Barium findings in retrograde intussusception

Giant Brunner's gland hamartoma causing retrograde jejuno-duodenal intussusception: A case report

Brunner's gland hamartoma is a rare benign duodenal tumor. It occurs in Brunner's glands, which are found in the duodenum and produce secretions that protect the duodenum from pancreatic enzymes, gastric acid, and other agents. Endoscopic or surgical resection is required for these hamartomas. Duodenal intussusception is a relatively rare condition, usually caused by the presence of benign tumors, such as fibroadenomas, lipomas, papillomas, or sometimes with malignant neoplasms.

We report a case of giant Brunner's gland hamartoma in the duodenum causing antiperistaltic intussusception in a 45-year-old female patient. The patient reported a 3-year history of chronic anemia, and this mass was detected incidentally by computed tomography (CT) during investigations for chronic anemia and weight loss. Pre-operative abdominal and pelvis contrast revealed a sausage-shaped intraluminal structure with alternating fat planes and vessels distended in the third part of the duodenum up to the first part of the duodenum. Pancreas-sparing duodenectomy was performed. The patient recovered very slowly and was discharged on postoperative day 15 in good condition. Histology showed a large polypoid mass measuring 12.0 × 7.5 × 2.0 cm³, consistent with Brunner's gland hamartoma.

Brunner's gland hamartoma can present with features of duodenal intussusception or ampullary obstruction but is rarely seen to cause retrograde jejuno-duodenal intussusception. Pancreas-sparing duodenectomy is the best surgical option in adult patients with intestinal intussusception associated with giant lesions close to the ampulla of Vater, especially in the presence of features of malignancy.

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Brunner's gland hamartoma is a rare benign duodenal tumor.

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Adult intussusception is usually caused by benign or malignant tumors, but rarely to be caused by Brunner's gland hamartoma.

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Pancreas-sparing duodenectomy is the surgical option for lesions close to the ampulla of Vater.

Adult enteric intussusception: additional observations on enteroclysis

Enteroclysis patterns encountered in four patients with adult intestinal intussusception of different etiology--including a leiomyoma, a Peutz-Jeghers hamartoma, a metastatic colon carcinoma, and adhesions--were analyzed and compared to surgical and pathological findings. Emphasis was given not only to radiological signs indicative of impaired circulation but also to the preoperative evaluation of the stimulating cause. A "stretched spring" pattern, corresponding to increased distance between large and thick concentric rings, was found to conform to a stage of strangulation with exudation, whereas sharply demarcated fine rings in close proximity were suggestive of the absence of vascular impairment. The morphology of the underlying lesion was also shown to conform to the dynamic appearance of the intussusception. Benign submucosal, intraluminal tumors led to a long, rather permanent intussusception, with the tumor being the leading point; whereas intussusception associated with annular malignancies or adhesions was shorter and transient or partial, as fixation was present. The cause of the intussusception was correctly identified preoperatively in each case; the vascular compromise involved was also indicated, and the correlation between radiological appearances and morphology at pathology specimens was excellent.

Retrograde jejunal-duodenal intussusception associated with a jejunal duplication cyst in a newborn

Retrograde intussusception is a rare occurrence. We report a retrograde jejunal-duodenal intussusception associated with a jejunal duplication cyst, which presented as intermittent biliary and upper gastrointestinal (UGI) obstruction and a mobile abdominal mass in a newborn infant.

Iatrogenic problems following gastric surgery

It is difficult to truly define iatrogenic complications in the postsurgical state in that the surgery is a condition originated by physician intervention and thus any problems that occur may be technically considered as physician created. In this article we attempt to demonstrate problems that occur both due to technical errors and the choice of operative procedure. In addition, unusual postsurgical anatomy is illustrated with the hope of avoiding further iatrogenic problems from lack of recognition.