101
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Goverman J, Greenwald M, Gellman L, Gadaleta D. Antiperistaltic (Retrograde) Intussusception after Roux-en-Y Gastric Bypass. Am Surg 2004. [DOI: 10.1177/000313480407000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Adult intussusception has been described after various types of gastrointestinal surgery. In some instances there may be intussusception of the jejunum into the stomach via a gastrointestinal stoma, a rare complication known as jejunogastric intussusception (JGI). We present a retrospective review of two cases of retrograde intussusception occurring years after open Roux- en-Y gastric bypass (RYGB) for morbid obesity. To our knowledge there have been no documented reports of JGI occurring after RYGB and only scattered reports of JGI after Roux-en-Y reconstruction in general. Two reports of intussusception following RYGB were identified in the English literature and comprised three patients, only one of whom suffered a retrograde intussusception. As the number of RYGB procedures continues to rise, we will likely see more of this entity; and it is therefore crucial that surgeons consider acute and chronic intussusception as a cause of abdominal pain in patients who have undergone RYGB.
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Affiliation(s)
- Jeremy Goverman
- From the Department of Surgery, North Shore Long Island Jewish Health Care System, North Shore University Hospital, Manhasset, New York
| | - Marc Greenwald
- From the Department of Surgery, North Shore Long Island Jewish Health Care System, North Shore University Hospital, Manhasset, New York
| | - Larry Gellman
- From the Department of Surgery, North Shore Long Island Jewish Health Care System, North Shore University Hospital, Manhasset, New York
| | - Dominick Gadaleta
- From the Department of Surgery, North Shore Long Island Jewish Health Care System, North Shore University Hospital, Manhasset, New York
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102
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Maldonado TS, Firoozi B, Stone D, Hiotis K. Colocolonic intussusception of a giant pseudopolyp in a patient with ulcerative colitis: a case report and review of the literature. Inflamm Bowel Dis 2004; 10:41-4. [PMID: 15058526 DOI: 10.1097/00054725-200401000-00007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Adult intussusception in the setting of inflammatory bowel disease (IBD) is a rare phenomenon. Giant pseudopolyps, while generally considered benign, may function as lead points for intussusception. Diagnosis and management of intussusception in the setting of IBD can be fraught with hazards. We report the case of a 27-year-old male, recently diagnosed with ulcerative colitis and giant pseudopolyps, who presented with colocolonic intussusception and obstruction. Diagnosis was confirmed using CT imaging and the patient underwent resection of the colocolonic intussusception without reduction. The following case underscores the challenges in managing adult intussusception in the setting of IBD and allows for a review of the literature to date. Resection of non-reduced intussusception, rather than endoscopic or enema reduction, should continue to be definitive treatment of patients presenting with this unusual problem.
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Affiliation(s)
- Thomas S Maldonado
- Department of Surgery, New York University Bellevue Hospital Center, New York, New York 10016, USA.
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103
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Furukawa A, Yamasaki M, Takahashi M, Nitta N, Tanaka T, Kanasaki S, Yokoyama K, Murata K, Sakamoto T. CT diagnosis of small bowel obstruction: scanning technique, interpretation and role in the diagnosis. Semin Ultrasound CT MR 2003; 24:336-52. [PMID: 14620716 DOI: 10.1016/j.sult.2003.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Intestinal obstruction is a relatively common condition with diagnosis based on the clinical signs, patient history, and radiographical findings. Once suspected, its presence should be determined and if present, the site and cause of obstruction, and presence of strangulation should be assessed for the appropriate patient management. With the recent technological developments, the role of computed tomography (CT) in the diagnosis of bowel obstruction has expanded. The examination should be performed with intravenous contrast administration and thinner sections and multi-planner image reformation are recommended to evaluate a site of particular interest. CT is reported to have a sensitivity refer to detection of a small bowel obstruction at over 90% for complete or high-grade obstruction and to disclose causes of obstruction in 70% to 95% of cases. CT also provides characteristic findings indicating the presence of closed-loop obstruction and intestinal ischemia, which leads to appropriate and timely management for these emergent cases.
