Adult intussusception: case reports and review of literature

Adult ileo cecal intussusception as a manifestation of colon carcinoma: A case report

BACKGROUND

Intussusception is the invagination of a segment of the bowel into an adjacent segment. It is the most common cause of intestinal obstruction in children, but in adults, it is rare, accounting for 1% of all intestinal obstructions and 5% of all intussusceptions, with malignancy being the most common cause. In the past, it was typically diagnosed intraoperatively. However, with the availability of computed tomography for abdominal imaging, recognizing the condition's signs has become crucial. Surgical intervention is essential for managing neoplastic cases and their complications.

CASE SUMMARY

A 45-year-old female presented with severe abdominal pain encompassing her entire abdomen, abdominal distension, vomiting, and persistent constipation. Over the past two months, she has also experienced considerable weight loss. After an initial history review, examination, and imaging investigations, the patient was diagnosed with ileo cecal intussusception resulting from a colo rectal mass located in the cecum and ascending colon. This condition was surgically managed through an extended right hemi colectomy.

CONCLUSION

Intussusception is uncommon in adults, but it should be considered in patients with intestinal obstruction. Surgical intervention is essential.

Nonobstructive gastroduodenal intussusception characterized by severe anemia: a case report

Gastroduodenal intussusception is a relatively rare condition in adults and is typically caused by mobile pedunculated submucosal tumors arising from the stomach. Its clinical presentation often includes nonspecific signs of gastric outlet obstruction, such as nausea, vomiting, abdominal pain, epigastric fullness, or abdominal distention. We report a case of gastroduodenal intussusception in a 38-year-old woman who presented with severe anemia but no symptoms of gastric outlet obstruction. The preoperative diagnosis was established through esophagogastroduodenoscopy and computed tomography of the abdomen, and it was confirmed during surgery. Postoperative pathology and immunohistochemistry identified the tumor as a gastric leiomyoma.

Adult gastro-gastric intussusception; a case report

INTRODUCTION AND IMPORTANCE

Intussusception in the proximal bowel is extremely rare, with only a few reported cases of gastroduodenal intussusception (GDI). Gastrogastric intussusception is the rarest form of intussusception in adults. Here, we present an exceptionally rare case of gastro-gastric intussusception caused by a gastric Gastrointestinal Stromal Tumor (GIST).

CASE PRESENTATION

A 36-year-old male presented with acute abdominal pain, suggestive of intussusception. The preoperative evaluation was unable to pinpoint the exact location or cause of the intussusception.

CLINICAL DISCUSSION

Intraoperative diagnosis of gastro-gastric intussusception was made, and the patient was treated with a gentle reduction of the intussusception, followed by a distal gastrectomy with Billroth I anastomosis. He was relieved of his symptoms and has been recurrence-free for the past two years.

CONCLUSIONS

Gastro-gastric intussusception is an exceedingly rare type of foregut intussusception, which presents with non-specific clinical presentation and commonly occurs in the presence of an underlying pathology. A delay in diagnosis and treatment may be fatal, so a high index of suspicion and early surgical management is paramount.

Exploring the Infectious Contribution to Intussusception Causality Using the Effects of COVID-19 Lockdowns in Australia: An Ecological Study

BACKGROUND

Intussusception is the primary cause of acute bowel obstruction in infants. The majority of cases <2 years of age are classed as idiopathic, with viral infection implicated as one of the causes. Coronavirus disease 2019 (COVID-19) public health measures led to significant decreases in communicable disease prevalence. During these times, reductions in intussusception frequency were greater than would be expected with our previous understanding of its infectious etiology.

METHODS

We conducted a retrospective, multistate, ecological study over a 12-year period. Monthly case numbers of "intussusception"-coded admissions (code K56.1; International Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) were acquired from state-wide admissions data sets from New South Wales, Victoria, and Queensland, representing 77.62% of the eligible Australian population. These counts within differing jurisdictional lockdowns were compared with non-lockdown periods in order to investigate a correlation between intussusception frequency and lockdown periods.

RESULTS

We found a negative association between intussusception frequency and lockdown periods in both eligible states. The largest reductions were seen in the <2-year age groups, with Victoria experiencing a 62.7% reduction (rate ratio, 0.37; P < .001) and New South Wales a 40.1% reduction (0.599; P = .006) during lockdown times. Controls for variations in lockdown restrictions between both regional and metropolitan areas also showed expected decreases.

CONCLUSIONS

Our ecological study demonstrates significant decreases in the frequency of pediatric intussusception admissions during the COVID-19 lockdown periods. The unexpected magnitude of the reductions suggests that the true proportion of infectious disease-caused idiopathic intussusception is greatly underestimated.

Case report: Rare benign colorectal intussusception due to rectal polyp treated non operatively

INTRODUCTION AND IMPORTANCE

Intestinal intussusception is rare in adults, involving telescoping of one intestinal segment into another. Commonly associated with colonic lesions, it presents as acute obstruction. Diagnosis relies on CT. We report a rare case of colorectal intussusception due to a polyp, managed by endoscopic polypectomy.

CASE PRESENTATION

We present a case of a 74-year-old man with chronic constipation, who presented with acute abdominal pain, vomiting, and cessation of bowel movements. Hemodynamically stable, he had a distended abdomen. We diagnosed acute bowel obstruction secondary to colorectal intussusception via CT scan. Surgery was planned after resuscitation. However, after induction of general anesthesia, the procedure was postponed due to a significant diarrheal episode and resolution of the abdominal distension. A subsequent colonoscopy revealed a 10 mm polyp, which was excised endoscopically. The patient's recovery was smooth, with no recurrence after a one-year follow-up.

