A Successful Case of Abdominal Section for Intussusception, with Remarks on this and other Methods of Treatment

Ileocolonic Intussusception Secondary to Colon Cancer: A Rare Cause of Abdominal Pain In Adults

Intussusception, defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one, is a rare cause of abdominal pain in the adult population due to underlying benign or malignant pathology. With the liberal use of CT in the evaluation of patients with abdominal pain, the diagnosis became more reliable. Resection of the bowel segment is the recommended treatment in most cases. We are presenting the case of a 76-year-old male patient who presented with a three-week history of abdominal pain and diarrhea. The evaluation was consistent with ileocolic intussusception. Robotic resection of the right colon was performed. Pathology revealed poorly differentiated adenocarcinoma of the cecum as the underlying pathology.

Inflammatory polyp of the ileum causing small bowel intussusception: A case report

Adult intussusception is rare, and an underlying benign or malignant aetiology is often found. Inflammatory fibroid polyp, a benign neoplastic polyp that can arise anywhere in the gastrointestinal tract is a rare cause of intussusception of the small bowel. Clinical presentation differs depending on the location of the lesion in the gastrointestinal tract. Diagnosis may be confirmed on a computed tomography scan or ultrasound. Definite diagnosis is based on histopathology and immunocytochemistry. We present the case of a 58-year-old lady with an inflammatory fibroid polyp who presented with microcytic anaemia and chronic abdominal pain due to recurrent intussusception.

The First 40 Years of Gastrojejunostomy: From Billroth to Murphy to Mayo

In the early era of therapeutic laparotomy, surgeons developed operations where the extirpation of pathology only required simple ligation of blood supply, detachment of diseased organs or drainage of infection. In 1881, when sutured anastomosis was in its infancy, a surgeon at Billroth's clinic in Vienna, Anton Wolfler, performed the first successful gastrojejunostomy to treat gastric outlet obstruction. The patient was a 38-year-old male who presented weak and emaciated with an obstructing stomach cancer. After Dr Wolfler's sutured gastrojejunostomy, the patient recovered without complication and was able to eat by mouth. Over the next 40 years, surgeons around the world explored variations in the technique of this operation until it was used in common practice for the management of gastric outlet obstruction. During that same era, gastrojejunostomy severed as a testing ground for sutured anastomosis, which became the accepted method of enteric anastomosis. This article will review the early history of gastrojejunostomy, its origination and the European and American innovators who created modifications of this life-saving operation. The importance that gastrojejunostomy had in the evolution of sutured enteric anastomosis will be highlighted.

Surgical Management of Intussusception in Children: A Retrospective Review of 212 Cases

Objectives The primary objective of this study was to analyze and review the demographics of children operated upon for intussusception. Secondary objectives were to review the clinical characteristics, surgical procedures performed, postoperative complications, and outcome.

Materials and Methods It is a single-institution, retrospective study and consists of children below the age of 12 years. This study was conducted at the author’s department of pediatric surgery for the past 21 years, from January 1, 2000 to December 31, 2020.

Results During the study period, 212 children were operated upon for intussusceptions and included 146 (68.86%) boys and 66 (31.13%) girls. This review consisted of infants 158 (74.52%), and children of 1 to 5 years of age (30; 14.15%), and 6 to 12 years of age (24; 11.32%). Clinically, 177 (83.49%) children presented with the features of acute intestinal obstruction, and the remaining 35 (16.5%) presented with features of perforation peritonitis. Primary (idiopathic) intussusception was documented in 188 (88.67%) of the cases. Gangrenous bowel was evident in 98 (46.22%) children. Sixty-two percent of the cases required bowel resection. Surgical procedures were executed in children for intussusception in the following order of frequency: (1) operative reduction with or without serosal tear/bowel perforation repair, n = 81 (38.2%); (2) resection of diseased ileum and ileoileal anastomosis, n = 52 (24.52%); (3) resection of diseased ileum ± part of colon and an ileostomy, n = 36 (16.98%); and (4) resection of diseased ileum, cecum, part of colon, and ileocolic (ileo-ascending or ileo-transverse) anastomosis, n = 43 (20.28%). Postoperatively, 9 (4.24%) children required reexploration for the management of their complications. Twenty-one (9.9%) children died during the postoperative period.

Conclusion Intussusception remains the most common cause of acute intestinal obstruction in infants and young children. Delay in the referral, diagnosis, and seeking treatment were significantly associated with bowel gangrene, required bowel resection during the surgical therapy, and also culminated in significantly higher mortalities.

Ileocecal Intussusception of the Adult Induced By the Gastrointestinal Stromal Tumor of the Ileocecal Valve – A Case Report

Adult intussusception is a rare entity which is distinct from paediatric cases in incidence, aetiology, and management. It represents 5% of all intussusceptions and is the cause of 1% of all intestinal obstructions, 0,08% of all abdominal surgeries and 0,003-0,02% of all hospital admissions. Ileocolic intussusception in adults is a unique variant in which nearly 100% of cases have a malignant lead point. In our report, we described a case of a patient with ileocecal intussusception caused by a rare type of the gastrointestinal tumor. The female patient was admitted to hospital for occasional pain in the lower right quadrant of the abdomen followed by abdominal discomfort and appearance of blood in the stool. The result of CT scan of the abdomen and pelvis showed a tumor mass and intussusception at the ileocecal junction, which was confirmed peroperatively. Open right hemicolectomy was performed adhering to oncological principles. The final pathologic diagnosis indicated the gastrointestinal stromal tumor of the ileocecal valvе. The diagnosis of intussusception in adults is delicate, and timely surgical treatment can be vital. Patients with the palpable abdominal mass, digestive tract obstruction, gastrointestinal bleeding, or lead point computed tomography must undergo a surgical examination. Given a high risk of malignancy, primary surgical resection using oncologic principles presents the best option for the treatment of ileocecal intussusception in adults.

