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Yadav AK, Regmi PR, Koirala B, adhikari B, Panthi B. The double target sign as ultrasonographic finding in a case of double intussusception: A case report. Radiol Case Rep 2024; 19:1990-1993. [PMID: 38440743 PMCID: PMC10909959 DOI: 10.1016/j.radcr.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Intussusception is one of the common conditions in children presenting with abdominal pain. The exact etiology of intussusception is unknown. Lead point is not identified in the majority of cases in children. Commonly, radiographic evidence suggests the presence of a target sign is diagnosis of intussusception. However, the presence of a double target sign in the case of intussusception is rare and depicts the presence of double intussusception. We present a case report of a 1-year-old child who presented to the emergency department with excessive crying for more than 10 hours. After the initial clinical assessment and acute management, an abdominal ultrasound revealed a double target sign on the sub-hepatic and left para-umbilical region which suggested double intussusception. No lead point was identified in our case. Early diagnosis and prompt treatment are the mainstay of management in such cases.
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Affiliation(s)
- Aalok kumar Yadav
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Pradeep Raj Regmi
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bibek Koirala
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bhupendra adhikari
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bishal Panthi
- Department of Oncology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Gruenberg B, Crane G, Arnold DH, Harrison NJ, Levine M. Yield of abdominal radiographs in children with suspected intussusception; rate of pneumoperitoneum and other abdominal pathology. Am J Emerg Med 2024; 78:18-21. [PMID: 38181541 DOI: 10.1016/j.ajem.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVES Ultrasound is the criterion standard imaging modality for the diagnosis of intussusception. However, to our knowledge the utility of abdominal radiographs to concurrently screen for pneumoperitoneum or other abdominal pathology that could have a similar presentation has not been studied. Our institutional protocol requires the performance of AP supine and left lateral decubitus views of the abdomen prior to ultrasound evaluation for intussusception, providing an opportunity to examine the yield of abdominal radiographs in this setting. Our primary objective was to determine the rate of pneumoperitoneum on screening abdominal radiographs in children undergoing evaluation for intussusception. Our secondary objective was to determine the rate that other clinically significant pathology is found on these screening abdominal radiographs. METHODS We performed a retrospective chart review of all patients under 6 years of age who had any imaging ordered in our large urban pediatric emergency department to evaluate for suspected intussusception during the calendar years 2018-2020. RESULTS 1115 patient encounters met our inclusion criteria. Among 1090 who had screening abdominal radiographs, 82 (8%) had findings concerning for intussusception. Of those not concerning for intussusception, 635 (58%) were read as normal, 263 (24%) showed moderate to large stool burden, 107 (10%) showed generalized bowel distention, and 22 (2%) showed abnormal gastric distention. Individually the remainder of all other findings compromised <1% of encounters and included radiopaque foreign body (8), intraabdominal calcification (4), pneumonia/effusion (3), pneumatosis intestinalis, abdominal mass (2), diaphragmatic hernia (1), rib fracture (1), appendicolith (1), feeding tube malposition (1), and bowel wall thickening (1). In one encounter the patient had a bowel perforation with pneumoperitoneum present secondary to ingestion of multiple magnets. CONCLUSIONS Our study indicates that radiograph-detected pneumoperitoneum is rare in children with suspected intussusception. Constipation is the most common abnormal finding on screening radiographs. Other findings occur in approximately 15% of total cases, some of which require further workup.
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Affiliation(s)
- Blake Gruenberg
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Emergency Medicine, 2200 Children's Way, Nashville, TN, 37232, USA.
| | - Gabriella Crane
- Vanderbilt University Medical Center, Department of Radiology, Division of Pediatric Radiology, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Donald H Arnold
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Emergency Medicine, 2200 Children's Way, Nashville, TN, 37232, USA
| | - Noah J Harrison
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN, 37232, USA
| | - Marla Levine
- Vanderbilt University Medical Center, Department of Pediatrics, Division of Pediatric Emergency Medicine, 2200 Children's Way, Nashville, TN, 37232, USA
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Hayashi R, Sawada G, Ichikawa Y, Takata A, Murakami M, Fukunaga H, Kimura H, Morita S. A case of intestinal intussusception with unique hemorrhagic polyps due to AL amyloidosis and excessive anticoagulation. Clin J Gastroenterol 2024; 17:258-262. [PMID: 38270839 DOI: 10.1007/s12328-023-01915-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
Most adult intussusceptions are secondary to various pathological conditions that serve as a lead point. Because of their serious nature, intussusceptions often require emergency surgery. We report a surgical case of amyloidosis associated with intussusception, probably due to polypoid protrusions and bleeding tendencies. An 80-year-old man with abdominal pain was suspected of having jejunal intussusception on computed tomography. He had been prescribed warfarin for atrial fibrillation, and excessive anticoagulation was observed with a prolonged prothrombin time/international normalized ratio of 5.44 at presentation. After the excessive anticoagulation was resolved, emergency surgery was performed. The intussuscepted jejunum was resected, and a 7 cm long dark-red pedunculated polyp was identified as the lead point, which was accompanied by multiple small pedunculated polyps. Histopathological examination showed that these were all hemorrhagic polyps. Amyloid depositions were observed in the muscularis mucosae, submucosa, and the walls of the blood vessels. Immunohistochemical analysis revealed immunoglobulin light chain amyloidosis. This case is informative to discuss the clinical sequelae of gastrointestinal amyloid deposition.
