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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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2
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Hayashi R, Sawada G, Ichikawa Y, Takata A, Murakami M, Fukunaga H, Kimura H, Morita S. A case of intestinal intussusception with unique hemorrhagic polyps due to AL amyloidosis and excessive anticoagulation. Clin J Gastroenterol 2024; 17:258-262. [PMID: 38270839 DOI: 10.1007/s12328-023-01915-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
Most adult intussusceptions are secondary to various pathological conditions that serve as a lead point. Because of their serious nature, intussusceptions often require emergency surgery. We report a surgical case of amyloidosis associated with intussusception, probably due to polypoid protrusions and bleeding tendencies. An 80-year-old man with abdominal pain was suspected of having jejunal intussusception on computed tomography. He had been prescribed warfarin for atrial fibrillation, and excessive anticoagulation was observed with a prolonged prothrombin time/international normalized ratio of 5.44 at presentation. After the excessive anticoagulation was resolved, emergency surgery was performed. The intussuscepted jejunum was resected, and a 7 cm long dark-red pedunculated polyp was identified as the lead point, which was accompanied by multiple small pedunculated polyps. Histopathological examination showed that these were all hemorrhagic polyps. Amyloid depositions were observed in the muscularis mucosae, submucosa, and the walls of the blood vessels. Immunohistochemical analysis revealed immunoglobulin light chain amyloidosis. This case is informative to discuss the clinical sequelae of gastrointestinal amyloid deposition.
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Affiliation(s)
- Rie Hayashi
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan.
| | - Genta Sawada
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Yoshitoshi Ichikawa
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Akihiro Takata
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Masahiro Murakami
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Hiroki Fukunaga
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Hayato Kimura
- Department of Diagnostic Pathology, Itami City Hospital, Itami, Hyogo, Japan
| | - Shunji Morita
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
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3
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Alfaifi J, Germain A. Adenocarcinoma-Induced Sigmoid Colon Intussusception and Postoperative Parastomal Evisceration in an Elderly Patient: A Case Report and Literature Review. Cureus 2024; 16:e53715. [PMID: 38455783 PMCID: PMC10919318 DOI: 10.7759/cureus.53715] [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: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Intussusception in adults is less frequent than in children, and it is less commonly seen in the colon than in the intestines. This may be explained by the fixation of the colon to the retroperitoneum. We herein describe a case of sigmoid colon intussusception caused by a sigmoid colon adenocarcinoma. An 81-year-old man presented with abdominal pain and signs and symptoms of gastrointestinal obstruction. CT revealed a "target sign" with a mass in the sigmoid colon. We diagnosed the patient with colonic obstruction secondary to intussusception of the sigmoid colon and performed an emergency transverse colostomy. On the first postoperative day, the patient had a parastomal evisceration. Oncologic resection of the sigmoid colon without reduction of the intussusception was performed. The tumor was pathologically diagnosed as well-differentiated adenocarcinoma and classified as pT3N0. The patient was discharged on the ninth postoperative day with an uneventful postoperative course. The surveillance was validated for this patient.
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Affiliation(s)
- Jaber Alfaifi
- Department of General Surgery, King Khalid University, Abha, SAU
- Department of Hepatobiliary, Colorectal, and Digestive Surgery, University Hospital of Nancy, Nancy, FRA
| | - Adeline Germain
- Department of Hepatobiliary, Colorectal, and Digestive Surgery, University Hospital of Nancy, Nancy, FRA
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4
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Guo Hou L, Nadia Nafasha B, Sultan Mohamed Arif H, Reynu R, Kosai Nik R, Hamidi Lizawati R. Adult idiopathic hypertrophic pyloric stenosis presenting with gastroduodenal intussusception: A rare case report. Turk J Surg 2023; 39:377-382. [PMID: 38694524 PMCID: PMC11057929 DOI: 10.47717/turkjsurg.2023.4552] [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: 06/12/2019] [Accepted: 05/05/2020] [Indexed: 05/04/2024]
Abstract
Adult idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare entity first described by Cruveilhier in 1835. There are only approximately 200 cases reported in the English literature to date. Histologically, it may be mistaken for spindle cell neoplasms such as gastrointestinal stromal tumour (GIST). Patients with AIHPS usually present with early satiety, abdominal fullness, postprandial vomiting, epigastric pain, and eructations. Adult intussusception is rare and only accounts for 5% of all intussusceptions. Gastroduodenal intussusception is one of the rare types of adult intussusception. This is more likely to occur when a benign or malignant stomach lesion acts as a lead point. We report a case of AIHPS in a 70-year-old lady presenting with gastroduodenal intussusception. An oesophagogastroduodenoscopy (OGDS) was performed, and it revealed a diffusely thickened and narrowed pyloric antrum. A contrasted computed tomography (CECT) of the thorax and abdomen showed a distended stomach with circumferential thickening of the pylorus. The pre-pyloric antrum was intussuscepting into the pylorus, and the apex is seen within the first part of duodenum. She underwent distal gastrectomy with a Roux-en-y reconstruction via laparoscopic approach and was discharged well. AIHPS is a rare condition and should be a differential in adults presenting with gastric outlet obstruction. We believe in cases of AIHPS presenting with gastroduodenal intussusception, a distal gastrectomy with reconstruction is a reasonable approach. A multidisciplinary approach is essential to obtain the best outcome.
