Colonic intussusception secondary to a calcium phosphate bezoar in a child receiving calcium carbonate for hyperphosphatemia

The diagnosis and treatment of retrograde intussusception: a single-centre experience

Background/Purpose

To investigate the clinical manifestations, treatments of retrograde intussusception and summarize the experience.

Methods

Children with retrograde intussusception treated in our hospital from January 2011 to January 2021 were retrospectively analysed. Demographics, clinical manifestations, preoperative colour Doppler ultrasound (CDU) findings, findings during surgery and follow-up results were collected.

Results

A total of 4719 cases of intussusception were treated in our department, including 12 cases of retrograde intussusception (0.25%). There were 8 males and 4 females.The age ranged from 4.1 to 14.3 months, with an average of (8.3 ± 2.8) months.; The weight ranged from 5.5 to 12.6 kg, with an average of (9.4 ± 2.3) kg; The onset time ranged from 6 to 15 h, with an average of (10.0 ± 2.4) h. All the children received CDU examination before surgery, and in one case, the possibility of 2 intussusception masses was considered. Emergency surgical exploration was performed after the failure of air enema reduction. During the operation, multiple types of intussusception were found (coincidence of anterograde and retrograde intussusception). The pattern of anterograde intussusception was all ileo-ileo-colic variety and the retrograde intussusception was proximal sigmoid colon into descending colon. All the children were successfully reduced by manual reduction without intestinal necrosis or intestinal malformation. All children were discharged 6–7 days after surgery, and had no recurrence after 3–6 months of follow-up.

Conclusions

Retrograde intussusception is easily misdiagnosed before surgery. During air enema, if the intussusception mass was fixed and did not move with increasing pressure, we should be aware of the possibility of retrograde intussusception, and the enema pressure should not be too large to avoid intestinal perforation. If the intraoperative position of the intussusception mass was not consistent with that of the preoperative enema, it was recommended to use bimanual examination to explore whether there was still a mass in the abdominal cavity to avoid misdiagnosis.

Phytobezoar-induced small bowel obstruction in an elderly patient undergoing dialysis: a case report

A phytobezoar is defined as an accumulation of poorly digested fruit and vegetable fibers in the gastrointestinal tract. Phytobezoar-induced small bowel obstruction is an uncommon entity and is usually removed surgically. We herein describe an elderly man undergoing dialysis who developed a phytobezoar because of excessive consumption of high-fiber fruits and inappropriate chewing. His potential predisposing factors were dialysis-related lifestyle changes, reduced activity levels, fluid restriction, and gastrointestinal motility dysfunction; however, he had no history of gastric surgery. The patient’s clinical history and characteristic imaging features aided in the diagnosis. He underwent medical treatment, and his recovery was uneventful. This case highlights the importance of an awareness of phytobezoar-induced small bowel obstruction in patients at increased risk of developing bezoars and demonstrates that this condition can occur in the absence of previous gastric surgery. We believe that elderly patients undergoing dialysis are at increased risk of developing bezoars. Excessive consumption of a strictly fibrous diet and insufficient chewing exacerbate the risk. A detailed dietary history and imaging features can aid in early diagnosis, leading to appropriate medical or surgical care. Surgical treatment is not inevitable in all cases. Individualized dietary suggestions in these patients are important for effective preventive control.

A ganglioneuroma of the sigmoid colon presenting as leading point of intussusception in a child: a case report

We present a case of intestinal ganglioneuroma (GN) of the sigmoid colon in a 5-year-old girl, which caused intermittent colocolic intussusception. Ganglioneuromas are rare benign tumors of the autonomic nervous system composed of mature ganglion cells and satellite cells. Colonic GNs are uncommon. The unusual intramural proliferation of neural elements in this case resembled the diffuse intestinal ganglioneuromatosis, which is known to be associated with multiple endocrine neoplasia type 2B. However, the specific mutations of multiple endocrine neoplasia type 2B were not found by genetic sequencing. This is the first pediatric case described in the literature of a solitary polypoid GN presenting as a colocolic intussusception. We present a brief overview of intestinal ganglioneuromatous lesions and associated conditions.

Small bowel obstruction caused by a medication bezoar: report of a case

We report herein the rare case of a 26-year-old woman who developed a small-bowel obstruction caused by a medication "bezoar" or enterolith, following the long-term ingestion of magnesium oxide cathartics for constipation. Medication bezoars resulting from laxatives or cathartics have rarely been reported and we were only able to find two other such cases in the literature.

Cecal vitamin bezoar formation inducing abdominal discomfort

OBJECTIVE

To document a case of cecal lecithin-vitamin B12 bezoar formation inducing abdominal discomfort.

DESIGN

Case study.

SETTING

500-bed, community teaching hospital.

PATIENT

81-year-old man with a history of multiple abdominal surgeries who presented with a chief complaint of abdominal pain. Flat plate X-ray of the abdomen revealed multiple capsule-shaped objects lodged in the cecum.

INTERVENTIONS

Catharsis with bisacodyl, magnesium citrate, NaCl 0.9%; dissolution with heated, dilute barium administered rectally in conjunction with external manipulation; laparotomy.

MAIN OUTCOME MEASURES

None planned; dissolution or transit of bezoar through gastrointestinal tract desired outcome.

RESULTS/DISCUSSION

Classification of bezoars and treatment discussed in relation to this case report.

CONCLUSIONS

Medicinal agents have been implicated in bezoar formation. Treatment options have included: cathartics, heated solvent enemas, and external manipulation and surgery.