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Sciberras N, Zammit SC, Sidhu R. Small bowel intussusception - aetiology & management. Curr Opin Gastroenterol 2024; 40:175-182. [PMID: 38190421 DOI: 10.1097/mog.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Adult small bowel intussusception (SBI) differs in incidence, symptomatology and management from the more commonly encountered paediatric intussusception. This review spans across the multitude of causes of adult SBI, and summarises the diagnostic work-up and management options according to recent literature. RECENT FINDINGS There has been an increase in use of small bowel capsule endoscopy and point-of-care ultrasound for the diagnosis of acute adult SBI. SUMMARY A high degree of suspicion of a malignant cause of SBI is required in the adult population. Alarm clinical features include weight loss, history of malignancy, and iron deficiency anaemia. CT remains the gold standard imaging technique as it may identify the lead point and thus aid in endoscopic or surgical management. If malignancy is excluded and no lead point is identified, serology and histology may be helpful to look for inflammatory, infective and autoimmune aetiology.
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Affiliation(s)
| | | | - Reena Sidhu
- Department of Gastroenterology, Sheffield Teaching Hospital NHS Foundation Trust, Department of Infection, Immunity & Cardiovascular Diseases, University of Sheffield, UK
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2
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Heng V, Oh S, Leng H, Chhun V, Lee YD. Adult colorectal intussusception caused by giant lipoma-A case report. Clin Case Rep 2024; 12:e8682. [PMID: 38562575 PMCID: PMC10982120 DOI: 10.1002/ccr3.8682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/04/2024] Open
Abstract
Key Clinical Message Adult intussusception commonly has a leading point. In the colon, malignancy is a prevalent etiology for the leading point; however, benign tumors should also be considered. We present a case of colorectal intussusception caused by a giant lipoma. Abstract Intussusception in adults is comparatively infrequent in contrast to children, and in adult colonic intussusception, malignancy is the predominant cause of the leading point. Lipoma, an uncommon tumor in the gastrointestinal tract, rarely induces colonic intussusception in adults. We present the case of a 55-year-old Cambodian man experiencing cramping abdominal pain. He presented with mild abdominal distension with tenderness in the lower abdomen. On the rectal examination a large palpable mass was detected three to four centimeters from the anal verge. Abdominal computerized tomography revealed a collapsed sigmoid colon with mesenteric fat invaginated into the lumen of the upper rectum. Emergency laparotomy was performed and during the surgery the sigmoid intussusception spontaneously reduced. A mass was identified in the mid-sigmoid colon, leading to the decision for segmental resection of the sigmoid colon with the mass and subsequent end-to-end anastomosis. Histological examination results confirmed the mass as a lipoma. Colorectal intussusception in adults due to a lipoma is a relatively rare, with only a few reported cases in the literature.
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Affiliation(s)
- Vouchly Heng
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Suk‐Kyu Oh
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Hour Leng
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
| | - Vireak Chhun
- Department of PathologyHebron Medical CenterPhnom PenhCambodia
| | - Young Don Lee
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
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Zabeirou A, Efared B, James Didier L, Younssa H, Adama S, Moussa Y, Rachid S. Appendiceal mucocele as an exceptional cause of ileocecocolic intussusception in adults: a case report. J Med Case Rep 2023; 17:392. [PMID: 37710264 PMCID: PMC10503163 DOI: 10.1186/s13256-023-04133-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Intussusception is a rare condition in adults, accounting for 5% of intestinal intussusception and being responsible for approximately 1% of all adult bowel obstructions. Neoplastic origin is the most common etiology of intestinal intussusception in adults, unlike pediatric intussusception, which is usually idiopathic. Intussusception due to the appendiceal mucocele is exceptional, and only a few cases have been reported in the medical literature. CASE PRESENTATION We report the case of a 25-year-old black African male patient with no medical history. He presented to the emergency department for abdominal pain, nausea, and bilious vomiting. The abdominal examination revealed typical signs of acute bowel obstruction. Enhanced abdominopelvic computed tomography showed an invagination of the last ileal loop, cecum, and ascending colon into the lumen of the transverse colon, with a rounded image with hypodense content and some calcifications compatible with an appendiceal mucocele. An emergency exploratory laparoscopy was performed and confirmed the ileocecocolic intussusception. Right hemicolectomy and ileocolic anastomosis were performed. The patient recovery postoperatively was uneventful, and he was discharged 4 days later. Histological examination of the surgical specimen confirmed the diagnosis of mucinous cystadenoma. CONCLUSION The symptoms of bowel intussusception with the appendiceal mucocele as the lead point in adults are similar to any other bowel intussusception. Differential diagnosis is often carried out thanks to the injected abdominal computed tomography scan.
