Jejunogastric intussusception

Retrograde Jejunogastric Intussusception (RJGI) is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. It was first described by Bozzi in 1914 in a patient with gastrojejunostomy. Clinically it is of two types acute and chronic. Anatomically it is of three types. The acute form is a surgical emergency. In the acute form there is chance of strangulation of the intussuscepted loop if early intervention is not done. To avoid mortality, early diagnosis and prompt surgical intervention is mandatory. There is no medical treatment for jejunogastric intussusception and surgical intervention is required for the definite treatment. It usually presents with abdominal pain, nausea, vomiting, haematemesis and a palpable diffuse lump in the upper abdomen. A history of gastric surgery can help in making a diagnosis. X-ray can occasionally be diagnostic. Endoscopy performed by someone familiar with this rare entity, is certainly diagnostic. We herein report a case of jejunogastric intussusception who presented with acute abdomen, haematemesis and abdominal lump.

Adult intestinal intussusception: CT appearances and identification of a causative lead point

The widespread application of computed tomography (CT) in different clinical situations has increased the detection of intussusception, particularly non-lead point intussusception, which tends to be transient. Consequently, determining the clinical significance of intussusception seen at CT poses a diagnostic challenge. Patients with intussusception may or may not be symptomatic, and symptoms can be acute, intermittent, or chronic, making clinical diagnosis difficult. In most cases, radiologists can readily make the correct diagnosis of intestinal intussusception by noting the typical bowel-within-bowel appearance at abdominal CT. However, the CT findings that help differentiate between lead point and non-lead point intussusception have not been well studied. Nevertheless, although there is considerable overlap of CT findings, when a lead mass is seen at CT as a separate and distinct entity vis-à-vis edematous bowel, it can be considered a reliable indicator of a lead point intussusception. Differentiating between lead point and non-lead point intussusception is important in determining the appropriate treatment and has the potential to reduce the prevalence of unnecessary surgery.

Digital assessment of lower rectum fixity in rectal prolapse (DALR): a simple clinical anatomical test to determine the most suitable approach (abdominal versus perineal) for repair

Selection of an appropriate approach to treat full thickness rectal prolapse remains problematic and controversial. We propose that rectal prolapse may be classified as 'low type' (true rectal prolapse) or 'high type' (intussusception of the sigmoid with a fixed lower rectum). This assessment can be made via a simple clinical test of digital rectal assessment of lower rectal fixity ('the hook test') based on anatomic changes in rectal prolapse to guide the selection process. In cases with the low-type prolapse, a perineal approach is appropriate (either Delorme's procedure, or rectosigmoidectomy with or without pelvic floor repair). For the high type, an abdominal rectopexy with or without high anterior resection is needed. Retrospective analysis of our cases treated over the last 6 years showed a recurrence rate of 6% in perineal procedures and 0% in abdominal rectopexy combined with resection to date. We believe that employing our simple test and classification can contribute to better patient selection for either approach, minimize anaesthetic and surgical risks and also result in lower recurrence rates.

Pattern of intussusception at Gondar, Ethiopia

Thirty three intussusception cases operated at the Gondar College of Medical Sciences hospital are presented. Thirteen of them were infants and the rest older children and adults. Clinical presentation, preoperative management, type of intussusception, cause, surgical procedures, and outcome are analysed.

Intussusception in children and adults in Zaria: a comparison

OBJECTIVES

To compare and contrast the symptomatology and the anatomical type of the intussusception in children and adults in Zaria.

DESIGN

Retrospective study.

SETTING

Hospital.

SUBJECTS

93 patients with intussusception.

MAIN OUTCOME MEASURES

Frequency of intussusception.

RESULTS

Colicky abdominal pain featured often enough in both groups with most symptoms and signs decreasing in frequency from infancy to adulthood. The ratio of small bowel to large bowel disease in infants, older children and adults was 1;8:1, 0;6:1 and 1:1 respectively. Infantile intussusception involving the small bowel was more common, and in older children large bowel involvement was commoner, while 50pc of adult intussusceptions were paradoxically small bowel. Overall, small bowel intussusception was most common with the ileocolic variety predominating.

CONCLUSIONS

The most common type of intussusception in our environment is the ileocolic variety.

[Videoproctography in the study of rectal intussusception. The authors' own experience]

Videoproctography has proved to be a useful diagnostic technique to investigate anorectal disorders; it can provide morphological and functional information which no other diagnostic method yields. From a series of 898 videoproctographs, the findings of 117 patients with rectal intussusception were retrospectively reviewed. The most common symptoms were an incomplete emptying feeling (93% of cases), obstructed defecation (78%), and a feeling of upright rectal weighting (71%). Of the three known types of rectal intussusception, the most common type was distal intussusception (44%), followed by the rectoanal type (38%) and finally by the proximal type (19%). The three types of intussusception were frequently (42%) associated with other disorders of rectal ampulla and especially with rectocele (15%), mucosal prolapse (8%), and descending perineum syndrome (12%); they had different clinical correlations and proctographic patterns and could be recognized in different defecation phases. In our personal experience, proctography with videorecording was a useful diagnostic tool in the dynamic assessment of this morphofunctional disorder which represents one of its major indications.

