[Intestinal invagination after vagotomy in adults]

Adult intussusception: diagnostic pitfalls, morbidity and mortality in a developing country

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.

Ileo-ileal invagination--a cause of recurrent mid-gastrointestinal bleeding: diagnostic and endoscopic therapy by means of push-and-pull enteroscopy

The types of lesions that cause bleeding in the small bowel are similar to those found in other areas in the gastrointestinal tract, such as vascular malformations, ulcers and inflammatory lesions, neoplasms and other less common lesions like Meckel's diverticulum. This report describes three patients with suspected mid-gastrointestinal bleeding with no significant past medical history. Before presenting to our unit the diagnostic work-up such as oesophagogastroduodenoscopy, colonoscopy and radiological small bowel imaging such as conventional enteroclysis or magnet resonance imaging enteroclysis had been performed without detecting any bleeding source. Capsule endoscopy suspected an angiodysplasia in the terminal ileum in one patient, in the other two patients a polyp in the region of the ileum as the potential bleeding source was diagnosed. In all three patients, a polyp with an ulcerated tip was found with the anal push-and-pull enteroscopy. An endosocpic resection was performed in all three cases without complication with the exception of one. In this patient a perforation occured 3 days after resection and was treated surgically without further complications. Histology revealed in all three cases, a polypoid diaphragmatic invagination of the small bowel with a vast area of chronic ulceration on the tip of this pseudopolyp with infiltration of the muscularis propria. In summary, the present paper describes the rare cases of erosive pseudopolyps after ileo-ileal invagination treated with endoscopic resection by means of push-and-pull enteroscopy.