CLINICAL DISCUSSION

Intestinal intussusception, rare in adults, primarily affects the small intestine but may involve the colon, often associated with organic lesions or postoperative adhesions. While colocolonic intussusceptions, mostly malignant, may stem from benign causes occasionally, symptoms are nonspecific, with common pain. Diagnosis relies on CT scans, with surgery typically required, except in select cases.

CONCLUSION

Colorectal intussusception, rare in adults, may necessitate laparotomy. Spontaneous symptom resolution enables conservative management. Clinician awareness is vital to prevent unnecessary and risky surgeries, given its rarity and potential for favorable outcomes sans intervention.

Adult Ileocolic Intussusception Secondary to Cecal Lipoma: A Case Report

Large intestinal intussusception is rare in adults. Among potential pathologic lead points for intussusception are lipomas, benign tumors very infrequently found in the large bowel. A 30-year-old woman presented to the emergency department with a chief complaint of generalized abdominal pain for two weeks. A computed tomography scan of her abdomen and pelvis showed an ileocolic intussusception with a lead point of 6.7 cm. The lead point appeared to be predominantly fat. A colonoscopy revealed a large, obstructing lesion in the transverse colon. The patient underwent exploratory laparotomy with a right hemicolectomy, and a pathologic diagnosis of a lipoma was made. The patient recovered from surgery without complications and returned to her normal diet three weeks after discharge. This case highlights an unusual and rare presentation of an ileocolic intussusception caused by a cecal lipoma acting as a lead point.

Small bowel intussusception - aetiology & management

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.

Adult colorectal intussusception caused by giant lipoma-A case report

Key Clinical Message

Adult intussusception commonly has a leading point. In the colon, malignancy is a prevalent etiology for the leading point; however, benign tumors should also be considered. We present a case of colorectal intussusception caused by a giant lipoma.

Abstract

Intussusception in adults is comparatively infrequent in contrast to children, and in adult colonic intussusception, malignancy is the predominant cause of the leading point. Lipoma, an uncommon tumor in the gastrointestinal tract, rarely induces colonic intussusception in adults. We present the case of a 55-year-old Cambodian man experiencing cramping abdominal pain. He presented with mild abdominal distension with tenderness in the lower abdomen. On the rectal examination a large palpable mass was detected three to four centimeters from the anal verge. Abdominal computerized tomography revealed a collapsed sigmoid colon with mesenteric fat invaginated into the lumen of the upper rectum. Emergency laparotomy was performed and during the surgery the sigmoid intussusception spontaneously reduced. A mass was identified in the mid-sigmoid colon, leading to the decision for segmental resection of the sigmoid colon with the mass and subsequent end-to-end anastomosis. Histological examination results confirmed the mass as a lipoma. Colorectal intussusception in adults due to a lipoma is a relatively rare, with only a few reported cases in the literature.

Ileocecal colonic intussusception with adenocarcinoma: A rare case report and management strategy

INTRODUCTION AND IMPORTANCE

Intussusception, a condition primarily seen in pediatric populations, involves the telescoping of one segment of the bowel into an adjacent section. In adults, intussusception is rare and presents unique diagnostic and management challenges. This case report highlights a 73-year-old female with ileocecal colonic intussusception complicated by an underlying adenocarcinoma, emphasizing the need for early diagnosis and a multidisciplinary approach.

CASE PRESENTATION

A 73-year-old female with a history of hypertension and type 2 diabetes presented with right-sided abdominal pain, nausea, and vomiting. Physical examination revealed tenderness in the right upper quadrant, and no palpable mass or rectal bleeding. Lab results, including tumour markers, were normal. Multi-detector computed tomography (MDCT) identified ileocecal colonic intussusception with the "target sign" and low colonic wall enhancement. An emergency laparoscopic right colectomy was performed due to compromised blood supply. Postoperatively, an anastomotic leak was managed with antibiotics, bowel rest, and wound care. Pathological examination revealed cecal adenocarcinoma with one positive lymph node, staged as T3N1aM0, necessitating adjuvant chemotherapy.

CLINICAL DISCUSSION

Adult intussusception, a rare condition, often has an identifiable organic cause, with clinical symptoms ranging from acute to chronic or asymptomatic. Diagnostic imaging, such as MDCT, plays a crucial role in diagnosis and evaluation. Surgical management varies based on the nature and location of the lead point. In this case, the chronic symptoms, lymph node as the lead point, and low colonic wall enhancement warranted an urgent laparoscopic right colectomy with complete mesocolic excision.

CONCLUSION

This case underscores the complexity of adult ileocecal colonic intussusception, especially when associated with adenocarcinoma. Timely diagnosis, multidisciplinary collaboration, and meticulous surgical intervention are essential. Effective management of postoperative complications, like the anastomotic leak, is crucial.

