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T Chand J, R R, Ganesh MS. Adult intussusception: a systematic review of current literature. Langenbecks Arch Surg 2024; 409:235. [PMID: 39085533 DOI: 10.1007/s00423-024-03429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Intussusception in adults is a rare condition characterized by a low incidence, which complicates the establishment of standardized management protocols unlike those readily available for pediatric cases. This study presents a case series from our institution alongside a systematic review of existing literature. The objective is to delineate effective management strategies for adult intussusception. METHODS A systematic search of databases was conducted covering the period from January 2000 to May 2024. The study focused on adult patients diagnosed with intussusception either pre-operatively or intraoperatively and managed with either surgical intervention or conservative methods. The analysis also included retrospective review of patient records from our institution, specifically targeting individuals over 18 years of age, to determine the predominant types of intussusception and identify any pathological lead points associated with these cases. RESULTS In our study, a total of 1,902 patients were included from 59 selected articles, with a mean age of 52.13 ± 14.95 years. Among them, 1,920 intussusceptions were diagnosed, with 98.3% of cases identified preoperatively. Computed tomography (CT) scan was the primary diagnostic modality used in 88.5% of cases. Abdominal pain was the predominant presenting symptom, observed in 86.23% of cases. Only 29 out of 1,920 cases underwent attempted reduction, while the majority required surgical resection due to the high incidence of malignancy in adult cases. The most common type of intussusception identified was colocolic (16.82%), followed by enteric (13.28%), ileocolic (4.89%), and ileocaecal (0.78%) types. A pathological lead point was observed in 302 out of 673 patients (44.84%), with a notably higher frequency of malignancy associated with colocolic intussusception. CONCLUSION Surgical management remains the cornerstone in treating adult intussusception, particularly in cases involving the colocolic type, where there is a significant risk of underlying malignancy. Attempts at reduction are generally avoided due to the potential risk of tumor dissemination, which could adversely impact patient outcomes. Contrast-enhanced computed tomography (CECT) of the abdomen is pivotal for accurately diagnosing intussusceptions and guiding appropriate management strategies. It is imperative to adhere strictly to oncological principles during surgical interventions to ensure optimal patient care and outcomes.
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Affiliation(s)
- Jithin T Chand
- Department of Surgical Oncology, Vydehi Cancer Centre, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India.
| | - Rakesh R
- Department of Surgical Gastroenterology and HPB Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - M S Ganesh
- Department of Surgical Oncology, Vydehi Cancer Centre, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
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Bergeron E, Pichette M, Boisvert G, Manière T, Désilets É. Rare etiology of colonic intussusception involving an adult with emphysematous cystic enteropathy: A case report and review of literature. World J Clin Cases 2024; 12:3161-3167. [PMID: 38898841 PMCID: PMC11185380 DOI: 10.12998/wjcc.v12.i17.3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Pneumatosis cystoides intestinalis (PCI), characterized by a collection of gas-filled cysts in the intestinal wall, is an uncommon but well-known condition in gastroenterology. Abdominal pain is the most frequent symptom associated with PCI. Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation. However, the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood. CASE SUMMARY A 52-year-old male, known with idiopathic PCI, presented seventeen months after initial diagnosis with a new right upper quadrant pain. A computed tomography-scan demonstrated a colonic intussusception at the hepatic flexure. PCI did not progress compared with initial investigation. The patient underwent an emergency right hemicolectomy. CONCLUSION Resection was recommended in this case because PCI proved to be persisting with no identified curable cause. Surgery allowed to address the underlying pathology, the potential relapse of intussusception, and the likely cause of recurrent abdominal pain, either invagination or PCI itself.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Maude Pichette
- Department of Surgery, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Geneviève Boisvert
- Department of Medical Imaging, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Thibaut Manière
- Department of Gastroenterology, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
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Sciberras N, Zammit SC, Sidhu R. Small bowel intussusception - aetiology & management. Curr Opin Gastroenterol 2024; 40:175-182. [PMID: 38190421 DOI: 10.1097/mog.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Adult small bowel intussusception (SBI) differs in incidence, symptomatology and management from the more commonly encountered paediatric intussusception. This review spans across the multitude of causes of adult SBI, and summarises the diagnostic work-up and management options according to recent literature. RECENT FINDINGS There has been an increase in use of small bowel capsule endoscopy and point-of-care ultrasound for the diagnosis of acute adult SBI. SUMMARY A high degree of suspicion of a malignant cause of SBI is required in the adult population. Alarm clinical features include weight loss, history of malignancy, and iron deficiency anaemia. CT remains the gold standard imaging technique as it may identify the lead point and thus aid in endoscopic or surgical management. If malignancy is excluded and no lead point is identified, serology and histology may be helpful to look for inflammatory, infective and autoimmune aetiology.
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Affiliation(s)
| | | | - Reena Sidhu
- Department of Gastroenterology, Sheffield Teaching Hospital NHS Foundation Trust, Department of Infection, Immunity & Cardiovascular Diseases, University of Sheffield, UK
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Heng V, Oh S, Leng H, Chhun V, Lee YD. Adult colorectal intussusception caused by giant lipoma-A case report. Clin Case Rep 2024; 12:e8682. [PMID: 38562575 PMCID: PMC10982120 DOI: 10.1002/ccr3.8682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/04/2024] Open
Abstract
Key Clinical Message Adult intussusception commonly has a leading point. In the colon, malignancy is a prevalent etiology for the leading point; however, benign tumors should also be considered. We present a case of colorectal intussusception caused by a giant lipoma. Abstract Intussusception in adults is comparatively infrequent in contrast to children, and in adult colonic intussusception, malignancy is the predominant cause of the leading point. Lipoma, an uncommon tumor in the gastrointestinal tract, rarely induces colonic intussusception in adults. We present the case of a 55-year-old Cambodian man experiencing cramping abdominal pain. He presented with mild abdominal distension with tenderness in the lower abdomen. On the rectal examination a large palpable mass was detected three to four centimeters from the anal verge. Abdominal computerized tomography revealed a collapsed sigmoid colon with mesenteric fat invaginated into the lumen of the upper rectum. Emergency laparotomy was performed and during the surgery the sigmoid intussusception spontaneously reduced. A mass was identified in the mid-sigmoid colon, leading to the decision for segmental resection of the sigmoid colon with the mass and subsequent end-to-end anastomosis. Histological examination results confirmed the mass as a lipoma. Colorectal intussusception in adults due to a lipoma is a relatively rare, with only a few reported cases in the literature.