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Affiliation(s)
- Rie Hayashi
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan.
| | - Genta Sawada
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Yoshitoshi Ichikawa
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Akihiro Takata
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Masahiro Murakami
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Hiroki Fukunaga
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
| | - Hayato Kimura
- Department of Diagnostic Pathology, Itami City Hospital, Itami, Hyogo, Japan
| | - Shunji Morita
- Department of Surgery, Itami City Hospital, 100 Koyaike, Itami, Hyogo, 664-8540, Japan
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Dixit S, Das MK, Ramadugu DC, Arora NK. Geospatial methodology for determining the regional prevalence of hospital-reported childhood intussusception in patients from India. Sci Rep 2024; 14:6664. [PMID: 38509132 PMCID: PMC10954623 DOI: 10.1038/s41598-024-57187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
Both developed and developing countries carry a large burden of pediatric intussusception. Sentinel site surveillance-based studies have highlighted the difference in the regional incidence of intussusception. The objectives of this manuscript were to geospatially map the locations of hospital-confirmed childhood intussusception cases reported from sentinel hospitals, identify clustering and dispersion, and reveal the potential causes of the underlying pattern. Geospatial analysis revealed positive clustering patterns, i.e., a Moran's I of 0.071 at a statistically significant (p value < 0.0010) Z score of 16.14 for the intussusception cases across India (cases mapped n = 2221), with 14 hotspots in two states (Kerala = 6 and Tamil Nadu = 8) at the 95% CI. Granular analysis indicated that 67% of the reported cases resided < 50 km from the sentinel hospitals, and the average travel distance to the sentinel hospital from the patient residence was calculated as 47 km (CI 95% min 1 km-max 378 km). Easy access and facility referral preferences were identified as the main causes of the existing clustering pattern of the disease. We recommend designing community-based surveillance studies to improve the understanding of the prevalence and regional epidemiological burden of the disease.
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Affiliation(s)
- Shikha Dixit
- The INCLEN Trust International, New Delhi, India
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Hashiguchi K, Mine S, Shiota J, Akashi T, Tabuchi M, Kitayama M, Matsushima K, Akazawa Y, Yamaguchi N, Nakao K. Colonic intussusception after endoscopic mucosal resection successfully managed by endoscopic procedure. Clin J Gastroenterol 2024:10.1007/s12328-024-01953-8. [PMID: 38504057 DOI: 10.1007/s12328-024-01953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
Adult-onset intussusception, particularly associated with colonoscopy, is extremely rare. A 78-year-old man, referred to our hospital for colonic endoscopic mucosal resection (EMR), experienced subsequent dull abdominal pain, as well as elevated peripheral blood leukocytosis and C-reactive protein levels. Abdominal computed tomography (CT) revealed a colocolonic intussusception at the hepatic flexure. Emergency colonoscopy revealed ball-like swollen mucosa distal to the EMR site of the ascending colon. The mucosa was intact without necrosis. The endoscopic approach was able to temporarily release the intussusception. A transanal drainage tube was inserted through the endoscope to prevent relapse. Both CT and colonoscopy showed release of the intussusception. Our case underscores the importance of considering colocolonic intussusception in post-colonoscopy abdominal pain, advocating for endoscopic management after excluding mucosal necrosis.
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Affiliation(s)
- Keiichi Hashiguchi
- Department of Endoscopy, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Shoichiro Mine
- Department of Gastroenterology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Junya Shiota
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taro Akashi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Maiko Tabuchi
- Department of Histology and Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Moto Kitayama
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kayoko Matsushima
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuko Akazawa
- Department of Histology and Biomedical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoyuki Yamaguchi
- Department of Endoscopy, Nagasaki University Hospital, 1-7-1, Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Anwari P, Burnett E, Chavers TP, Samsor A, Safi H, Safi N, Clark AD, Parashar UD, Tate JE. Post-marketing surveillance of intussusception after Rotarix administration in Afghanistan, 2018-2022. Vaccine 2024; 42:2059-2064. [PMID: 38413278 DOI: 10.1016/j.vaccine.2024.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND In January 2018, Afghanistan introduced the monovalent oral rotavirus vaccine (Rotarix) nationwide, administered as a 2-dose series at six and ten weeks of age. We describe characteristics of intussusception cases and assess potential intussusception risk associated with Rotarix vaccination in Afghan infants. METHODS Multi-center prospective active hospital-based surveillance for intussusception was conducted from May 2018 to March 2022 in four sentinel sites in Afghanistan. We applied the Brighton Level 1 criteria for intussusception and verified vaccination status by reviewing vaccine cards. We used the self-controlled case series (SCCS) methodology to compare intussusception incidence in the 1 to 21 days after each dose of Rotarix vaccination against non-risk periods. RESULTS A total of 468 intussusception cases were identified in infants under 12 months, with 264 cases aged between 28 and 245 days having confirmed vaccination status contributing to the SCCS analysis. Most case-patients (98 %) required surgery for treatment, and over half (59 %) of those who underwent surgery required intestinal resection. Nineteen (7 %) case-patients died. Eighty-six percent of case-patients received the first dose of Rotarix, and 69 % received the second dose before intussusception symptom onset. There was no increased risk of intussusception in the 1-7 days (relative incidence: 0.9, 95 % CI: 0.1, 7.5), 8-21 days (1.3, 95 % CI: 0.4, 4.2), or 1-21 days (1.1, 95 % CI: 0.4, 3.4) following receipt of the first dose or in the 1-7 days (0.2, 95 % CI: 0.3, 1.8), 8-21 days (0.7, 95 % CI: 0.3, 1.5), or 1-21 days (0.6, 95 % CI: 0.3, 1.2) following the second dose. CONCLUSION Rotarix vaccination was not associated with an increased intussusception risk, supporting its continued use in Afghanistan's immunization program. However, there was a high level of death and resection due to intussusception among Afghan infants.