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Affiliation(s)
- Loo Guo Hou
- Department of General Surgery, National University of Malaysia Faculty of Medicine, Bandar Tun Razak, Malaysia
| | - Baharudin Nadia Nafasha
- Department of General Surgery, National University of Malaysia Faculty of Medicine, Bandar Tun Razak, Malaysia
| | - Hameed Sultan Mohamed Arif
- Department of General Surgery, National University of Malaysia Faculty of Medicine, Bandar Tun Razak, Malaysia
| | - Rajan Reynu
- Department of General Surgery, National University of Malaysia Faculty of Medicine, Bandar Tun Razak, Malaysia
| | - Ritza Kosai Nik
- Department of General Surgery, National University of Malaysia Faculty of Medicine, Bandar Tun Razak, Malaysia
| | - Rasul Hamidi Lizawati
- Department of Pathology, National University of Malaysia Faculty of Medicine, Bandar Tun Razak, Malaysia
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5
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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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Elghezewi A, Hammad M, Mohamed M, Chirico P, Frandah W. A Rare Case of Anterograde Gastroduodenal Intussusception Caused by Migrated Percutaneous Endoscopic Gastrostomy Feeding Tube. J Med Cases 2023; 14:169-173. [PMID: 37303971 PMCID: PMC10251706 DOI: 10.14740/jmc4101] [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: 04/20/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Gastroduodenal intussusception is a critical condition in which stomach protrudes into the duodenum. It is a very rare condition in adults. Most common causes include intra luminal lesions in the stomach including benign or malignant tumors of the stomach. Most common tumors included are gastrointestinal stromal tumors (GISTs), gastric carcinoma, gastric lipoma, gastric leiomyoma, and gastric schwannoma. It is extremely rare to be caused by migration of percutaneous feeding tube. A 50-year-old woman with a past medical history (PMH) of dysphagia status post percutaneous endoscopic gastrostomy (PEG) tube, history of spastic quadriplegia, presented with acute nausea, vomiting and abdominal distention, and was found to have gastroduodenal intussusception in computed tomography (CT) scan. Condition resolved after retracting PEG tube. Endoscopy did not reveal any intra luminal lesions. External fixation using Avanos Saf-T-Pexy T-fasteners was performed to prevent recurrence of this condition. Most common of causes of gastroduodenal intussusception are GIST tumors of stomach. CT abdomen is the most accurate test and upper endoscopy is needed to rule out any intra luminal causes. Treatment of choice is either endoscopic or surgical resection. External fixation is essential to prevent recurrence.
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Affiliation(s)
- Abdelwahap Elghezewi
- Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Mohamed Hammad
- Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Mujtaba Mohamed
- Section of Gastroenterology and Hepatology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Peter Chirico
- Department of Radiology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
| | - Wesam Frandah
- Section of Gastroenterology and Hepatology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA
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7
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Chiam KH, Sannasey S, Rajaintharan S, Muthukaruppan R. Atypical endoscopic finding of colocolic intussusception: case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1290. [PMID: 36618802 PMCID: PMC9816856 DOI: 10.21037/atm-2022-61] [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: 10/01/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
Background Adult-onset colonic intussusception is a rarely encountered condition that leads to large intestinal obstruction with time. Patients often present with a variety of symptoms that are non-specific making it challenging to arrive at a definitive diagnosis. This is worrying as diagnostic delay could lead to a significant increase in morbidity and mortality. We wish to present and describe a case of an atypical endoscopic finding of colocolic intussusception secondary to ascending colon cancer. Case Description Sixty-seven-year-old lady was referred for 1 month's duration of passing melenic stools with mucus followed by a week's complain of hematochezia. Clinical examination and other relevant blood results were unremarkable except for iron deficiency anemia. Initial colonoscopy revealed a large mass within the splenic flexure with inconclusive biopsies. A more detailed colonoscopy repeated the following day revealed a massive, black-to-yellowish lesion within the splenic flexure with no viable mucosa seen. Colonic bezoar was initially suspected, however various endoscopic retrieval methods proved futile. Switching to a slimmer diagnostic gastroscope, the colon was carefully negotiated until a large ulcer was found within the ascending colon, adjacent to the mass' origin. An emergency CT abdomen and subsequently extended right hemicolectomy performed revealed a colocolic intussusception with sealed perforation secondary to an ascending colonic mass acting as an intussusceptum. Histopathology evaluation confirmed an ascending colon adenocarcinoma (pT2N0M0) amidst a background of extensive ischemic changes. Conclusions Endoscopic descriptions of colonic intussusception are unusual given their rarity. Furthermore, these lesions can mimic a colonic bezoar as a result of fecal accretion and this can ultimately lead to false diagnostic and therapeutic decisions. In such instances, clarification with a CT scan before management decision can potentially avert unnecessary endoscopic intervention and complications.
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Affiliation(s)
- Keng Hoong Chiam
- Gastroenterology Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Sumithra Sannasey
- Radiology Department, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | | | - Raman Muthukaruppan
- Gastroenterology Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
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8
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Zhang W, Chen H, Zhu L, Kong Z, Wang T, Li W. Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor in adults: a case report and literature review. J Int Med Res 2022; 50:3000605221100772. [PMID: 35632985 PMCID: PMC9150259 DOI: 10.1177/03000605221100772] [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] [Indexed: 11/18/2022] Open
Abstract
Intussusception mostly occurs in childhood and is rare in adults. Although intussusception can occur in any part of the gastrointestinal tract, gastroduodenal intussusception caused by a gastric tumor is relatively uncommon in clinical practice. A PubMed search identified 24 published cases of gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor (GIST); however, it is possible that we missed other cases not included in PubMed. Here we report a case of gastroduodenal intussusception caused by gastric GIST in an 85-year-old man. He came to the hospital because of recurrent black stools. Plain computed tomography (CT) scan indicated a mass in the gastric antrum, with slight enhancement in the arterial phase on enhanced CT scan. He was diagnosed with GIST. In addition, images indicated that the mass overlapped into the duodenum, and gastroduodenal intussusception was thus considered. Gastroscopy showed a huge mass in the gastric body. According to the gastroscopy and CT results, gastroduodenal intussusception caused by a gastric tumor was considered. The patient underwent complete surgical removal, which revealed a mass originating from the gastric antrum and overlapping into the duodenum. The postoperative pathological diagnosis was intermediate-risk gastric GIST. The patient was followed up for 4 months without tumor recurrence.
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Affiliation(s)
- Wenbing Zhang
- Department of Gastrointestinal Surgery, the First People's Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Haifeng Chen
- Department of Gastroenterology, the First People's Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Lulu Zhu
- Department of Pathology, the First People's Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Zhiyuan Kong
- Department of Gastrointestinal Surgery, the First People's Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Tingting Wang
- Department of Nephrology, the First People's Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
| | - Weiping Li
- Department of Gastrointestinal Surgery, the First People's Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang City, Jiangsu Province, China
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9
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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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10
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Wang TL, Gong XS, Wang J, Long CY. Intestinal intussusception caused by intestinal duplication and ectopic pancreas: A case report and review of literature. World J Clin Cases 2022; 10:2261-2267. [PMID: 35321161 PMCID: PMC8895165 DOI: 10.12998/wjcc.v10.i7.2261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/17/2021] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intestinal intussusception caused by intestinal duplication and ectopic pancreas is extremely rare in the clinic and has not been reported previously.