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Affiliation(s)
- Vouchly Heng
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Suk‐Kyu Oh
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Hour Leng
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
| | - Vireak Chhun
- Department of PathologyHebron Medical CenterPhnom PenhCambodia
| | - Young Don Lee
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
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Chetcuti Zammit S, Yadav A, McNamara D, Bojorquez A, Carretero-Ribón C, Keuchel M, Baltes P, Margalit-Yehuda R, Kopylov U, Sidhu R, Marmo C, Riccioni ME, Dray X, Leenhardt R, Rondonotti E, Giulia S, Micallef K, Ellul P. Where does capsule endoscopy fit in the diagnostic algorithm of small bowel intussusception? Dig Liver Dis 2023; 55:1719-1724. [PMID: 37394371 DOI: 10.1016/j.dld.2023.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/22/2023] [Accepted: 05/28/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION The investigation of small bowel (SB) intussusception is variable, reflecting the lack of existing standards. The aim of this study was to understand the role of small bowel capsule endoscopy (SBCE) to investigate this pathology. METHODOLOGY This was a retrospective multi-centre study. Patients with intussusception on SBCE and those where SBCE was carried out due to findings of intussusception on radiological investigations were included. Relevant information was collected. RESULTS Ninety-five patients (median age 39+/-SD19.1 years, IQR 30) were included. Radiological investigations were carried out in 71 patients (74.7%) prior to SBCE with intussusception being present in 60 patients on radiological investigations (84.5%). Thirty patients (42.2%) had intussusception on radiological investigations followed by a normal SBCE. Ten patients (14.1%) had findings of intussusception on radiological investigations, a normal SBCE and repeat radiological investigations that were also normal. Abnormal findings were noted on SBCE that could explain intussusception on imaging in (16 patients) 22.5% of patients. Five patients (5.3%) underwent radiological investigations and SBCE to investigate coeliac disease and intussusception. None had associated malignancy. Four patients (4.2%) underwent SBCE to investigate familial polyposis syndromes and went on to SB enteroscopy and surgery accordingly. Most patients (n = 14; 14.8%) with intussusception on initial SBCE (without prior radiological imaging) had suspected SB bleeding (n = 10, 10.5%). Four patients (4.2%) had additional findings of a mass on CT scan and went on to have surgery. CONCLUSION SBCE should be used to complement radiology when investigating intussusception. It is a safe non-invasive test that will minimise unnecessary surgery. Additional radiological investigations following a negative SBCE in cases of intussusception noted on initial radiological investigations are unlikely to yield positive findings. Radiological investigations following intussusception noted on SBCE in case of patients presenting with obscure gastrointestinal bleeding, may yield additional findings.
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Affiliation(s)
| | - Aman Yadav
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght University Hospital, Dublin, Ireland
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght University Hospital, Dublin, Ireland
| | - Alejandro Bojorquez
- Departamento de Digestivo, Unidad de Endoscopia, Unidad de Prevención de Tumores Digestivos, Clínica Universidad de Navarra, Pamplona, Spain
| | - Cristina Carretero-Ribón
- Departamento de Digestivo, Unidad de Endoscopia, Unidad de Prevención de Tumores Digestivos, Clínica Universidad de Navarra, Pamplona, Spain
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany; Clinic for Gastroenterology, Asklepios Klinik Altona, Hamburg, Germany
| | - Peter Baltes
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany; Clinic for Gastroenterology, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Uri Kopylov
- Institute of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Reena Sidhu
- Academic Unit of gastroenterology, Sheffield teaching hospitals NHS Trust, Sheffield, United Kingdom; Dept of Infection, Immunity and cardiovascular disease, University of Sheffield
| | - Clelia Marmo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Xavier Dray
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | - Romain Leenhardt
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | | | | | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida MSD 2090, Malta
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Necas M, Thomas S, Prout K. Transient intussusception - What the sonographer needs to know. Australas J Ultrasound Med 2023; 26:191-198. [PMID: 37701765 PMCID: PMC10493360 DOI: 10.1002/ajum.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Intussusception is typically considered an acute emergency; however, the increased utilisation of medical imaging has revealed that intussusceptions can also be transient, asymptomatic and possibly physiologic. Sonographers should be aware of three categories of intussusceptions: (i) persistent intussusceptions resulting in acute abdomen and requiring urgent intervention, (ii) transient symptomatic intussusceptions which may be amenable to a 'wait-and-see' strategy and (iii) transient asymptomatic intussusceptions which almost always involve the small bowel. In particular, the incidental discovery of enteroenteric intussusceptions in children should not be confused with acute pathology. In adults, sonographers should be mindful of the frequent presence of pathological lead points and further investigations may be warranted. In this literature review, we provide an overview of transient intussusceptions, highlight important differences between children and adults and describe sonographic appearances of various intussusceptions and their mimics.