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Affiliation(s)
- Palwasha Anwari
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Eleanor Burnett
- Division of Viral Diseases, NCIRD, CDC, Atlanta, United States of America
| | - Tyler P Chavers
- Division of Viral Diseases, NCIRD, CDC, Atlanta, United States of America
| | | | | | | | - Andrew D Clark
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Umesh D Parashar
- Division of Viral Diseases, NCIRD, CDC, Atlanta, United States of America
| | - Jacqueline E Tate
- Division of Viral Diseases, NCIRD, CDC, Atlanta, United States of America
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Bodson C, Geurde B, Jourdan JL, Leonard M, Seydel B. [Ileo-colic intussusception in adult secondary to a large neoplasia of the lower caecal fundus]. Rev Med Liege 2024; 79:129-130. [PMID: 38487904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Intussusception is rare in adults, accounting for 1 to 5 % of mechanical bowel obstructions. It is due to pathologic lead point within the bowel which is malignant in up to 77 % of cases. Benign lesions may also be responsible for intussusception (polyp, Meckel diverticulum). The lead point is pulled forward by normal peristaltism, prolapsing the affected segment of bowel into another segment. The most common presentation in adults is intermittent abdominal pain and bowel obstruction (nausea, vomiting, inability to pass gas or stools). Abdominal scanner is the key exam for the diagnosis and the treatment is always surgical resection.
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Affiliation(s)
- Céline Bodson
- Service de Chirurgie digestive, Centre Hospitalier du Bois de l'Abbaye, Seraing, Belgique
| | - Bernard Geurde
- Service de Chirurgie digestive, Centre Hospitalier du Bois de l'Abbaye, Seraing, Belgique
| | - Jean-Luc Jourdan
- Service de Chirurgie digestive, Centre Hospitalier du Bois de l'Abbaye, Seraing, Belgique
| | - Morgane Leonard
- Service de Chirurgie digestive, Centre Hospitalier du Bois de l'Abbaye, Seraing, Belgique
| | - Benoit Seydel
- Service de Chirurgie digestive, Centre Hospitalier du Bois de l'Abbaye, Seraing, Belgique
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Zewde Y, Bugie T, Daniel A, Wodajo A, Meskele M. Clinical presentation and management outcome of pediatric intussusception at Wolaita Sodo University Comprehensive Specialized Hospital: a retrospective cross-sectional study. J Int Med Res 2024; 52:3000605241233525. [PMID: 38518196 PMCID: PMC10960347 DOI: 10.1177/03000605241233525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/29/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE To assess the pattern of clinical presentations and factors associated with the management outcome of pediatric intussusception among children treated at Wolaita Sodo University Comprehensive Specialized Hospital, Ethiopia. METHODS This retrospective cross-sectional study included the medical records of 103 children treated for intussusception from 2018 to 2020. The data collected were analyzed using SPSS 25.0 (IBM Corp., Armonk, NY, USA). RESULTS In total, 84 (81.6%) patients were released with a favorable outcome. Ileocolic intussusception was a positive predictor, with a nine-fold higher likelihood of a favorable outcome than other types of intussusception [adjusted odds ratio (AOR), 9.16; 95% confidence interval (CI), 2.39-21.2]. Additionally, a favorable outcome was three times more likely in patients who did than did not undergo manual reduction (AOR, 3.08; 95% CI, 3.05-5.48). Patients aged <1 year were 96% less likely to have a positive outcome than those aged >4 years (AOR, 0.04; 95% CI, 0.03-0.57). CONCLUSION Most patients were discharged with favorable outcomes. Having ileocolic intussusception and undergoing manual reduction were associated with significantly more favorable outcomes of pediatric intussusception. Therefore, nonsurgical management such as hydrostatic enema and pneumatic reduction is recommended to reduce hospital discharge of patients with unfavorable outcomes.
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Affiliation(s)
- Yohannes Zewde
- Department of Surgery, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tamrat Bugie
- Department of Surgery, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abel Daniel
- Department of Pediatrics, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Awoke Wodajo
- Department of Pediatrics, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mengistu Meskele
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Asbah M, Shrateh ON, Ashqar H, Musleh A, Abbadi K, Amro W. Waugh syndrome: A rare coexistence of intussusception and intestinal malrotation: Case report and literature review. Int J Surg Case Rep 2024; 116:109411. [PMID: 38394938 PMCID: PMC10944001 DOI: 10.1016/j.ijscr.2024.109411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Waugh's syndrome, characterized by the concurrent presence of acute intussusception and gut malrotation, is a rare clinical entity. The relationship between these conditions is not well-explored, and the true incidence may be underreported. CASE PRESENTATION A 4 month old male infant, with an uneventful medical history, presented to the pediatric emergency department due to irritability and rectal bleeding lasting one day. The infant had a history of bilious vomiting and dark bloody rectal discharge. Physical examination revealed a hypoactive, dehydrated child with a palpable mass in the left lower abdomen. Abdominal ultrasound indicated Colo-colonic intussusception, and attempts at hydrostatic reduction were unsuccessful. Subsequent CT scan revealed malrotation with ileo-Colo-rectal intussusception. The patient underwent a two-step operation, involving manual reduction and Ladd's procedure, with a successful recovery and no post-surgical complications. CLINICAL DISCUSSION Reviewing the cases, we explore the unique features of Waugh's syndrome, its diverse age presentation, and the challenges in timely diagnosis. Diagnostic modalities, including abdominal ultrasound and contrast studies, are discussed, emphasizing the importance of recognizing malrotation in conjunction with intussusception for appropriate management. CONCLUSION Our experience highlights the potential underrecognition of Waugh's syndrome and emphasizes the need for a high index of suspicion. The rarity of laparoscopic interventions in documented cases is noted, emphasizing the prevailing reliance on open surgical approaches. A call for prospective studies is made to determine the actual incidence of intussusception in intestinal malrotation cases and to enhance understanding for optimal patient management.