A Case of Long-Tract Ileocolic Intussusception Secondary to Well-Differentiated Cecal Adenocarcinoma

Intussusception denotes the intricate phenomenon wherein one segment of the bowel undergoes invagination or telescoping into its contiguous distal segment. The ensuing invaginated segment may be propelled forward through peristaltic movements, potentially precipitating bowel obstruction or ischemia, culminating in necrosis of the affected bowel segment. Although the precise etiology of intussusception remains elusive, particularly in cases devoid of an identifiable lead point, dysrhythmic contractions and lymphoid hyperplasia have been implicated in the pathophysiology of this condition. We present the case of an 86-year-old African American female with a past medical history of hypertension and asthma who presented to our emergency room with a seven-day history of worsening abdominal. The pain was described as sharp and intermittent, and it would worsen with every meal or drink. A physical exam demonstrated the right lower quadrant with vague abdominal tenderness, especially below the umbilical region. Computed tomography of the abdomen and pelvis revealed a long segment of ileocolic obstructing intussusception in the ascending colon, with a 2.6 cm solid mass serving as a lead point. Swift intervention ensued with an urgent exploratory laparotomy, culminating in a right hemicolectomy to excise the intussuscepted segment of the bowel. The pathological examination identified a well-differentiated adenocarcinoma of the cecum, categorized as T1N0M0, with all 20 resected lymph nodes yielding negative results. This illustrative case presents a unique insight into a patient with ileocolic obstructing intussusception, caused by a well-differentiated adenocarcinoma acting as the lead point, a relatively uncommon occurrence in adults. Diagnosing intussusception in adults is challenging due to its nonspecific symptoms, which are similar to those of various other gastrointestinal disorders. Therefore, it is crucial for medical providers to be acutely aware of the possibility that adenocarcinoma can trigger obstructing intussusception in various parts of the bowel.

Burkitt Lymphoma Presenting as Ileocolic Intussusception in an Adult

Adult intussusception is rare, highly associated with a malignant lead point, and often requires emergent surgical management. We report the case of a 44-year-old male who presented with generalized abdominal pain and was found to have early ileocolic intussusception secondary to a large ileocecal mass. Biopsies of the mass and an enlarged cardiophrenic lymph node, as well as pleural fluid cytology were all consistent with Burkitt lymphoma (BL). Curiously, the patient's abdominal exam was reassuring, and the intussusception and malignant bowel obstruction resolved over 36 hours with conservative management alone. With a Burkitt lymphoma international prognostic index (BL-IPI) score of 2, the patient proceeded to treatment with combination chemoimmunotherapy and attained a complete response after four cycles. There was no bowel perforation or recurrent intussusception throughout treatment. Thus, this report marks the first reported case of adult BL-associated intussusception to resolve with non-invasive management and establishes a precedent for conservative management in select patients.

Management of Colonic Emergencies

The etiology of colonic emergencies includes a wide-ranging and diverse set of pathologic conditions. Fortunately, for the surgeon treating a patient with one of these emergencies, the surgical management of these various causes is limited to choosing among proximal diversion, segmental colectomy with or without proximal diversion, or a total abdominal colectomy with end ileostomy (or rarely, an ileorectal anastomosis). The nuanced complexity in these situations usually revolves around the nonsurgical and/or endoscopic options and deciding when to proceed to the operating room.

Intussusception in Incisional Hernia: A Case Report and Literature Review

Intussusception in adults is a rare condition. Most frequently, intussusception involves the small intestine and, very rarely, the large intestine. In this report, we present the case of a 79-year-old male who was admitted with symptoms and signs of bowel obstruction due to an incarcerated incisional hernia (a tender irreducible incisional hernia associated with nausea and vomiting). His CT scan confirmed intussusception in his incisional hernia, showing the target sign. An emergency laparotomy, small bowel resection, and anastomosis were done. The histopathology report revealed the cause of intussusception to be a polypoid small bowel B cell lymphoma. It is necessary to excise the affected bowel segment in order to treat adult intussusception because it is commonly associated with malignant organic lesions. Computed tomography is the most sensitive imaging modality for intussusception; thus, we must consider a low threshold for a scan for patients presenting with abdominal pain.

Colonic Lipoma: A Rare Cause of Intussusception

The most common and challenging chief complaint in the emergency department is abdominal pain. Intussusception, although rare in adults, is an important etiology to consider. The diagnosis is often delayed because of the nonspecific symptoms, especially in adults. This case highlights a rare case of intussusception in a middle-aged male with a colonic lipoma as a leading point. Endo-loop was applied to the colonic lipoma, leading to the resolution of intussusception. Therefore, this can be an effective alternative to surgery in select cases.

Ileocecal intussusception as presentation for ascending colon carcinoma. Case report

INTRODUCTION AND IMPORTANCE

Intussusception is described as invagination of a segment of the bowel into the lumen of an adjacent segment. Although it is the most frequent cause of intestine obstruction during childhood, it is unusual in adulthood, where intussusception represents 1% of all intestine obstructions and 5 % of all intussusceptions.

CASE PRESENTATION

A 64-year-old female presented with a history of weight loss, intermittent diarrhea, and occasional transrectal bleeding. An abdominal computed tomography (CT scan) was performed showing a neoproliferative appearance and associated intussusception of the ascending colon. Colonoscopy revealed an ileocecal intussusception and a tumor on the ascending colon. Right hemicolectomy was performed. Histopathological findings were consistent with colon adenocarcinoma.

CLINICAL DISCUSSION

Adults have an organic lesion within the intussusception in up to 70 % of cases. The clinical presentation of intussusception can vary significantly between children and adults, who will often exhibit chronic nonspecific symptoms including nausea, changes in bowel habits, and gastrointestinal bleeding. The imaging diagnosis of intussusception is a difficult subject, the basis for the diagnosis is a high index of clinical suspicion and noninvasive techniques.

CONCLUSION

Intussusception is an extremely rare condition in adults, in this age group, the malignant entity is one of the main etiologies. Intussusception continues to be a rare entity and should be considered as a differential diagnosis of chronic abdominal pain and intestinal motility disorders; the treatment of choice continues to be surgical.

Adenocarcinoma of the sigmoid colon causing sigmoido-rectal intussusception: A rare entity in adults

INTRODUCTION

Intussusception occurs when a more proximal portion of the bowel (intussusceptum) invaginates into the more distal bowel (intussuscipiens). The pathomechanism is thought to involve altered bowel peristalsis at the intraluminal lesion, which is then a lead point for the intussusceptum. Intestinal intussusception is rare in adults, accounting for approximately 1 % of all bowel obstructions. We report a unique case in which a partially obstructing sigmoid cancer caused full thickness rectal prolapse requiring surgical intervention.