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Affiliation(s)
- Martin Necas
- Ultrasound DepartmentWaikato HospitalHamiltonNew Zealand
| | - Stacey Thomas
- Ultrasound DepartmentWaikato HospitalHamiltonNew Zealand
| | - Kara Prout
- Ultrasound DepartmentWaikato HospitalHamiltonNew Zealand
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7
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Eschlböck SM, Weixler B, Weidinger C, Pozios I. Postoperative intussusception: a rare but critical complication in adult patients with Crohn's disease - case report and literature review. Innov Surg Sci 2023; 8:3-8. [PMID: 37842197 PMCID: PMC10576550 DOI: 10.1515/iss-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/10/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives Postoperative entero-enteric intussusception is a rare complication in adult patients with Crohn's disease (CD). The knowledge of this distinct complication and its timely diagnosis and therapy are of utmost importance to prevent fatal intestinal necrosis. There is no consensus about the optimal management of postoperative entero-enteric intussusception, although surgical exploration is widely advised. Case presentation In this report we describe an unusual case of postoperative jejuno-jejunal intussusception following small bowel resection in a patient with stricturing CD. Furthermore, this report offers an overview of the available literature and summarizes the best approach and management strategies for adult intussusception associated with CD. Conclusions Delay in diagnosis and therapy can lead to life-threatening complications. Early diagnosis and emergent surgical treatment prevent intestinal necrosis and reduce the risk of short bowel syndrome.
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Affiliation(s)
- Sophie M. Eschlböck
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Campus Benjamin Franklin, Hindenburgdamm 30, 12203Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Campus Benjamin Franklin, Hindenburgdamm 30, 12203Berlin, Germany
| | - Carl Weidinger
- Department of Gastroenterology, Rheumatology and Infectiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203Berlin, Germany
| | - Ioannis Pozios
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Campus Benjamin Franklin, Hindenburgdamm 30, 12203Berlin, Germany
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Dong QJ, Yao Y, Zhang CL, Li XG, Chen X, Wang Y. Predictors of malignant intussusception in adults using clinical manifestations and multidetector computed tomographic findings. Eur J Radiol 2023; 160:110692. [PMID: 36640714 DOI: 10.1016/j.ejrad.2023.110692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
PURPOSE To investigate the diagnostic performance of clinical manifestations and multidetector computed tomographic (MDCT) features in detecting predictors of malignant intussusception in adults. MATERIAL AND METHODS We retrospectively reviewed 88 adults with 91 intussusceptions who were diagnosed by MDCT. Their clinical manifestations and MDCT features were reviewed and compared between the malignant and benign groups. Uni- and multivariate logistic regression analyses were used to identify independent predictors of malignant intussusception. RESULTS There were 61 patients in the malignant group and 27 patients in the benign group. The malignant group had older age (mean, 62.61 vs 54.22 years, P = 0.014), more colon-related intussusception (89.06% vs 55.56%, P < 0.001), shorter intussusception length (median, 6.53 vs 9.73 cm, P = 0.009), higher maximum short axis diameter (mean, 4.85 vs 4.10 cm, P = 0.001), more enlarged lymph nodes (40.63% vs 11.11%, P = 0.006) than the benign group. Lead points were mainly presented as masses, which were irregular (44.74%) and lobular (28.95%) in the malignant group, and round or oval (92.00%) in the benign group. On the unenhanced MDCT, 90.62% of them in the malignant group showed non-hypodense. Multivariate analysis showed that intussusception length (P = 0.013), maximum short axis diameter (P = 0.007), non-round/oval lead point (P < 0.001) and non-hypodense lead point (P = 0.030) were independent factors of malignant intussusception. CONCLUSION Malignant intussusception can be identified using independent predictors such as intussusception length, maximum short axis diameter, non-round/oval and non-hypodense lead point. When integrating these four factors, radiologists can make qualitative diagnoses withhigher sensitivity and specificity, allowing clinicians to develop more appropriate treatments.
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Affiliation(s)
- Qiu-Jie Dong
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China; Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Yun Yao
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Chun-Lai Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Xiao-Guang Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Xiao Chen
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China.
| | - Yi Wang
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing 400042, China.
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Chiam KH, Sannasey S, Rajaintharan S, Muthukaruppan R. Atypical endoscopic finding of colocolic intussusception: case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1290. [PMID: 36618802 PMCID: PMC9816856 DOI: 10.21037/atm-2022-61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
Background Adult-onset colonic intussusception is a rarely encountered condition that leads to large intestinal obstruction with time. Patients often present with a variety of symptoms that are non-specific making it challenging to arrive at a definitive diagnosis. This is worrying as diagnostic delay could lead to a significant increase in morbidity and mortality. We wish to present and describe a case of an atypical endoscopic finding of colocolic intussusception secondary to ascending colon cancer. Case Description Sixty-seven-year-old lady was referred for 1 month's duration of passing melenic stools with mucus followed by a week's complain of hematochezia. Clinical examination and other relevant blood results were unremarkable except for iron deficiency anemia. Initial colonoscopy revealed a large mass within the splenic flexure with inconclusive biopsies. A more detailed colonoscopy repeated the following day revealed a massive, black-to-yellowish lesion within the splenic flexure with no viable mucosa seen. Colonic bezoar was initially suspected, however various endoscopic retrieval methods proved futile. Switching to a slimmer diagnostic gastroscope, the colon was carefully negotiated until a large ulcer was found within the ascending colon, adjacent to the mass' origin. An emergency CT abdomen and subsequently extended right hemicolectomy performed revealed a colocolic intussusception with sealed perforation secondary to an ascending colonic mass acting as an intussusceptum. Histopathology evaluation confirmed an ascending colon adenocarcinoma (pT2N0M0) amidst a background of extensive ischemic changes. Conclusions Endoscopic descriptions of colonic intussusception are unusual given their rarity. Furthermore, these lesions can mimic a colonic bezoar as a result of fecal accretion and this can ultimately lead to false diagnostic and therapeutic decisions. In such instances, clarification with a CT scan before management decision can potentially avert unnecessary endoscopic intervention and complications.
