesions are malignant.
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Affiliation(s)
- Abralena Wilson
- Lincoln Medical and Mental Health Center, Fort Lee, N.J., USA
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Abstract
Protrusion of a bowel segment into another (intussusception) produces severe abdominal pain and culminates in intestinal obstruction. In adults, intestinal obstruction due to intussusception is relatively rare phenomenon, as it accounts for minority of intestinal obstructions in this population demographic. Organic lesion is usually identifiable as the cause of adult intussusceptions, neoplasms account for the majority. Therefore, surgical resection without reduction is almost always necessary and is advocated as the best treatment of adult intussusception. Here, we describe a rare case of a 44-year-old male with a diffuse large B-cell lymphoma involving the terminal ileum, which had caused ileocolic intussusception and subsequently developed intestinal obstruction requiring surgical intervention. This case emphasizes the importance of recognizing intussusception as the initial presentation for bowel malignancy.
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Saini DK, Chaudhary P, Durga CK, Saini K. Role of multislice computed tomography in evaluation and management of intestinal obstruction. Clin Pract 2013; 3:e20. [PMID: 24765508 PMCID: PMC3981259 DOI: 10.4081/cp.2013.e20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/22/2013] [Accepted: 03/25/2013] [Indexed: 11/23/2022] Open
Abstract
The aims and objectives of this study were: i) to evaluate the efficacy of computed tomography (CT) imaging in diagnosing the presence, level, degree, and cause of intestinal obstruction, and the role of CT in detecting presence of complications; ii) to assess impact of CT in decision making and management (surgical/conservative); iii) to correlate CT findings with intra operative findings whenever possible. A prospective study of 40 patients presented in outpatient/emergency department with features suggestive of intestinal obstruction. Multislice contrast enhanced computed tomography of whole abdomen was done in all patients after preliminary investigations. Whenever indicated, patients were explored. Statistical analysis was performed to determine the efficacy of multidetector computed tomography (MDCT) in diagnosing intestinal obstruction and its complications. Out of 40, 30 patients underwent exploratory laparotomy and it was found that MDCT was 85% sensitive and 70% specific in diagnosing bowel obstruction. Association between MDCT findings suggestive of obstruction and intra-operative findings turn out to be significant (P=0.003). MDCT findings were consistent with intraoperative findings in 22 out of 30 patients (73%). MDCT is sensitive and specific in determining the presence of bowel obstruction and should be recommended for patients with suspected bowel obstruction because it affects outcome in these patients.
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Affiliation(s)
- Durgesh Kumar Saini
- Post graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital (Dr RMLH and PGIMER) , New Delhi, India
| | - Poras Chaudhary
- Post graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital (Dr RMLH and PGIMER) , New Delhi, India
| | - Chikkala Kanak Durga
- Post graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital (Dr RMLH and PGIMER) , New Delhi, India
| | - Kiran Saini
- Post graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital (Dr RMLH and PGIMER) , New Delhi, India
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Ozogul B, Kisaoglu A, Ozturk G, Atamanalp SS, Yıldırgan Mİ, Aköz A, Aydinli B. Adult Intussusception: Clinical Experience from a Single Center. Indian J Surg 2013; 77:490-4. [PMID: 26730051 DOI: 10.1007/s12262-013-0889-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 02/07/2013] [Indexed: 11/28/2022] Open
Abstract
Though frequently observed in children, intussusception is a rare state in adults. The treatment of intussusception in adults is different. In this trial, we have presented intussusception cases in adults that were treated and followed up in our department. The records of 31 adult intussusception cases surgically treated in our department between January 1993 and July 2012 were evaluated retrospectively. Among the 31 adult cases of intussusception that were treated during a period of 19 years, 10 were men, and 21 were women. The mean age was determined as 39.7 ± 5.3. The presentation symptom was abdominal pain in all the patients. Failure to pass gas or feces was observed in 23 patients (74.2 %); nausea and vomiting, in 22 patients (70.9 %); hematochezia, in 16 patients (51.6 %); and weight loss, in 3 patients (9.6 %). The mean duration of symptoms was 4.8 days. Abdominal tenderness was found in all the patients. Muscular defense and rebound tenderness were determined in 13 patients (41.9 %). Findings of intussusception were found in 80.9 % of patients examined by abdominal ultrasonography and in 63.1 % of cases examined by computerized tomography. Resection of the intussuscepted bowel segment was performed in 87 % of the patients. In conclusion, intussusception in adults is a rare clinical entity. Intussusception should be considered in the differential diagnosis in patients presenting with spasmodic abdominal pain, especially in cases with intestinal obstruction. The recommended surgical method is en bloc resection of the intussuscepted segment in cases suspected to carry a risk of malignancy.
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Affiliation(s)
- Bunyami Ozogul
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25040 Erzurum, Turkey
| | - Abdullah Kisaoglu
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25040 Erzurum, Turkey
| | - Gurkan Ozturk
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25040 Erzurum, Turkey
| | - Sabri Selcuk Atamanalp
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25040 Erzurum, Turkey
| | - Mehmet İlhan Yıldırgan
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25040 Erzurum, Turkey
| | - Ayhan Aköz
- Department of Emergency Medicine, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Bulent Aydinli
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25040 Erzurum, Turkey
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