1
|
Zewde Y, Bugie T, Daniel A, Wodajo A, Meskele M. Clinical presentation and management outcome of pediatric intussusception at Wolaita Sodo University Comprehensive Specialized Hospital: a retrospective cross-sectional study. J Int Med Res 2024; 52:3000605241233525. [PMID: 38518196 PMCID: PMC10960347 DOI: 10.1177/03000605241233525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/29/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To assess the pattern of clinical presentations and factors associated with the management outcome of pediatric intussusception among children treated at Wolaita Sodo University Comprehensive Specialized Hospital, Ethiopia. METHODS This retrospective cross-sectional study included the medical records of 103 children treated for intussusception from 2018 to 2020. The data collected were analyzed using SPSS 25.0 (IBM Corp., Armonk, NY, USA). RESULTS In total, 84 (81.6%) patients were released with a favorable outcome. Ileocolic intussusception was a positive predictor, with a nine-fold higher likelihood of a favorable outcome than other types of intussusception [adjusted odds ratio (AOR), 9.16; 95% confidence interval (CI), 2.39-21.2]. Additionally, a favorable outcome was three times more likely in patients who did than did not undergo manual reduction (AOR, 3.08; 95% CI, 3.05-5.48). Patients aged <1 year were 96% less likely to have a positive outcome than those aged >4 years (AOR, 0.04; 95% CI, 0.03-0.57). CONCLUSION Most patients were discharged with favorable outcomes. Having ileocolic intussusception and undergoing manual reduction were associated with significantly more favorable outcomes of pediatric intussusception. Therefore, nonsurgical management such as hydrostatic enema and pneumatic reduction is recommended to reduce hospital discharge of patients with unfavorable outcomes.
Collapse
Affiliation(s)
- Yohannes Zewde
- Department of Surgery, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tamrat Bugie
- Department of Surgery, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abel Daniel
- Department of Pediatrics, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Awoke Wodajo
- Department of Pediatrics, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mengistu Meskele
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| |
Collapse
|
2
|
Xie X, Gao X, Chen X, Wang S, Wang J, Pei G. An intussusception caused by a rare transverse colon lipoma: Case report. Int J Surg Case Rep 2023; 110:108668. [PMID: 37603912 PMCID: PMC10469518 DOI: 10.1016/j.ijscr.2023.108668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Intestinal lipoma is a rare benign tumor with a reported incidence of 0.2 % to 4.4 %. It is seen mainly in patients aged 50 to 70 years. Intestinal lipoma as a pathological lead point of intussusception is rare. There are few reports of colic lipoma in children. PRESENTATION OF CASE We reported a 7-year-old girl with a 4-year history of intermittent abdominal pain. Ultrasound examination showed a homogeneous hyperechoic mass near the distal transverse colon, which was similar to the surrounding lipid tissue. Histopathological examination confirmed the diagnosis of intestinal lipoma. DISCUSSION Colonic lipoma is very rare in children. If intussusception occurs repeatedly, or if it occurs in older children, we should consider the presence of pathological lead point. Early diagnosis and immediate surgical intervention are the key factors to a successful outcome. CONCLUSION In this case we report a pediatric case of intussusception secondary to colonic lipoma, and describe imaging and pathologic signs suggestive of intestinal lipoma.
Collapse
Affiliation(s)
- Xiaoying Xie
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Department of Ultrasound, Tianjin Children's Hospital, Tianjin, China
| | - Xinfeng Gao
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Emergency Surgery, Tianjin Children's Hospital, Tianjin, China
| | - Xiaofang Chen
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Shicheng Wang
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Department of Ultrasound, Tianjin Children's Hospital, Tianjin, China
| | - Jizhong Wang
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Emergency Surgery, Tianjin Children's Hospital, Tianjin, China.
| | - Guanghua Pei
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Department of Ultrasound, Tianjin Children's Hospital, Tianjin, China.
| |
Collapse
|
3
|
Li Y, Zhou Q, Liu C, Sun C, Sun H, Li X, Zhang L. Epidemiology, clinical characteristics, and treatment of children with acute intussusception: a case series. BMC Pediatr 2023; 23:143. [PMID: 36997992 PMCID: PMC10061978 DOI: 10.1186/s12887-023-03961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND To summarize the clinical and epidemiological characteristics of acute intussusception. METHODS This retrospective study included pediatric patients with acute intussusception admitted to the Department of Pediatric Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, from January 2014 to December 2019. RESULTS A total of 402 infants/children were included (301 males and 101 females) with a mean age of 2.4 ± 1.5 years (2 months to 9 years). Thirty patients (7.5%) had a history of cold food intake, diarrhea, and upper respiratory infection before disease onset. Paroxysmal abdominal pain and crying occurred in 338 patients (84.1%). Eight patients (2.0%) had the typical triad, 167 (41.5%) had vomiting, 24 (6.0%) had bloody stools, and 273 (67.9%) had palpable abdominal mass. The average intussusception depth was 4.0 ± 1.4 cm. Air enema reduction was performed in 344 cases: 335 (97.3%) were successful. Fifty-eight patients were treated with intravenous phloroglucinol (2 mg/kg), and 53 (91.4%) were successful. Sixty-five patients suffered relapses, with a relapse rate of 16.8%. CONCLUSIONS Pediatric acute intussusception is common. There was no obvious etiology. The clinical manifestations are mostly atypical. Abdominal pain is the most common complaint. Air enema reduction is an effective treatment. The recurrence rate is high.