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Affiliation(s)
- Aliou Zabeirou
- Department of General and Visceral Surgery, Hôpital Général de Référence, Niamey, Niger.
| | - Boubacar Efared
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Lassey James Didier
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Hama Younssa
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Saidou Adama
- Department of General and Visceral Surgery, Hôpital Général de Référence, Niamey, Niger
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Younoussa Moussa
- Department of General and Visceral Surgery, Hôpital Général de Référence, Niamey, Niger
| | - Sani Rachid
- Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
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Tagliaferri AR, Naseer M, Melki G, Azam S, Cavanagh Y. A Rare Presentation of Gastrointestinal Stromal Tumor Causing Gastroduodenal Intussusception. Cureus 2023; 15:e34632. [PMID: 36891025 PMCID: PMC9988366 DOI: 10.7759/cureus.34632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/07/2023] Open
Abstract
Adult intussusception is exceedingly rare and most commonly occurs in the stomach or ileum. It is less common for adult intussusception to be classified as gastroduodenal, which also carries a higher mortality rate. Adult intussusception usually warrants surgical intervention as the underlying cause is often malignancy. However, rarely, the etiology is a gastrointestinal stromal tumor (GIST). Here, we present the case of a patient who presented with abdominal pain, vomiting, and hemorrhagic shock and was diagnosed with gastroduodenal intussusception secondary to a gastric GIST.
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Affiliation(s)
| | - Minha Naseer
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Gabriel Melki
- Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Shoaib Azam
- Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, USA
| | - Yana Cavanagh
- Gastroenterology, St. Joseph's Regional Medical Center, Paterson, USA
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Zhao G, Meng W, Bai L, Li Q. Case report: An adult intussusception caused by ascending colon cancer. Front Surg 2022; 9:984853. [PMID: 36157411 PMCID: PMC9500318 DOI: 10.3389/fsurg.2022.984853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Adults with bowel intussusception caused by malignant tumors are fairly uncommon. We presented a case of a 64-year-old woman whose intussusception was secondary to ascending colon cancer. A color Doppler ultrasonography of the abdomen revealed a low echo mass in the right middle abdomen. Physical examination and digital rectal examination were both unremarkable. Computed tomography (CT) revealed a concentric circle change in the colon, as well as the mesenterium and arteries. Electronic colonoscopy discovered the colonic giant proliferative lesions and stenosis. Adenocarcinoma with moderate differentiation was discovered after a biopsy. Then laparotomy showed intussusception and the tumor was located in the ascending colon. The postoperative pathological test revealed moderately differentiated adenocarcinoma in the right colon invaded the whole layer. After hospitalization, the patient was discharged without any complications. This case highlights that rational use of CT, endoscopy, and timely surgery combines an effective strategy for the treatment of adult intussusception.
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Affiliation(s)
- Guowei Zhao
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Wenjun Meng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lian Bai
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Qigang Li
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
- Correspondence: Qigang Li
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Panzera F, Di Venere B, Rizzi M, Biscaglia A, Praticò CA, Nasti G, Mardighian A, Nunes TF, Inchingolo R. Bowel intussusception in adult: Prevalence, diagnostic tools and therapy. World J Methodol 2021; 11:81-87. [PMID: 34026581 PMCID: PMC8127421 DOI: 10.5662/wjm.v11.i3.81] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
Intussusception is defined as invagination of one segment of the bowel into an immediately adjacent segment. The intussusception refers to the proximal segment that invaginates into the distal segment, or the intussusception (recipient segment). Intussusception, more common occur in the small bowel and rarely involve only the large bowel. In direct contrast to pediatric etiologies, adult intussusception is associated with an identifiable cause in almost all the symptomatic cases while the idiopathic causes are extremely rare. As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. In this review, we discuss the symptoms, location, etiology, characteristics, diagnostic methods and treatment strategies of this rare and enigmatic clinical entity in adult.