CASE SUMMARY A 29-year-old man was admitted to the hospital for chronic abdominal pain and bloating. The preoperative diagnosis was intestinal obstruction and intussusception. Then, laparotomy, partial small intestinal resection and extraintestinal decompression were performed. Postoperative pathology confirmed intestinal duplication and ectopic pancreas. After surgery, the patient recovered well with no complications. No recurrence was observed after more than 5 mo of follow-up.
CONCLUSION We report a new case of a young male with intussusception caused by intestinal duplication and ectopic pancreas. Surgery is the main treatment for these conditions. This study aimed to raise awareness and provide information to improve the clinical management of this rare yet serious condition.
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Affiliation(s)
- Tao-Li Wang
- Department of Pathology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Xiao-Song Gong
- The Second Department of General Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Jin Wang
- The Second Department of General Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Chen-Yan Long
- The Second Department of General Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
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11
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Maruta S, Inoue S, Odaka A, Muta Y, Takeuchi Y, Beck Y, Kikuchi J. Small bowel intussusception caused by a solitary Peutz-Jeghers–type polyp. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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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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Jadhav KP, Krishnan G. Triple Intussusception in an Adult-A Rare Presentation of Adenocarcinoma Ileum. Surg J (N Y) 2021; 7:e271-e274. [PMID: 34632062 PMCID: PMC8492135 DOI: 10.1055/s-0041-1733834] [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: 05/27/2021] [Accepted: 06/16/2021] [Indexed: 11/03/2022] Open
Abstract
Intestinal intussusception is uncommon in adults. It occurs more often in the small intestine than in the colon. In adults, when small bowel intussusception occurs, it can be due to a malignant lead point. Malignant etiology is most frequently due to diffuse metastatic disease. We present a rare case of an 18-year-old woman who was diagnosed with jejunojejunal, jejunoileal, and colocolic intussusceptions. She presented with vomiting, abdominal pain, and passage of semisolid stools for 5 days. During emergency exploratory laparotomy, multiple polyps were found in the jejunum, ileum, and sigmoid. Jejunotomy and sigmoidotomy were done to remove the respective polyps. The ileal polyp showed hemorrhagic changes; hence, an intraoperative decision was taken to proceed with resection and anastomosis. On histopathological examination, the resected ileal part showed moderately differentiated adenocarcinoma (grade 2) arising from an adenomatous polyp, while the jejunal polyp and sigmoid polyp were adenomatous polyps with low-grade dysplasia. Patient received six cycles of adjuvant chemotherapy consisting of capecitabine and oxaliplatin (CAPEOX regimen). After 2 years, she is symptom free with a normal colonoscopy. The treatment of intussusception in adults typically involves surgery, often with bowel resection as there is always a pathologic leading cause which may be malignant, like in our case.
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Affiliation(s)
- Kirankumar P Jadhav
- Department of Surgery, B. J. Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Gayathri Krishnan
- Department of Surgery, B. J. Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India
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14
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Kotb M, Abdelaziz M, Abdelmeguid Y, Hassan A, Mashali N, Saad-Eldin Y. Gastroduodenal Intussusception Due to Gastric Mucosal Prolapse Polyp in a 2-Year-Old Child. Fetal Pediatr Pathol 2021; 40:511-517. [PMID: 31986949 DOI: 10.1080/15513815.2020.1716898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gastroduodenal intussusception is an invagination of a portion of the stomach into the duodenum. It predominately occurs in adults. Case Report: We present a gastroduodenal intussusception in an hypochromic microcytic anemic 2-year-old girl. A large filling defect in the second and third parts of the duodenum, indenting the pyloric antrum, was due to a gastroduodenal intussusception secondary to a cauliflower-like gastric mucosal prolapse polyp, a type of gastric hyperplastic polyp. Conclusion: Anemia may accompany a gastric mucosal prolapse polyp.
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Affiliation(s)
- Mostafa Kotb
- Faculty of Medicine, Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Marwa Abdelaziz
- Faculty of Medicine, Pathology, Alexandria University, Alexandria, Egypt
| | | | - Ahmed Hassan
- Faculty of Medicine, Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Nagwa Mashali
- Faculty of Medicine, Pathology, Beirut Arab University, Beirut, Lebanon
| | - Yasser Saad-Eldin
- Faculty of Medicine, Pediatric Surgery, Alexandria University, Alexandria, Egypt
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15
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Numpraphrut P, Niltwat S, Parakonthun T, Pausawasdi N. Gastroduodenal Intussusception of a Gastrointestinal Stromal Tumor: A Rare Cause of Acute Pancreatitis. Clin Endosc 2021; 55:447-451. [PMID: 34154306 PMCID: PMC9178139 DOI: 10.5946/ce.2021.073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 11/14/2022] Open
Abstract
Patients with symptomatic gastrointestinal stromal tumor (GIST) typically present with gastrointestinal bleeding and abdominal pain. This report presents an unusual case of fundic GIST complicated by gastroduodenal intussusception, manifesting as acute pancreatitis. The patient presented with epigastric pain and pancreatic enzyme elevation; thus, he was diagnosed with acute pancreatitis. Computed tomography showed evidence of pancreatitis and a 4×4.7 cm well-defined hyperdense lesion in the 2nd part of the duodenum, compressing the pancreatic head and pancreatic duct. Esophagogastroduodenoscopy revealed invagination of the gastric folds into the duodenum, causing pyloric canal blockage consistent with gastroduodenal intussusception. Spontaneous reduction of the lesion during endoscopy revealed a 4 cm pedunculated subepithelial mass with central ulceration originating from the gastric fundus. Endoscopic ultrasound demonstrated a heterogeneous hypoechoic lesion originating from the 4th layer of the gastric wall. Laparoscopic-endoscopic intragastric wedge resection of the fundic lesion was subsequently performed, and surgical histology confirmed GIST.
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Affiliation(s)
- Pornpayom Numpraphrut
- Vikit Viranuvatti Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sorachat Niltwat
- Vikit Viranuvatti Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Gastroenterology, Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Thammawat Parakonthun
- Vikit Viranuvatti Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Minimally Invasive Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nonthalee Pausawasdi
- Vikit Viranuvatti Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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16
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Kansoun A, Mohtar IA, Bahmad M, Houcheimi F, Maanieh N, Hazim M, Rahal K, Amiry AR, Hoteit A, Saeed AA, Fakhruddin N, Wehbe M. Colo-colic intussusception secondary to colon lipoma: A case report. Int J Surg Case Rep 2021; 81:105695. [PMID: 33721822 PMCID: PMC7970352 DOI: 10.1016/j.ijscr.2021.105695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/14/2021] [Accepted: 02/14/2021] [Indexed: 11/25/2022] Open
Abstract
Intestinal intussusception is rare in adults and it is associated with lead points. Lipomas are very rare benign tumors which may act as lead points for intestinal intussusception. Colo-colic intussusception caused by lipoma must be considered in the differential when diagnosing adults with right lower quadrant pain.