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Affiliation(s)
- Keng Hoong Chiam
- Gastroenterology Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Sumithra Sannasey
- Radiology Department, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | | | - Raman Muthukaruppan
- Gastroenterology Unit, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
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Sun M, Li Z, Shu Z, Wu Q, Liu X. Adult intussusception: a challenge to laparoscopic surgery? PeerJ 2022; 10:e14495. [PMID: 36518277 PMCID: PMC9744142 DOI: 10.7717/peerj.14495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intussusception can occur at any age and is common in children but less common in adults. This study aimed to evaluate our experience of 51 adult intussusception and study the etiology, clinical manifestations, diagnosis, and treatment. Methods This analysis assessed the clinical manifestations, etiology, diagnosis, and treatment of adult intussusception in 51 adult patients at the Department of Gastrointestinal Surgery of China-Japan Union Hospital of Jilin University from January 2010 to December 2020. Results The mean age of the cohort was 54.43 ± 18.21 years, and 42 patients were diagnosed by abdominal ultrasonography and abdominal computed tomography (CT). Among them, 76.5% (39/51) had abdominal pain, 11.8% (6/51) had blood in stool, and 5.9% (3/51) had a palpable abdominal mass. Of these, 62.7% had tumors: malignant accounted for 39.2% (20/51) and benign accounted for 23.5% (12/51). CT is the preferred imaging method with a sensitivity of 92.2%, while colonoscopy provides a complementary diagnosis in patients involving the colon. All patients underwent surgical treatment, including 21.6% (11/51) laparoscopic surgery, 74.5% (38/51) open surgery, and 5.9% (3/51) intussusception reduction during the operation. The average operation time of the open group was 133.27 ± 43.75 min and the average hospital stay was 16.24 ± 12.55 days, while the average operation time of the laparoscopic group was 140.50 ± 46.15 mins, and the average hospital stay was 16.60 ± 16.98 days (P > 0.05). Conclusion Adult intussusception is a rare disease in clinic. Laparoscopic surgery can be useful and safe for adult intussusception.
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Affiliation(s)
- Mingze Sun
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhongmin Li
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Zhenbo Shu
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Qi Wu
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xue Liu
- Obstetrics and Gynacology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
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Intussusception Caused by Cecal Duplication in an Adult: A Case Report. Case Rep Surg 2022; 2022:9520191. [PMID: 36262933 PMCID: PMC9576413 DOI: 10.1155/2022/9520191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
Cecal duplication is a rare congenital malformation and majority of the cases are discovered in the first years of life. Ileocolic intussusception is also a rare situation encountered in adults. A 19-year-old female presented with acute abdominal pain and bowel occlusion in relation with an ileocecal intussusception. She underwent an emergent laparotomy and ileocecal resection. A cecal duplication cyst was found to be the cause of the intussusception. While duplications and intussusception are very rare situations encountered in the adult life, the presence of both at the same time remains frankly anecdotal. The present case demonstrates that intussusception may likely be involved with any cecal lesion, like duplication.
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12
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Orhan A, Demiryas S. Lipoma causing ileocecal intussusception and its endoscopic resection. Int J Surg Case Rep 2022; 98:107605. [PMCID: PMC9468395 DOI: 10.1016/j.ijscr.2022.107605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction In adults, intussusception is a rare disorder, and it might lead to acute mechanical intestinal obstruction, (AMIO) which is not typically considered in the differential diagnosis. Our case report presents a rare, fully endoscopic management of an ileocecal intussusception without any further surgical intervention. Endoscopic manipulations of such distant lesions under correct indications will surely avoid unnecessary surgery and increase patient comfort. Case description A 58-year-old male was admitted with complaints of nausea, vomiting, abdominal pain, and distention. Physical examination, blood tests and radiological assessments revealed the patient was suffering from AMIO. The cause of AMIO was ileocecal intussusception due to an ileal lipoma. After intussuscepted segment was uncluttered by endoscopic pneumatic reduction(ER), ileal lipoma was resected colonoscopically. The patient was discharged without any complications. Discussion Intussusception may appear because of benign or malignant etiologies. Cases in which malignancy is ruled out, endoscopic resection can be utilized safely in diagnosis and treatment. Endoscopic resection will also save the patient from unnecessary and costly surgical interventions. Colonoscopic treatment for lipomas located in the terminal ileum is not impossible. Endoscopic resection for suitable patients under favorable conditions may result with total cure. Endoscopic treatment might save patient from undergoing further surgical intervention.
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Morais SM, Santos Costa C, Mourato MB, Mogne T, Santos G. Intestinal Intussusception: A Shocking Diagnosis. Cureus 2022; 14:e25368. [PMID: 35774641 PMCID: PMC9236693 DOI: 10.7759/cureus.25368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
Intussusception is a rare condition diagnosed in adults, with few cases reported as idiopathic. It is defined as the invagination of an intestinal segment into another adjacent one, due to the presence of a lead point, or in some cases, without identifiable causative lesions. The presentation is non-specific, even with careful evaluation, and most of the time, the diagnosis is made during surgery. We hereby present the case of a 73-year-old woman with idiopathic intussusception who presented in the emergency room. She was taken to the operating theatre, where intestinal resection was performed. Few cases of true idiopathic intestinal intussusception in adults are seen, and literature on this topic remains scarce. We discuss diagnostic and therapeutic options and do a brief review of the literature.