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Affiliation(s)
- Francesco Panzera
- Department of Endoscopy, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Beatrice Di Venere
- Department of Surgery, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Marina Rizzi
- Department of Endoscopy, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Assunta Biscaglia
- Department of Radiology, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | | | - Gennaro Nasti
- Department of Surgery, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Andrea Mardighian
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Thiago Franchi Nunes
- Department of Radiology, Santa Casa de Campo Grande, Campo Grande 79010-050, Brazil
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
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Tarchouli M, Ait Ali A. Adult Intussusception: An Uncommon Condition and Challenging Management. Visc Med 2021; 37:120-127. [PMID: 33981752 PMCID: PMC8077547 DOI: 10.1159/000507380] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/19/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Intussusception is a rare condition in adults. A pathological lesion is usually found with a significant percentage of malignancy. The optimal treatment is still not universally clear. METHODS This is a retrospective review of adult patients with a diagnosis of intestinal intussusception and surgically treated at our institution from January 2009 to December 2018. Clinical, operative, and histological details were collected and analyzed. RESULTS A total of 26 cases, 16 males and 10 females, were diagnosed with surgically proven intussusception during the 10-year period. The mean age was 45 years (range 21-70). Using ultrasound and/or computed tomography as imaging study, the preoperative diagnosis was made in 21/26 (81%) patients. Five intussusceptions were discovered only upon exploratory laparotomy for intestinal obstruction. There were 19 (73%) cases of enteric and 7 (27%) cases of colonic intussusceptions. All patients underwent surgical exploration. Intestinal resection with immediate anastomosis was the technique of choice for most patients. A single patient underwent stoma for peritonitis secondary to intestinal perforation. An organic cause has been systematically revealed, and no idiopathic intussusception was detected. Etiology was malignant in 9 (35%) cases. CONCLUSION Adult intussusception should be considered in any patient with subacute abdominal pain. Considering the high rate of malignancy, intestinal resection without attempting reduction is highly recommended for colonic intussusceptions. However, a more selective approach can be adopted for enteric intussusceptions.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Surgery, First Medical and Surgical Center, Agadir, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Abdelmounaim Ait Ali
- Department of Visceral Surgery, Mohammed V Military Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Su T, He L, Zhou T, Wu M, Guo Y, Wang Q, Jiang J, Cao X. Most Adult Intussusceptions are Caused by Tumors: A Single-Centre Analysis. Cancer Manag Res 2020; 12:10011-10015. [PMID: 33116857 PMCID: PMC7576473 DOI: 10.2147/cmar.s268921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Adult intussusception is less common than paediatric intussusception. The aim of this study was to explore the clinical presentation, aetiology, diagnosis and treatment of adult intussusception. Methods Adults (>18 years) with intussusception treated by surgical or conservative measures were included from January 2005 to January 2018, and the manifestation, types, diagnosis and treatment of adult intussusception in our centre were reviewed. Results A total of 150 patients with adult intussusception were included in this study. The clinical manifestations included 111 cases (74%) of abdominal pain, 38 cases (25.3%) of bloody stool, 37 cases (24.7%) of bowel obstructions, 33 cases (22%) of abdominal distension, 29 cases (19.3%) of nausea and vomiting, 19 cases (12.7%) of an abdominal mass, and 12 cases (8.0%) of diarrhoea. The types of intussusception were classified into 36 cases (24%) of enteric intussusception, 87 cases (58%) of intestine-colon intussusception and 27 cases (18%) of colonic intussusception. Surgical intervention was applied in 139 cases (92.7%), including 115 patients who underwent open surgery, and laparoscopy-assisted surgery was performed in 24 patients. The main pathogenesis of intussusception was malignant tumors in 51 cases (36.7%) and benign tumors and polyps in 49 cases (35.3%). Conclusion Malignant and benign tumors are the main causes of adult intussusception. Abdominal CT is the preferred evaluation method for the preoperative diagnosis of this condition. The choice of surgical procedure depends on the location and type of intussusception.
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Affiliation(s)
- Tongrong Su
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, People's Republic of China
| | - Liang He
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, People's Republic of China
| | - Tianyu Zhou
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, People's Republic of China
| | - Menghui Wu
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, People's Republic of China
| | - Yaohua Guo
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, People's Republic of China
| | - Quan Wang
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, People's Republic of China
| | - Jing Jiang
- Division of Clinical Research, The First Hospital of Jilin University, Changchun 130021, Jilin Province, People's Republic of China
| | - Xueyuan Cao
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, People's Republic of China
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9
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Jejunal Intussusception in Adolescent Crohn's Disease: An Extremely Rare Complication. Case Rep Surg 2020; 2020:8880100. [PMID: 33005470 PMCID: PMC7509544 DOI: 10.1155/2020/8880100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022] Open
Abstract
Proximal small bowel intussusception occurring in an adolescent Crohn's disease patient is an extremely rare entity. It is usually primary without a lead point and quite often a transient phenomenon. We report such transient and intermittent jejunal intussusception in a 16-year-old male, developing immediately in a postoperative period after a stoma reversal for jejunal stricture perforation peritonitis.