Introduction and importance Intestinal intussusception is rare in adults and it is associated with lead points affecting the colon in around 17% of patients. Lipomas are very rare benign tumors which may act as lead points for intestinal intussusception. Indeed, the incidence of intestinal intussusception is much rare when caused by lipomas. Case presentation Our patient is a 29-year-old male, previously healthy and admitted for severe right lower quadrant abdominal pain of 2-day duration. Computed tomography (CT) scan of the abdomen and pelvis showed large mass of fat consistency containing colon structure. Clinical Discussion Urgent laparotomy was opted during which colo-colic intussusception was diagnosed and right hemicolectomy with primary ileocolic anastomosis was performed. Pathology report showed that intussusception was induced by a colon lipoma. Patient had an uneventful hospital stay and was discharged on post-operative day 5. Conclusion Thus we recommend that colo-colic intussusception caused by lipoma be considered in the differential when diagnosing adults with right lower quadrant pain.
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Affiliation(s)
- Alaa Kansoun
- Lebanese University, Faculty of Medical Sciences, Department of General Surgery, Beirut, Lebanon.
| | - Iyad Al Mohtar
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
| | - Marwan Bahmad
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
| | | | - Nisreen Maanieh
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
| | - Mouhamad Hazim
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
| | - Khaled Rahal
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
| | | | - Ali Hoteit
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
| | | | - Najla Fakhruddin
- Department of Pathology, Hammoud Hospital University Medical Center, Saida, Lebanon.
| | - Mohammad Wehbe
- Department of General Surgery, Hammoud Hospital University Medical Center, Saida, Lebanon.
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17
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Naik AS, Roshini AP, Sardesai V, Radhika Raj CG. An uncommon diagnosis of a common presentation of mass per rectum. Int J Surg Case Rep 2020; 74:277-280. [PMID: 32773293 PMCID: PMC7503787 DOI: 10.1016/j.ijscr.2020.06.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/20/2020] [Accepted: 06/20/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction - In adults, protrusion of intussuscepted sigmoid growth through the anal canal is exceedingly rare, with only 9 cases being reported till date. Case Report - A 52-year old man presented to emergency department with what appeared to be an episode of rectal prolapse following straining while defaecating. On examination, he had a prolapsed 8 × 8 cm bowel, with a 2 × 2 cm friable villous growth as the lead point, with space between the mass and the perianal skin. Computed Tomography of the abdomen was done which was suggestive of telescoping of the sigmoid into the rectum protruding out through the anal canal with features of intestinal obstruction. He underwent exploratory laparotomy with sigmoidectomy with Hartman's Procedure. Post-operative period was uneventful. Histopathology was suggestive of moderately differentiated carcinoma. Discussion - In colo-anal intussusception, as was in our patient, the preferred approach is to reduce the intussusception before resection, to perform a sphincter saving operation as compared to an Abdominoperineal Resection (APR) otherwise. Conclusion -A high index of suspicion is important to diagnose and treat such cases early to avoid lethal outcomes by misdiagnosing it as simple rectal prolapse.
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Affiliation(s)
- Akshay Surendra Naik
- Department of General Surgery, Goa Medical College Hospital, Bambolim, Goa, India
| | - A P Roshini
- Department of General Surgery, Goa Medical College Hospital, Bambolim, Goa, India.
| | - Vishal Sardesai
- Department of General Surgery, Goa Medical College Hospital, Bambolim, Goa, India
| | - C G Radhika Raj
- Department of General Surgery, Goa Medical College Hospital, Bambolim, Goa, India
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18
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Đokić M, Novak J, Petrič M, Ranković B, Štabuc M, Trotovšek B. Case report and literature review: patient with gastroduodenal intussusception due to the gastrointestinal stromal tumor of the lesser curvature of the gastric body. BMC Surg 2019; 19:158. [PMID: 31664984 PMCID: PMC6819360 DOI: 10.1186/s12893-019-0608-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intussusception in adult patient is rare. Gastroduodenal intussusception due to the gastrointestinal stromal tumors is infrequently described in the literature. Authors present a case of gastroduodenal intussusception due to the low-risk gastrointestinal stromal tumor of the lesser curvature of the gastric body with literature review. CASE PRESENTATION Sixty-two-year-old male was admitted to our hospital with symptoms of acute gastric outlet obstruction. Imaging studies confirmed a lesion of the gastric wall producing gastroduodenal intussusception with pylorus obstruction. Upon laparotomy a tumor mass of the lesser curvature of the gastric body that invaginated through the pylorus into the duodenum was found. Desinvagination and resection of the tumor with the adequate resection margins were performed. Histology reveled a low-risk gastrointestinal stromal tumor. Due to favorable outcome only observation was suggested by the multidisciplinary team. CONCLUSIONS Gastroduodenal intussusception due to the gastrointestinal stromal tumor of the gastric wall is a rare event. Surgical resection is the treatment of choice. In selected cases laparosopic resection of the tumor can be performed.
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Affiliation(s)
- Mihajlo Đokić
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta 7, 1000, Ljubljana, Slovenia
| | - Jerica Novak
- Department of Surgical Oncology, Ljubljana Institute of OncologyActa Chir Belg, Zaloška cesta 2, 1000, Ljubljana, Slovenia.
| | - Miha Petrič
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta 7, 1000, Ljubljana, Slovenia
| | - Branislava Ranković
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Miha Štabuc
- Department of Radiology, Ljubljana University Medical Center, Zaloška cesta 7, 1000, Ljubljana, Slovenia
| | - Blaž Trotovšek
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta 7, 1000, Ljubljana, Slovenia
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19
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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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20
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Alomari M, Alomari A, Hitawala A, Khazaaleh S, Al Momani LA. Anterograde Gastroduodenal Intussusception: A Rare but Lethal Complication of Percutaneous Endoscopic Gastrostomy Tube Placement. Cureus 2019; 11:e4347. [PMID: 31187012 PMCID: PMC6541164 DOI: 10.7759/cureus.4347] [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] [Indexed: 11/05/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the methods of providing enteral nutrition support and is often used in critically ill patients. There are several complications of PEG tube placement, including intussusception. Jejunojejunal and retrograde jejunoduodenogastric intussusception are well-documented complications of PEG tube placement. Here we describe the case of a 25-year-old female who was diagnosed with anterograde gastroduodenal intussusception with the PEG tube acting as a lead point. Our case is unique as, to the best of our knowledge, there are no documented cases of PEG tube-related anterograde gastroduodenal intussusception. The reported patient was found to have extensive gastric pneumatosis and portal venous gas concerning for acute ischemia. Such cases warrant immediate surgical intervention. However, in our case, the patient's family opted for comfort care measures.
