Intussusception Secondary to a Meckel's Diverticulum in an Adolescent

Jejuno-gastric intussusception: A case report of unusual cause of food intolerance after roux-En-Y gastric bypass

INTRODUCTION

Morbid obesity is increasing worldwide as a result, weight loss procedures such as Roux- En-Y gastric bypass (RYGB) are increasing as well. RYGB has multiple complications including intussusception, most of the cases are jejuno-jejunal. Only one case reported to be Jejuno-gastric intussusception (JGI) but through the remnant and not the gastro-jejunostomy anastomosis (GJ).

CASE REPORT

A 50-year-old female presented to the emergency department complaining of diffuse abdominal pain, nausea, and vomiting. Her surgical history is significant for an RYGB 17 years ago. Nausea and food intolerance were the most prominent symptoms. CT scan of the abdomen and upper GI series were normal. Only Esophagogastroduodenoscopy (EGD) showed JGI through GJ, with friable mucosa and a small gastro-gastric fistula. Patient underwent successful reconstruction of GJ and had no symptoms afterwards.

CONCLUSION

JGI is a rare of cause of abdominal pain, nausea and vomiting after RYGB. Early diagnosis is crucial, a thorough work up is needed to make diagnosis of JGI including EGD. Revision of GJ anastomosis is necessary to address this phenomenon.

Meckel's Diverticulitis Masquerading as Acute Pancreatitis: A Diagnostic Dilemma

Meckel's diverticulum is a remnant of the proximal part of the vitellointestinal duct and is the most common congenital anomaly of the gastrointestinal tract. It may either remain asymptomatic or present with myriad of clinical presentations. Gastrointestinal bleeding is the most common presentation in children whereas it is intestinal obstruction in the case of adults. We report a 9-year-old boy who presented with acute onset of periumbilical pain and nonbilious vomiting. His clinical and laboratory parameters were unremarkable, except for serum amylase levels. He was conservatively managed initially as acute pancreatitis with paralytic ileus. However, the child deteriorated in a course of 2 days with bilious vomiting, abdominal distension, and dehydration. Imaging was suggestive of an ileoileal intussusception, and exploratory laparotomy identified Meckel's diverticulum as the lead point for the intussusception. The histopathological examination revealed inflamed heterotopic pancreatic tissue at the apex of the diverticulum thus explaining the elevated amylase levels. This case is reported to highlight the atypical presentation of Meckel's diverticulum and the high clinical suspicion warranted in diagnosing such concomitant intussusception.

Clinical characteristics of intussusception secondary to pathologic lead points in children: a single-center experience with 65 cases

OBJECTIVE

Intussusception secondary to pathologic lead points (PLPs) is a challenging condition for pediatric surgeons, and few studies have been published on this subject. The aim of this study was to review and analyze clinical data on the diagnosis and management of intussusception secondary to PLPs in children.

METHODS

Between 2002 and 2016, a total of 65 pediatric patients with a diagnosis of intussusception secondary to PLPs were retrospectively reviewed.

RESULTS

The series comprised 47 males and 18 females. The average age of the patients was 4.9 years old. All patients had typical clinical manifestations, and intussusception was proven by ultrasound. Fifty-one patients had recurrent intussusception, of whom 21 had one, 14 had two, 10 had three, and 6 had more than three. There were 20 episodes of recurrence within 24 h (39.2%), 15 episodes were found between 24 and 72 h (29.4%), and the remaining 31.4% (16/51) of recurrences occurred after 72 h. All patients received surgical intussusception reduction. Meanwhile, enterectomy was the procedure of choice in 55 patients, polypectomy in 5 patients, and cystectomy in 3 patients. The types of intussusception secondary to PLPs included small intestinal (n = 25), ileocolic (n = 19), ileocecal (n = 11), ileo-ileocolic (n = 9) and cecalcolic (n = 1). The types of PLPs included Meckel diverticulum (n = 32), intestinal duplication (n = 14), benign polyps (n = 5), malignant lymphoma (n = 4), Peutz-Jeghers syndrome (n = 3), mesenteric cyst (n = 3), intestinal wall hematoma of hemophilia (n = 2), allergic purpura (n = 1), and hamartoma (n = 1). All patients recovered well with no relapse during follow-up, except for one patient who had an intestinal obstruction from adhesions that occurred approximately 3 months after discharge and who was curable after conservative treatment.

CONCLUSIONS

Intussusception secondary to PLPs tends to exhibit recurrence. There are various types of intussusception secondary to PLPs. It is necessary to improve auxiliary examinations to identify the etiology and avoid intraoperative omission. Surgical reduction of intussusception secondary to PLPs is the preferred clinical management.

Laparoscopic-assisted resection of jejunojejunal intussusception caused by a juvenile polyp in an adult

Most bowel intussusceptions in adults have a leading point. However, there have been few reports of jejunojejunal intussusception secondary to a solitary juvenile polyp in adult. We report herein the case of a 19-year-old female with a solitary juvenile polyp in the jejunum causing intussusception. Laparoscopic-assisted reduction and segmental resection of the jejunum were successfully done for the patient.