1
|
Wang KC, Chu CH, Chiang CM, Zeng FR, Huang CW, Lin CM. Recalcitrant intussusception: exploring potential associations with Helicobacter pylori infection - a case report and literature review. Gut Pathog 2024; 16:28. [PMID: 38824586 PMCID: PMC11144320 DOI: 10.1186/s13099-024-00621-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Intussusception, a common cause of abdominal pain in children, often lacks clear underlying causes and is mostly idiopathic. Recurrence, though rare, raises clinical concerns, with rates escalating after each episode. Factors like pathological lead points and Henoch-Schönlein purpura (HSP) are associated with recurrent cases. On the other hand, the prevalence of Helicobacter pylori (H. pylori), often asymptomatic, in children has been declining. Although its infection is reported to be linked with HSP, its role in recurrent intussusception remains unexplored. Further research is needed to understand the interplay among H. pylori (culprit pathogen), HSP (trigger), and intractable intussusception so as to develop effective management strategies. CASE PRESENTATION A two-year-old girl experienced four atypical episodes of intussusception at distinct locations, which later coincided with HSP. Despite treatment with steroids, recurrent intussusception persisted, suggesting that HSP itself was not a major cause for intractable presentations. Subsequent identification of H. pylori infection and treatment with triple therapy resulted in complete resolution of her recalcitrant intussusception. CONCLUSION This instructive case underscored a sequence wherein H. pylori infection triggered HSP, subsequently resulting in recurrent intussusception. While H. pylori infection is not common in young children, the coexistence of intractable intussusception and steroid-resistant recurrent HSP necessitates consideration of H. pylori infection as a potential underlying pathogen.
Collapse
Affiliation(s)
- Kuan-Chieh Wang
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Hao Chu
- Department of Pediatrics, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec.2, Chenggong Rd., Neihu District, Taipei, 114, Taiwan
| | - Che-Ming Chiang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec.2, Chenggong Rd., Neihu District, Taipei, 114, Taiwan
| | - Fu-Ruei Zeng
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec.2, Chenggong Rd., Neihu District, Taipei, 114, Taiwan
| | - Ching-Wen Huang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec.2, Chenggong Rd., Neihu District, Taipei, 114, Taiwan
| | - Chien-Ming Lin
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec.2, Chenggong Rd., Neihu District, Taipei, 114, Taiwan.
| |
Collapse
|
2
|
Matsuura H, Saito A, Amano Y, Morishima K, Sasanuma H, Lefor AK, Sata N. Intussusception of the third portion of the duodenum secondary to a primary duodenal malignancy: A case report. Int J Surg Case Rep 2022; 94:107085. [PMID: 35439730 PMCID: PMC9027327 DOI: 10.1016/j.ijscr.2022.107085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Intussusception is invagination of the bowel and is rare in adults, representing only 5% of all cases of intussusception. Duodenal intussusception is also very rare. To the best of our knowledge, there is only one previous report of a malignant tumor in the fourth portion of the duodenum as the lead point of intussusception (Vaibhav et al., 2021 [1]). This reports a duodenal-duodenal intussusception caused by a malignant tumor in the third portion of the duodenum. Case presentation A 36-year-old woman with abdominal pain was diagnosed with duodenal intussusception by abdominal ultrasonography and computed tomography scan. Double balloon endoscopy showed that the intussusception had spontaneously reduced, and a tumor was found in the third portion of the duodenum. Open resection was performed because of the tumor location. Pathologic examination revealed adenocarcinoma with an adenoma of the duodenum. The patient had no evidence of recurrence for 4 years after resection. Clinical discussion This patient had a primary duodenal malignancy and presented with intussusception, Duodenal intussusception is a rare condition requiring prompt intervention, usually requiring surgery. In this patient, since endoscopic resection was difficult, partial resection of duodenum was performed by open surgery assisted by double balloon enteroscopy. The pathological diagnosis of the resected specimen was primary duodenal malignancy. Conclusion This is a report of adult duodenal intussusception caused by a primary duodenal malignancy. This rare condition posed an intriguing challenge for the optimal operative approach. Duodenal intussusception caused by a primary tumor is extremely rare. Intussusception is rare in adults. A duodenal tumor was identified with double balloon endoscopy and resected.