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Affiliation(s)
| | - Ahmed Alomari
- Internal Medicine, The Hashmite University, Al-Zarqa, JOR
| | - Asif Hitawala
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland , USA
| | | | - Laith A Al Momani
- Internal Medicine, East Tennessee State University, Johnson City, USA
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21
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Suda T, Hodo Y, Shirota Y. Gastroduodenal intussusception of a gastric carcinoma. Dig Endosc 2019; 31:e38-e39. [PMID: 30536924 DOI: 10.1111/den.13313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/03/2018] [Indexed: 01/26/2023]
Affiliation(s)
| | - Yuji Hodo
- Saiseikai Kanazawa Hospital, Ishikawa, Japan
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22
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Unusual Presentation of Duodenal Ulcer Presenting with Duodenal Intussusception. ACG Case Rep J 2018; 5:e25. [PMID: 29619400 PMCID: PMC5876451 DOI: 10.14309/crj.2018.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/25/2018] [Indexed: 12/29/2022] Open
Abstract
We present a unique case of duodeno-duodenal intussusception from a duodenal bulb ulcer. A 38-year-old man presented with nausea, vomiting, and abdominal pain. Computed tomography showed duodenal intussusception. Esophagogastroduodenoscopy (EGD) showed a linear gastric ulcer and a duodenal bulb ulcer with an overlying blood clot. Helicobacter pylori status was positive. Intussusception resolved spontaneously without intervention. He completed treatment for H. pylori infection, and repeat EGD showed ulcer healing. Duodenal intussusception is rarely reported; intussusception from an edematous duodenal ulcer with an overlying blood clot mimicking a mass lesion acting as lead point has never been reported to our knowledge.
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23
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Jameel ARA, Segamalai D, Murugaiyan G, Shanmugasundaram R, Obla NB. Gastroduodenal Intussusception due to Gastrointestinal Stromal Tumour (GIST). J Clin Diagn Res 2017; 11:PD09-PD10. [PMID: 28969200 DOI: 10.7860/jcdr/2017/26292.10398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 05/11/2017] [Indexed: 02/04/2023]
Abstract
Gastroduodenal intussusception is the rarest forms of adult intussusception. We present a case of gastroduodenal intussusception due to a gastric Gastrointestinal Stromal Tumour (GIST). The patient was a 65-year-old female who clinically presented as acute gastric outlet obstruction. The patient was managed by gentle reduction of the intussusception, followed by wedge resection of the tumour. She was relieved of her symptoms and recurrence free for past one year.
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Affiliation(s)
- Abdul Rehman Abdul Jameel
- Postgraduate, Department of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Durairaj Segamalai
- Postgraduate, Department of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India
| | - Gnanasekaran Murugaiyan
- Assistant Professor, Department of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | - Naganath Babu Obla
- Director and Professor, Department of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India
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24
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Yamauchi K, Iwamuro M, Ishii E, Narita M, Hirata N, Okada H. Gastroduodenal Intussusception with a Gastric Gastrointestinal Stromal Tumor Treated by Endoscopic Submucosal Dissection. Intern Med 2017; 56. [PMID: 28626176 PMCID: PMC5505906 DOI: 10.2169/internalmedicine.56.8160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 95-year-old Japanese woman presented to our hospital with intermittent vomiting and several episodes of melena. Abdominal computed tomography revealed intussusception of the gastric tumor into the duodenum. After endoscopic reduction, endoscopic ultrasonography identified a hypoechogenic lesion limited to the submucosal layer. Endoscopic resection was performed as a localized treatment for the prevention of recurrent gastroduodenal intussusception. To our knowledge, there have been no other reports describing a gastric gastrointestinal stromal tumor presenting with gastroduodenal intussusception and treated using an endoscopic submucosal dissection technique.
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Affiliation(s)
- Kenji Yamauchi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | | | - Makoto Narita
- Department of Pathology, Kameda Medical Center, Japan
| | - Nobuto Hirata
- Department of Gastroenterology, Kameda Medical Center, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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25
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Recurrent Intussusception due to Multiple Intestinal Metastases From Lung Adenocarcinoma. Int Surg 2016. [DOI: 10.9738/intsurg-d-15-00322.1] [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
Metastasis to the small intestine presents occasionally as multiple lesions and is associated with numerous complications. However, metastasis-induced intussusception in adults is a rare phenomenon. We report a case of recurrent intussusception induced by metastatic lesions from lung cancer. A 54-year-old male was referred to our hospital with intermittent lower right abdominal pain. Chest computed tomography (CT) revealed a mass, suggesting lung cancer, and abdominal CT showed characteristic target-shaped lesions highly suggestive of enteric intussusception in the ileum. The patient underwent segmental resection of the intussuscepted ileum, and analysis of the resected specimen identified a poorly differentiated adenocarcinoma that was pathologically and immunohistologically identical to the lung specimen obtained by percutaneous needle biopsy. Although the symptoms transiently resolved after surgery, intussusception recurred 3 weeks later, and the patient died 28 days after surgery. Multiple metastatic lesions should be considered in adult intussusception, particularly in patients with a history of malignancy.