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Moniakis AA, Flamourakis ME, Gkionis IG, Giakoumakis MI, Tsagkataki ES, Kazamias GM, Spiridakis KG, Christodoulakis MS. Ileocolic Intussusception in a Woman: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933341. [PMID: 34623978 PMCID: PMC8515498 DOI: 10.12659/ajcr.933341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intussusception is a rare pathological entity in adults and remains a diagnostic challenge for clinicians, as it shares many clinical signs and symptoms with other morbid conditions (including appendicitis, abdominal hernias, colic, volvulus, and Meckel diverticulum). High clinical suspicion and use of appropriate imaging techniques are essential for early diagnosis and treatment of intussusception. Surgical intervention is the treatment of choice in cases of sustained and persistent invagination. CASE REPORT We present the case of a 65-year-old woman with a medical history of Crohn's disease, diabetes mellitus type II, hypertension, and rheumatoid arthritis. She was hospitalized for diarrhea, fatigue, and anemia. Computerized tomography of the abdomen and a colonoscopy revealed telescoping of the ileum, ileocecal valve, and part of the ascending colon inside the terminal segment of the ascending colon. The antegrade ileocolic intussusception was treated by performing a right hemicolectomy. The pathologic examination of the excised intestine showed mucosal lesions compatible with Crohn's disease, an inflammatory fibroid polyp at the terminal section of the ileum, and a low-grade appendiceal mucinous neoplasm. CONCLUSIONS Regardless of the etiology, when the normal motility of the intestine is altered, it can lead to invagination. Although intussusception is rare, it must always be part of the differential diagnosis for a patient presenting with constant abdominal pain.
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Affiliation(s)
- Alexandros A Moniakis
- Department of General Surgery, Venizeleio General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Mathaios E Flamourakis
- Department of General Surgery, Venizeleio General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Ioannis G Gkionis
- Department of General Surgery, Venizeleio General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Michail I Giakoumakis
- Department of General Surgery, Venizeleio General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Eleni S Tsagkataki
- Department of General Surgery, Venizeleio General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Georgios M Kazamias
- Department of Pathology, Venizeleio General Hospital of Heraklion, Heraklion, Crete, Greece
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15
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Al Zaabi AHY, Al Janahi JA, Alremeithi SN, Qayyum H. Jejunojejunal intussusception in an adult: a rare presentation of abdominal pain in the emergency department. BMJ Case Rep 2021; 14:14/7/e243787. [PMID: 34281946 DOI: 10.1136/bcr-2021-243787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abdominal pain is a common presentation to the emergency department (ED) and the differential diagnoses is broad. Intussusception is more common in children, with only 5% of cases reported in adults. 80%-90% of adult intussusception is due to a well-defined lesion resulting in a lead point, whereas in children, most cases are idiopathic. The most common site of involvement in adults is the small bowel. Treatment in adults is generally operative management whereas in children, a more conservative approach is taken with non-operative reduction. We present a case of a 54-year-old woman who presented to our ED with severe abdominal pain and vomiting. CT of the abdomen revealed a jejunojejunal intussusception. The patient had an urgent laparoscopy and small bowel resection of the intussusception segment was performed. Histopathological examination of the resected specimen found no pathologic lead point and, therefore, the intussusception was determined to be idiopathic.
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Affiliation(s)
- Ahmed Hasan Yousef Al Zaabi
- Emergency Department, Shaikh Shakhbout Medical City, Abu Dhabi, Abu Dhabi, UAE.,Emergency Department, Zayed Military Hospital, Abu Dhabi, Abu Dhabi, UAE
| | | | | | - Hasan Qayyum
- Emergency Department, Shaikh Shakhbout Medical City, Abu Dhabi, Abu Dhabi, UAE
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16
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Ayyanar P, Behera G, Mishra TS, Purkait S, Patra S, Mitra S. The Clinico-histopathological Spectrum of Tumors and Tumor-Like Lesions in Adult Intussusception. J Gastrointest Cancer 2021; 53:511-519. [PMID: 34014410 DOI: 10.1007/s12029-021-00647-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intussusception is an uncommon cause of intestinal obstruction in adults. The etiology of this disease differs from the children. Thus, its management depends on the possible etiology and is different from pediatric cases. AIMS We aimed to study the clinico-histopathological spectrum of the tumors and tumor-like lesions in the intussusception in adults. MATERIAL AND METHODS A retrospective review of the adult (> 18 years) intussusception cases was performed. The clinical data and follow-up were obtained. The histopathology was reviewed along with the special stains and immunohistochemistry for ascertaining a histopathological diagnosis. RESULTS Fifteen cases of adult intussusception were identified from 107 resected specimens of adult intestinal obstruction. The mean age was 44.5 years with a male/female ratio of 1.1:1. A definitive pathology could be ascertained in 80% of the cases (n = 12/15). Eight cases had benign non-neoplastic etiology (53.3%) (33.3% tumor-like lesions) while seven cases (46.7%) had neoplastic etiology (20% benign neoplastic; 26.7% malignant neoplastic). All cases of colonic or enterocolic intussusceptions were associated with neoplasia whereas 90% of the enteric intussusceptions occurred due to benign non-neoplastic causes. CONCLUSIONS: Non-neoplastic causes are predominant in the enteric intussusceptions while neoplastic causes are more commonly associated with colonic or enterocolic intussusceptions. The post-operative histopathological examination concludes on the adequacy of the index surgery or the provision of further management if required.
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Affiliation(s)
- Pavithra Ayyanar
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | - Gayatri Behera
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | | | - Suvendu Purkait
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | - Susama Patra
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | - Suvradeep Mitra
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India.