The changing pattern of intussusception in northern Nigeria: an analysis of 85 consecutive cases

In many regions of Africa intussusception is the most common cause of intestinal obstruction next to strangulated hernia. More recent reports seem to indicate a change in the clinical pattern of the disease. This retrospective analysis covering a period of ten years is of 85 patients aged between 11 weeks and 50 years. There were 65 males and 20 females; 69 were children between 1 month and 15 years. The anatomical pattern of the disease has changed from being of the caecocolic type to the ileocolic variety while the pathology of the disease has remained largely unidentified. 32 patients had the ileocolic variety. 20 were ileocaecal, 14 colo-colic, 8 caecocolic, 8 ileo ileal, 2 jejuno jejunal, and 1 jejuno ileal. There were 2 ileal and 4 colonic neoplasms. There was a high rate of bowel resection (54/85) and 8 deaths.

Intussusception of the appendix. A report of four cases and review of the literature

The clinical and pathologic features of four cases of intussusception of the appendix are reported and the literature is reviewed. All patients had vague abdominal symptoms. The diagnosis of intussusception of the appendix was not made preoperatively in any of these cases. All four patients were females who ranged from 37 to 70 years of age (mean age, 46 years). Examination of the surgical specimens showed tow appendixes that had completely inverted, one with a polyp attached at the base of the appendix forming the intussusceptum and the other with inversion of the appendiceal tip. Three cases were associated with endometriosis and one with a tubulovillous adenoma. Radiologically and endoscopically, the intussuscepted appendix may mimic a neoplastic lesion. Since intussusception may be caused by both benign and malignant conditions, appropriate management will depend on the associated cause.

[Appendico-cecal invagination (considerations on a case)]

Taking as their starting point the observation of an isolated case of appendicocecal invagination in a homogeneous series of 4,200 appendicectomies observed, the authors take the opportunity of addressing in some detail the many aspects of the problem posed by this rare condition. With the aid of a review of the literature, an attempt is made to define and explain the aetiology, pathogenesis and classification of such forms. The authors review the various clinical criteria and instrumental aids available for reaching a correct diagnosis, assessing their respective virtues and defects, especially as regards the radiological, ultrasonographic and endoscopic investigations used; they come to the conclusion that none of these is in itself specific for this condition, and stress that a clinical suspicion of appendicocecal invagination can only emerge of the basis of an overall assessment of the various test findings in conjunction with actual clinical experience. Lastly, the authors review the therapeutic possibilities and conclude that surgical therapy, which varies from case to case, is the most reliable approach, in that the endoscopic therapy attempted by some cassies an excessively high degree of risk.

Intussusception revisited: clinicopathologic analysis of 261 cases, with emphasis on pathogenesis

In the ten-year period from 1978 through 1987, 261 patients with intussusception were admitted to Chang Gung Memorial Hospital. The diagnosis was established by barium enema or at laparotomy. The patients were divided into two groups; there were 228 children ranging in age from 1 month to 14 years, and 33 adults. Among the children, 134 (59%) were male and 94 (41%) were female, a ratio of 1.4:1. There was no clear seasonal incidence. The age group most commonly affected was between 3 and 11 months of age (72.4%). The classic triad of abdominal pain, vomiting, and rectal bleeding was encountered in 187 cases (82%). Two hundred one cases (88%) were idiopathic, without any definite leading point. In these cases, the ileocecal area was the site most commonly involved (82%), hypertrophic Peyer's patches of the terminal ileum being responsible for 39% of the idiopathic intussusceptions in the ileocolic area. Enlargement of the mesenteric lymph nodes occurred in 67 of the idiopathic cases (33%). Local pathology or the leading point precipitating intussusception was found in 27 cases (12%); there were eight benign tumors, six malignant tumors, and 13 tumor-like lesions. In 32 of the 33 cases in adults, there was a definite contributing pathologic entity, including 18 benign tumors, 11 malignant tumors, and three tumor-like lesions. In infants and young children, there is usually no apparent predisposing disease, and a contributing or causative local pathologic lesion is seldom found. In contrast, intussusception in adults is almost invariably caused by some preexisting lesion involving the bowel wall. Furthermore, trauma, lymphoid hyperplasia, pregnancy, and viral infection may be possible predisposing factors in the production of intussusception.

Acute jejunogastric intussusception

Acute jejunogastric intussusception is a rare complication following gastric surgery. Three patients were treated for this condition during the past 15 years. Common presenting manifestations are vomiting, hematemesis, upper abdominal pain, and palpable abdominal mass within the left hypogastrium. The diagnosis is established by gastroscopy or upper gastrointestinal radiographs. Four categories of classification are described. Optimal operative management consists of prompt laparotomy. Manual reduction of the intussusception is followed by resection of compromised bowel. Procedures to prevent recurrence are individualized.

Non-infantile intussusception

In Europe and North America, most cases of non-infantile intussusception are associated with intestinal neoplasm. At the University College Hospital, Ibadan, Nigeria, the majority of cases of intussusception seen are ileocecocolic and cecocolic types. These are usually not associated with intestinal neoplasm and simple reduction is all that is required.Intussusception occurring in other segments of the intestinal tract is found to be associated with intestinal neoplasm, mesenteric lymphadenopathy, and ascaris worms. The very mobile cecum and ascending colon found in this population may be related to the high incidence of ileocecocolic and cecocolic intussusception.Indications for resection of intussusception include presence of intestinal neoplasm, irreducibility, gangrenous bowel, and chronicity.

Intussusception in adults

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