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26
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Kim JS, Lim JH, Jeong JH, Kim WS. [Conservative management of adult small bowel intussusception detected at abdominal computed tomography]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 65:291-6. [PMID: 25998975 DOI: 10.4166/kjg.2015.65.5.291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS The incidence of adult small bowel intussusception detected at CT has increased with advanced imaging techniques and universal utilization of CT scan. We aimed to identify factors that could predict the necessity of surgical intervention in adult patients with small bowel intussusception detected at CT during the past decade. METHODS There were 39 cases of adult small-bowel intussusception detected at CT from January 2004 to June 2014. The data on clinical factors, radiological factors and outcomes were collected by retrospectively reviewing all available medical records. Patients were classified as surgical group and conservative group according to the outcome. Association between predictive factors and outcome was assessed by Fisher's exact test and logistic regression models. RESULTS Among a total of 39 patients, there were 32 patients (82%) in the conservative group and 7 patients (18%) in the surgical group. Spontaneous reduction was confirmed at short-term follow-up studies (abdominal ultrasonography [n=14], single contrast small bowel series [n=14], CT [n=4]) in the conservative group. No recurrence occurred during the median follow-up period of 14.1 months (range, 0-67.5 months). Patients in the surgical group had significantly higher white blood cell (WBC) counts (OR 1.001, p=0.048), more frequent obstruction (n=4 vs. n=4, p=0.022) or leading point (n=5 vs. n=0, p<0.001) and longer intussuception length (OR 1.929, p=0.032). CONCLUSIONS Factors associated with the necessity to resort to surgical intervention in adults with small bowel intussusceptions were higher WBC counts, presence of obstruction or leading point, and longer intussuception length. Conservative management can be considered with short-term follow-up for those without these predictive factors.
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27
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Yildiz MS, Doğan A, Koparan IH, Adin ME. Acute Pancreatitis and Gastroduodenal Intussusception Induced by an Underlying Gastric Gastrointestinal Stromal Tumor: A Case Report. J Gastric Cancer 2016; 16:54-7. [PMID: 27104028 PMCID: PMC4834622 DOI: 10.5230/jgc.2016.16.1.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 01/08/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal system and comprise only 1% to 3% of all gastrointestinal tract tumors, with the majority of them arising in the stomach. In this report, we present the unique findings of a case of gastroduodenal intussusception caused by an underlying gastric GIST and complicated with severe acute pancreatitis.
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Affiliation(s)
| | - Ahmet Doğan
- Department of General Surgery, Dunya Hospital, Batman, Turkey
| | | | - Mehmet Emin Adin
- Department of Radiology, Silvan Dr. Yusuf Azizoğlu Hospital, Diyarbakır, Turkey
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28
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Hombal P, Uppin VM, Koujalagi RS. Intussusception by Villous Adenoma of the Appendix. Indian J Surg 2016; 77:1391-2. [PMID: 27011572 DOI: 10.1007/s12262-013-1027-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/17/2013] [Indexed: 11/26/2022] Open
Abstract
Appendiceal intussusception is an uncommon pathologic condition; however, villous adenoma of the appendix is a distinctly rare entity. We report herein a case of appendiceal intussusception induced by villous adenoma.
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Affiliation(s)
- P Hombal
- Department of General Surgery, Jawaharlal Nehru Medical College, KLE University, H. NO 39, 2nd Main, 2nd Cross, Sadashivnagar, Belgaum India
| | - V M Uppin
- Department of General Surgery, Jawaharlal Nehru Medical College, KLE University, H. NO 39, 2nd Main, 2nd Cross, Sadashivnagar, Belgaum India
| | - R S Koujalagi
- Department of General Surgery, Jawaharlal Nehru Medical College, KLE University, H. NO 39, 2nd Main, 2nd Cross, Sadashivnagar, Belgaum India
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29
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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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30
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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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31
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Aref H, Nawawi A, Altaf A, Aljiffry M. Transient small bowel intussusception in an adult: case report with intraoperative video and literature review. BMC Surg 2015; 15:36. [PMID: 25881028 PMCID: PMC4416349 DOI: 10.1186/s12893-015-0020-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/17/2015] [Indexed: 11/25/2022] Open
Abstract
Background The term intussusception refers to invagination of a segment of the gastrointestinal tract into the lumen of an adjacent segment. This is a rare entity and it is more prevalent in children and less common in adults. The diagnosis of intussusception in adults is difficult as a result of the nonspecific signs and symptoms. As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. The laparoscopic approach offers both a diagnostic option and a therapeutic one for intussusception in adults. Case presentation We report a forty-one year old male patient, who presented to our Emergency Department complaining of peri-umbilical pain associated with nausea and vomiting for 1 day. Diagnosed with transient small bowel intussusception without any obvious underlying pathology. This report is the first to present an intra-operative video showing the small bowel intussuscepting and reducing spontaneously. Furthermore, the authors present a review about this rare condition, including previously reported similar cases in literature. Conclusion Transient intussusception is extremely rare and is a challenging condition. Imaging techniques, especially CT scan, are helpful in the diagnosis of intussusception. However, laparoscopy offers the advantage of distinguishing transient intussusception from persistent intussusception. Electronic supplementary material The online version of this article (doi:10.1186/s12893-015-0020-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hager Aref
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abrar Nawawi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulmalik Altaf
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Murad Aljiffry
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Nevo Y, Lebedyev A, Nevler A. Ileo-colonic intussusception. ANZ J Surg 2015; 85:786-7. [PMID: 25766499 DOI: 10.1111/ans.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yehonatan Nevo
- Department of General Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Alexander Lebedyev
- Department of General Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Avinoam Nevler
- Department of General Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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33
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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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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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Chahla E, Kim MA, Beal BT, Alkaade S, Garrett RW, Omran L, Ogawa MT, Taylor JR. Gastroduodenal Intussusception, Intermittent Biliary Obstruction and Biochemical Pancreatitis due to a Gastric Hyperplastic Polyp. Case Rep Gastroenterol 2014; 8:371-6. [PMID: 25685129 PMCID: PMC4322696 DOI: 10.1159/000369548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We present the case of a 76-year-old man with gastroduodenal intussusception secondary to a gastric hyperplastic polyp. Intussusception in the adult population occurs infrequently. Our patient presented with gastroduodenal intussusception, which is very uncommon and accounts for <10% of all types of intussusception. This case is unique in that partial endoscopic resection of the gastric hyperplastic polyp resolved the patient's gastroduodenal intussusception, biliary obstruction and biochemical pancreatitis without the need for surgical intervention.