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Affiliation(s)
- Malvina Asbah
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hadeel Ashqar
- Department of Radiology, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Asil Musleh
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Khaled Abbadi
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine.
| | - Wael Amro
- Department of Pediatric Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
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Roberts J, Gerlt D. Laparoscopic Management of Small Bowel Intussusception After Duodenal Switch. Obes Surg 2024; 34:1054. [PMID: 38236348 DOI: 10.1007/s11695-024-07058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Jay Roberts
- Ultimate Bariatrics, 2501 Parkview Dr #560, Fort Worth, TX, 76102, USA.
| | - Deitrich Gerlt
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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Liaqath Ali MN, Bharucha T, Kaarne M, Hayes N. Inverted left atrial appendage mimicking potential left atrial thrombus in an infant following cardiac surgery: a case report. Eur Heart J Case Rep 2024; 8:ytae105. [PMID: 38487588 PMCID: PMC10939120 DOI: 10.1093/ehjcr/ytae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/17/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
Background Inverted left atrial appendage (iLAA) is an infrequent complication following cardiac surgery, seen both in children and adults. Following a recent encounter, this review article is aimed to remind the reader about its occurrence, clinical manifestations, differential diagnoses, and management options. Case summary A 3-month-old baby underwent successful surgical repair of a large ventricular septal defect. Intraoperative epicardial echocardiogram at the end of the case demonstrated an unexpected left atrial mass, raising suspicion of a thrombus adjacent to the mitral valve. Urgent re-establishment of cardiopulmonary bypass and exploration of the left atrium did not reveal a thrombus, but this was subsequently identified as an iLAA. This completely resolved after manual external reduction of the appendage. Discussion Published literature is confined to case reports only, with most cases observed post-operatively, but some occurring spontaneously. Awareness of this unusual manifestation is particularly important in the intraoperative period as it can usually be addressed without the need for further cardiopulmonary bypass.
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Affiliation(s)
- Muhammad Najih Liaqath Ali
- Department of Paediatric Cardiology, University Hospital of Southampton NHS Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Tara Bharucha
- Department of Paediatric Cardiology, University Hospital of Southampton NHS Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Markku Kaarne
- Department of Congenital Cardiac Surgery, University Hospital of Southampton NHS Trust, Southampton, UK
| | - Nicholas Hayes
- Department of Paediatric Cardiology, University Hospital of Southampton NHS Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK
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Zhu J, Cheng W, Xu Y, Guo Y, Shi L. Two cases of small bowel necrosis due to intussusception secondary to abnormal proliferation of intestinal Peyer's patches in infants after MMR vaccination. BMC Pediatr 2024; 24:147. [PMID: 38418948 PMCID: PMC10903061 DOI: 10.1186/s12887-024-04618-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/03/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Intussusception is one of the most common acute abdominal conditions in pediatric patients, and if left untreated, it may result in intestinal necrosis and even death. The etiology of the disease is unknown and may be related to a variety of factors, and there are only limited reports of small bowel necrosis secondary to abnormal Peyer's node hyperplasia after MMR vaccination. CASE PRESENTATION In this report, we present two infants who had an abnormal proliferation of Peyer's nodes secondary to intussusception eventually leading to small bowel necrosis after MMR vaccination. CONCLUSIONS Intestinal necrosis and infectious shock are the most common causes of infant mortality, and early detection and management are critical.
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Affiliation(s)
- Junzhao Zhu
- Xi'an International Medical Center Hospital Affiliated to Northwest University, No.777 Xitai Road, Chang'an District, Xi'an City, Shaanxi Province, China
| | - Weiping Cheng
- The Affiliated Hospital of Northwest University/Xi'an No.3 Hospital, No. 10 East Section of Fengcheng 3rd Road, Weiyang District, Xi'an , China
| | - Youbo Xu
- Xi'an International Medical Center Hospital Affiliated to Northwest University, No.777 Xitai Road, Chang'an District, Xi'an City, Shaanxi Province, China
| | - Yingqiang Guo
- Xi'an International Medical Center Hospital Affiliated to Northwest University, No.777 Xitai Road, Chang'an District, Xi'an City, Shaanxi Province, China
| | - Lexiang Shi
- Xi'an International Medical Center Hospital Affiliated to Northwest University, No.777 Xitai Road, Chang'an District, Xi'an City, Shaanxi Province, China.
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Townley B, Akin D, Dimaguila GL, Sawires R, Sepulveda Kattan G, King S, Bines J, Wood N, Lambert S, Buttery J. Exploring the infectious contribution to intussusception causality using the effects of COVID-19 lockdowns in Australia: An ecological study. Clin Infect Dis 2024:ciae084. [PMID: 38376945 DOI: 10.1093/cid/ciae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Intussusception is the primary cause of acute bowel obstruction in infants. The majority of cases under 2 years of age are classed as idiopathic with viral infection implicated as one of the causes. COVID-19 public health measures led to significant decreases in communicable disease prevalence. During these times, reductions in intussusception frequency were reported - reductions greater than would be expected with our previous understanding of its infectious aetiology. METHODS We conducted a retrospective, multi-state, ecological study over a twelve-year period. Monthly case numbers of ICD-10-AM K56.1 'Intussusception' coded admissions were acquired from state-wide admissions datasets from New South Wales (NSW), Victoria and Queensland, representing 77.62% of the eligible Australian population. These counts within differing jurisdictional lockdowns were compared to non-lockdown periods in order to investigate a correlation between intussusception frequency and lockdown periods. RESULTS We found a negative association between intussusception frequency and lockdown periods in both eligible states. The largest reductions were seen in the under 2 year age groups with Victoria experiencing a 62.7% reduction (Rate ratio (RR) = 0.37, p < 0.0001) and NSW a 40.1% reduction (RR = 0.599, p = 0.006) during lockdown times. Controls for variations in lockdown restrictions between both regional and metropolitan areas also showed expected decreases. CONCLUSION Our ecological study demonstrates significant decreases in the frequency of paediatric intussusception admissions during the COVID-19 lockdown periods. The unexpected magnitude of the reductions suggests that the true proportion of infectious disease-caused idiopathic intussusception is greatly underestimated.