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10
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Transient jejuno-jejunal intussusception in an anabolic steroid user-A case report. Int J Surg Case Rep 2020; 70:126-129. [PMID: 32428711 PMCID: PMC7235922 DOI: 10.1016/j.ijscr.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/22/2020] [Accepted: 04/01/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Adult intussusception (AI) is both a challenging and rare diagnosis, with predisposing factors including malignancy, surgery and infection to name a few. Transient jejunal intussusception is a subset of AI which is usually diagnosed radiologically, with diagnostic laparoscopy utilised to determine whether a malignant cause is identifiable and subsequently treatable. PRESENTING CASE We present the case of a previously healthy 36-year-old male diagnosed with transient jejunal intussusception on computed tomography after presenting with abdominal pain. Blood tests on admission were normal apart from polycythaemia. His only significant history was that of chronic anabolic steroid use. He had a subsequent normal gastroscopy and colonoscopy with diagnostic laparoscopy demonstrating thickening of the small bowel. Histopathological analysis of the intraoperative specimen was normal. The patient improved and was discharged with no further complications. CONCLUSION This case highlights the potential association between anabolic steroid use resulting in polycythaemia, and AI or transient jejunal intussusception, along with further validating a conservative approach in the management of AI in patients deemed to be low risk of malignancy on pre-operative evaluation.
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Park KB, Jee YS, Kim DW. Laparoscopic resection of two inflammatory fibroid polyps: An unusual cause of jejunojejunal intussusception. Int J Surg Case Rep 2020; 69:20-23. [PMID: 32248011 PMCID: PMC7132045 DOI: 10.1016/j.ijscr.2020.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 01/25/2023] Open
Abstract
IFPs are rare, clinically benign tumors that can present as an intussusception. 23-year-old man suffered from intussusception caused by two IFPs. Surgical resection may be the optimal treatment method for IFPs accompanied by intussusception.
Introduction Inflammatory fibroid polyps (IFPs) are rare, clinically benign tumors that can present as an intussusception causing intestinal obstruction. Presentation of case We present a rare case of a 23-year-old man who suffered from intussusception caused by two IFPs. The patient complained of aggravated squeezing epigastric pain that prompted him to visit the emergency department. Moderate abdominal distention with mild tenderness was noted without signs of peritonitis. Abdominal computed tomography confirmed the presence of intussusception in the left lower quadrant. During laparoscopic surgery, the intussuscepted segment of the jejunum was identified, after which laparoscopic small bowel resection and anastomosis were performed. The patient was subsequently discharged without postoperative complications. Discussion IFPs are rare, clinically benign tumors of the gastrointestinal tract originating from the submucosa. IFPs can present as an intussusception causing intestinal obstruction. Conclusion Surgical resection is the optimal treatment method for IFPs accompanied by intussusception.
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Affiliation(s)
- Ki Bum Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ye Seob Jee
- Department of Surgery, Dankook University Hospital, Chungnam, Republic of Korea
| | - Dong-Wook Kim
- Department of Surgery, Dankook University Hospital, Chungnam, Republic of Korea.
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Kim YK. Single-incision laparoscopic surgery for jejuno-jejunal intussusception caused by an angiolipomatous polyp in an adult: A case report. Medicine (Baltimore) 2019; 98:e18280. [PMID: 31852102 PMCID: PMC6922439 DOI: 10.1097/md.0000000000018280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Small bowel intussusception in adults is rare but is more likely to occur in the presence of a lead point. Surgical intervention is necessary in most cases, even if there is successful nonsurgical reduction of the intussusception. PATIENT CONCERNS A 54-year-old woman who was transferred to our emergency room with complaints of intermittent cramping pain of 4 days' duration. DIAGNOSIS Abdominal contrast-enhanced computed tomography revealed a jejuno-jejunal intussusception due to an angiolipomatous polyp. INTERVENTION A single-incision laparoscopic surgery (SILS) was performed without the need for any additional incisions. OUTCOMES She was uneventfully discharged on postoperative day 4. LESSONS The SILS procedure with adequate preoperative diagnosis by CT, with or without US, can offer good clinical outcomes for small bowel intussusception. Even surgeons who have little experience with laparoscopic intestinal anastomosis can consider SILS to treat small bowel intussusception in adults.