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17
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Shimoyama H, Ueno K, Samizo M. Successful treatment of adult cecorectal intussusception caused by cecum cancer with mobile cecum: a case report. Surg Case Rep 2021; 7:96. [PMID: 33856564 PMCID: PMC8050182 DOI: 10.1186/s40792-021-01180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intussusception occurs when a segment of the bowel (the intussusceptum) telescopes into an adjacent segment (the intussuscipiens). Adult intussusception occurs rarely and often requires surgical resection for its treatment. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature. Case presentation A 71-year-old woman was transferred to our hospital for the treatment of upper abdominal pain. Physical examination, laboratory tests, and imaging inspections showed strangulated bowel obstruction induced by intussusception associated with the intra-rectal mass. We performed an emergency operation and treated the intussusception using a combined transabdominal and trans-anal approach. The intraoperative findings revealed bloody ascites and a potentially malignant tumor that had moved toward the anal side from peritoneal reflection. The tumor served as the lead point in the cecum with mobile cecum. After reducing the intussusception using the combined procedure, we removed the ileocecal portion. The intraoperative and histopathological findings suggested that cecum cancer with mobile cecum had caused the cecorectal intussusception. The patient had an uneventful postoperative course, except for postoperative pulmonary pneumonia. Conclusion To the best of our knowledge, this is the first reported case of adult cecorectal intussusception due to cecum cancer with mobile cecum successfully treated using the combined transabdominal and trans-anal approach. This combined procedure may be useful in treating the intussusception where the lead point is distal from the peritoneal reflection.
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Affiliation(s)
- Hayato Shimoyama
- Department of Surgery, Kobe Rosai Hospital, 4-2-23 Kagoikedori, Chuouku, Kobe, Hyogo, 651-0053, Japan. .,Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan.
| | - Kimihiko Ueno
- Department of Surgery, Kobe Rosai Hospital, 4-2-23 Kagoikedori, Chuouku, Kobe, Hyogo, 651-0053, Japan.,Department of Gastroenterological Surgery, National Hospital Organization Kobe Medical Center, 3-1-1, Nishiochiai, Sumaku, Kobe, Hyogo, 654-0155, Japan
| | - Masahiro Samizo
- Department of Surgery, Kobe Rosai Hospital, 4-2-23 Kagoikedori, Chuouku, Kobe, Hyogo, 651-0053, Japan.,Department of Surgery, Sanda City Hospital, 3-1-1 Keyakidai, Sanda, Hyogo, 669-1321, Japan
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18
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Tarchouli M, Ait Ali A. Adult Intussusception: An Uncommon Condition and Challenging Management. Visc Med 2021; 37:120-127. [PMID: 33981752 PMCID: PMC8077547 DOI: 10.1159/000507380] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/19/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Intussusception is a rare condition in adults. A pathological lesion is usually found with a significant percentage of malignancy. The optimal treatment is still not universally clear. METHODS This is a retrospective review of adult patients with a diagnosis of intestinal intussusception and surgically treated at our institution from January 2009 to December 2018. Clinical, operative, and histological details were collected and analyzed. RESULTS A total of 26 cases, 16 males and 10 females, were diagnosed with surgically proven intussusception during the 10-year period. The mean age was 45 years (range 21-70). Using ultrasound and/or computed tomography as imaging study, the preoperative diagnosis was made in 21/26 (81%) patients. Five intussusceptions were discovered only upon exploratory laparotomy for intestinal obstruction. There were 19 (73%) cases of enteric and 7 (27%) cases of colonic intussusceptions. All patients underwent surgical exploration. Intestinal resection with immediate anastomosis was the technique of choice for most patients. A single patient underwent stoma for peritonitis secondary to intestinal perforation. An organic cause has been systematically revealed, and no idiopathic intussusception was detected. Etiology was malignant in 9 (35%) cases. CONCLUSION Adult intussusception should be considered in any patient with subacute abdominal pain. Considering the high rate of malignancy, intestinal resection without attempting reduction is highly recommended for colonic intussusceptions. However, a more selective approach can be adopted for enteric intussusceptions.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Surgery, First Medical and Surgical Center, Agadir, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Abdelmounaim Ait Ali
- Department of Visceral Surgery, Mohammed V Military Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Ileocecal Intussusception of the Adult Induced By the Gastrointestinal Stromal Tumor of the Ileocecal Valve – A Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2020-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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.
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20
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Murshed KA, Khawar M, Petkar M. Heterotopic Gastric Mucosa in the Ileum: A Rare Cause for Intussusception in Adults. Case Rep Gastroenterol 2020; 14:609-614. [PMID: 33362448 DOI: 10.1159/000509504] [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: 05/06/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022] Open
Abstract
Intussusception is the leading cause for intestinal obstruction in children. However, it accounts for only 5% of bowel obstructions in adults. Heterotopic gastric mucosa (HGM) can occur anywhere in the gastrointestinal tract; nevertheless, its occurrence in the small intestine is rare unless associated with remnants of vitelline duct (Meckel's diverticulum). Herein, we describe a case of a 33-year-old male who presented with symptoms and signs of intestinal obstruction caused by ileo-colic intussusception, in which polypoid HGM acted as the organic lead point for intussusception. Several cases of intussusception caused by HGM have been reported in pediatric age group; however, this event is exceedingly rare in adults.