Collapse
Affiliation(s)
- Yan Li
- Department of Scientific Research, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Qi Zhou
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Chao Liu
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Chao Sun
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Hao Sun
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Xiang Li
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China
| | - Lei Zhang
- Department of Pediatric Surgery, Cheeloo College of Medicine, Qilu Hospital, Shandong University, Qingdao, China.
| |
Collapse
|
4
|
Li SM, Wu XY, Luo CF, Yu LJ. Laparoscopic approach for managing intussusception in children: Analysis of 65 cases. World J Clin Cases 2022; 10:830-839. [PMID: 35127899 PMCID: PMC8790435 DOI: 10.12998/wjcc.v10.i3.830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/19/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intussusception can be managed by pneumatic reduction, ultrasound-guided hydrostatic reduction, open or laparoscopic surgery, but laparoscopy in such cases remains controversial.
AIM To explore the clinical characteristics, effectiveness, and complications of surgical reduction for intussusception using laparoscopy in children.
METHODS This study was a retrospective case series of pediatric patients with intussusception who underwent surgical reduction by laparoscopy from May 2011 to April 2016 at Taizhou Hospital of Zhejiang Province. Clinical characteristics (operation time, intraoperative blood loss, conversion rate of laparotomy, reasons for conversion, postoperative hospital stay, and adverse events) were described.
RESULTS The 65 patients included 45 boys and 20 girls. The average age was 2.3 years (27.5 ± 24.5 mo). Of the 65 patients, 61 underwent surgical reduction by laparoscopy after a failed enema reduction of intussusception, and four underwent the procedure directly. All patients were treated successfully and 57 (87.7%) patients underwent successful laparoscopic surgery, two of which had a spontaneous reduction. Among the remaining cases, one was converted to open surgery via right upper quadrant incision, and seven required enlarged umbilical incisions. Intestinal resection was performed in 5 patients because of abnormal bowel lesions. There were no complications (intestinal perforations, wound infections, or intestinal adhesions) during the follow-up of 3 years to 8 years. Two patients experienced a recurrence of intussusception; one was resolved with pneumatic reduction, and the other underwent a second laparoscopic surgery.
CONCLUSION Laparoscopic approach for pediatric intussusception is feasible and safe. Bowel resection if required can be performed by extending umbilical incision without the conventional laparotomy.
Collapse
Affiliation(s)
- Sheng-Miao Li
- Department Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
| | - Xiao-Ying Wu
- Department Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
| | - Chun-Fen Luo
- Department Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
| | - Lin-Jun Yu
- Department Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
| |
Collapse
|
5
|
Wang TY, Su YT, Ko PJ, Chen YL, Shih HH, Tsai CC. Chronic Nocturnal Abdominal Pain as the Presentation of Inverted Meckel Diverticulum: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9010069. [PMID: 35053695 PMCID: PMC8774205 DOI: 10.3390/children9010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 04/15/2023]
Abstract
The common clinical manifestations of Meckel's diverticulum include painless lower gastrointestinal bleeding and intestinal obstruction due to intussusception. Intussusception induced by inverted Meckel's diverticulum has rarely been reported; furthermore, there is no report thus far of chronic nocturnal abdominal pain as a presenting symptom in children with Meckel's diverticulum. A 4-year-and-10-month-old girl with no significant history of previous illness presented with the sole complaint of chronic nocturnal abdominal pain for 3 months. The patient was reported to be asymptomatic during the day. A provisional diagnosis of chronic ileoileal intussusception was already under consideration in her previous hospital visits elsewhere. Physical examination revealed a soft, non-distended abdomen without tenderness. Imaging studies revealed ileoileal intussusception. Exploratory laparotomy showed ileoileal intussusception induced by an inverted Meckel's diverticulum with ulceration. The patient underwent successful surgery and made a full recovery. We report this case to remind physicians that Meckel's diverticulum should be considered in differential diagnosis of children presenting with the isolated symptom of chronic nocturnal abdominal pain.
Collapse
Affiliation(s)
- Ting-Yu Wang
- Department of Pediatrics, E-Da Hospital, Kaohsiung City 824005, Taiwan; (T.-Y.W.); (Y.-T.S.); (Y.-L.C.)
- Department of Pediatrics, U-Sheng Hospital, Pingtung City 900023, Taiwan
| | - Yu-Tsun Su
- Department of Pediatrics, E-Da Hospital, Kaohsiung City 824005, Taiwan; (T.-Y.W.); (Y.-T.S.); (Y.-L.C.)
- School of Medicine, I-Shou University, Kaohsiung City 824005, Taiwan
| | - Po-Jui Ko
- Department of Pediatric Surgery, E-Da Hospital, Kaohsiung City 824005, Taiwan;
| | - Yea-Ling Chen
- Department of Pediatrics, E-Da Hospital, Kaohsiung City 824005, Taiwan; (T.-Y.W.); (Y.-T.S.); (Y.-L.C.)
- School of Medicine, I-Shou University, Kaohsiung City 824005, Taiwan
| | - Hsiang-Hung Shih
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 807387, Taiwan;
| | - Ching-Chung Tsai
- Department of Pediatrics, E-Da Hospital, Kaohsiung City 824005, Taiwan; (T.-Y.W.); (Y.-T.S.); (Y.-L.C.)