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Affiliation(s)
- Benjamin Townley
- Murdoch Children's Research Institute, Child Health Analytics and Informatics Research, Parkville, VIC, Australia
- Monash University, School of Medicine, Clayton, VIC, Australia
| | - Deniz Akin
- Murdoch Children's Research Institute, Child Health Analytics and Informatics Research, Parkville, VIC, Australia
| | - Gerardo Luis Dimaguila
- Murdoch Children's Research Institute, Child Health Analytics and Informatics Research, Parkville, VIC, Australia
| | - Rana Sawires
- Murdoch Children's Research Institute, Child Health Analytics and Informatics Research, Parkville, VIC, Australia
- Monash University, School of Medicine, Clayton, VIC, Australia
| | - Gonzalo Sepulveda Kattan
- Murdoch Children's Research Institute, Child Health Analytics and Informatics Research, Parkville, VIC, Australia
| | - Sebastian King
- Murdoch Children's Research Institute, Department of Paediatrics, Parkville, VIC, Australia
- Royal Children's Hospital, Parkville, VIC, Australia
- University of Melbourne, Department of Paediatrics
| | - Julie Bines
- Royal Children's Hospital, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Enteric Diseases, Parkville, VIC, Australia
- University of Melbourne, Department of Paediatrics
| | - Nicholas Wood
- Sydney Children's Hospital Network, National Centre for Immunisation Research and Surveillance, Sydney, NSW, Australia
| | - Stephen Lambert
- Sydney Children's Hospital Network, National Centre for Immunisation Research and Surveillance, Sydney, NSW, Australia
- Communicable Diseases Branch, Queensland Health, Brisbane, QLD, Australia
| | - Jim Buttery
- Murdoch Children's Research Institute, Child Health Analytics and Informatics Research, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Department of Paediatrics, Parkville, VIC, Australia
- Royal Children's Hospital, Parkville, VIC, Australia
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Di Stefano C, Salvatori E, Savino L, Forte V, Paoletti S, Ricciardi F, Floris R, Garaci F. Colo-colic intussusception in an adult caused by lipoma: Case report of a rare condition. Radiol Case Rep 2024; 19:665-670. [PMID: 38111559 PMCID: PMC10726323 DOI: 10.1016/j.radcr.2023.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/20/2023] Open
Abstract
This report describes the case of a 56-year-old woman who presented at the emergency room with a 3-week history of severe, intermittent abdominal pain. A CT scan revealed colo-colic intussusception caused by a large, substenosing mass with predominant adipose density. Subsequent endoscopic examination with biopsy revealed a necrotic tissue covering the mass, without definitive histological characterization. A second biopsy led to the extremely rare diagnosis of colo-colic lipoma. While intussusception is rare in adults, it's important to consider it as a differential diagnosis, especially when presenting with abdominal pain and signs of bowel obstruction. Timely diagnosis and appropriate treatment are essential to prevent complications.
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Affiliation(s)
- Carla Di Stefano
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy
| | - Eva Salvatori
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy
| | - Luca Savino
- Institute of Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy
| | - Valentina Forte
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy
| | - Stefano Paoletti
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy
| | - Federica Ricciardi
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy
| | - Roberto Floris
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy
| | - Francesco Garaci
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy
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Liagre A, Martini F, Debs T, Barone SC, Petrucciani N. Roux en Y gastric bypass and iterative intussusception at the jejuno-jejunal anastomosis: Conversion into one anastomosis gastric bypass (with video) - A case report. Int J Surg Case Rep 2024; 115:109244. [PMID: 38215577 PMCID: PMC10821620 DOI: 10.1016/j.ijscr.2024.109244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION The aim of this article is to describe a rare complication of Roux en Y gastric bypass (RYGB): recurrent intestinal intussusception of the biliary limb, and an original treatment: the removal of the jejuno-jejunal anastomosis with conversion into "short limb" one anastomosis gastric bypass (OAGB). PRESENTATION OF CASE A 25-year-old patient underwent RYGB fashioned with a 50 cm-length biliary loop and a 150 cm-length alimentary loop. She was hospitalized other 3 times in the following months for episodes of acute abdominal pain and excessive weight loss, with CT scans showing intussusception at the jejuno-jejunal anastomosis. Conversion from RYGB to OAGB with "short biliary limb" was performed. The patient at 60-month follow-up has no bile reflux and regained weight. DISCUSSION Small bowel intussusception is a rare complication that can occur following Roux-en-Y gastric bypass (RYGB) surgery, leading to symptoms like acute or chronic abdominal pain. Treatment options reported in medical literature include resection and re-fashioning of the jejuno-jejunal anastomosis, simple reduction (with a risk of recurrence), and imbrication/plication of the jejuno-jejunal anastomosis. Given the rarity of this complication, there are no standardized recommendations, and the best treatment should be determined on a case-by-case basis, taking into consideration the patient's unique circumstances and the medical team's expertise. CONCLUSION Intestinal intussusception at the jejuno-jejunal anastomosis responsible for chronic abdominal pain is a rare complication after RYGB. One of the possible treatments is conversion into OAGB.
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Affiliation(s)
- Arnaud Liagre
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Francesco Martini
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Tarek Debs
- Institut Arnault Tzanck, 116 Rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Sara Claudia Barone
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.