PRESENTATION OF CASE

A 75-year-old male presented in the emergency department due to anal haemorrhage for 5 days. On clinical examination his abdomen was distended with signs of peritoneal irritation in the right quadrants. The CT scan showed sigmoid-rectal intussusception with an sigmoid colonic tumour. The patient underwent emergency anterior resection of the rectum without reduction of the intussusception. Histological examination revealed a sigmoid adenocarcinoma.

DISCUSSION

Intussusception is the most common urgent situation among the pediatric population but its incidence in adults is very rare. The diagnosis is difficult to establish with history and physical exam findings alone. Since in adults, unlike children, in most cases a malignant pathology acts as a lead point, the treatment of this pathology still reserves doubts. Recognizing and understanding pertinent signs, symptoms, and imaging findings is essential to the early diagnosis and appropriate management of adult intussusception.

CONCLUSION

The appropriate management of adult intussusception is not always clear cut. There is controversy about the reduction before resection in cases of sigmoidorectal intussusception.

A Case of Jejuno-Jejunal Intussusception Caused by Underlying Metastatic Melanoma

Intussusception in adults is a rare finding with a majority of cases occurring in the pediatric population. It occurs infrequently and its presentation, etiology, and treatment differ from childhood intussusception. When discovered in adults, it raises suspicion for a neoplastic process serving as the pathological lead point. Cross-sectional imaging is the primary study of choice for diagnosis, but at times, a more invasive approach involving an exploratory laparotomy is required posing an increased risk for morbidity and mortality. Here we present a 64-year-old male who was found to have jejunal-jejunal intussusception that was surgically removed with pathology revealing metastatic melanoma as the lead point. This case highlights a unique presentation of a melanoma that was previously eradicated with immunotherapy and now had metastasized to the intestine many years later.

Relapse of melanoma presenting as jejunal intussusception

Melanoma is a relatively rare tumour with tendency to metastasize to the gastrointestinal tract. Metastasis to the intestine constitutes a majority of the gastrointestinal tract melanoma metastases and confers a poor prognosis. While post-mortem studies detect that more than half of the melanoma patients have gastrointestinal tract metastasis, only minority are diagnosed, and even rarer present with intussusception. Intussusception, mainly a paediatric entity, is also seen among adult patients with underlying inflammatory bowel disease or tumour. In this report, we describe a patient with a melanoma in remission who presented with intestinal obstruction after months of vague abdominal complaints. Laparotomy revealed jejunal intussusception and histopathological staining confirmed the melanoma diagnosis. No other distant metastases other than the jejunum were revealed after extensive investigation.

Case Report: A Closed Loop Obstruction Secondary to Idiopathic Small Bowel Intussusception in an Elderly Woman

Intussusception is primarily a disease of children and is the primary cause of intestinal obstruction in the pediatric age group. It accounts for around 5-16% of cases of intestinal obstruction in adults of the western population. Most cases of adult intussusception (up to 90%) are secondary to an identified structural lesion or a lead point contrary to pediatric intussusception. Adults with intussusception present with subacute or chronic symptoms of partial obstruction. CT is the best imaging to make a preoperative diagnosis of adult intussusception. The standard treatment for adult intussusception is surgery, and non-operative reduction should not be attempted. Here, we present a rare case of idiopathic small bowel intussusception in a 50-year-old woman. She presented with crampy abdominal pain for one-week duration. It was associated with frequent vomiting of bilious matter. She claimed to have had similar symptoms for the past 2 months and had repeatedly visited nearby health facilities. She had an abdominal CT, which suggested a complicated small bowel intussusception. Exploratory laparotomy was done, and there was a small bowel intussusception and an inflammatory stricture at the end of the intussusceptum, which is believed to form a closed-loop like obstruction. The intussusceptum was resected en-bloc then end-to-end jejuno-jejunal anastomosis was performed. This case report makes physicians aware of this rare condition in adults. So that they have a high index of suspicion when a patient presents with symptoms of subacute or chronic intestinal obstruction and inform that abdominal CT should be done in these circumstances and surgery is the mainstay of treatment. Our case is unique, and there is no report in the literature similar to ours.

Sigmoid lipoma as an exceptional cause of intussusception and bowel obstruction in adults: A case report and review of literature

Acute intestinal intussusception in adults is a rare condition, most often secondary to an organic lesion (tumor or inflammation), representing 1%-5% of intestinal obstructions. Pure colic intussusception on lipoma rectal causing bowel obstruction is an exceptional situation. A 60-year-old man presented to the emergency department for acute abdominal pain with marked abdominal distention and red rectal bleeding. A contrast-enhanced abdominal CT scan was performed, which revealed a recto-sigmoid intussusception on lipoma, causing mechanical intestinal obstruction. The patient underwent a partial reduction of the intussusception with partial sigmoid resection and end colostomy. Colonic lipomas of the recto-sigmoid region represent a very rare condition and a subsequent etiology for intussusception and bowel obstruction in adults. However, it should be considered in the differential diagnosis of such situations.