- School of Medicine, I-Shou University, Kaohsiung City 824005, Taiwan
- Correspondence: ; Tel.: +886-7-6150011 (ext. 251295); Fax: +886-7-6150950
| |
Collapse
|
6
|
Tesfaye DD, Adem BM, Ketema I, Mehadi A, Eshetu B, Teshager T, Asfaw H, Desalew A. Clinical profile and treatment outcome of acute intussusception among children in eastern Ethiopia: A seven years retrospective study. Front Pediatr 2022; 10:968072. [PMID: 36518776 PMCID: PMC9742419 DOI: 10.3389/fped.2022.968072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Acute intussusception is the main cause of abdominal surgical emergencies worldwide in young children, with an incidence of approximately 1 to 4 per 2,000 children. An accurate estimate of the treatment outcomes of acute intussusception in children is unknown in low-and middle-income countries like Ethiopia. Hence, this study aimed to determine the clinical profile, treatment outcomes of acute intussusception and its associated factors among children admitted to Hiwot Fana Specialized University Hospital in eastern Ethiopia. METHODS An institutional-based retrospective cross-sectional study was conducted from November 01 to 30, 2021, among children admitted and managed for acute intussusception. All medical records of children admitted and managed for acute intussusception at Hiwot Fana Specialized University hospital between January 2014 and December 2020 were included. Data were collected using pretested structured checklists through a review of medical records, entered and analyzed using Statistical Package for Social Sciences version 25.0. Chi-square (χ 2) tests were applied to determine the associated factors with treatment outcome. The statistical significance was considered at a p-value < 0.05. RESULTS In this chart review of children, 13.3% (95% CL: 11.8-14.8) died. The median age of the study participant was 13 months. The majority, 72% were male and 76% were less than 24 months old. Regarding the clinical profile; abdominal pain (94.7%), vomiting (93.3%), bloody diarrhea (70.7%), and abdominal distention (76.0%) were the most common clinical presentations. Age less than 24 months [X 2 = 8.13 (df = 1); p = 0.004], preoperative vital signs [X 2 = 19.21 (df = 2); p = 0.000], intraoperative findings [X 2 = 18.89 (df = 1); p = 0.000], and postoperative complications [X 2 = 14.60 (df = 1); p = 0.000] were significantly associated with treatment outcome of acute intussusception. CONCLUSION In this chart review, the overall mortality rate in children was relatively high. One in seven children died from acute intussusception. Age less than 24 months, preoperative vital signs, intraoperative findings, and postoperative complications were significantly associated with acute intussusception treatment outcomes. Surgical management was the only treatment performed in all cases. Delayed presentation of patients and lack of other treatment modalities such as non-surgical interventions are serious concerns in this facility. The initiation of non-surgical reduction may reduce the need for surgical intervention-related complications, and child mortality.
Collapse
Affiliation(s)
- Dawit Desta Tesfaye
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Burka Mohammed Adem
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Indeshaw Ketema
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ame Mehadi
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bajrond Eshetu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Teshager
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Henock Asfaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Assefa Desalew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
7
|
Decreased Incidence of Pediatric Intussusception during COVID-19. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111072. [PMID: 34828785 PMCID: PMC8625463 DOI: 10.3390/children8111072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) changed the epidemiology of various diseases. The present study retrospectively investigates the epidemiologic and clinical changes in pediatric intussusception for ages ≤ 7 years before (February 2019–January 2020) and after (February 2020–January 2021) the COVID-19 outbreak in a single pediatric emergency department of a university-affiliated tertiary hospital. The incidence of communicable diseases—defined as infectious diseases with the potential for human-to-human transmission via all methods, non-communicable diseases, and intussusception were decreased following the COVID-19 outbreak (15,932 to 3880 (24.4%), 12,994 to 8050 (62.0%), and 87 to 27 (31.0%), respectively). The incidence of intussusception correlated significantly with the change in incidence of communicable diseases (Poisson log-linear regression, odds ratio = 2.15, 95% CI = 1.08–4.26, and p = 0.029). Compared with the pre-pandemic period, patients of the pandemic period showed higher proportions of pathologic leading point (PLP) and hospitalization (14.8% vs. 2.3% and 18.5% vs. 4.6%, respectively), lower base excesses (−4.8 mmol/L vs. −3.6 mmol/L), and higher lactate concentrations (1.7 mmol/L vs. 1.5 mmol/L). The incidence of pediatric intussusception decreased after the COVID-19 pandemic. This reduced incidence may be related to the reduced incidence of communicable diseases. However, the proportions of more severe diseases and PLPs were higher after the COVID-19 pandemic.
Collapse
|
8
|
Allawati M, Logman T, Al Qubtan MT. Colonic Lipoma as a Leading Cause of Intussusception Resulting in Bowel Obstruction. Cureus 2021; 13:e18261. [PMID: 34712536 PMCID: PMC8542912 DOI: 10.7759/cureus.18261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
A colon lipoma is defined as a benign tumor made of adipose tissue present in the submucosa. Lipomas of the colon are unusual with a frequency of 0.035%-4.4%. We present an uncommon case of a 41-year-old female with left colonic lipoma causing intussusception. The patient presented with abdominal pain at the left iliac fossa. She underwent an emergency exploratory laparotomy plus left hemicolectomy and was followed in the surgical out-patient clinic postoperatively. She was found doing well taking a normal diet and having normal bowel habits. The overall prognosis depends on the complete removal of the tumor.