Case of Irreducible Ileocecal Intussusception Due to Leiomyoma of the Colon

Intussusception is defined as the telescoping of the proximal segment of the bowel into the distal segment. In most clinical cases, pediatric intussusception is much more common than adult intussusception. Pediatric intussusception is often due to viral or bacterial infections, which lead to the inflammation of lymphoid tissue in the intestine. Adult intussusception is typically secondary to tumors and idiopathic causes. Malignant tumors tend to affect the colon, while benign tumors affect the small intestine. Lipomas are the leading cause of benign tumors which cause intussusception. Conversely, adenocarcinomas are the leading cause of malignant tumors that cause intussusception.  Our case focuses on a young adult who developed intussusception secondary to a leiomyoma present near the ileocecal junction of the intestine. The treatment of intussusception caused by tumors is either surgical reduction or excision of the involved tissue. If excised, the specimens are sent to the pathology department for confirmation of the potential cause. If leiomyomas are suspected, staining is used to differentiate them from gastrointestinal stromal tumors (GISTs). These stromal tumors are unusual causes of intussusception, which require further research to determine their disease course and age at presentation.

Intussusception: past, present and future

Intussusception is a common etiology of acute abdominal pain in children. Over the last 70 years, there have been significant changes in how we diagnose and treat intussusception, with a more recent focus on the role of ultrasound. In this article we discuss historical and current approaches to intussusception, with an emphasis on ultrasound as a diagnostic and therapeutic modality.

A CASE OF COMPOUND INTUSSUSCEPTIONS IN A NIGERIAN CHILD - A RARE FINDING IN A COMMON DISEASE

Intussusception is the most common, non-congenital, cause of intestinal obstruction in infants. There are various patterns of intussusception seen in children with the most common being ileo-colic variety. Compound intussusception in which intussusception involves more than one non-adjacent segment is a rare finding in the literature and it can be associated with worse morbidity than typically occurs, especially in a region where delayed presentation is a major contributor to morbidity and mortality in the treatment of intestinal obstruction. We report the first documented case of double compound intussusception in an African child and reviewed relevant literature.

External manual reduction of paediatric idiopathic ileocolic intussusception with US assistance: a new, standardised, effective and safe manoeuvre

BACKGROUND

The ultimate goal in the management of paediatric ileocolic intussusception is to achieve non-operative reduction and therefore patient cure. The standard non-surgical treatment consists of enema (air or liquid media).

OBJECTIVE

The purpose of this study is to present external manual reduction for paediatric ileocolic intussusception. We present a new manoeuvre that is standardised, simple, safe and effective for the radiologist in the non-surgical management of this pathology.

MATERIALS AND METHODS

External manual reduction is performed under sedation. Execution of the manoeuvre is detailed and illustrated. The procedure was carried out 15 times in 13 paediatric patients with idiopathic ileocolic intussusception.

RESULTS

Complete reduction exclusively by external manual reduction was accomplished on 12 occasions (80%). In the remaining three procedures, partial reduction to the cecum was obtained. Subsequent enema achieved complete reduction in two. Overall non-surgical reduction rate was 93%.

CONCLUSION

External manual reduction is a radiation-free, safe and effective procedure. In case of incomplete reduction, it facilitates enema performance. External manual reduction incorporates and additional initial step in the non-surgical reduction of intussusception and should be considered a first-line procedure.

John Hunter, Frederick Treves and intussusception

Early this century, intussusception in childhood was usually fatal. John Hunter, one of the founding fathers of scientific surgery was amongst the first to accurately describe the clinico-pathological features of the condition and one of the great nineteenth century surgeons, Sir Frederick Treves, suggested a plan of management for intussusception which remains little changed up to the present day.

The management of intussusception

A scheme of management to achieve maximum success in hydrostatic reduction of intussusception is presented. This takes into account patient selection, radiological technique and the follow-up clinical assessment. By standardizing the management we have increased our success rate and avoided laparotomy in 64% of our patients. Most of the patients in whom the technique failed had infarcted bowel which required resection.

Intussusception following resection of Wilms tumor

Postoperative intussusception is a documented complication of pediatric surgical and pediatric urologic abdominal operations. In contrast to "primary" intussusception's triad of crampy abdominal pain, palpable abdominal mass, and "currant jelly" stools, postoperative intussusception is generally characterized by abdominal pain and vomiting. An abdominal mass is not usually palpable, and few children have bloody stools. Proper diagnosis and treatment may be delayed because of similar abdominal symptoms in children who may be receiving radiation and chemotherapy, or with prolonged ileus. Two children operated on for Wilms tumor demonstrate the need for awareness of this potential problem in the postoperative patient.

Management of intussusception. Barium enema versus surgery

Reducing intussusception by enema given under fluoroscopic control is being performed more often, in the U. S. A. as well as other countries. This report describes the technic, indications and contraindications in a busy British clinic.

Acute intussusception in childhood

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