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Hong KD, Kim J, Ji W, Wexner SD. Adult intussusception: a systematic review and meta-analysis. Tech Coloproctol 2019; 23:315-324. [PMID: 31011846 DOI: 10.1007/s10151-019-01980-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/01/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Perhaps partly because intussusception in adults is rare, optimal treatment remains controversial. The aim of this study was to determine the appropriate surgical procedure for adult intussusception. METHODS A systematic search was undertaken using PubMed, Embase, and Web of Science from 1/1980 to 12/2016. Adults (> 15 years) with intussusception treated by surgical or conservative measures were included. RESULTS One thousand two hundred twenty-nine patients were identified from 40 retrospective case series. Pooled rates of malignant and benign tumors and idiopathic etiologies were 32.9% (95% CI 28.6-37.4), 37.4% (95% CI 32.7-42.3), and 15.1% (95% CI 11.7-19.3), respectively. Pooled rates of enteric, ileocolic, and colonic location types were 49.5% (95% CI 41.8-57.2), 29.1% (95% CI 23.0-36.1), and 19.9% (95% CI 16.3-24.1), respectively. Pooled rates of malignant tumors in enteric, ileocolic, and colonic intussusception were 22.5% (95% CI 18.3-27.3), 36.9% (95% CI 27.3-47.6), and 46.5% (31.1-62.6), respectively. Metastatic carcinoma was the main cause of malignant tumor in enteric intussusception. Conversely, primary adenocarcinoma was the main cause of malignant tumor in ileocolic and colonic intussusception. Considering the high rate of malignancy of colonic intussusception the majority of the studies surveyed recommend en bloc resection without reduction to avoid potential intraluminal seeding or venous tumor dissemination. Pooled rates of postoperative complications and mortality were 22.1% (95% CI 17.5-27.5) and 5.2% (95% CI 3.7-7.4), respectively. CONCLUSION Whereas enteric intussusception can be managed by reduction followed by resection, colonic intussusception should be resected en bloc. Due to the intermediate forms between enteric and colonic intussusception, a selective approach is recommended. Surgery remains the mainstay in adult intussusception.
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Affiliation(s)
- K D Hong
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea
| | - J Kim
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea
| | - W Ji
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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Girón F, Báez Y, Amaya J. Autotrasplante renal por aneurisma de arteria renal en un paciente con riñón funcional único: reporte de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Gueye ML, Sarr ISS, Gueye MN, Thiam O, Seck M, Toure AO, Cisse M, Ka O, Dieng M. Adult ileocecal intussusception induced by adenomatous ileal polyp: case report and literature review. J Surg Case Rep 2018; 2018:rjy256. [PMID: 30283630 PMCID: PMC6162352 DOI: 10.1093/jscr/rjy256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 09/12/2018] [Indexed: 01/27/2023] Open
Abstract
Intussusception is a rare cause of bowel obstruction in adults, and has generally an organic etiology. However, adenomatous polyp of the small bowel is an uncommon etiology. Moreover, there’s a great difference with childhood intussusception in its presentation, etiology and management. We describe herein a case of adult ileocecal intussusception due to an adenomatous ileal polyp with a preoperative diagnosis made on computed tomography. We performed a right hemicolectomy, without attempting to reduce the intussusception, and an end-to-end ileotransverse anastomosis. The pathological examination of the surgical specimen revealed an adenomatous polyp with a high grade dysplasia on the terminal ileum, being the cause of the ileocecal intussusception.
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Affiliation(s)
- M L Gueye
- Department of General Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
| | - I S S Sarr
- Department of General Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
| | - M N Gueye
- Department of Hepatogastroenterology, Aristide Le Dantec Hospital, Dakar, Senegal
| | - O Thiam
- Department of General Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
| | - M Seck
- Department of General Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
| | - A O Toure
- Department of General Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
| | - M Cisse
- Department of General Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
| | - O Ka
- Department of General Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
| | - M Dieng
- Department of General Surgery, Aristide Le Dantec Hospital, Dakar, Senegal
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16
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Small bowel intussusception due to inflammatory fibroid polyp: A case report. Radiol Case Rep 2018; 13:801-804. [PMID: 29988929 PMCID: PMC6034136 DOI: 10.1016/j.radcr.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/10/2018] [Accepted: 05/13/2018] [Indexed: 02/07/2023] Open
Abstract
Inflammatory fibroid polyp (IFP), or Vanek's tumor, is a rare benign lesion of the gastrointestinal tract. According to the location and the size of the lesion, patients present with different clinical manifestations. Our case describes a patient who presented with a picture of a small bowel obstruction. Computed tomography revealed ileoileal intussusception without a clear lead point. The patient underwent resection of the intussuscepted small bowel with primary anastomosis. A polypoid mass was identified as the pathologic lead point. Histopathologic analysis revealed an inflammatory fibroid polyp.