Collapse
Affiliation(s)
- Meetham Allawati
- Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
| | | | | |
Collapse
|
9
|
Guanà R, Pagliara C, Zambaiti E, Scottoni F, Pane A, Garofalo S, Pizzol A, Giuliani F, Carpino A, Gennari F. Incidental Ultrasound Diagnosis of Neonatal Intussusception Secondary to Meckel's Diverticulum in a Neurologically Impaired Child. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932280. [PMID: 34482359 PMCID: PMC8428622 DOI: 10.12659/ajcr.932280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient: Female, 1-month-old
Final Diagnosis: Intussusception
Symptoms: Rectal bleeding
Medication: —
Clinical Procedure: Ultrasonography
Specialty: Pediatrics and Neonatology
Collapse
Affiliation(s)
- Riccardo Guanà
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Camilla Pagliara
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Elisa Zambaiti
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Federico Scottoni
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Alessandro Pane
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Salvatore Garofalo
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| | - Antonio Pizzol
- Department of Pediatric Gastroenterology, Regina Margherita Children's Hospital, Turin, Italy
| | - Francesca Giuliani
- Department of Pediatrics and Neonatology, Regina Margherita Children's Hospital, Turin, Italy
| | - Andrea Carpino
- Department of Pediatrics and Health Sciences, Turin University, Turin, Italy
| | - Fabrizio Gennari
- Department of Pediatric Surgery, Regina Margherita Children's Hospital, Turin, Italy
| |
Collapse
|
10
|
Wong L, Kanthasamy SV, Durairaj G, Thangaratnam RR. Neuroendocrine tumour masquerading as intussusception: A case report. Int J Surg Case Rep 2020; 77:48-52. [PMID: 33137672 PMCID: PMC7610031 DOI: 10.1016/j.ijscr.2020.10.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
Intussusception commonly occurs in the paediatric population. Presentation in the adult population is likely malignant. It is important for an intussusception to be managed surgically in adults. Neuroendocrine tumour can present as intussusception in the adult population. Resection with lymph node clearance is needed for complete staging.
Introduction Intussusception usually occurs in the paediatric population. When it occurs in the adult population, it is normally caused by a malignant intraluminal pathology. Presentation of case A 72-year-old female presented to us with right-sided abdominal pain for 3 weeks, associated with vomiting and diarrhoea. She had an appendectomy done 30 years ago and a recent myocardial infarction. Abdominal examination revealed a previous appendectomy scar and tenderness over the right lumbar region. Computed tomography showed ileocaecal intussusception. Right hemicolectomy with a double barrel stoma was performed as she was unstable intraoperatively. Histopathological examination of the tumour showed a well-differentiated neuroendocrine tumour. Subsequent PET scan showed no systemic disease and a reversal of the stoma was done. She remained disease free for a year. Discussion Our patient had undergone a right hemicolectomy despite the high risk of mortality, as there is a high chance of malignancy. Double barrel stoma was done, as she was unstable intraoperatively. Fortunately, she recovered well and had her stoma reversed without any further recurrence of her disease. Conclusion Adult patients who present with intussusception should be managed with resection, as there is a high possibility of a malignancy. Early resection should be planned to prevent further spread of the tumour.
Collapse
Affiliation(s)
- Lingwei Wong
- Hospital Serdang, Selangor, Malaysia; University of Malaya, Kuala Lumpur, Malaysia.
| | | | - Gunaseelan Durairaj
- Hospital Serdang, Jalan Puchong, 43000, Kajang, Selangor Darul Ehsan, Malaysia
| | | |
Collapse
|
11
|
Patel DM, Loewen JM, Braithwaite KA, Milla SS, Richer EJ. Radiographic findings predictive of irreducibility and surgical resection in ileocolic intussusception. Pediatr Radiol 2020; 50:1249-1254. [PMID: 32519054 DOI: 10.1007/s00247-020-04695-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/14/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ileocolic intussusception is a common cause of intestinal obstruction in young children. Radiographs may be of limited value in the diagnosis of intussusception and are sometimes utilized primarily to exclude pneumoperitoneum before therapeutic enema reduction. OBJECTIVE The goal of this study was to determine if radiographic findings in ileocolic intussusception can offer prognostic information regarding the outcome of therapeutic air enema and, for those requiring surgical intervention, surgical outcomes and/or complications. MATERIALS AND METHODS A single institution retrospective study was performed including all enemas for intussusception performed during a 5-year period from September 2012 to August 2017. Radiographs obtained before therapeutic enema, including our institution radiographs, outside facility radiographs, or scout images obtained during fluoroscopy or computed tomography (CT), were independently scored by two pediatric radiologists for normal bowel gas pattern, soft-tissue mass, paucity of bowel gas, meniscus sign and bowel obstruction. The reviewers were blinded to enema and surgical outcomes at the time of review. Differences were resolved by consensus. Cases were excluded in which there was no adequate pre-procedure radiograph. In total, 182 cases were reviewed. The medical records were reviewed for enema and surgical outcomes. RESULTS Radiographic findings included normal bowel gas pattern in 13%, soft-tissue mass in 26%, paucity of bowel gas in 65%, meniscus sign in 12% and obstruction in 10% of the cases, with 17.5% of patients having more than one finding. In patients with bowel obstruction on radiographs, there was a statistically significant decrease in success of therapeutic enema (83% vs. 21%, P=0.0001), increase in complicated surgical reductions (47% vs. 4%, P=0.0012), and increase in bowel resection (42% vs. 4%, P=0.003) compared to patients with normal bowel gas pattern. CONCLUSION Radiographs can offer prognostic information regarding the potential for therapeutic enema success, as well as potential surgical outcomes in patients failing enema reduction. Particularly, bowel obstruction significantly decreases the success of therapeutic enema and increases the need for bowel resection.