Collapse
|
3
|
Fontana F, Piacentino F, Ossola C, Pascarella RD, Franchi C, Curti M, Coppola A, Basile A, Saverio SD, Carcano G, Venturini M. Gangliocytic paraganglioma leading to duodeno-jejunal intussusception: A case report. Radiol Case Rep 2021; 16:3977-3981. [PMID: 34729128 PMCID: PMC8545659 DOI: 10.1016/j.radcr.2021.09.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023] Open
Abstract
The intussusception of the small bowel is rarely encountered in adult patients and is frequently associated with a lead point that is often malignant. In a 69-year-old female patient with an episode of gastrointestinal (GI) bleeding, computed tomography (CT) showed a duodenal-jejunal intussusception caused by an intraluminal mass. Open polypectomy and reduction of intussusception were performed and the diagnosis of gangliocytic paraganglioma was made at pathological evaluation. It would be important to consider neoplasms like gangliocytic paraganglioma in the setting of adult small bowel intussusception.
Collapse
Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
| | - Christian Ossola
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
| | | | - Caterina Franchi
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
| | - Marco Curti
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
| | - Antonio Basile
- Department of Medical and Surgical Sciences and Advanced Technologies, Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania 95123, Italy
| | - Salomone Di Saverio
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
- Department of General Surgery, ASUR Marche, AV5, Hospital of San Benedetto del Tronto, San Benedetto del Tronto 63074, Italy
| | - Giulio Carcano
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
- Surgery Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Ospedale di Circolo, ASST dei Sette Laghi, Varese 21100, Italy
- School of Medicine and Surgery, Università degli Studi dell'Insubria, Varese 21100, Italy
| |
Collapse
|
4
|
Ileocolic intussusception caused by mass-forming fibro-granulation from healed ulcer masquerading as small bowel lipoma. Clin J Gastroenterol 2021; 14:522-530. [PMID: 33405177 DOI: 10.1007/s12328-020-01329-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Small bowel intussusception in adults is rare. Unlike children, adults with intussusception generally have a causative lead point, of which a majority is benign. We report the case of a 55-year-old woman with systemic lupus erythematosus on steroids and nonsteroidal anti-inflammatory drugs who presented with intermittent melena. Contrast computed tomography revealed intussusception of the terminal ileum, with a low density mass which had advanced into the cecum as the lead point. The patient was diagnosed with ileocolic intussusception. The mass was observed in the terminal ileum on colonoscopy, indicating spontaneous reduction. As endoscopic treatment did not appear feasible, laparoscopic small bowel resection was performed with no complications. The resected specimen revealed a pedunculated mass over a healed ulcer. Pathology showed a deep ulcer reaching the subserosa with fibro-granulation, with no evidence of mesenteric vasculitis, thrombus, bacteria, fungi, granulomas, lipoma, or other tumors. The patient was diagnosed with ileocolic intussusception due to a fibro-granulation mass formed on a healed ulcer. Based on the patient's systemic lupus erythematosus being well controlled, the absence of other causative factors, and the discovery of several small bowel erosions on subsequent capsule endoscopy, the ulcer was strongly suspected to be drug induced. Both steroids and nonsteroidal anti-inflammatory drugs were reduced and proton pump inhibitors were discontinued by her rheumatologist after surgery. No recurrence has been observed during 4 months of follow-up.
Collapse
|
5
|
Wang KP, Jiang H, Kong C, Wang LZ, Wang GY, Mo JG, Jin C. Adult duodenal intussusception with horizontal adenoma: A rare case report. World J Clin Cases 2020; 8:3314-3319. [PMID: 32874987 PMCID: PMC7441246 DOI: 10.12998/wjcc.v8.i15.3314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/01/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adult duodenal intussusception rarely occurs, and the majority of duodenal adenomas are located in the descending part of the duodenum. Therefore, adenomas in the horizontal part of the duodenum presenting as duodenal intussusception in adults are extremely rare.
CASE SUMMARY A 36-year-old man complained of abdominal pain for 13 d. Blood analysis showed anemia. Magnetic resonance cholangiopancreatography and computed tomography revealed a tumor in the horizontal part of the duodenum as the main finding, leading to duodeno-duodenal intussusception. No obvious abnormalities were found on endoscopy or upper gastrointestinal radiography. He was diagnosed with duodenal intussusception secondary to duodenal adenoma. Laparotomy showed duodeno-duodenal intussusception and a tumor in the horizontal part of the duodenum near the ascending part. Postoperative pathology revealed tubular-villous adenoma with low-grade glandular intraepithelial neoplasia (local high-grade intraepithelial neoplasia). He was discharged without complications.