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17
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Reardon R, Chua TC, Cross J, Curtin A. Rare differential for large bowel obstruction. ANZ J Surg 2018; 89:962-963. [PMID: 29363257 DOI: 10.1111/ans.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca Reardon
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
| | - Terence C Chua
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
| | - Jane Cross
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
| | - Austin Curtin
- Department of General Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
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18
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An infrequent case of intussusception caused by gastrointestinal stromal tumor in an adult patient. North Clin Istanb 2017; 4:192-194. [PMID: 28971180 PMCID: PMC5613270 DOI: 10.14744/nci.2015.53825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/08/2015] [Indexed: 11/23/2022] Open
Abstract
Intussusception may occur anywhere in the gastrointestinal system. Unlike its idiopathic childhood counterpart, it is uncommon during adult life and a definitive cause is usually found; almost half of cases develop with malignancy. Gastrointestinal stromal tumors (GIST) originate from interstitial Cajal cells of the gastrointestinal tract. They more frequently occur in the stomach and small intestines, and often grow extraluminally, making it unlikely to cause an obstruction or bleeding. Presently described is an unusual instance of ileo-ileal intussusception due to GIST.
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19
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Lee DE, Choe JY. Ileocolic intussusception caused by a lipoma in an adult. World J Clin Cases 2017; 5:254-257. [PMID: 28685139 PMCID: PMC5480074 DOI: 10.12998/wjcc.v5.i6.254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/19/2016] [Accepted: 03/22/2017] [Indexed: 02/05/2023] Open
Abstract
Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.
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20
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Cavanagh Y, Shah N, Thomas AB, Gupta A. Multiple Intussusceptions Associated with Polycythemia in an Anabolic Steroid Abuser, A Case Report and Literature Review. Ann Med Health Sci Res 2015; 5:368-72. [PMID: 26500796 PMCID: PMC4594352 DOI: 10.4103/2141-9248.165259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Intussusceptions are generally associated with mechanical lead points or localized inflammation that function as foci for intestinal telescoping. We present the case of a patient whose abuse of anabolic steroids resulted in the development of multiple simultaneous intussusceptions. Our patient had no additional identifiable risk factors for intussusception. Consistent with previous reports, corticosteroid induced polycythemia and its consequent hyperviscosity led to intravascular sludging and mesenteric ischemia with associated bowel wall thickening. The localized intestinal induration then served as mechanical foci for intussusception. Due to the illicit nature of anabolic androgenic steroid (AAS) abuse, the physiologic effects of supraphysiologic doses are sparsely reported and poorly understood. The scope of AAS abuse and its consequences are likely under-reported and under-recognized within the medical community. Our case presented a unique diagnostic and therapeutic challenge with which we aim to increasing awareness and clinical suspicion for AAS among healthcare personnel.
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Affiliation(s)
- Y Cavanagh
- Department of Medicine, St. Joseph's Regional Medical Center, Paterson, NJ, USA
| | - N Shah
- Department of Gastroenterology, St. Joseph's Regional Medical Center, Paterson, NJ, USA ; Department of Gastroenterology, Seton Hall University, West Orange, New Jersey, USA
| | - A B Thomas
- Department of Medicine, St. Joseph's Regional Medical Center, Paterson, NJ, USA
| | - A Gupta
- Department of Gastroenterology, St. Joseph's Regional Medical Center, Paterson, NJ, USA
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21
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Abboud B. Vanek’s tumor of the small bowel in adults. World J Gastroenterol 2015; 21:4802-4808. [PMID: 25944993 PMCID: PMC4408452 DOI: 10.3748/wjg.v21.i16.4802] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/28/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
Inflammatory fibroid polyps (IFPs), or Vanek’s tumor, are one of the least common benign small bowel tumors. IFP affects both sexes and all age groups, with a peak of incidence in the fifth and seventh decades. They can be found throughout the gastrointestinal tract but most commonly in the gastric antrum or ileum. The underlying cause of IFPs is still unknown. Genetic study of IFP showed mutations in platelet derived growth factor alpha in some cases. At the time of diagnosis most IFPs have a diameter of 3 to 4 cm. The lesions have always been recorded as solitary polyps. Symptoms depend on the location and the size of the lesion, including abdominal pain, vomiting, altered small bowel movements, gastrointestinal bleeding and loss of weight. IFPs arising below the Treitz ligament can present with an acute abdomen, usually due to intussusceptions. Abdominal computed tomography is currently considered the most sensitive radiological method to show the polyp or to confirm intussusceptions. Most inflammatory fibroid polyps can be removed by endoscopy. Surgery is rarely needed. Exploratory laparoscopy or laparotomy is frequently recommended as the best treatment for intussusceptions caused by IFP. The operation should be performed as early as possible in order to prevent the intussusceptions from leading to ischemia, necrosis and subsequent perforation of the invaginated bowel segment. This report aims at reviewing the diagnosis, etiology, genetics, clinical presentation, endoscopy, radiology, and best treatment of IFP.