Collapse
Affiliation(s)
- Dhruv M Patel
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Jonathan M Loewen
- Department of Radiology, Emory University/Children's Healthcare of Atlanta, 1405 Clifton Rd., Atlanta, GA, 30329, USA
| | - Kiery A Braithwaite
- Department of Radiology, Emory University/Children's Healthcare of Atlanta, 1405 Clifton Rd., Atlanta, GA, 30329, USA
| | - Sarah S Milla
- Department of Radiology, Emory University/Children's Healthcare of Atlanta, 1405 Clifton Rd., Atlanta, GA, 30329, USA
| | - Edward J Richer
- Department of Radiology, Emory University/Children's Healthcare of Atlanta, 1405 Clifton Rd., Atlanta, GA, 30329, USA.
| |
Collapse
|
12
|
Pandiaraja J. Adult Jejuno-Jejunal Intussusceptions due to Gastrointestinal Stromal Tumor. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_203_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractIntussusception is telescoping of proximal segment of the intestine within the lumen of adjacent segment of intestine. In children, most of the intussusception is idiopathic, whereas in adults, it is always associated with pathological lead point. In adults, jejuno-jejunal intussusception is very rare compared to children. Preoperative diagnosis is difficult in most of the cases, so adequate negative margin is mandatory when a gastrointestinal stromal tumor (GIST) is suspected as the cause of jejuno-jejunal intussusception. This case is reported because jejunal intussusception is one of the rare presentations of GIST.
Collapse
Affiliation(s)
- Jayabal Pandiaraja
- Department of General Surgery, Care Hospital, Chennai, Tamil Nadu, India
| |
Collapse
|
13
|
Thanh Xuan N, Huu Son N, Huu Thien H. Treatment Outcome of Acute Intussusception in Children Under Two Years of Age: A Prospective Cohort Study. Cureus 2020; 12:e7729. [PMID: 32432007 PMCID: PMC7234032 DOI: 10.7759/cureus.7729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Intussusception is a common cause of small intestinal obstruction in children under two years of age. Late diagnosis can lead to a potentially worse condition. This prospective study aims to describe the clinical manifestation and develop a conservative management protocol for acute ileocaecal intussusception in children under two years of age. Methods This prospective study was carried out in 118 consecutive patients under two years of age. Patients presented with symptoms and signs of acute intestinal obstruction and a diagnosis of ileocaecal intussusception confirmed by ultrasound were included in this study. All the patients were managed with either pneumatic reduction or operation. Results There were 70 boys and 48 girls ranging in age from three months to two years with a median of 12.5 months. Clinical presentation included abdominal pain (100%), vomiting (82.2%), bloody stool (11.9%), and a palpable mass (43.2%). Patients hospitalized with the symptoms and signs for less than 24 hours accounted for 80.5% of the cases. The overall success rate of pneumatic reduction was 98.3%. Late hospital admission (≥ 24 hours from illness onset), bloody stool, and presenting with the classic triad of symptoms of intussusception were found as the factors that correlated to the surgical management outcome. All patients recovered well without any complications. The median of postoperative hospital stay of two days for the pneumatic reduction group and six days for the operation group. Conclusion The early diagnosis of intussusception contributes to the success of pneumatic reduction and reduces the requirement of surgical intervention.
Collapse
Affiliation(s)
- Nguyen Thanh Xuan
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, VNM
| | | | - Ho Huu Thien
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, VNM
| |
Collapse
|
14
|
Zhang J, Tran DH, Uradomo L, Verceles AC, Chow RD. Carcinoid tumor causing ileoceccal intussusception in an adult patient. J Community Hosp Intern Med Perspect 2019; 9:267-270. [PMID: 31258872 PMCID: PMC6586133 DOI: 10.1080/20009666.2019.1601058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/25/2019] [Indexed: 01/05/2023] Open
Abstract
Introduction: Little is known about adult intussusception, but current evidence suggests that malignancy, polyps, and diverticula are usual etiologies. We present a case of adult ileoceccal intussusception secondary to carcinoid tumor. Case Presentation: A 53-year-old African American male presented with hematochezia and non-radiating constant left upper quadrant pain accompanied by nausea and vomiting. CT of the pelvis demonstrated a pathognomic ‘target’ sign, consistent with ileoceccal intussusception and early small bowel obstruction. Two years prior to this current presentation, the patient had experienced an episode of hematochezia for which he underwent colonoscopy and polypectomy, with subsequent pathology results negative for colon cancer. He denies diarrhea, constipation, weight loss, decreased appetite or skin flushing. Due to persistent symptoms of bowel obstruction, he underwent exploratory laparotomy. During the surgery a white-colored, chalky mass indicative of penetrating tumor was noted 13 cm proximal to the ileocecal valve. An extended right hemi-colectomy followed the discovery of the mass. Pathology showed a well-differentiated neuroendocrine tumor consistent with carcinoid tumor. Evaluation for metastatic disease using 5-HIAA and chromogranin A was unremarkable, and the resection of the right colon carcinoid tumor was felt to be curative. Conclusion: It is uncommon for adults to present with intussusception; in such cases, malignancy should be ruled out as an underlying cause. Carcinoid should be listed among the other secondary causes, which include inflammatory bowel disease, diverticulitis, polyps, scar tissue, adhesions, and lipomas. Abbreviation: CT (Computer tomography), 5-HIAA (5-hydroxyindole acetic acid), NCCN (National Comprehensive Cancer Network)