CONCLUSION This case highlights that rational use of computed tomography, magnetic resonance cholangiopancreatography, endoscopy and upper gastrointestinal radiography for preoperative diagnosis and timely surgery is an effective strategy for the treatment of adult duodenal intussusception with duodenal masses.
Collapse
Affiliation(s)
- Kun-Peng Wang
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Hao Jiang
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Can Kong
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Lie-Zhi Wang
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Guo-Yu Wang
- Department of Radiology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Jing-Gang Mo
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| | - Chong Jin
- Department of General Surgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang Province, China
| |
Collapse
|
6
|
Guo Y, Liu B, Pan Z, Zhang Y. Acute duodenal obstruction secondary to intussusception caused by the duodenal diverticulum: a case report. BMC Gastroenterol 2020; 20:234. [PMID: 32698796 PMCID: PMC7376838 DOI: 10.1186/s12876-020-01379-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background The duodenal intussusception is rarely reported and usually occurs secondary to organic diseases of the duodenum such as polyps, tumors and duplication cysts. Herein we report a case of duodenal intussusception caused by duodenal diverticulum. Case presentation A 21-year old male patient presented with abdominal pain and vomiting for one day. A contrast enhanced computed tomography of the abdomen revealed duodenal intussusception. On emergency laparotomy, the intussusception had reduced spontaneously while an invaginated diverticulum was seen at the junction of the descending and horizontal segments of the duodenum. The diverticulum was resected and the patient had uneventful recovery. Conclusion Duodenal intussusception is a rare complication of duodenal diverticulum. Being aware of this complication of diverticulum can help in timely diagnosis and treatment.
Collapse
Affiliation(s)
- Yuchen Guo
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Bin Liu
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Ziwen Pan
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Yang Zhang
- Department of Gastrointestinal Surgery, First Hospital of Jilin University, Changchun, 130021, Jilin, China.
| |
Collapse
|
7
|
A. N. Alzerwi N. Duodenoduodenal and duodenojejunal intussusceptions in adults: A systematic review with a focus on demographics, diagnosis, and etiology. AIMS MEDICAL SCIENCE 2020. [DOI: 10.3934/medsci.2020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
8
|
Ban T, Kawakami H, Kubota Y, Nanashima A, Yano K, Sato Y. The Development of Gastric Outlet Obstruction due to a Lumen-occupying Protruding Duodenal Ulcer Mimicking a Submucosal Tumor. Intern Med 2019; 58:1267-1271. [PMID: 30626826 PMCID: PMC6543217 DOI: 10.2169/internalmedicine.1916-18] [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: 11/16/2022] Open
Abstract
Even in the era of Helicobacter pylori eradication and proton pump inhibitors, peptic ulcer remains an important disease. Stricture due to a duodenal ulcer in the healing stage is a well-known etiology of benign gastric outlet obstruction. However, a duodenal ulcer-induced submucosal tumor-like change with gastric outlet obstruction is a very rare manifestation. We herein present a rare case of a patient with deteriorating symptoms of gastric outlet obstruction caused by an unusual manifestation of a lumen-occupying protruding duodenal ulcer mimicking a submucosal tumor.
Collapse
Affiliation(s)
- Tesshin Ban
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki, Japan
- Department of Gastroenterology and Hepatology, Division of Endoscopy, and Center for Digestive Disease, University of Miyazaki Hospital, Japan
| | - Hiroshi Kawakami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki, Japan
- Department of Gastroenterology and Hepatology, Division of Endoscopy, and Center for Digestive Disease, University of Miyazaki Hospital, Japan
| | - Yoshimasa Kubota
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Miyazaki, Japan
- Department of Gastroenterology and Hepatology, Division of Endoscopy, and Center for Digestive Disease, University of Miyazaki Hospital, Japan
| | - Atsushi Nanashima
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki, Japan
| | - Koichi Yano
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki, Japan
| | - Yuichiro Sato
- Pathology Division, University of Miyazaki Hospital, Japan
| |
Collapse
|