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Affiliation(s)
- Akira Furukawa
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
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104
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Dean AJ, Lafferty K, Villanueva TC. Emergency medicine bedside ultrasound diagnosis of intussusception in a patient with chronic abdominal pain and unrecognized Peutz-Jeghers syndrome. J Emerg Med 2003; 24:203-10. [PMID: 12609653 DOI: 10.1016/s0736-4679(02)00726-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An adult patient presented to the Emergency Department (ED) with abdominal pain caused by intussusception. The diagnosis had not been made despite several prior evaluations for episodes of similar symptoms. The diagnosis was finally made by bedside ultrasound performed by the treating physicians in the ED. The patient's underlying condition of Peutz-Jeghers Syndrome with intestinal polyps was also previously undiagnosed. The discussion reviews and compares clinical aspects of intussusception in adults and children. Sonographic findings of intussusception and their pathological basis are described, and the accuracy of sonography in the diagnosis of intussusception is reviewed.
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Affiliation(s)
- Anthony J Dean
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4283, USA
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105
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Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Kori T, Kuwano H. The diagnosis and treatment of adult intussusception. J Clin Gastroenterol 2003; 36:18-21. [PMID: 12488701 DOI: 10.1097/00004836-200301000-00007] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intussusception in adults is often diagnosed on computed tomography (CT), and the optimal treatment of this entity is not universally agreed upon. We report our experience in an attempt to clarify the usefulness of CT scan and the optimal treatment of this entity. STUDY Seven cases of adult intussusception were encountered at our institute between 1991 and 2001. Data related to presentation, diagnosis, treatment, and pathology were analyzed. RESULTS Preoperative diagnosis was made in four patients by CT scan and/or ultrasonography. Two patients had colonic cancer and one had jejunal cancer. Three of four patients with small bowel intussusception underwent reduction before resection and the other one underwent resection without reduction because of severe ischemic bowel. CONCLUSIONS The CT scan is most useful in making the diagnosis of intussusception. Colonic lesions should be resected without reduction. Small bowel lesions should be reduced only in patients in whom a benign diagnosis has been strongly suggested preoperatively or in patients in whom resection may result in short gut syndrome.
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Affiliation(s)
- Kunio Takeuchi
- Department of Surgery, Tone Chuo Hospital, 1855-1, Higashiharashin-machi, Numata-city, Gunma 378-0053, Japan
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106
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Gayer G, Zissin R, Apter S, Papa M, Hertz M. Pictorial review: adult intussusception--a CT diagnosis. Br J Radiol 2002; 75:185-90. [PMID: 11893645 DOI: 10.1259/bjr.75.890.750185] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Intussusception, usually thought of as a childhood condition, may be encountered in adults as well, and is then more often associated with underlying pathology. While the condition is mostly unsuspected clinically, as patients present with non-specific abdominal pain that is often of long duration, CT findings are characteristic. Examples are shown of intussusception both in the small bowel and colon. Awareness of these findings allows the radiologist to make the correct diagnosis.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 52621, Israel
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107
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Tiao MM, Wan YL, Ng SH, Ko SF, Lee TY, Chen MC, Shieh CS, Chuang JH. Sonographic features of small-bowel intussusception in pediatric patients. Acad Emerg Med 2001; 8:368-73. [PMID: 11282672 DOI: 10.1111/j.1553-2712.2001.tb02115.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Small-bowel intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI. METHODS The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed. RESULTS Most of the patients presented with nonspecific symptoms, including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively. CONCLUSIONS Small-bowel intussusception is often over-looked due to nonspecific clinical presentations. Sonographic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.
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Affiliation(s)
- M M Tiao
- Department of Pediatrics, Chang Gung University, Chang Gung Memorial Hospitals at Kaohsiung and Linkou, Kaohsiung, Taiwan
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108
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Furukawa A, Yamasaki M, Furuichi K, Yokoyama K, Nagata T, Takahashi M, Murata K, Sakamoto T. Helical CT in the diagnosis of small bowel obstruction. Radiographics 2001; 21:341-55. [PMID: 11259698 DOI: 10.1148/radiographics.21.2.g01mr05341] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
With recent technologic developments, the role of computed tomography (CT) in the diagnosis of bowel obstruction has expanded. CT is recommended when clinical and initial radiographic findings remain indeterminate or strangulation is suspected. This modality clearly demonstrates pathologic processes involving the bowel wall as well as the mesentery, mesenteric vessels, and peritoneal cavity. CT should be performed with intravenous injection of contrast material, and use of thin sections is recommended to evaluate a particular region of interest. CT is reported to have a sensitivity of 78%-100% for the detection of complete or high-grade small bowel obstruction but may not allow accurate diagnosis in cases involving incomplete obstruction. In such cases, the use of adjunct enteroclysis is indicated. Furthermore, multiplanar reformatted imaging may help identify the site, level, and cause of obstruction when axial CT findings are indeterminate. CT can also demonstrate findings that indicate the presence of closed-loop obstruction or strangulation, both of which necessitate emergency exploratory laparotomy. Unfortunately, these pathologic conditions may be missed, and patients with suspected severe obstruction or bowel ischemia in whom CT and clinical findings are widely disparate must also undergo laparotomy. In general, however, CT allows appropriate and timely management of these emergency cases.