Collapse
Affiliation(s)
- Jennie Zhang
- Division of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Dena H Tran
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lance Uradomo
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Avelino C Verceles
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Dobbin Chow
- Division of Internal Medicine, University of Maryland Midtown Campus, Baltimore, MD, USA
| |
Collapse
|
15
|
Tang SJ, Wu R. Ilececum: A Comprehensive Review. Can J Gastroenterol Hepatol 2019; 2019:1451835. [PMID: 30854348 PMCID: PMC6378086 DOI: 10.1155/2019/1451835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/18/2018] [Accepted: 12/09/2018] [Indexed: 02/07/2023] Open
Abstract
For gastrointestinal endoscopists, the ileocecum is the finishing line during colonoscopy and it is identified by three endoscopic landmarks: terminal ileum, ileocecal valve, and the appendiceal orifice. Although ileal intubation is recommended during routine screening colonoscopy, it is not required in most cases of screening colonoscopy. Ileal intubation is indicated in certain circumstances such as suspected inflammatory bowel disease and GI bleeding. There is much pathology that can be observed within the ileocecum. Careful and systematic examination should be stressed during GI endoscopic training and practice. In this review, the authors demonstrate its anatomy, endoscopic findings, and pathologies.
Collapse
Affiliation(s)
- Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, USA
| |
Collapse
|
16
|
Bower KL, Lollar DI, Williams SL, Adkins FC, Luyimbazi DT, Bower CE. Small Bowel Obstruction. Surg Clin North Am 2018; 98:945-971. [PMID: 30243455 DOI: 10.1016/j.suc.2018.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Identifying patients with small bowel obstruction who need operative intervention and those who will fail nonoperative management is a challenge. Without indications for urgent intervention, a computed tomography scan with/without intravenous contrast should be obtained to identify location, grade, and etiology of the obstruction. Most small bowel obstructions resolve with nonoperative management. Open and laparoscopic operative management are acceptable approaches. Malnutrition needs to be identified early and managed, especially if the patient is to undergo operative management. Confounding conditions include age greater than 65, post Roux-en-Y gastric bypass, inflammatory bowel disease, malignancy, virgin abdomen, pregnancy, hernia, and early postoperative state.
Collapse
Affiliation(s)
- Katie Love Bower
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA.
| | - Daniel I Lollar
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
| | - Sharon L Williams
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
| | - Farrell C Adkins
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
| | - David T Luyimbazi
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
| | - Curtis E Bower
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA
| |
Collapse
|
17
|
Long B, April MD. What Measures Improve Reduction of Intussusception in Pediatric Patients? Ann Emerg Med 2018; 71:236-238. [DOI: 10.1016/j.annemergmed.2017.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Indexed: 10/18/2022]
|
18
|
Sunkara T, Caughey ME, Culliford A, Gaduputi V. A Rare Case of Adult Colonic Intussusception from Benign Etiology. Cureus 2018. [PMID: 29531876 PMCID: PMC5837297 DOI: 10.7759/cureus.2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Defined as the tunneling of one bowel segment into an adjacent bowel segment, intussusception is typically observed in pediatric populations. Here, we present the case of a 78-year-old man who, in a series of unlikely events, developed colonic intussusception due to a benign lead point pathology. Intussusception of the colon is an uncommon occurrence in adults. However, adult colonic intussusception, observed in the absence of a malignant lead point pathology, represents a true clinical anomaly.
Collapse
Affiliation(s)
- Tagore Sunkara
- Internal Medicine/gastroenterology, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121 Dekalb Avenue, Brooklyn, Ny 11201
| | - Megan E Caughey
- Internal Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, Ny
| | - Andrea Culliford
- Department of Internal Medicine, SBH Health System, 4422 Third Ave, Bronx, Ny 10457
| | - Vinaya Gaduputi
- Department of Internal Medicine, SBH Health System, 4422 Third Ave, Bronx, Ny 10457
| |
Collapse
|
19
|
Transient Descending Colocolonic Intussusception Due to a Large Fecaloma in an Adult. ACG Case Rep J 2017; 4:e94. [PMID: 28798942 PMCID: PMC5541757 DOI: 10.14309/crj.2017.94] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/25/2017] [Indexed: 12/26/2022] Open
Abstract
Intussusception typically occurs in infants and children, with adults representing 5% of cases. A 53-year-old African American woman presented with lower abdominal pain and tenderness. Computed tomography of the abdomen and pelvis demonstrated a 3.5 cm colocolonic intussusception in the descending colon. Emergent colonoscopy found solid stool in the mid descending colon. Water-soluble rectal enema showed a filling defect in the mid descending colon. Repeat colonoscopy demonstrated presence of a large fecaloma in left colon. Laxatives were initiated, and abdominal pain subsided. To our knowledge, this is the first report of colocolonic intussusception secondary to fecaloma.