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Affiliation(s)
- Khaled A Murshed
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mahwish Khawar
- Department of General Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mahir Petkar
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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21
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Kakish D, Alaoudi M, Welch B, Fan D, Meghpara M, Mandava N, Kumthekar N. Small bowel intussusception in marijuana users. J Surg Case Rep 2020; 2020:rjaa335. [PMID: 33024532 PMCID: PMC7524600 DOI: 10.1093/jscr/rjaa335] [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] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022] Open
Abstract
Intussusception occurs when one portion of bowel ‘telescopes’ into another due to a lead point created by a range of benign or pathologic process. Intussusception mostly occurs in children. Although adult intussusception (AI) is rare, accounting for <5% of intestinal obstructions, it is more concerning in adults as malignancy accounts for nearly 65% of lead points in AI. Patients present with severe abdominal pain concerning for an acute abdomen along with a degree of bowel obstruction. We have experienced a total of 11 patients within recent years presenting with symptoms of an acute abdomen due to AI. None of these patients were found to have a pathologic process creating a lead point. However, we found that all of them were marijuana users. In this report, we compare their management, hospital course and review of the literature discussing proposed mechanisms that suggest an association between cannabis and intussusception.
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Affiliation(s)
- Daniel Kakish
- Department of Surgery, Flushing Hospital Medical Center, New York City, NY, USA
| | - Marwan Alaoudi
- Department of Surgery, Flushing Hospital Medical Center, New York City, NY, USA
| | - Brian Welch
- Department of Surgery, Flushing Hospital Medical Center, New York City, NY, USA
| | - David Fan
- Department of Surgery, Flushing Hospital Medical Center, New York City, NY, USA
| | - Melissa Meghpara
- Department of Surgery, Flushing Hospital Medical Center, New York City, NY, USA
| | - Nageswara Mandava
- Department of Surgery, Flushing Hospital Medical Center, New York City, NY, USA
| | - Narendra Kumthekar
- General Surgery Department, Kingsbrook Jewish Medical Center, Brooklyn, NY, USA
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22
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Transient jejuno-jejunal intussusception in an anabolic steroid user-A case report. Int J Surg Case Rep 2020; 70:126-129. [PMID: 32428711 PMCID: PMC7235922 DOI: 10.1016/j.ijscr.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/22/2020] [Accepted: 04/01/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Adult intussusception (AI) is both a challenging and rare diagnosis, with predisposing factors including malignancy, surgery and infection to name a few. Transient jejunal intussusception is a subset of AI which is usually diagnosed radiologically, with diagnostic laparoscopy utilised to determine whether a malignant cause is identifiable and subsequently treatable. PRESENTING CASE We present the case of a previously healthy 36-year-old male diagnosed with transient jejunal intussusception on computed tomography after presenting with abdominal pain. Blood tests on admission were normal apart from polycythaemia. His only significant history was that of chronic anabolic steroid use. He had a subsequent normal gastroscopy and colonoscopy with diagnostic laparoscopy demonstrating thickening of the small bowel. Histopathological analysis of the intraoperative specimen was normal. The patient improved and was discharged with no further complications. CONCLUSION This case highlights the potential association between anabolic steroid use resulting in polycythaemia, and AI or transient jejunal intussusception, along with further validating a conservative approach in the management of AI in patients deemed to be low risk of malignancy on pre-operative evaluation.
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Wassmer CH, Abbassi Z, Ris F, Berney T. Intussusception in an Immunocompromised Patient: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e919974. [PMID: 31937749 PMCID: PMC6977626 DOI: 10.12659/ajcr.919974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patient: Female, 55-year-old Final Diagnosis: Septic shock with multi-organ failure Symptoms: Respiratory distress Medication: None Clinical Procedure: Laparotomy Specialty: Visceral Surgery
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Affiliation(s)
- Charles-Henri Wassmer
- Department of Visceral and Transplant Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Ziad Abbassi
- Department of Visceral and Transplant Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Frédéric Ris
- Department of Visceral and Transplant Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Thierry Berney
- Department of Visceral and Transplant Surgery, University Hospital of Geneva, Geneva, Switzerland
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Kim YK. Single-incision laparoscopic surgery for jejuno-jejunal intussusception caused by an angiolipomatous polyp in an adult: A case report. Medicine (Baltimore) 2019; 98:e18280. [PMID: 31852102 PMCID: PMC6922439 DOI: 10.1097/md.0000000000018280] [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: 11/25/2022] Open
Abstract
RATIONALE Small bowel intussusception in adults is rare but is more likely to occur in the presence of a lead point. Surgical intervention is necessary in most cases, even if there is successful nonsurgical reduction of the intussusception. PATIENT CONCERNS A 54-year-old woman who was transferred to our emergency room with complaints of intermittent cramping pain of 4 days' duration. DIAGNOSIS Abdominal contrast-enhanced computed tomography revealed a jejuno-jejunal intussusception due to an angiolipomatous polyp. INTERVENTION A single-incision laparoscopic surgery (SILS) was performed without the need for any additional incisions. OUTCOMES She was uneventfully discharged on postoperative day 4. LESSONS The SILS procedure with adequate preoperative diagnosis by CT, with or without US, can offer good clinical outcomes for small bowel intussusception. Even surgeons who have little experience with laparoscopic intestinal anastomosis can consider SILS to treat small bowel intussusception in adults.
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Balogun OS, Olajide TO, Afolayan M, Lawal A, Osinowo AO, Adesanya AA. An appraisal of the presentation and management of adult intussusception at a Nigerian Tertiary Hospital. Niger Postgrad Med J 2019; 26:169-173. [PMID: 31441455 DOI: 10.4103/npmj.npmj_47_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Intussusception in adults is considered rare in surgical practice. It is the causative lesion in a small proportion of cases of intestinal obstruction and lower gastrointestinal bleeding. In the last decade, the incidence of adult intussusception appears to be increasing at our centre. Aims This study aims to document the pattern of presentation and management outcome of adult intussusception at our institution during the last decade. We also observed the occurring trends of this lesion. Patients and Methods This was a 10-year retrospective study of consecutive adult patients with intussusception seen at our institution from July 2008 to June 2018. Information on biodata, clinicopathological features and management outcome retrieved from case notes and pathology records were analysed on a personal computer using SPSS version 23. Results Twenty adult patients who had intussusception were seen during this period. There were 9 (45%) males and 11 (55%) females giving a male-to-female ratio of 1:1.2. The mean age of presentation was 45 (range 18-66) years. Clinical features were abdominal pain (85%), abdominal distension (80%), vomiting (70%), rectal bleeding (70%) and palpable abdominal mass (35%). Majority of patients (70%) presented with features of intestinal obstruction. Idiopathic intussusception (55%) accounted for more than half of the cases with the jejunoileal variety (30%) as the most common pathological type. One patient who had intussusception in the postoperative period was treated with manual reduction at laparotomy. Bowel resections were performed in the remaining 19 (95%) patients. Conclusion Adult intussusception is still uncommon in our general surgical practice. Bowel resection is the mainstay of treatment.