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22
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Kouladouros K, Gärtner D, Münch S, Paul M, Schön MR. Recurrent intussusception as initial manifestation of primary intestinal melanoma: Case report and literature review. World J Gastroenterol 2015; 21:3114-3120. [PMID: 25780313 PMCID: PMC4356935 DOI: 10.3748/wjg.v21.i10.3114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/17/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
Enteric intussusception caused by primary intestinal malignant melanoma is a very rare cause of intestinal obstruction. We herein present a case of a 42-year-old female patient with no prior medical history of malignant melanoma, who was admitted with persistent abdominal pain, nausea, and vomiting. A computed tomography scan revealed an intestinal obstruction due to ileocolic intussusception. An emergency laparoscopy and subsequent laparotomy revealed multiple small solid tumors across the whole small bowel. An oncologic resection was not feasible due to the insufficient length of the remaining small bowel. Only a small segment of ileum, which included the largest tumors causing the intussusception, was resected. The pathologic examination revealed two intestinal malignant melanoma lesions. A systematic clinical examination, endoscopic procedures, and fluorodeoxyglucose positron emission tomography-computed tomography scan all failed to reveal any indication of cutaneous, anal, or retinal melanoma. Hence, the tumor was classified as a primary intestinal malignant melanoma with multiple intestinal metastases. Since a complete oncologic resection of tumors was not possible, in order to prevent future intestinal obstruction, a surgical resection of the largest lesions was performed with palliative intention. The epidemiology, clinical manifestations, diagnosis and management of primary intestinal malignant melanoma, and intestinal intussusception in adults are discussed along with a review of the current literature.
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Feldis M, Dilly M, Marty M, Laurent F, Cassinotto C. An inflammatory fibroid polyp responsible for an ileal intussusception discovered on an MRI. Diagn Interv Imaging 2014; 96:89-92. [PMID: 24618561 DOI: 10.1016/j.diii.2014.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M Feldis
- Diagnostic and Interventional Radiology Department, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France.
| | - M Dilly
- Department of Pathological Anatomy, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
| | - M Marty
- Department of Pathological Anatomy, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
| | - F Laurent
- Diagnostic and Interventional Radiology Department, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
| | - C Cassinotto
- Diagnostic and Interventional Radiology Department, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
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24
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Akbulut S. Intussusception due to inflammatory fibroid polyp: A case report and comprehensive literature review. World J Gastroenterol 2012; 18:5745-52. [PMID: 23155316 PMCID: PMC3484344 DOI: 10.3748/wjg.v18.i40.5745] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 07/16/2012] [Accepted: 10/23/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To give an overview of the literature on intussusception due to inflammatory fibroid polyp (IFP).
METHODS: We present a new case of ileal intussusception due to IFP and a literature review of studies published in English language on intussusception due to IFP, accessed via PubMed and Google Scholar databases. For the search, the keywords used were: intussusception, IFP, intussusception and IFP, intussusception due to IFP, and IFP presenting as intussusception. The search covered all articles from 1976 to November 2011.
RESULTS: We present a 38-year-old woman who was admitted 10 d after experiencing abdominal pain, vomiting, and nausea. Ultrasonography demonstrated small bowel intussusception. An ileal intussusception due to a mass lesion 50 cm proximal to the ileocecal junction was found during laparotomy. Partial ileal resection and anastomosis were performed. A diagnosis of ileal IFP was made based on the immunohistochemical findings. In addition, a total of 56 reports concerning 85 cases of intussusception due to IFP meeting the aforementioned criteria was included in the literature review. The patients were aged 4 to 81 years (mean, 49 ± 16.2 years); 44 were women (mean, 51.8 ± 14.3 years) and 41 were men (mean, 46 ± 17.5 years). According to the location of the IFP, ileal intussusception was found in 63 patients, while 17 had jejunal, three had colonic, and two had ileojejunal intussusception.
CONCLUSION: Although IFPs are rare and benign, surgery is the only solution in case of intestinal obstruction. Differential diagnosis should be made via immunohistochemical examination.
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Adult intussusception: diagnostic pitfalls, morbidity and mortality in a developing country. J Visc Surg 2012; 149:e211-4. [PMID: 22633569 DOI: 10.1016/j.jviscsurg.2012.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To study diagnostic pitfalls, morbidity and mortality of adult intussusception. PATIENTS AND METHODS Retrospective study of adult patients records operated between 1979 and 2007 with the diagnosis of adult intussusception. RESULTS We found 41 cases of adult intussusception. The mean age was 35.2 years (standard deviation (SD)=7.1). The delay between onset and medical consultation was 15 days. The diagnosis was made pre-operatively in 11 cases. Abdominal ultrasound showed an abdominal mass in 11 cases. Ileo-ileal intussusception was most frequent (16 cases). Intussusception was secondary in 24 cases. There were seven instances of intestinal necrosis. Intestinal resection was performed in 34 cases. Surgical site infection occurred in four patients, three patients died. CONCLUSION The pre-operative diagnosis of acute intestinal intussusception is difficult. Morbidity and mortality rates are high. Improved diagnostic investigations in developing countries could improve the prognosis of this condition.