Collapse
|
20
|
Abstract
BACKGROUND Intussusception is a common abdominal emergency in children with significant morbidity. Prompt diagnosis and management reduces associated risks and the need for surgical intervention. Despite widespread agreement on the use of contrast enema as opposed to surgery for initial management in most cases, debate persists on the appropriate contrast medium, imaging modality, pharmacological adjuvant, and protocol for delayed repeat enema, and on the best approach for surgical management for intussusception in children. OBJECTIVES To assess the safety and effectiveness of non-surgical and surgical approaches in the management of intussusception in children. SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library; Ovid MEDLINE (1950 to September 2016); Ovid Embase (1974 to September 2016); Science Citation Index Expanded (via Web of Science) (1900 to September 2016); and BIOSIS Previews (1969 to September 2016).We examined the reference lists of all eligible trials to identify additional studies. To locate unpublished studies, we contacted content experts, searched the World Health Organization International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (September 2016), and explored proceedings from meetings of the British Association of Paedatric Surgeons (BAPS), the American Soceity of Pediatric Surgery, and the World Congress of Pediatric Surgery. SELECTION CRITERIA We included all randomised controlled trials comparing contrast media, imaging modalities, pharmacological adjuvants, protocols for delayed repeat enema, and/or surgical approaches for the management of intussusception in children. We applied no language, publication date, or publication status restrictions. DATA COLLECTION AND ANALYSIS Two review authors independently conducted study selection and data extraction and assessed risk of bias using a standardised form. We resolved disagreements by consensus with a third review author when necessary. We reported dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs). We analysed data on an intention-to-treat basis and evaluated the overall quality of evidence supporting the outcomes by using GRADE criteria. MAIN RESULTS We included six randomised controlled trials (RCTs) with a total of 822 participants. Two trials compared liquid enema reduction plus glucagon versus liquid enema alone. One trial compared liquid enema plus dexamethasone versus liquid enema alone. Another trial compared air enema plus dexamethasone versus air enema alone, and two trials compared use of liquid enema versus air enema. We identified three ongoing trials.We judged all included trials to be at risk of bias owing to omissions in reported methods. We judged five of six trials as having high risk of bias in at least one domain. Therefore, the quality of the evidence (GRADE) for outcomes was low. Interventions and data presentation varied greatly across trials; therefore meta-analysis was not possible for most review outcomes. Enema plus glucagon versus enema alone It is uncertain whether use of glucagon improves the rate of successful reduction of intussusception when compared with enema alone (reported in two trials, 218 participants; RR 1.09, 95% CI 0.94 to 1.26;low quality of evidence). No trials in this comparison reported on the number of children with bowel perforation(s) nor on the number of children with recurrent intussusception. Enema plus dexamethasone versus enema alone Use of the adjunct, dexamethasone, may be beneficial in reducing intussusception recurrence with liquid or air enema (two trials, 299 participants; RR 0.14, 95% CI 0.03 to 0.60; low quality of evidence). This equates to a number needed to treat for an additional beneficial outcome of 13 (95% CI 8 to 37). It is uncertain whether use of the adjunct, dexamethasone, improves the rate of successful reduction of intussusception when compared with enema alone (reported in two trials, 356 participants; RR 1.01, 95% CI 0.92 to 1.10;low quality of evidence). Air enema versus liquid enema Air enema may be more successful than liquid enema for reducing intussusception (two trials, 199 participants; RR 1.28, 95% CI 1.10 to 1.49; low quality of evidence). This equates to a number needed to treat for an additional beneficial outcome of 6 (95% CI 4 to 19). No trials in this comparison reported on the number of children with bowel perforation(s) or on the number of children with recurrent intussusception nor any intraoperative complications, such as bowel perforation, or other adverse effects. Only one trial reported postoperative complications, but owing to the method of reporting used, a quantitative analysis was not possible. We identified no studies that exclusively evaluated surgical interventions for management of intussusception. AUTHORS' CONCLUSIONS This review identified a small number of trials that assessed a variety of interventions. All included trials provided evidence of low quality and were subject to serious concerns about imprecision, high risk of bias, or both. Air enema may be superior to liquid enema for successfully reducing intussusception in children; however, this finding is based on a few studies including small numbers of participants. Dexamethasone as an adjuvant may be more effective in reducing intussusception recurrence rates following air enema or liquid enema, but these results are also based on a few studies of small numbers of participants. This review highlights several points that need to be addressed in future studies, including reducing the risk of bias and including relevant outcomes. Specifically, surgical trials are lacking, and future research is needed to address this evidence gap.