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Affiliation(s)
- Elie Chahla
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Michael A Kim
- Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Brandon T Beal
- Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Samer Alkaade
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Robert W Garrett
- Department of Radiology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Louay Omran
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Michael T Ogawa
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Jason R Taylor
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
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36
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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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37
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Kadowaki Y, Nishimura T, Komoto S, Yuasa T, Tamura R, Okamoto T, Ishido N. Gastroduodenal intussusception caused by a gastric collision tumor consisting of adenocarcinoma and neuroendocrine carcinoma. Case Rep Gastroenterol 2014; 8:89-94. [PMID: 24803892 PMCID: PMC3999580 DOI: 10.1159/000356818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Adenocarcinoma is the most common histological type of gastric tumor. Gastric tumor arising from collision of an adenocarcinoma with a neuroendocrine carcinoma is extremely rare. Moreover, this uncommon gastric collision tumor in our case had prolapsed into the duodenum. A 77-year-old woman was admitted to our hospital complaining of vomiting and severe weight loss. Abdominal X-ray showed gastric distension, and computed tomography revealed a duodenal giant mass spreading from the bulb to the horizontal part of the duodenum. Upper gastrointestinal endoscopy was not helpful in confirming the diagnosis of the tumor. We suspected duodenal malignant tumor and performed laparotomy. The operative findings indicated that the gastric antrum was deeply invaginated into the duodenum because of the gastric tumor. Partial resection of the stomach and duodenum was performed because the tumor was irreducible. Intraoperative diagnosis of the frozen section was well-differentiated adenocarcinoma and undifferentiated carcinoma. Additional distal gastrectomy with lymphadenectomy was performed. We herein report the first case of gastroduodenal intussusception caused by a gastric collision tumor consisting of well-differentiated adenocarcinoma and poorly differentiated neuroendocrine carcinoma.
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Affiliation(s)
| | | | - Satoshi Komoto
- Department of Surgery, Kobe Red Cross Hospital, Kobe, Japan
| | - Takeshi Yuasa
- Department of Surgery, Kobe Red Cross Hospital, Kobe, Japan
| | - Ryuji Tamura
- Department of Surgery, Kobe Red Cross Hospital, Kobe, Japan
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38
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Is Surgery Always Necessary in Patients with Abdominal Pain and Computed Tomography-suggested Intussusception? Am Surg 2014. [DOI: 10.1177/000313481408000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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Abstract
Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into an adjacent distal segment. This rare form of bowel obstruction occurs infrequently in adults. We report a case of small bowel intussusception in an adult male patient. We have also performed a literature review of this rare condition.
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Affiliation(s)
- J Potts
- South Tyneside NHS Foundation Trust, UK
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40
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Gastroduodenal intussusception of a gastrointestinal stromal tumor (GIST): case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2013; 23:e70-3. [PMID: 23579533 DOI: 10.1097/sle.0b013e31826d72d4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in adults. They frequently occur in the stomach. Gastric GISTs typically present as a gastrointestinal bleed but can sometimes cause obstructive symptoms such as nausea and vomiting. We present a patient with a gastric GIST and liver metastases who during treatment with iminitab therapy presented with an acute gastric outlet obstruction. A computed tomography scan revealed a gastroduodenal intussusception of the gastric GIST. The patient underwent a laparoscopic exploration and resection of the GIST. We reviewed the English language literature of GISTs that presented as a gastroduodenal intussusception and put our case in the context of the previously reported cases. We discuss the diagnostic and therapeutic challenges that arise when treating these patients.
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41
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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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42
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LIANOS G, XEROPOTAMOS N, BALI C, BALTOGIANNIS G, IGNATIADOU E. Adult bowel intussusception: presentation, location, etiology, diagnosis and treatment. G Chir 2013; 34:280-3. [PMID: 24629817 PMCID: PMC3926485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bowel intussusception is rare in adults but common in children. Almost 90% of adult intussusceptions are secondary to a pathologic condition and the clinical picture can be very aspecific and challenging. In this review we discuss the symptoms, location, etiology, characteristics, diagnostic methods and treatment strategies of this rare and enigmatic clinical entity in adults. We have to highlight the high index of suspicion that is necessary for the operating surgeon, when dealing with acute, subacute or chronic abdominal pain in adults, because any misinterpretation may result in unfavorable outcomes.
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Affiliation(s)
- G. LIANOS
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - N. XEROPOTAMOS
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - C. BALI
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - G. BALTOGIANNIS
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
| | - E. IGNATIADOU
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece
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43
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Chen JH, Wu JS. Single port laparoscopic right hemicolectomy for ileocolic intussusception. World J Gastroenterol 2013; 19:1489-1493. [PMID: 23538552 PMCID: PMC3602511 DOI: 10.3748/wjg.v19.i9.1489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/27/2012] [Accepted: 12/17/2012] [Indexed: 02/06/2023] Open
Abstract
A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.
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44
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Adult intussusception: a single-center 10-year experience. Eur Surg 2013. [DOI: 10.1007/s10353-012-0188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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45
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Wilson MH, Ayoub F, McGreal P, Collins C. Gastrointestinal stromal tumour presenting as gastroduodenal intussusception. BMJ Case Rep 2012; 2012:bcr-2012-006787. [PMID: 22927285 DOI: 10.1136/bcr-2012-006787] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Gastroduodenal intussusception secondary to gastrointestinal stromal tumour is a very rare cause for intestinal obstruction. The diagnosis of this condition can be challenging, as symptoms are often non-specific and intermittent. This article reports a case where the diagnosis was made preoperatively with abdominal imaging and was treated by a combination of endoscopic reduction and laparoscopic resection.
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Affiliation(s)
- Mark H Wilson
- Department of Surgery, Portiuncula Hospital, Galway, Ireland.
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46
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Onkendi EO, Grotz TE, Murray JA, Donohue JH. Adult intussusception in the last 25 years of modern imaging: is surgery still indicated? J Gastrointest Surg 2011; 15:1699-705. [PMID: 21830152 DOI: 10.1007/s11605-011-1609-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 06/20/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Because most adult intussusceptions are reportedly due to malignancy, operative treatment is recommended. With current availability of computed tomography, we questioned the role of mandatory operative exploration for all adult intussusceptions. METHODS This study is a retrospective review of all adults treated from 1983 to 2008 at a large tertiary referral center for intussusception. RESULTS One hundred ninety-six patients had intussusception over the 25-year study period. Computed tomography was obtained in 60% of patients. Neoplasms [malignant, (21%); benign, (24%)] were the commonest etiology; 30% cases were idiopathic. One hundred twenty (61%) patients underwent operative treatment for intussusception. Six of the 58 idiopathic or asymptomatic cases were operated on with negative findings in all. Palpable mass (OR 4.56, p < 0.035), obstructive symptoms (OR 9.13, p < 0.001) or obstruction (OR 9.67, p < 0.001), GI bleeding (OR 14.41, p < 0.001), and a lead point on computed tomography (OR 10.08, p < 0.001) were associated with the need for operation. CONCLUSION In the current era of computed tomography, idiopathic or asymptomatic intussusception is being seen more commonly; however, the majority of adult intussusceptions still have pathologic lead points. From our experience, all patients with palpable mass, obstructive symptoms or obstruction, gastrointestinal bleeding, or a lead point on computed tomography should undergo operative exploration.