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Taniguchi A, Endo I, Nishiyama T, Watanabe N, Yoshida O, Asano H, Kubo M, Udaka T. Multiple enteric muco-submucosal elongated polyps causing intussusception. Clin J Gastroenterol 2024; 17:41-45. [PMID: 37976018 DOI: 10.1007/s12328-023-01888-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
A 20-year-old woman presented to our hospital with abdominal pain. Abdominal computed tomography revealed multiple masses in the upper jejunum, which were suspected as lipomas. Partial resection of the small intestine, including the masses, was performed on the same day due to intussusception secondary to the masses. Pathological examination revealed that the masses consisted of mucosa and edematous submucosa with multiple dilated blood vessels and lymphatic ducts without muscularis propria. The masses were diagnosed as multiple muco-submucosal elongated polyps (MSEP), a type of non-neoplastic polyp. MSEP was originally named colonic MSEP, but with the development of endoscopic techniques and imaging tests, similar polyps have been reported to occur not only in the colon but also in the entire intestinal tract. In this case, multiple MSEPs in the upper jejunum caused intussusception. As reported cases of multiple lesions causing intussusception are few, our case may help to clarify the pathogenesis of this disease.
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Affiliation(s)
- Atsuki Taniguchi
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan.
| | - Izuru Endo
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Takeyoshi Nishiyama
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Nobuyuki Watanabe
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Osamu Yoshida
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Hiroaki Asano
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Masatoshi Kubo
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
| | - Tetsunobu Udaka
- Department of Surgery, Mitoyo General Hospital, 809, Toyohama-cho Himehama, Kanonji-shi, Kagawa, 769-1695, Japan
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Yu HW, Yan JG, Zheng L, Huang JH. Ileum intussusception secondary to submucosal liposarcoma in adult:A case report. Heliyon 2024; 10:e23432. [PMID: 38192766 PMCID: PMC10772086 DOI: 10.1016/j.heliyon.2023.e23432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Intussusception in adults is a rare surgical emergency. Unlike in children, most adult intussusceptions arise from a pathological lead point. Ileal intussusception caused by a submucosal liposarcoma is a particularly rare phenomenon. This report describes the diagnosis and management of adult ileal intussusception secondary to submucosal liposarcoma in adult to provide a reference for future clinical work. A 64-year-old female presented to the emergency department with worsening abdominal pain associated with an 8 h history of intermittent vomiting. Based on physical examination, laboratory investigations, and computed tomography, the most likely diagnosis was ileal intussusception secondary to liposarcoma. Thus, emergency laparotomy was performed. During exploration, an ileal invagination was visualised approximately 30 cm from the ileocecal valve, and a flexible polypoid mass was palpable at the lead point of the intussusception. Subsequently, the patient underwent radical resection of pathological tissues with a primary end-to-end ileal anastomosis. Histopathological examination revealed a well-differentiated submucosal liposarcoma. Postoperatively, the patient recovered uneventfully and was doing well at the 6-month follow-up in the outpatient clinic. Thus, clinicians should consider the origin of submucosal liposarcomas in adult with intussusception. Once ileal intussusception secondary to submucosal liposarcoma is diagnosed, timely radical resection is recommended.
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Affiliation(s)
- Hong-wei Yu
- Division of Gastrointestinal Surgery, Wenzhou Medical University Affiliated Zhoushan Hospital, Zhoushan, Zhejiang Province, China
| | - Jin-gang Yan
- Division of Gastrointestinal Surgery, Wenzhou Medical University Affiliated Zhoushan Hospital, Zhoushan, Zhejiang Province, China
| | - Lei Zheng
- Division of Gastrointestinal Surgery, Wenzhou Medical University Affiliated Zhoushan Hospital, Zhoushan, Zhejiang Province, China
| | - Jun-hua Huang
- Division of Gastrointestinal Surgery, Wenzhou Medical University Affiliated Zhoushan Hospital, Zhoushan, Zhejiang Province, China
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18
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Kim SW, Cheon JE, Choi YH, Hwang JY, Shin SM, Cho YJ, Lee S, Lee SB. Feasibility of a deep learning artificial intelligence model for the diagnosis of pediatric ileocolic intussusception with grayscale ultrasonography. Ultrasonography 2024; 43:57-67. [PMID: 38109893 PMCID: PMC10766885 DOI: 10.14366/usg.23153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 12/20/2023] Open
Abstract
PURPOSE This study explored the feasibility of utilizing a deep learning artificial intelligence (AI) model to detect ileocolic intussusception on grayscale ultrasound images. METHODS This retrospective observational study incorporated ultrasound images of children who underwent emergency ultrasonography for suspected ileocolic intussusception. After excluding video clips, Doppler images, and annotated images, 40,765 images from two tertiary hospitals were included (positive-to-negative ratio: hospital A, 2,775:35,373; hospital B, 140:2,477). Images from hospital A were split into a training set, a tuning set, and an internal test set (ITS) at a ratio of 7:1.5:1.5. Images from hospital B comprised an external test set (ETS). For each image indicating intussusception, two radiologists provided a bounding box as the ground-truth label. If intussusception was suspected in the input image, the model generated a bounding box with a confidence score (0-1) at the estimated lesion location. Average precision (AP) was used to evaluate overall model performance. The performance of practical thresholds for the modelgenerated confidence score, as determined from the ITS, was verified using the ETS. RESULTS The AP values for the ITS and ETS were 0.952 and 0.936, respectively. Two confidence thresholds, CTopt and CTprecision, were set at 0.557 and 0.790, respectively. For the ETS, the perimage precision and recall were 95.7% and 80.0% with CTopt, and 98.4% and 44.3% with CTprecision. For per-patient diagnosis, the sensitivity and specificity were 100.0% and 97.1% with CTopt, and 100.0% and 99.0% with CTprecision. The average number of false positives per patient was 0.04 with CTopt and 0.01 for CTprecision. CONCLUSION The feasibility of using an AI model to diagnose ileocolic intussusception on ultrasonography was demonstrated. However, further study involving bias-free data is warranted for robust clinical validation.