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Affiliation(s)
- A Furukawa
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho Otsu, Shiga 520-2192, Japan.
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109
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Rosales Juega J, Jorge Iglesias M, Rosales Juega D, Couselo Villanueva J, Moreda Pérez M, Maseda Díaz O. Invaginación sigmoidoanal: caso clínico. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71720-4] [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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110
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Baig MK, Hussain S, Wise M, Wexner SD. Controversy in the Treatment of Adult Long Ileocolic Intussusception: Case Report. Am Surg 2000. [DOI: 10.1177/000313480006600810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Adult intussusception is an unusual cause of intestinal obstruction. In contrast to children, intussusception in adults is usually due to an identifiable cause. We present a case of an 81-year-old female who was diagnosed with a long intussusception on CT scan of the abdomen. Because of the likelihood of neoplasia, a right hemicolectomy was undertaken, after which the patient recovered well. The correct treatment of adult intussusception is not unanimously agreed upon. We present a case of long intussusception in which partial reduction of viable small bowel before the resection was done by applying gentle traction. This provided sufficient small bowel mesentery length, preventing any damage to superior mesenteric vessels and avoiding unnecessary excision of healthy bowel.
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Affiliation(s)
- Mirza Khurrum Baig
- Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida
| | - Shahid Hussain
- Queen Alexandra Hospital, Cosham, Portsmouth, United Kingdom
| | - Martin Wise
- Queen Alexandra Hospital, Cosham, Portsmouth, United Kingdom
| | - Steven D. Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida
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111
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Zerbib P, Chambon JP, Bertheloot D, Quandalle P. [Acute primary intestinal intussusception in an adult diagnosed by ultrasonography]. ANNALES DE CHIRURGIE 2000; 125:291-2. [PMID: 10829512 DOI: 10.1016/s0001-4001(00)00140-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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112
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Martin CJ, Lim KS. Intussusception in coeliac disease: a little-known association. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 2000; 70:313-4. [PMID: 10779065 DOI: 10.1046/j.1440-1622.2000.01809.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C J Martin
- Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia
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113
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Abstract
PURPOSE To determine the clinical presentation in cases of adult intussusception demonstrated at computed tomography (CT) or magnetic resonance (MR) imaging and to correlate the imaging appearance with clinical diagnosis. MATERIALS AND METHODS Retrospective review of CT and MR images and clinical records of all patients with an intussusception demonstrated on CT or MR images from January 1, 1991, through April 30, 1998. RESULTS Thirty-three patients had one or more intussusceptions demonstrated on CT (n = 30) or MR (n = 3) images. Twenty-nine patients had enteroenteric intussusceptions, and four had intussusceptions involving the colon. Ten patients (30%) had a neoplastic lead point, including all four of the intussusceptions involving the colon (benign mass, n = 3; malignant mass, n = 7). In 23 cases (70%), no neoplastic lead point was identified. A variety of causes were implicated in these cases, with 16 cases (48%) classified as idiopathic. Enteric intussusceptions in the nonneoplastic group were shorter in length (median, 4 vs 10.8 cm; P = .002), smaller in diameter (median, 3 vs 4 cm; P = .002), and less likely to be associated with obstruction (4.3% vs 50%; P = .02). CONCLUSION Less than one-third of adult intussusceptions demonstrated at CT or MR imaging were caused by a neoplastic lead point. Almost half of adult cases in this series were idiopathic.
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Affiliation(s)
- D M Warshauer
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599-7510, USA.
