Intussusception caused by blunt abdominal trauma

Idiopathic Ileo-Ileo-Cecal Intussuception in a 25-Year-Old Female

BACKGROUND Intussusception is defined as the penetration or telescoping of a segment of bowel into a more distal segment. Intussusception is a common cause of small bowel obstruction, especially in children. However, this finding is much less common in adults. Furthermore, when present in adults, intussusception is often found in association with some sort of organic mass, such as a tumor or pancreatic divisum that acts as a lead point, dragging the proximal segment into the distal one. The presence of an intussusception in an adult patient with no obvious lead point is very uncommon. CASE REPORT Here we report a case of ileo-ileo-cecal double intussusception in an adult patient that yielded no lead point on surgical exploration. The patient was a 25-year-old female who presented with symptoms of obstruction and was diagnosed with the intussusception via computed tomography scan. Surgical resection of the bowel was necessary as reduction could not be accomplished. CONCLUSIONS The finding of intussusception in an adult patient is far less common than in children, and even more rare when a lead point is not established. When surgery is required, a thorough exploration should be performed to search any signs of a potential lead point. Laparoscopy is usually preferred to laparotomy; however, in this case the degree of distention determined the surgical approach. Thus, due to severe distention, laparotomy was preferred.

A rare cause of obstructive defecation in a 29-year-old woman: Ileo-colo-colonic intussusception treated by subtotal colectomy with posterior rectopexy

Adult intussusception is a rare clinical condition. In majority of adult cases, there is an underlying cause such as polyps or colon cancers. In the present study, a 29-year-old woman with intermittent and colicky abdominal pain, constipation, and painful defecation, accompanied with distention and sense of rectal fullness, was evaluated with computed tomography. Ileo-colo-colic intussusception was determined. Subtotal colectomy with posterior rectopexy was performed. After the surgery, she was doing well at 13-month follow-up.

Spontaneous reduction of ileoileal adult intussusception after blunt abdominal injury

This is the first case report of an adult who had spontaneous reduction of ileoileal intussusception occurred after punching to the abdomen. A 40-year-old man was brought to our emergency department by ground ambulance due to pounding and punching a few hours ago. Physical examination showed multiple dermabrasions on his face, abdomen, and lower extremities. All other examinations were unremarkable except that of mild abdominal pain. Laboratory results gave no clues. On abdominal x-ray, paucity of intestinal gas, pseudomass and surrounding gas appearances were visible. No nausea or vomiting occurred during observation. His abdominal pain resolved gradually. On the 24th hour after admission, control computed tomography showed that the findings of intussusception disappeared. He was discharged after 1 day of observation. Outpatient follow-up did not show any abnormality. We suggest that, in patients with mild to moderate trauma, even if the patient has mild abdominal pain, physicians should rule out invagination. Computed tomography is the suggested imaging modality. These patients should be kept in close follow-up. If symptoms resolve and intussusception findings disappear in computed tomography, no further treatment is required.

Adult intussusception: diagnostic pitfalls, morbidity and mortality in a developing country

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.

Traumatic intussusception with intramural haematoma

Traumatic intussusception due to intramural haematoma as the lead point is rare. We present the CT findings of a large duodenojejunal intramural haematoma acting as the lead point of a jejunojejunal intussusception in a 12-year-old boy.

Approach to management of intussusception in adults: a new paradigm in the computed tomography era

Intussusception has been considered an operative indication in adults as a result of the risk of ischemia and the possibility of a malignant lead point. Computed tomographic (CT) scans can reveal unsuspected intussusception. All CT reports from July 1999 to December 2005 were scanned electronically for letter strings to include the keyword intussusception. Identified CT scans were analyzed to characterize the intussusception and associated findings. Clinical, laboratory, pathological, and follow-up variables were gleaned from medical records. Findings were analyzed by treatment and findings at operation. Review of 380,999 CT reports yielded 170 (0.04%) adult patients (mean age, 41 years) with intussusceptions described as enteroenteric in 149 (87.6%), ileocecal in eight (4.7%), colocolonic in 10 (5.9%), and gastroenteric in three (1.8%). Radiological features included mean length of 4.4 cm (range, 0.8-20.5 cm) and diameter of 3.2 cm (range, 1.6-11.5 cm). Twenty-nine (17.1%) had a lead point, and 12 (7.1%) had bowel obstruction. Clinically, 88 (48.2%) patients reported abdominal pain, 52 (30.6%) had nausea and/or vomiting, and 74 (43.5%) had objective findings on abdominal examination. Thirty of 170 (17.6%) patients underwent operation, but only 15 (8.8%) patients had pathologic findings that correlated with CT findings. Seven had,enteroenteric intussusceptions from benign neoplasms (two), adhesions (one), local inflammation (one), previous anastomosis (one), Crohn's disease (one), and idiopathic (one). Three had ileocolic disease, including cecal cancer (one), metastatic melanoma (one) and idiopathic (one; whereas five patients had colocolonic intussusception from colon cancer (three), tubulovillous adenoma (one), and local inflammation (one). Of the 15 without intussusception at exploration, five had pathology related to trauma, four had nonincarcerated internal hernia after Roux-en-Y gastric bypass, four had negative explorations, one had adhesions, and one had appendicitis that did not correlate with CT findings. No patient in the observation group required subsequent operative exploration for intussusception at mean 14.1 months (range, 0.25-67.5 months) follow up. All operative patients demonstrated gastrointestinal symptoms versus 55.3 per cent of the observation group (P < 0.006). Analysis of CT features demonstrated differences among patients observed without operation, those without intussusception at exploration, and confirmed intussusception with regard to mean intussusception length 3.8 versus 3.8 versus 9.6 cm, diameter 3.0 versus 3.2 versus 4.8 cm, lead point 12.1 per cent versus 30 per cent versus 53.3 per cent, and proximal obstruction 3.8 per cent versus 0 per cent versus 46.7 per cent, respectively. Intussusceptions in adults discovered by CT scanning do not always mandate exploration. Most cases can be treated expectantly despite the presence of gastrointestinal symptoms. Close follow up is recommended with imaging and/or endoscopic surveillance. Length and diameter of the intussusception, presence of a lead point, or bowel obstruction on CT are predictive of findings that warrant exploration.

MDCT in blunt intestinal trauma

Injuries to the small and large intestine from blunt trauma represent a defined clinical entity, often not easy to correctly diagnose in emergency but extremely important for the therapeutic assessment of patients. This article summarizes the MDCT spectrum of findings in intestinal blunt lesions, from functional disorders to hemorrhage and perforation.

Adult intussusception: case reports and review of literature

Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, aetiology, and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms and most cases are diagnosed at emergency laparotomy. With more frequent use of computed tomography in the evaluation of patients with abdominal pain, the condition can be diagnosed more reliably. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial, but there is a shift against this, especially in colonic cases. Surgical treatment can be difficult in gastroduodenal and coloanal intussusceptions, sometimes requiring innovative techniques. This paper presents the diagnosis and management of four cases of adult intussusception, followed by review of the literature.