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Affiliation(s)
- Se Woo Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su-Mi Shin
- Department of Radiology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
| | - Seul Bi Lee
- Department of Radiology, Seoul National University Children’s Hospital, Seoul, Korea
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Hailemariam T, Sisay S, Mebratu Y, Belay F, Getinet T, Solomon S, Belina M, Abebe A, Hilawi Tewodros B, Manyazewal T. Effects of sedatives on radiologic enema reduction in children with ileocolic intussusception: A systematic review and meta-analysis. Eur J Radiol 2024; 170:111237. [PMID: 38039783 DOI: 10.1016/j.ejrad.2023.111237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/05/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND In children with ileocolic intussusception, sedatives such as midazolam, ketamine and propofol may facilitate radiologic enema reduction, but studies on their separate and joint effects remain controversial. OBJECTIVES We aimed to systematically analyze studies for the effects of sedatives on the radiologic reduction of ileocolic intussusception in children. METHODS We searched PubMed, EMBASE, CINAHL, Scopus and Web of Science from database inception through March 2023 for articles that enrolled children with ileocolic intussusception who underwent non-operative pneumatic or hydrostatic enema reduction under ultrasound or fluoroscopic guidance with or without the use of sedatives. The primary and secondary outcomes were success rate in radiologic reduction of ileocolic intussusception and risk of perforation, respectively. Effect estimates from the individual studies were extracted and combined using the Hartung-Knapp-Sidik-Jonkman log-odds random-effects model. Heterogeneity between studies was checked using Cochran's Q test and the I2 statistic. RESULTS A total of 17 studies with 2094 participants were included in the final review, of which 15 were included in the meta-analysis. Nine studies reported on the success rate of radiologic reduction performed under sedation in all participants, while six studies compared the success rate in two patient groups undergoing the procedure with or without sedation. The pooled success rate of non-operative reduction under sedation was 87 % (95 % CI: 80-95 %), P = 0.000 with considerable heterogeneity (I2 = 85 %). A higher success rate of 94 % (95 % CI: 88-99 %) and homogeneity (I2 = 12 %) were found in studies with pneumatic enema reduction. Among comparative studies, the odds of success of non-operative reduction were increased when the procedure was performed under sedation, with a pooled odds ratio of 2.41 (95 % CI: 1.27-4.57), P = 0.010 and moderate heterogeneity (I2 = 60 %). In a sensitivity analysis, homogeneity was found between analyzed studies when two outliers were excluded (I2 = 0.73 %). The risk of perforation was not significantly different (OR 1.52, 95 % CI: 0.09-23.34), P = 0.764 indicating small study effects. No publication, bias was detected on visual inspection of the funnel plots or the Begg's and Egger's bias tests. Most studies were categorized as having a low risk of bias using Joanna Briggs Institute checklists. CONCLUSIONS In selected patient groups, sedation can increase the success rate of radiologic enema reduction in children with ileocolic intussusception without evidence of increased risk of perforation. Systematic review protocol registration: PROSPERO CRD42023404887.
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Affiliation(s)
- Tesfahunegn Hailemariam
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia; Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia.
| | - Samuel Sisay
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia.
| | - Yonas Mebratu
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Fekadu Belay
- Wachemo University, College of Medicine and Health Sciences, Department of Pediatrics and Child Health, Hossana, Ethiopia
| | - Tewodros Getinet
- St. Paul's Hospital Millennium Medical College, School of Public Health, Addis Ababa, Ethiopia
| | - Samrawit Solomon
- St. Paul's Hospital Millennium Medical College, School of Public Health, Addis Ababa, Ethiopia.
| | - Merga Belina
- Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Abel Abebe
- Detroit Medical Center/Wayne State University, Sinai Grace Hospital, Detroit, MI, USA
| | | | - Tsegahun Manyazewal
- Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
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Zhang R, Zhang M, Deng R, Li Y, Guo C. Lymphoma-related intussusception in children: diagnostic challenges and clinical characteristics. Eur J Pediatr 2024; 183:219-227. [PMID: 37861794 DOI: 10.1007/s00431-023-05289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
Intussusception is a common cause of acute abdominal pain in children and the most frequent cause of intestinal obstruction in infants. Although often idiopathic, it can stem from conditions like lymphoma. This study delves into lymphoma-related intussusception in children, aiming to enhance early detection and management. A retrospective review encompassed children admitted from 2012 to 2023 with intussusception due to intestinal lymphoma. Demographic, clinical, and imaging data were meticulously extracted and analyzed. The study included 31 children in the lymphoma-related intussusception group. Contrasted with non-lymphoma-related cases, the patients of lymphoma-related intussusception were notably older (median age: 87 months vs. 18.5 months), predominantly male, and demonstrated protracted abdominal pain. Ultrasound unveiled mesenteric lymph node enlargement and distinct intra-abdominal masses; enema reduction success rates were notably diminished. Detecting lymphoma-related intussusception remains intricate. Age, prolonged symptoms, and distinctive ultrasound findings can arouse suspicion. Timely surgical intervention, based on preoperative imaging, proves pivotal for accurate diagnosis. CONCLUSION Swift identification of lymphoma-related intussusception, distinguished by unique clinical and ultrasound features, is imperative for timely intervention and treatment. Further research is warranted to refine diagnostic approaches. WHAT IS KNOWN • Intussusception in pediatric patients can be caused by a wide spectrum of underlying diseases including lymphoma. • Early Identifying the exact underlying cause of intussusception is crucial for tailored therapy, however often challenging and time-consuming. WHAT IS NEW • Lymphoma-related intussusception may present with increased abdominal fluid accumulation, intestinal obstruction, and a higher likelihood of failed reduction during enema procedures. • For high-risk children, repeated ultrasound examinations or further investigations may be necessary to confirm the diagnosis.