Case report: An adult intussusception caused by ascending colon cancer

Adults with bowel intussusception caused by malignant tumors are fairly uncommon. We presented a case of a 64-year-old woman whose intussusception was secondary to ascending colon cancer. A color Doppler ultrasonography of the abdomen revealed a low echo mass in the right middle abdomen. Physical examination and digital rectal examination were both unremarkable. Computed tomography (CT) revealed a concentric circle change in the colon, as well as the mesenterium and arteries. Electronic colonoscopy discovered the colonic giant proliferative lesions and stenosis. Adenocarcinoma with moderate differentiation was discovered after a biopsy. Then laparotomy showed intussusception and the tumor was located in the ascending colon. The postoperative pathological test revealed moderately differentiated adenocarcinoma in the right colon invaded the whole layer. After hospitalization, the patient was discharged without any complications. This case highlights that rational use of CT, endoscopy, and timely surgery combines an effective strategy for the treatment of adult intussusception.

Intussusception of the bowel in a young woman: A case report

Intussusception is a condition in which a segment of the gastrointestinal tract invaginates into the lumen of another segment. Adult intussusception is less common than juvenile intussusception in terms of cause, appearance, and treatment. Because the clinical picture can be quite atypical and difficult to interpret, it is frequently misdiagnosed at first. Herein, we report the case of a previously healthy 23-year-old female patient who presented to the Emergency Department (ED) with acute abdominal pain, vomiting, and diarrhea for 1 day following her last menstrual period. Ileocecal intussusception was discovered throughout the investigation. She was rushed for open abdominal surgery. Meckel's diverticulum was found as a pathologic lead point in the resected specimen, with no evidence of malignancy. Although intussusception is rare in adults, it should be considered in patients who have nonspecific stomach pain.

Cachexia and Invisible Stomach on Endoscopy: An Endoscopist's Enigma and a Surgeon's Axiom

Gastroduodenal intussusception (GDI) is a very rare clinical entity in adults. GDI can present acutely or chronically in adults with varying spectrum of symptoms and signs. GDI can present acutely with abdominal pain, vomiting and palpable mass. In rare instances it can lead to anemia and cachexia. Computed tomography (CT) of the abdomen can demonstrate GDI in majority of cases. However, endoscopy findings could lead to identifying etiological factor and tissue diagnosis. In majority of the cases endoscopy may show mucosal or submucosal lesion leading to GDI. We bring forward a case of GDI wherein patient presented with cachexia, intermittent vomiting along with anemia. Further workup including imaging has resulted in the rare diagnosis of GDI. Interestingly we encountered a rare of its kind, endoscopic presentation where there was total absence of stomach due to its complete invagination through the pylorus into the duodenum arising from a giant gastric hyperplastic polyp. We have successfully managed this patient with surgical intervention leading to positive clinical outcomes. On review of literature, we found that it is extremely rare to have a completely absent stomach on endoscopy in a patient with no previous surgical intervention. We would like to share our experience so that endoscopists are aware of such uncommon and interesting presentations. To the best of our knowledge, such a case has not been reported so far in literature.

Colocolic intussusception secondary to colonic adenocarcinoma with impending caecal perforation in an elderly patient: A rare case report

Introduction

Intussusception is a surgical emergency in which a part of the intestine slides into the distal adjacent part. Adult colocolic intussusception secondary to a tumoral process is a rare but serious clinical condition requiring immediate surgical intervention.

Case presentation

We report a case of a 65-year-old male patient presenting with abdominal pain and distention, subsequently diagnosed with colocolic intussusception in the descending colon with closed-loop bowel obstruction with impending caecal perforation. An exophytic mass on the descending colon was discovered intra-operatively, prompting a subtotal colectomy with ileosigmoidal anastomosis and loop ileostomy with the suspicion of malignancy. The histopathological examination of the surgical specimen concluded a moderately-differentiated colonic adenocarcinoma with 40% mucinous component.

Clinical discussion

Adult intestinal intussusception is a rare but serious condition differing greatly in etiology from its pediatric counterpart. Its preoperative diagnosis is challenging in adults, which appears to be due to its imprecise presenting signs and symptoms; thus, the condition can be mistaken for other causes of intestinal obstruction. Adenocarcinomas remain the most common cause of malignant tumors in the colon, which also makes them one of the causes for colocolic intussusception.

Conclusion

Intussusception can appear as a surgical emergency even in the elderly, necessitating prompt surgical intervention to avoid intestinal ischemia and gangrene. Its diagnosis can be aided to a great degree by CT imaging.

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Colocolic intussusception is a rare surgical emergency in adults and is often associated with neoplastic lead points.

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Clinical diagnosis of the disease is challenging because of its non-specific presenting features. However, its diagnosis can be aided to a great degree by CT imaging.

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The disease necessitates prompt surgical intervention to avoid intestinal ischemia and gangrene.

Gangliocytic paraganglioma leading to duodeno-jejunal intussusception: A case report

The intussusception of the small bowel is rarely encountered in adult patients and is frequently associated with a lead point that is often malignant. In a 69-year-old female patient with an episode of gastrointestinal (GI) bleeding, computed tomography (CT) showed a duodenal-jejunal intussusception caused by an intraluminal mass. Open polypectomy and reduction of intussusception were performed and the diagnosis of gangliocytic paraganglioma was made at pathological evaluation. It would be important to consider neoplasms like gangliocytic paraganglioma in the setting of adult small bowel intussusception.