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114
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Draganic B, Williamson M, Stewart P. Colonic intussusception in Crohn's disease. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1999; 69:683-4. [PMID: 10515350 DOI: 10.1046/j.1440-1622.1999.01667.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- B Draganic
- Department of Colon and Rectal Surgery, University of Sydney, Concord Hospital, New South Wales, Australia
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115
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Abstract
BACKGROUND Intestinal intussusception in the adult is a rare entity that differs greatly in etiology from its pediatric counterpart. Controversy remains regarding the optimal management of this problem in the adult patient. The purpose of this study was to determine the cause(s) of intussusception and to determine the role of intestinal reduction in the management of intussusception in adults. STUDY DESIGN A retrospective review performed at The Mount Sinai Medical Center identified 27 patients, 16 years and older, with a diagnosis of intestinal intussusception. Data related to presentation, diagnosis, treatment, and pathology were analyzed. RESULTS There were 13 males and 14 females. The median age of the group was 52 years with a range of 16 to 90 years. Abdominal pain was the most common presenting complaint. A preoperative diagnosis was suspected in 11 of 27 patients (40%). There were 22 small bowel lesions and 5 colonic lesions. A pathologic cause was identified in 85% of patients with 8 of 22 (36%) small bowel and 4 of 5 (80%) of large bowel lesions being malignant. All small bowel cancers represented metastatic disease and all large bowel malignancies were primary adenocarcinomas. The median age of patients with malignant disease was 60 years; it was 44 years for those with benign disease. Operative treatment consisted of resection alone in 58% of patients and resection after reduction in 42%. Three patients were treated nonoperatively. CONCLUSIONS Our data support a selective approach to the operative treatment of intussusception in adults. Colonic lesions should not be reduced before resection because they most likely represent a primary adenocarcinoma. Small bowel intussusception should be reduced only in patients in whom a benign diagnosis has been made preoperatively or in patients in whom resection may result in short gut syndrome.
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Affiliation(s)
- L K Eisen
- Department of Surgery, The Mount Sinai Medical Center, New York, NY, USA
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116
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Lorenzi M, Iroatulam AJN, Vernillo R, Banducci T, Mancini S, Tiribocchi A, Ferrari FS, Mancini S. Adult Colonic Intussusception Caused by Malignant Tumor of the Transverse Colon. Am Surg 1999. [DOI: 10.1177/000313489906500103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adult colonic intussusception is rare and often originates from neoplasms. In emergency situations it can be difficult to diagnose. Our aim was to show how the integration of readily available diagnostic means in emergency situations can help in making a correct diagnosis of this disease. A 68-year old male patient presented with vomiting and abdominal pain. The abdomen was distended, with pain to palpation in the left quadrants without a mass. Plain radiographs of the abdomen showed a large amount of gas in the small bowel and in the right and transverse colon. A barium enema demonstrated an endoluminal filling defect in the descending colon. Abdominal ultrasonography revealed the presence of intraperitoneal fluid and thickened left colonic wall at the site of the lesion, with an aspect of a “double ring” consistent with intussusception. A solid formation was also revealed at a point distal to the thickened colonic wall. At emergency laparotomy an approximately 8-cm-long mass was palpable through the left colon. A colostomy was fashioned, and subsequently colonoscopy revealed the presence of a left colon tumor. At the subsequent operation an invagination of the left transverse colon into the descending colon was confirmed. The left transverse and descending colon were resected with high ligation of the left colic artery. Macroscopic examination of the invaginating head showed a vegetating transverse colon neoplasm. We conclude that in emergency settings the association of readily available diagnostic means such as plain abdominal radiography, water soluble contrast enema and ultrasonography may yield reliable information for diagnosing colonic intussusception.
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Affiliation(s)
- Marco Lorenzi
- Istituto di Chirurgia Generate e Specialitá Chirurgiche, University of Siena, Siena, Italy
| | | | - Remo Vernillo
- Istituto di Chirurgia Generate e Specialitá Chirurgiche, University of Siena, Siena, Italy
| | - Tania Banducci
- Istituto di Chirurgia Generate e Specialitá Chirurgiche, University of Siena, Siena, Italy
| | - Stefano Mancini
- Istituto di Chirurgia Generate e Specialitá Chirurgiche, University of Siena, Siena, Italy
| | - Andrea Tiribocchi
- Istituto di Scienze Eidologiche e Radiologiche, University of Siena, Siena, Italy
| | - Francesco S. Ferrari
- Istituto di Scienze Eidologiche e Radiologiche, University of Siena, Siena, Italy
| | - Sergio Mancini
- Istituto di Chirurgia Generate e Specialitá Chirurgiche, University of Siena, Siena, Italy
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117
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Atten MJ, Attar BM, Mahkri MA, Del Pino A, Orsay CP. Giant pseudopolyps presenting as colocolic intussusception in Crohn's colitis. Am J Gastroenterol 1998; 93:1591-2. [PMID: 9732958 DOI: 10.1111/j.1572-0241.1998.00491.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bowel obstruction is a well-known complication of Crohn's disease and is usually a result of stricture formation. Intussusception due to giant pseudopolyps is a rare form of bowel obstruction even in Crohn's disease. These giant pseudopolyps rarely regress with medical management alone and often require surgical resection.