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Affiliation(s)
- Olanrewaju Samuel Balogun
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Thomas O Olajide
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Michael Afolayan
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Abdulrazzak Lawal
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adedapo Olumide Osinowo
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adedoyin A Adesanya
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
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Girón F, Báez Y, Amaya J. Autotrasplante renal por aneurisma de arteria renal en un paciente con riñón funcional único: reporte de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Paramythiotis D, Goulas P, Moysidis M, Papavramidis T, Michalopoulos A. Bowel intussusception in adults: a report of three interesting cases and current trends for diagnosis and surgical management. Hippokratia 2019; 23:37-41. [PMID: 32256038 PMCID: PMC7124870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Bowel intussusception in adults remains a rare and constant diagnostic challenge for surgeons. It has an incidence of around 2-3 new cases per million per year, and its primary cause is benign or malignant neoplasms of the small bowel and colon. This report aims to outline the importance of high clinical suspicion regarding intussusception in adults presenting with abdominal pain in the emergency department. Case report: This is a retrospective review of three cases of adult ileocecal intussusception that were treated in a single surgical department in three years (2015-2018). All patients underwent right hemicolectomy in keeping with the principles of surgical oncology. Each patient had a different clinical presentation, while, in terms of the underlining pathology, the first had an adenocarcinoma of the ascending colon, the second an adenocarcinoma of the ileocecal valve, and the third one an inflammatory fibroid polyp of the ileocecal valve, also known as Vanek's tumor. CONCLUSION Large bowel intussusception in adults is quite an interesting entity, not only for its rarity but for its non-specific and atypical clinical presentation as well. High suspicion from the clinician's part and availability of a computed tomography scan is the key to diagnosis. It is not unusual for imaging modalities to be unable to identify the cause of the intussusception. Thus, surgery is always the preferred method of treatment, as, more often than not, a neoplasm of the small or the large bowel is the underlining pathology. HIPPOKRATIA 2019, 23(1): 37-41.
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Affiliation(s)
- D Paramythiotis
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - P Goulas
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - M Moysidis
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - T Papavramidis
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - A Michalopoulos
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
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Guerra Veloz MF, Gómez Rodríguez BJ, Chaaro Benallal D. Ileocecal endometriosis as an infrequent cause of intussusception. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:129. [PMID: 29278003 DOI: 10.17235/reed.2017.5183/2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a case of ileocecal endometriosis as a cause of infrequent ileocolic intussusception in an adult patient. It is reviewed as published by the authors Sanchez Cifuentes, A et al. 2016, emphasizing the rarity of the location of endometriosis, and its association as a cause of intussusception.
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Affiliation(s)
| | | | - Dina Chaaro Benallal
- Unidad de Gestión Clínica Intercentros de Aparato , Hospital Universitario Virgen Macarena, España
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Infantile Hemangioma Presenting as Colocolic Intussusception in an Infant Case Report with Review of Pathologic Lead Points. Case Rep Pediatr 2018; 2018:6494075. [PMID: 30034903 PMCID: PMC6035826 DOI: 10.1155/2018/6494075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/10/2018] [Indexed: 12/26/2022] Open
Abstract
Infantile hemangioma (IH) is one of the most common vascular anomalies of early childhood and is usually recognized in the first few weeks to months of life as a solitary cutaneous lesion. This report documents our experience with a GLUT-1 positive IH presenting as the pathologic lead point in a colocolic intussusception in a 10-week-old infant who had no skin lesions. Literature suggests approximately 2% of all children presenting with an intussusception require surgical intervention; however, an IH as the pathologic lead point is unique.
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30
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Sakthivel H, Sahoo AK, Amaranathan A, Raj Kumar N, Maroju NK. A Surgical Conundrum in Feeding Jejunostomy-Jejunojejunal Intussusception: A Case Series. Cureus 2018; 10:e2233. [PMID: 29713578 PMCID: PMC5919769 DOI: 10.7759/cureus.2233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Intussusception is a common cause of intestinal obstruction in the pediatric population. Usually, it is primary and benign and can be managed by nonoperative interventions in 80% of the cases. Adult intussusception accounts for only 5% of all cases of intussusception and 1%–5% of all cases of intestinal obstruction. Unlike in the pediatric population, intussusception in adults is usually caused by a pathologic lead point. The initial investigation to diagnose it is an ultrasound abdomen followed by contrast-enhanced computed tomography (CECT) of the abdomen. The placement of an intestinal tube for feeding purposes has been rarely reported as a cause of intussusception. Here, we present a case series of four patients who had jejunojejunal intussusception following the placement of feeding tubes into the jejunum. Three patients were operatively managed and one was managed conservatively.
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Affiliation(s)
- H Sakthivel
- MBBS, Ms Senior Resident, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ashok Kumar Sahoo
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anandhi Amaranathan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nagarajan Raj Kumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nanda K Maroju
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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