Small Bowel Intussusception Due to Rare Cardiac Intimal Sarcoma Metastasis: A Case Report

Background: Intimal sarcomas are rare malignant mesenchymal tumors arising from the heart and large blood vessels. Their intraluminal growth leads to vascular obstructive symptoms and peripheral neoplastic embolization. Direct infiltration of the lungs or metastases to the pulmonary system, occur in 40% of cases and extrathoracic spread is frequent, also in presentation. Intussusception is an unusual event in adults, accounting for <5% of bowel obstructions. In most cases it is caused by a malignancy and requires surgical resection. Case Presentation: We describe a rare case of a 50-year-old man suffering of bowel obstruction due to intussusception sustained by a small bowel metastasis of a primary cardiac intimal sarcoma. One year and a half before the onset of abdominal symptoms, a grade II intimal sarcoma was removed from his left atrium and consequently he followed a chemotherapy protocol. Four months later a CT scan revealed local recurrence. Eighteen months after heart surgery he referred to the ER with abdominal pain. CT scan showed an ileal intussusception and the patient was scheduled for surgery. A tract of 10 cm ileus was removed containing an intramural polypoid solid mass. Histological analyses revealed a grade II intimal sarcoma consistent with his first diagnosis. Conclusion: Primary heart tumors are late found and often partially resected, therefore metastatic pathways are to be expected. Adult small bowel intussusception is a rare event and caused by a malignancy in one third of cases. Therefore, our recommendation is to always resect the tract involved in order to perform a proper diagnosis.

Plasmablastic Lymphoma Causing Adult Intussusception After Cardiac Transplantation

Intussusception in adults is a rare occurrence at approximately 5% and malignancy as the cause comprises half that number. The most common malignancies found are primary adenocarcinoma, metastatic carcinoma, lymphoma, and gastrointestinal stromal tumors. Lymphoma is the second most common. The management of adult intussusception is generally surgical, which is due to the higher likelihood of malignancy being the underlying cause. The patient's history helps to direct management and the most likely underlying diagnosis. This is especially important in patients who are immunosuppressed and with a history of lymphoproliferative disease. Early management and proper surgical intervention allow for the best survival rate. Here we present a case of adult intussusception caused by a rare and aggressive type of non-Hodgkin lymphoma.

Follicular Lymphoma Presenting as Intussusception in an Adult

A 61-year-old male with no past medical history presented with intense abdominal pain for three days, associated with hematochezia, nausea, and non-bloody vomiting. CT scan of the abdomen showed distended small bowel, diffuse lymphadenopathy, and intussusception of the distal ileum into the cecum with obstruction. Ileocolic resection and histopathological staining confirmed the diagnosis of follicular lymphoma and appropriate treatment was initiated. Intussusception is a condition that involves the invagination of the proximal segment of a bowel tract into its contiguous distal segment as a result of enthusiastic or impaired peristalsis. Only 5% of the total intussusception cases are found in adults. Most cases in adults are caused by pathological lead points which can be benign or malignant. Lymphomas rarely present with intussusception and follicular lymphomas are even less common. To the best of our knowledge, there have only been a few such cases of follicular lymphomas with the initial presentation of intussusception. In this article, we present a rare case of follicular lymphoma presenting as intussusception. Considering lymphomas as a cause of intussusception in adults can decrease diagnostic delays and guide treatment.

Intussusception and Chronic Marijuana Use in a Young Adult

Patient: Female, 26-year-old

Final Diagnosis: Intussusception

Symptoms: Abdominal pain • nausea

Medication: —

Clinical Procedure: CT scan • surgery

Specialty: Gastroenterology and Hepatology • General and Internal Medicine • Surgery

Large Bowel Obstruction

Nearly one-quarter of bowel obstructions occur in the large bowel. As with all bowel obstructions, large bowel obstructions have three defining characteristics: partial or complete, intrinsic or extrinsic, benign or malignant. The work-up for a large bowel obstruction should focus on the etiology of the obstruction as well as severity. Management strategy is contingent on the previous characteristics and can include endoscopy, diversion, or resection. This chapter will discuss common and rare etiologies of large bowel obstructions as well as management strategies for clinical guidance.

Intussusception in Adults: A Retrospective Review from a Single Institution

Purpose

Intussusception is uncommon in adults and often manifests as nonspecific symptoms. Owing to its low incidence and the lack of knowledge on the symptoms, causes, and treatment of adult intussusception (AI), many surgeons may have limited experience in the diagnosis and treatment of intussusception. This study aimed to describe the experience of AI and discuss its clinical presentation, etiology, and management.

Material and Methods

I retrospectively reviewed patients aged 19 years and older who were diagnosed with intussusception at a single institution between March 2010 and December 2019.

Results

Among 28 patients who were finally analyzed, abdominal pain was the most commonly observed symptom. Ileocolic and ileoileal intussusceptions were the most common locations, and a lead point was observed in 19 cases (68%), of which malignancy was observed in six (21%). Bowel resection was performed in 27 cases. According to the pathological findings of the tissue from the resected section, nine and three cases of small bowel intussusception (SBI) were benign and malignant, respectively, whereas 13 and three cases of colonic intussusception (CI) were benign and malignant, respectively. On comparing SBI and CI, it was observed that most variables did not significantly differ, except for the duration of symptoms.

Conclusion

SBI had a higher lead point than CI. The rate of malignancy in CI cases in this study was lower than that reported in other studies. En-bloc resection can be considered the first option for the treatment of AI.

Bowel intussusception in adult: Prevalence, diagnostic tools and therapy

Intussusception is defined as invagination of one segment of the bowel into an immediately adjacent segment. The intussusception refers to the proximal segment that invaginates into the distal segment, or the intussusception (recipient segment). Intussusception, more common occur in the small bowel and rarely involve only the large bowel. In direct contrast to pediatric etiologies, adult intussusception is associated with an identifiable cause in almost all the symptomatic cases while the idiopathic causes are extremely rare. As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. In this review, we discuss the symptoms, location, etiology, characteristics, diagnostic methods and treatment strategies of this rare and enigmatic clinical entity in adult.