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47
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Basterra Ederra M, Bolado Concejo F, Caballero García P, Oteiza Martínez F. [Giant lipoma-induced colonic intussusception. Laparoscopic management]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:589-90. [PMID: 21930329 DOI: 10.1016/j.gastrohep.2011.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 04/12/2011] [Accepted: 04/20/2011] [Indexed: 10/17/2022]
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Bousseaden A, Afifi R, Essamri W, Benelbarhdadi I, Ajana FZ, Benazzouz M, Essaid A. Adult colocolic intussusception diagnosed by ultrasonography: a case report. J Med Case Rep 2011; 5:294. [PMID: 21736707 PMCID: PMC3155120 DOI: 10.1186/1752-1947-5-294] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 07/07/2011] [Indexed: 01/02/2023] Open
Abstract
Introduction Intussusception is highly uncommon in adults and accounts for only 5% of all reported cases. It is more commonly secondary to an identifiable bowel lesion in 90% of cases, whereas 10% have no discernable cause. Diagnosis is difficult due to non-specific symptoms of the disease. Diagnostic imaging plays an important role in the diagnosis of the condition. Sonography and computed tomography are the most commonly used imaging techniques. In adults, intussusception usually requires treatment by surgical resection of the affected bowel. Case presentation A 35-year-old Moroccan woman presented with a five-month history of intermittent abdominal pain and one episode of bleeding from the rectum. At physical examination an abdominal mass was noted. Abdominal sonography revealed a 6.3 × 8.5 cm midline mass in her upper abdomen that was tender. In transverse section, the mass had the multiple concentric rings of hypoechoic and echogenic layers associated with the sonographic appearance of intussusception. In longitudinal section, the mass had the sonographic aspect of multiple parallel lines, giving the so-called "sandwich appearance". A corresponding contrast-enhanced abdominal computed tomography scan also demonstrated the intussusception. Surgery confirmed a colocolic intussusception with a large, firm, indurated mass as the lead point. A right hemicolectomy was undertaken because of concern about possible malignancy. The resected ascending colon was then opened up, to find a protruding tumor of the ascending colon that was acting as the lead point. It measured 7.6 × 6.9 × 2.4 cm. Pathology diagnosed an infiltrating, differentiated adenocarcinoma of the ascending colon invading through the muscularis propria. No lymphovascular invasion was seen. Our patient has recovered well. Conclusion Intussusception is relatively rare in the adult population, and this, along with the vague clinical features, makes diagnosis difficult. Ultrasonography and computed tomography have been proven to be effective diagnostic modalities. Ultrasonography can be performed quickly and accurately, and is widely available. In adults, intussusception is usually associated with an underlying cause and requires treatment by surgical resection.
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Affiliation(s)
- Amal Bousseaden
- Department of Gastroenterology, Medical Clinic, University Hospital Ibn Sina, Rabat, Morocco.
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49
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Laparoscopic resection of ileal lipoma diagnosed by multidetector-row computed tomography. Surg Laparosc Endosc Percutan Tech 2011; 20:e226-9. [PMID: 21150408 DOI: 10.1097/sle.0b013e3182002ac4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Intussusception is rare in adults and it is difficult to diagnose on admission. We present the case of a 43-year-old woman with the chief complaint of nausea and upper abdominal pain. Abdominal multidetector-row computed tomography showed ileo-ileal small bowel intussusception with an intraluminal soft tissue mass with attenuation numbers suggestive of a lipoma. The patient was treated with a laparoscopic-assisted extracorporeal partial resection of the small bowel including ileal lipoma, followed by a functional end-to-end anastomosis. Histologic diagnosis of the resected tumor, 2.4×2.0×2.0 cm, was an intestinal lipoma. This case serves as the basis of a review of small bowel intussusception in adults secondary to lipomas. It focuses on the utility of multidetector-row computed tomography and the cosmetic, physical, and economic benefits of laparoscopic surgery as well as the rarity of the disease.
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50
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Gupta RK, Agrawal CS, Yadav R, Bajracharya A, Sah PL. Intussusception in adults: institutional review. Int J Surg 2010; 9:91-5. [PMID: 20951844 DOI: 10.1016/j.ijsu.2010.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 09/24/2010] [Accepted: 10/02/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objectives were to review adult intussusception (AI), its diagnosis and treatment. BACKGROUND DATA Intussusception is a different entity in adults than it is in children. AI represents 1% of all bowel obstructions, 5% of all intussusceptions. METHODS The records of all patients, 18 years and older, with the postoperative diagnosis of intussusception at the B.P.K.I.H.S during the years 2003-2009 were reviewed retrospectively. RESULTS In six years, there were thirty-eight patients of surgically proven AI. The patients' mean age was 49.6 years, M:F ratio was 1.3:1. Intestinal obstructions of various extents were the commonest presentation in twenty-seven patients (71%). There were 42% enteric, 32% ileocolic and 26% colonic AI. The diagnostic accuracy of the ultrasonography was 78.5%, CT scan was 90% and colonoscopy was 100%. The pathological lesions were found in 94% of AI. Among the pathological lesion, enteric have 62% benign, 38% malignant, ileocolic have 50% benign, 50% malignant, and in colocolic 70% malignant, 30% benign. In enteric AI, 68% were reduced successfully, 25% reduction was not attempted. Of ileocolic AI, 58.3% were reduced successfully, 41.6% had resection without reduction. Of colocolic AI, 30% of them were reduced successfully before resection, 70% had resection without reduction. CONCLUSIONS AI is a rare entity and requires a high index of suspicion. CT scanning proved to be the most useful diagnostic radiologic method. Colonoscopy is most accurate in ileocolic and colonic AI. The treatment of adult intussusception is surgical. Our review supports that small-bowel intussusception should be reduced before resection if the underlying etiology is suspected to be benign or if the resection required without reduction is deemed to be massive. Large bowel should generally be resected without reduction because pathology is mostly malignant.
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Affiliation(s)
- Rakesh Kr Gupta
- Gastrointestinal (GI) Unit, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
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