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26
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Gupta A, Gupta S, Tandon A, Kotru M, Kumar S. Gastrointestinal stromal tumor causing ileo-ileal intussusception in an adult patient a rare presentation with review of literature. Pan Afr Med J 2011; 8:29. [PMID: 22121438 PMCID: PMC3201593 DOI: 10.4314/pamj.v8i1.71086] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/17/2011] [Indexed: 11/29/2022] Open
Abstract
Gastrointestinal stromal tumors (GIST) are mesenchymal tumors occurring anywhere along the gastrointestinal tract and are believed to originate from the interstitial cells of Cajal. They commonly arise in the stomach or small intestine. The usual growth pattern is exophytic invading adjacent organs or perforation into the peritoneal cavity which may result in bleeding or obstructive symptoms. Intussusception and obstruction is a very uncommon presentation of these lesions because of their tendency to grow in an extraluminal fashion. We report an unusual case of 59 yrs old man presenting with acute small bowel obstruction, which on exploration was found to be due to ileo-ileal intussusception and the lead point of intussusception was a tumor, which was histologically diagnosed as GIST
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Affiliation(s)
- Amit Gupta
- Department of Surgery, University College of Medical Sciences, and Guru Teg Bahadur Hospital, New Delhi, India
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27
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Gupta V, Doley RP, Subramanya Bharathy KG, Yadav TD, Joshi K, Kalra N, Kang M, Kochhar R, Wig JD. Adult intussusception in Northern India. Int J Surg 2011; 9:297-301. [PMID: 21262396 DOI: 10.1016/j.ijsu.2011.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 12/20/2010] [Accepted: 01/10/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adult intussusception is infrequently encountered in Asians. The diagnosis is often late because of the variable presentation. The optimal treatment is not universally agreed upon. PURPOSE To determine the causes and management of this uncommon entity in India. METHODS A retrospective review of patients with postoperative diagnosis of intussusception between March 2003 and March 2008 was conducted in a tertiary care centre in North India. Data relating to diagnosis, treatment and histopathology was analyzed. RESULTS Twenty-seven patients, aged 15-72 years with 28 intussusceptions were studied. Four patients (14.29%) had acute presentation, 16 (57.14%) subacute and 7 (25%) had chronic symptoms. The most common type of intussusception was enteroenteric. A diagnosis of intussusception on contrast enhanced computed tomogram was made in 84% and a lead point was identified in 89%. A causative factor could be identified in 89% (25 out of 28 intussusceptions) which was malignant in 37% and benign in 48%. The most common underlying malignant lesions were adenocarcinoma (50%), and lymphoma (25%). Among benign lesions, small bowel polyps were the most common (57%). All cases underwent surgical intervention. Bowel resection was performed in 89%. There was no mortality. CONCLUSION Our series highlights a high frequency of a demonstrable cause of intussusception in a tropical country. Overall our results are similar to those reported from other countries. Resection of the involved bowel is recommended because of high incidence of underlying pathology.
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Affiliation(s)
- Vikas Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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28
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Wang N, Fan JP, Guo RX, Guo KJ. Preoperative diagnosis of mechanical intestinal obstruction: analysis of 127 cases. Shijie Huaren Xiaohua Zazhi 2010; 18:3485-3488. [DOI: 10.11569/wcjd.v18.i32.3485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To improve the preoperative diagnosis of mechanical intestinal obstruction.
METHODS: The clinical data for 127 patients with mechanical intestinal obstruction confirmed by laparotomy and pathological examination were retrospectively analyzed. The diagnostic value of abdominal plain film, ultrasonography and CT in assessing the presence of intestinal obstruction and strangulation or not, obstruction site and etiology was comparatively analyzed.
RESULTS: The accuracy of CT in assessing the presence of intestinal obstruction, obstruction site and etiology were 97.4%, 98.7% and 75.6%, respectively, significantly higher than that of abdominal plain film and ultrasonography (all P < 0.05). The incidence of free fluid detected by ultrasonography was significantly higher in patients with strangulated intestinal obstruction than in those with non-strangulated disease (87.1% vs 45.2%, P < 0.05).
CONCLUSION: CT has higher diagnostic accuracy than abdominal plain film and ultrasonography in assessing the presence of intestinal obstruction or not, obstruction site and etiology. When free fluid is detected by ultrasonography in patients with small bowel obstruction, strangulation should be considered.
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