Primary ovarian Burkitt's lymphoma presentation in a young woman: A case report

INTRODUCTION AND IMPORTANCE

Burkitt's lymphoma is one of the fastest growing human cancers and it needs a rapid diagnosis.

CASE PRESENTATION

A young woman presented to our institution with acute abdominal pain, tenderness and constipation. Ultrasound reported a right ovarian mass; at laparoscopy, we discovered ascites, peritoneal carcinomatosis and a voluminous pelvic mass.

CLINICAL DISCUSSION

Diagnosis was confirmed as non-Hodgkin sporadic Burkitt's lymphoma: the careful workup was the key to initiate multiagent chemotherapy.

CONCLUSION

Primary ovarian Burkitt's lymphoma, in a young woman in a non-endemic zone, is a rarity that represents a strong diagnostic challenge, but rapid identification can lead the patient to appropriate therapies and improvement of prognosis.

Successful treatment of adult cecorectal intussusception caused by cecum cancer with mobile cecum: a case report

Background

Intussusception occurs when a segment of the bowel (the intussusceptum) telescopes into an adjacent segment (the intussuscipiens). Adult intussusception occurs rarely and often requires surgical resection for its treatment. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature.

Case presentation

A 71-year-old woman was transferred to our hospital for the treatment of upper abdominal pain. Physical examination, laboratory tests, and imaging inspections showed strangulated bowel obstruction induced by intussusception associated with the intra-rectal mass. We performed an emergency operation and treated the intussusception using a combined transabdominal and trans-anal approach. The intraoperative findings revealed bloody ascites and a potentially malignant tumor that had moved toward the anal side from peritoneal reflection. The tumor served as the lead point in the cecum with mobile cecum. After reducing the intussusception using the combined procedure, we removed the ileocecal portion. The intraoperative and histopathological findings suggested that cecum cancer with mobile cecum had caused the cecorectal intussusception. The patient had an uneventful postoperative course, except for postoperative pulmonary pneumonia.

Conclusion

To the best of our knowledge, this is the first reported case of adult cecorectal intussusception due to cecum cancer with mobile cecum successfully treated using the combined transabdominal and trans-anal approach. This combined procedure may be useful in treating the intussusception where the lead point is distal from the peritoneal reflection.

Expectant management of traumatic intussusception

Mesenteric injuries and traumatic intussusception are rare surgical presentations following blunt trauma, with potentially life-threatening complications. Diagnosis relies on high clinical suspicion and judicious use of imaging in trauma. Literature suggests that these presentations should always be managed operatively for diagnostic clarity, manual reduction of intussusception and, if indicated, resection of involvement segment. However, in the setting of a stable patient with a reassuring examination, this may not be necessary. This case presents the successful expectant management of a traumatic mesenteric haematoma acting as a pathologic lead point for small bowel intussusception.

Large pedunculated colonic lipoma: a rare cause of colorectal intussusception in adults

Colo-rectal intussusception is rare in adults and is often secondary to malignant lesions, rarely benign lesions such as colonic lipomas can also be the cause. We present the case a 60-year-old man who presented to the emergency department with acute abdominal pain. On physical examination, the abdomen was distended with diffuse tenderness. CT scan of the abdomen revealed a colo-rectal intussusception secondary to a rectal lipoma with parietal pneumatosis of the invaginated loop. An emergency laparotomy was performed. Intraoperatively the radiological findings were confirmed. A rectosigmoid resection (Hartmann's procedure) taking off the lipoma and the invaginated segment of the colon was performed and the patient had an unevent full recovery. Histopathology confirmed a 6cm sub-mucosal lipoma without evidence of malignancy. As the diagnosis of a benign disease in patients presenting with colonic intussusception can only be made on pathological examination, this entity should be managed as a malignant lesion due to the high incidence of malignancy.

A rare case of bowel intussusception due to adenocarcinomatous polyp in a 14 year-old child: case report

BACKGROUND

Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. It is an uncommon condition in children older than 2 years and causes intestinal obstruction. On the contrary of adult intussusception, childhood intussusception does not usually happen on a lead point of a malignant organic lesion.

CASE PRESENTATION

A 14-year-old male presented with complaints of heavy, bilious emesis and periumbilical colicky pain. Ultrasonography showed a dilated intestinal loop with absent bowel movement. CT scan revealed two masses in the abdomen. We performed an exploratory laparotomy that revealed invaginated intestines and showed a polyp near the area of interest. Necrotic segments and the polyp were removed and examined pathologically. Pathology showed adenocarcinoma in the polyp. After surgery, the general condition of the patient was normal and no complications occurred.

CONCLUSIONS

Intussusception mainly occurs during infancy and early childhood. Mostly it is an idiopathic ileo-colic invagination. In our case, the patient had a jejuno-jejunal intussusception in his late childhood, and the lead point was an adenocarcinomatous polyp, which is rare in children. Amongst the many types of treatment, we chose surgical resection because of patient's age.

An uncommon diagnosis of a common presentation of mass per rectum

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.

Ileocolic intussusception caused by ileal lipoma: A case report

RATIONALE

Adult intussusception is rarely observed, accounting for about 5% of all cases of intussusception. Most ileal lipomas are asymptomatic and do not need any special treatment. Herein, we describe a case with ileocolic intussusception caused by ileal lipoma.

PATIENT CONCERNS

A 27-year-old woman complaints of intermittent abdominal pain for 10 days.

DIAGNOSIS

Abdominal computed tomography demonstrated ileocolic intussusception. Colonoscopy revealed a spherical polypoid lesion with surface capillary rising from the lateral wall of the ileum. A diagnosis of ileocolic intussusception was made.

