Current Views in the Diagnosis and Treatment of Intestinal Intussusception

Ileocecal intussusception as presentation for ascending colon carcinoma. Case report

INTRODUCTION AND IMPORTANCE

Intussusception is described as invagination of a segment of the bowel into the lumen of an adjacent segment. Although it is the most frequent cause of intestine obstruction during childhood, it is unusual in adulthood, where intussusception represents 1% of all intestine obstructions and 5 % of all intussusceptions.

CASE PRESENTATION

A 64-year-old female presented with a history of weight loss, intermittent diarrhea, and occasional transrectal bleeding. An abdominal computed tomography (CT scan) was performed showing a neoproliferative appearance and associated intussusception of the ascending colon. Colonoscopy revealed an ileocecal intussusception and a tumor on the ascending colon. Right hemicolectomy was performed. Histopathological findings were consistent with colon adenocarcinoma.

CLINICAL DISCUSSION

Adults have an organic lesion within the intussusception in up to 70 % of cases. The clinical presentation of intussusception can vary significantly between children and adults, who will often exhibit chronic nonspecific symptoms including nausea, changes in bowel habits, and gastrointestinal bleeding. The imaging diagnosis of intussusception is a difficult subject, the basis for the diagnosis is a high index of clinical suspicion and noninvasive techniques.

CONCLUSION

Intussusception is an extremely rare condition in adults, in this age group, the malignant entity is one of the main etiologies. Intussusception continues to be a rare entity and should be considered as a differential diagnosis of chronic abdominal pain and intestinal motility disorders; the treatment of choice continues to be surgical.

Noninvasive hydrostatic reduction of an ileocecocolic intussusception in a puppy

A 5-week-old male intact Golden Retriever puppy was presented for a history of vomiting and diarrhea with hematochezia. Ultrasound findings confirmed the presence of an ileocecocolic intussusception. Surgical correction was declined because of financial concerns. Based on a pediatric procedure used in humans, an ultrasound-guided hydrostatic reduction (USGHR) was performed. This procedure consisted in injecting saline rectally under controlled pressure to mechanically reduce the intussusception. Reduction of the intussusception and evaluation of potential complications were concurrently evaluated by ultrasound during the procedure. No recurrence was observed the next day and the puppy was discharged. Follow-up indicated that the dog was still doing well 6 months later. This case report describes a new technique in veterinary medicine allowing successful nonsurgical reduction of an ileocecocolic intussusception in a dog. This procedure is innovative, simple, and substantially decreases the cost and minimizes morbidity potentially associated with surgical management.

Performance of Deep Learning-Based Algorithm for Detection of Pediatric Intussusception on Abdominal Ultrasound Images

Background and Aims

Diagnosing pediatric intussusception from ultrasound images can be a difficult task in many primary care hospitals that lack experienced radiologists. To address this challenge, this study developed an artificial intelligence- (AI-) based system for automatic detection of “concentric circles” signs on ultrasound images, thereby improving the efficiency and accuracy of pediatric intussusception diagnosis.

Methods

A total of 440 cases (373 pediatric intussusception and 67 normal cases) were retrospectively collected from Children's Hospital affiliated to Zhejiang University School of Medicine from January 2020 to December 2020. An improved Faster RCNN deep learning framework was used to detect “concentric circle” signs. Finally, independent validation set was used to evaluate the performance of the developed AI tool.

Results

The data of pediatric intussusception were divided into a training set and validation set according to the ratio of 8 : 2, with training set (298 pediatric intussusception) and validation set (75 pediatric intussusception and 67 normal cases). In the “concentric circle” detection model, the detection rate, recall, specificity, and F1 score assessed by the validation set were 92.8%, 95.0%, 92.2%, and 86.4%, respectively. Pediatric intussusception was classified by “concentric circle” signs, and the accuracy, recall, specificity, and F1 score were 93.0%, 92.0%, 94.1%, and 93.2% on the validation set, respectively.

Conclusion

The model established in this paper can realize the automatic detection of “concentric circle” signs in the ultrasound images of abdominal intussusception in children; the AI tool can improve the diagnosis speed of pediatric intussusception. It is necessary to further develop an artificial intelligence system for real-time detection of “concentric circles” in ultrasound images for the judgment of children with intussusception.

A promising new predictive factor for detecting bowel resection in childhood intussusception: the lymphocyte-C-reactive protein ratio

Background

The most critical concern for the management of childhood intussusception is bowel resection due to intestinal ischemia and necrosis. The early prediction of this problem is of great importance. We investigated the value of various combinations of inflammatory factors to predict intestinal necrosis and resection.

Methods

We retrospectively reviewed the medical records of pediatric patients with intussusception who underwent surgical management. During the research period, 47 patients who underwent intestinal resection due to intestinal necrosis and 68 patients who did not undergo intestinal resection were enrolled. We evaluated the diagnostic value of various combinations of inflammatory markers from preoperative laboratory analyses using the receiver operating characteristic (ROC) method.

Results

In the current cohort, 115 patients underwent operations for intussusception; among them, 47 patients (40.9%) underwent intestinal resections. In the patients with intestinal resection, the neutrophil count(p = 0.013), CRP level(p = 0.002), platelet–lymphocyte ratio (PLR, p = 0.008), NLR (neutrophil–lymphocyte ratio, p = 0.026), and LCR (lymphocyte–CRP ratio, p < 0.001) values were significantly higher than those in the patients without any resection. The receiver operating characteristic (ROC) analysis results showed that the combination of lymphocytic count along with C-reactive protein levels (LCR) demonstrated the highest correlation with intestinal resection due to intussusception compared with other parameters in the patients, with a sensitivity of 0.82 (0.73–0.86) and specificity of 0.80 (0.57–0.94) for the diagnosis of strangulation.

Conclusion

The preoperative LCR level is a useful marker to predict the need for intestinal resection due to intestinal necrosis in patients with intussusception.