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Affiliation(s)
- M J Atten
- Department of Medicine, Cook County Hospital and Rush Medical College, Chicago, Illinois 60612, USA
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118
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Berkelhammer C, Caed D, Mesleh G, Bolanos J, McGinnis P, Zeiger H. Ileocecal intussusception of small-bowel lymphoma: diagnosis by colonoscopy. J Clin Gastroenterol 1997; 25:358-61. [PMID: 9412921 DOI: 10.1097/00004836-199707000-00014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intussusception is rare in adults. There is little information on the role of colonoscopy in colonic intussusception. We report, to our knowledge, the first adult case of small-bowel lymphoma causing ileocecal intussusception in which the diagnosis was made by colonoscopy. Colonoscopy has a useful role in the diagnosis and management of ileocecal intussusception.
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Affiliation(s)
- C Berkelhammer
- Department of Gastroenterology, Christ Hospital & Medical Center, Oak Lawn, Illinois 60453, USA
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119
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Abstract
BACKGROUND While intussusception is relatively common in children, it is a rare clinical entity in adults, where the condition is almost always secondary to a definable lesion. DATA SOURCES Thirteen cases of intussusception occurring in individuals older than 16 were encountered at our institute between 1981 and 1994. RESULTS Presenting signs/symptoms included recurrent bowel obstruction, intermittent pain, and red blood per rectum. Correct preoperative diagnosis was made in six patients using colonoscopy, flexible sigmoidoscopy, upper gastrointestinal (GI) series and computed tomography (CT). At surgery the lead point was identified in the small intestine in eight cases, in the colon in four cases, and one small intestinal intussusception was considered idiopathic. Twelve patients underwent laparotomy and one patient was both diagnosed and treated by colonoscopy alone. CONCLUSIONS Adult intussusception is an unusual cause of bowel obstruction. The likelihood of neoplasia, particularly in the colon as a cause, is high. Operative management is thus almost always necessary.
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Affiliation(s)
- D G Begos
- Yale University School of Medicine, Department of Surgery, New Haven, CT 06520-8062, USA
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120
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Finn PJ, Parry BR. Endo-anal approaches to adult sigmoido-rectal intussusception. ANZ J Surg 1992; 62:908-10. [PMID: 20169714 DOI: 10.1111/j.1445-2197.1992.tb06951.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intussusception of intestinal lesions in the adult is an infrequent event, indeed, those occurring in the distal large bowel are quite rare. Popular management options centre on laparotomy with resection of involved bowel. Two recent cases of intussuscepting polypoid lesions of the rectosigmoid that were successfully managed using an endo-anal approach are presented.
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Affiliation(s)
- P J Finn
- Department of Surgery, Dunedin Public Hospital, New Zealand
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121
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Courtney SP, Ibrahim N, Longstaff AJ, Davidson CM. Intussusception in the adult: clinical, radiological and histological features. Postgrad Med J 1992; 68:449-52. [PMID: 1437925 PMCID: PMC2399348 DOI: 10.1136/pgmj.68.800.449] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Intussusception in the adult is an unusual cause of bowel obstruction. Unlike in childhood the clinical presentation is not clear cut and there are no distinct pathognomonic features. The radiological features are variable. Five patients presented to Frenchay Hospital over a five month period. The patients' clinical courses demonstrate the differing presenting features. Ultrasound investigation and CT scanning may show characteristic signs. Surgical treatment is mandatory as there is nearly always an underlying pathological abnormality which may be malignant.
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Affiliation(s)
- S P Courtney
- Department of General Surgery, Frenchay Hospital, Bristol, UK
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122
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Goetting MG, Tiznado-Garcia E, Bakdash TF. Intussusception encephalopathy: an underrecognized cause of coma in children. Pediatr Neurol 1990; 6:419-21. [PMID: 2073304 DOI: 10.1016/0887-8994(90)90012-p] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Intestinal intussusception is a common cause of bowel obstruction in infancy and early childhood. Typically the presenting signs and symptoms are referable to the abdomen. On occasion the most prominent presenting feature is depressed level of consciousness. We describe 3 patients who presented with coma associated with intussusception.
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Affiliation(s)
- M G Goetting
- Department of Pediatrics, Henry Ford Hospital, Detroit, Michigan
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