INTERVENTIONS

The patient underwent primary resection of the intussuscepted intestine after which an end-to-end anastomosis was performed.

OUTCOMES

Histopathology report confirmed a 4.5 cm × 3.5 cm lipoma in the terminal ileum. The patient was discharged on a postoperative day 9 without complications.

LESSONS

We describe the difficulties in diagnosis and treatment of this rare cause of intussusception and review the literature on adult intussusceptions. The ileal lipoma is a very rare cause of ileocolic intussusception. Abdominal CT and colonoscopy are important for the diagnosis of intussusception and abdominal lipomas. Surgical resection remains the treatment of choice.

Ileocecal intussusception caused by two different tumors - which is the culprit lesion? A case report

BACKGROUND

Ileocecal intussusception caused by two different tumors is rare, according to a literature review. We describe a case of a male patient with a cauliflower-like mass in the middle of the transverse colon observed by colonoscopy before surgery. It was considered to be intussusception caused by colon cancer. However, a substantial lipomatous mass was seen in the distal end of the intussusception by computed tomography before surgery, which posed a challenge in the preoperative diagnosis.

CASE SUMMARY

We report a 72-year-old male patient with intussusception. The patient underwent right hemicolectomy and cholecystectomy in our hospital on April 29, 2019. During operation, the ileum was inserted into the ascending colon by about 15 cm, and a tumor with a diameter of approximately 3.0 cm was observed in the distal part of the intestine. An atypical liposarcoma/highly differentiated liposarcoma in the adipose tissue was suspected in the postoperative pathology, and a lipoma was diagnosed after MDM2 gene testing. A 4.0 cm × 5.0 cm polypoid mass was seen immediately adjacent to the mass, and the postoperative pathology report suggested a high-level tubular adenoma. The patient was eventually cured and discharged with an uneventful follow-up.

CONCLUSION

Intussusception caused by two different types of masses is extremely rare. At present, surgery is the best treatment once intussusception is diagnosed.

Adult Intussusception at a Tertiary Care Center: A Retrospective Study

Background:

In adults, the majority of cases of intussusception are due to malignancy.

Aims:

The aim of the study is to describe the pattern of intussusception in the adult population diagnosed and treated at a tertiary care center.

Subjects and Methods:

Study Design: This is a retrospective cross-sectional study based on chart review, and data collection was made from the computer database and inpatient case records. Study Setting: Adult intussusception cases diagnosed and treated at a tertiary care referral center in South India. All inpatient case sheets including investigations and histopathology information on the computer database of all patients diagnosed with intussusception in the period of August 2012 to July 2016 were retracted based on a pretested and standardized form. Demographic data and other baseline data were summarized with descriptive statistics. SPSS software was used for data analysis.

Results:

Of the 77 patients, 47 (61%) were male. The common presentations were abdominal pain (95%), vomiting (64%), and rectal bleeding (29%). Common examination findings were abdominal tenderness (45%), guarding (39%), and abdominal mass (38%). On ultrasonography, fifty (65%) patients had intussusception with ileocolic (25) as the most common type. Computed tomography abdomen was taken for 28 (36%) patients, in which 23 (82%) had intussusception with ileocolic (9) as the most common type. Surgery was done for 53 (69%) patients, and the most common procedure was right hemicolectomy (25) followed by resection and anastomosis of the small bowel (23). Intraoperatively, 42 (79%) patients had intussusception with ileocolic (23) as the most common type. Intraoperatively, 14 (26%) patients had a bowel gangrene. Biopsy-proven cause for intussusception was present in 46 patients, with malignancy (21) as the most common cause. The patients were on regular follow-up. Recurrence of intussusception occurred in six patients of the small bowel intussusception who had polyposis.

Conclusions:

Adult intussusception is often associated with malignancy. Hence, a formal resection without reduction is needed and surgery should be done following oncological principles.

Bowel Intussusception in Adults: Think Cancer!

Intussusception is a rare phenomenon in adults and usually presents with bowel obstruction. Unlike child intussusception, adult intussusception is seldom idiopathic and frequently associated with secondary causes such as benign and malignant tumors. While most cases are treated surgically, emerging data suggest a more conservative management approach for patients with short-segment adult intussusception and without high-risk features such as bowel obstruction, mass seen on imaging, colon involvement, or constitutional symptoms of malignancy. We present a rare case of adult intussusception due to unsuspected adenocarcinoma of the jejunum, treated successfully with surgical resection followed by adjuvant chemotherapy. We favor the surgical rather than conservative approach for adult patients with intussusception to avoid missing unsuspected malignant tumors that are not readily visualized on imaging studies.

Adult Ileocolic Intussusception from the Appendix

Intussusception is more commonly considered in the pediatric patient with abdominal pain, but can occur in adults as well. Adult patients are more likely to have an underlying intra-abdominal pathology leading to the condition. We present an adult patient presenting with abdominal pain with ileocecal intussusception diagnosed on imaging and confirmed surgically. In this case, appendiceal pathology served as the lead point for the intussusception.

Intussusception of a large circumferential caecal adenoma with ileocaecal valve consumption

We present a case of an unusually large, circumferential tubulovillous adenoma involving the terminal ileum and the caecum with ileocaecal valve consumption, presenting as intussusception in an otherwise healthy 90-year-old woman. The patient presented with several months of chronic symptoms of weight loss and diarrhoea. Clinical examination revealed a right-sided mass. Investigations revealed a large right-sided lesion suspicious of intussusception. The patient underwent a right-sided hemicolectomy where the intussusception was resected. Histology of the resected mass revealed a tubulovillous adenoma with focal invasive adenocarcinoma.