Collapse
Affiliation(s)
- Steven Gluckman
- Sydney Adventist HospitalUniversity of SydneyWahroonga NSW 2076SydneyAustralia
| | | | - Angela C Webster
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
| | - Richard G McGee
- The Children's Hospital at WestmeadInstitute of Endocrinology and DiabetesLocked Bag 4001WestmeadNSWAustralia2145
| | | |
Collapse
|
21
|
Wiener-Carrillo I, González-Alvarado C, Cervantes-Valladolid M, Echaverry-Navarrete D, Zubieta-O'Farrill G, Gudiño-Chávez A. Intussusception secondary to a carcinoid tumor in an adult patient. Int J Surg Case Rep 2014; 5:265-7. [PMID: 24727207 PMCID: PMC4008859 DOI: 10.1016/j.ijscr.2014.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 01/01/2014] [Accepted: 01/29/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Intussusception in adult patients represents 5% of all intussusceptions and 1–5% of bowel obstructions in adults. In contrast to pediatric patients, 90% of the time, in adults, it's caused by well-established pathologic mechanisms, such as carcinoma, polyps, diverticula, Meckel diverticula, stenosis, or benign neoplasms. Small intestine intussusceptions are more frequent, but colonic intussusceptions are caused 50% of the time by malignant neoplasms, especially adenocarcinoma. PRESENTATION OF CASE We present a 70-year-old woman, with no relevant familial history, who presented with a 3-day symptomatology consisting of epigastric, colic, diffuse, abdominal pain of moderate intensity, which progressed till reaching a severe intensity, also referring abdominal distension, nausea, and gastrointestinal-content vomits. DISCUSSION In adult patients, the exact mechanism of intussusception is unknown in 8–20% of the cases, however, secondary intussusception can occur with any lesion of the intestinal wall or any irritant factor in its lumen that alters normal peristaltic activity and that could serve as a trigger to start an intussusception of one bowel segment over another the most common site is the small intestine. CONCLUSION Intussusception represents an unusual problem in adult patients; it requires a high clinical suspicion, mainly as a differential diagnosis in patients with intestinal obstruction, and it clinically presents as a subacute or chronic illness. CT represents the most useful diagnostic tool. An attempt to perform reduction procedures in small intestine intussusceptions can be done, however, in ileocolic or colonic intussusceptions, a formal resection of the segment is recommended.
Collapse
|
22
|
Ludvigsson JF, Nordenskjöld A, Murray JA, Olén O. A large nationwide population-based case-control study of the association between intussusception and later celiac disease. BMC Gastroenterol 2013; 13:89. [PMID: 23679928 PMCID: PMC3661363 DOI: 10.1186/1471-230x-13-89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 05/13/2013] [Indexed: 02/07/2023] Open
Abstract
Background Case reports and case series studies suggest a positive association between intussusception and celiac disease (CD). Methods We contacted Sweden’s 28 pathology departments and obtained data on 29,096 patients with biopsy-verified CD (equal to Marsh stage 3) through biopsy reports. Patients with CD were matched for age, sex, calendar period and county of residence with up to five reference individuals from the general population (n = 144,522). Cases of intussusception were identified from nationwide inpatient, hospital-based outpatient and day-surgery data from the Swedish Patient Register. Odds ratios (ORs) for future CD in patients with intussusception were estimated using conditional logistic regression. Results 34 (0.12%) individuals with CD had a diagnosis of intussusception vs. 143 (0.10%) reference individuals, suggesting that intussusception was not a risk factor for later CD (OR = 1.17; 95% confidence interval (CI) = 0.82–1.67). The OR for CD in patients with at least two records of intussusception was 0.40 (95% CI = 0.06–2.99). In contrast, a post-hoc analysis showed that CD was associated with a statistically significantly increased risk of intussusception after CD diagnosis (hazard ratio = 1.95; 95% CI = 1.01–3.77); however, this analysis was based on only 12 cases with both CD and intussusception. Conclusion We found no association between intussusception and future CD; and a mostly modest increased risk of intussusception after a diagnosis of CD.
Collapse
Affiliation(s)
- Jonas F Ludvigsson
- Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Karolinska, Sweden.
| | | | | | | |
Collapse
|
23
|
Amoruso M, D'Abbicco D, Praino S, Conversano A, Margari A. Idiopathic adult colo-colonic intussusception: Case report and review of the literature. Int J Surg Case Rep 2013; 4:416-8. [PMID: 23500747 DOI: 10.1016/j.ijscr.2013.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/16/2013] [Accepted: 01/17/2013] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Acute colonic intussusception occurring in the absence of organic cause is uncommon in adults. PRESENTATION OF CASE We report acute colonic intussusception in a 46-year-old female; clinical evidence of a palpable mass, abdominal pain and bloody mucoid stools appeared a few hours after hospital admission. Multislice CT-scan confirmed the clinical diagnosis and surgical exploration revealed right colonic obstruction caused by intussusception of the cecum into the ascending colon. Right hemicolectomy was performed and histopathological examination did not reveal any causative pathology. DISCUSSION Intussusception remains a rare condition in adults, representing 1-5% of bowel obstruction and accounting for 0.003-0.02% of all hospital admissions. Intussusception occurs more frequently in the small (50-80%) than in the large bowel (12-50%). It is estimated that approximately 90% of intussusceptions in adults are secondary to an anatomical or pathological condition, of which more than half are malignant. Idiopathic cases are the exception in adults. The clinical presentation of adult intussusception differs considerably from the classic pediatric presentation of abdominal pain, palpable mass, and blood per rectum, which is rarely seen in adults. A pre-operative CT-scan showed a 10cm intussuscepted segment of right colon. Surgical resection was considered mandatory because of severe bowel obstruction, and the theoretical possibility of occult malignancy. This approach was vindicated by the presence of widespread ischemic lesions in the wall of the resected bowel, without any obvious lead point. CONCLUSION There are few reports in the medical literature of acute colonic intussusception occurring in the absence of organic cause in adults.
Collapse
Affiliation(s)
- Michele Amoruso
- Unità Operativa di Chirurgia Generale "Giuseppe Marinaccio" Azienda Ospedaliero Universitaria Policlinico di Bari Piazza Giulio Cesare, 11 70124, Italy.
| | | | | | | | | |
Collapse
|