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Affiliation(s)
- Rensen Zhang
- Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Chongqing health center for Women and Children, Chongqing Medical University, 120 Longshan Road, Yubei District, Chongqing, 401147, People's Republic of China
| | - Minjie Zhang
- Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Ruyu Deng
- Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yao Li
- Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Department of Pediatrics, Chongqing health center for Women and Children, Chongqing Medical University, 120 Longshan Road, Yubei District, Chongqing, 401147, People's Republic of China
| | - Chunbao Guo
- Department of Pediatrics, Chongqing health center for Women and Children, Chongqing Medical University, 120 Longshan Road, Yubei District, Chongqing, 401147, People's Republic of China.
- Department of Pediatrics, Women and Children's Hospital, Chongqing medical University, Chongqing, China.
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Simargi Y, Dewi AP, Mulia RO, Puspasari AF, Puspaningrum A, Ronny, Susilo F. Adult intussusception with multiple intestinal adhesions: A case report. Radiol Case Rep 2024; 19:431-434. [PMID: 38028292 PMCID: PMC10679857 DOI: 10.1016/j.radcr.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Intussusception occurs when a part of the intestine enters another segment of the intestine causing bowel obstruction. It is common in children but not in adults with only <5% of prevalence of all intussusceptions. Most of the cases have an underlying neoplastic pathology. However, we found a case where an adult patient with 2 weeks of ileus obstruction is caused by intussusception with multiple intestinal adhesions. A 59-year-old man complained of being unable to defecate, or vomit and had a tender abdomen for 2 weeks. Contrast abdominal CT showed a dilated and thickened intestinal wall, with ileo-ileal intussusception in the distal terminal ileum, indicating a diagnosis of ileus obstruction due to intussusception. During laparotomy, intussusception was found but released spontaneously followed by ancillary findings were multiple adhesions in the ileum that caused the intussusception and obstruction. In conclusion, transient intussusception in adults with multiple adhesions has never been reported before, and a CT scan is an important clinical tool to diagnose and identify the cause of this condition. Recognizing the imaging abnormalities earlier is important to prevent further complications.
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Affiliation(s)
- Yopi Simargi
- Department of Radiology, School of Medicine, and Health Sciences, Atma Jaya Catholic University of Indonesia-Atma Jaya Hospital, Jakarta, Indonesia
| | - Apriliani P. Dewi
- Department of Radiology, School of Medicine, and Health Sciences, Atma Jaya Catholic University of Indonesia-Atma Jaya Hospital, Jakarta, Indonesia
| | - Resley O. Mulia
- Department of Radiology, School of Medicine, and Health Sciences, Atma Jaya Catholic University of Indonesia-Atma Jaya Hospital, Jakarta, Indonesia
| | - Anita F. Puspasari
- Department of Radiology, School of Medicine, and Health Sciences, Atma Jaya Catholic University of Indonesia-Atma Jaya Hospital, Jakarta, Indonesia
| | - Ayuningtyas Puspaningrum
- Department of Radiology, School of Medicine, and Health Sciences, Atma Jaya Catholic University of Indonesia-Atma Jaya Hospital, Jakarta, Indonesia
| | - Ronny
- Department of Radiology, School of Medicine, and Health Sciences, Atma Jaya Catholic University of Indonesia-Atma Jaya Hospital, Jakarta, Indonesia
| | - Fenny Susilo
- Department of Radiology, School of Medicine, and Health Sciences, Atma Jaya Catholic University of Indonesia-Atma Jaya Hospital, Jakarta, Indonesia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Liu Z, Li N, Liu G, Xu L, Dong Y, Meng R, Yang Y, Zhan S. No increased risk of intussusception after pentavalent rotavirus vaccination in China: a retrospective birth cohort using electronic health records of Ningbo city. Emerg Microbes Infect 2023; 12:2270062. [PMID: 37815175 PMCID: PMC10606783 DOI: 10.1080/22221751.2023.2270062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
Some post-licensure studies have shown a potential increased risk of intussusception following vaccination with rotavirus vaccines. This is the first study that aimed to assess the incidence and risk of intussusception within 90 days after vaccination with RotaTeq in Chinese infants. A population-based birth cohort from 27th November 2018 to 30th June 2021 included all newborns in Ningbo city. The records of intussusception were identified through the ICD-10 code K56.1 or Chinese keywords "Chang Tao" from all hospital discharge records. Each episode was confirmed in line with the Brighton criteria, and only Brighton level 1 cases were included. The association of RotaTeq vaccination and intussusception was evaluated using the Poisson regression. A total of 108,405 eligible subjects from birth cohort were eligible, with 52.30% males. Among them, 26, 847 (24.77%) infants received at least one dose of RotaTeq, and 95.52% of them were fully vaccinated, with 76, 934 doses in total. After adjudication, none of the cases occurred post first, or second dose, the cumulative number of cases that occurred 1-7, 1-14, 1-21, 1-42, and 1-90 days post third dose was 0, 1, 1, 3, and 7, respectively. Adjusting for age, sex, birth year, birth season and location, the incidence rate ratio of intussusception after RotaTeq vaccination was 0.90 (90% two-sided CI: 0.46, 1.75). Increasing age and male gender were associated with higher risk of intussusception. In summary, no increased risk of IS was observed following 3 months of RotaTeq vaccination in this study.
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Affiliation(s)
- Zhike Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, People’s Republic of China
| | - Ning Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, People’s Republic of China
| | - Guangxu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, People’s Republic of China
| | - Ying Dong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, People’s Republic of China
| | - Ruogu Meng
- Institute for Artificial Intelligence, Peking University, Beijing, People’s Republic of China
| | - Yu Yang
- Institute for Artificial Intelligence, Peking University, Beijing, People’s Republic of China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, People’s Republic of China
- Institute for Artificial Intelligence, Peking University, Beijing, People’s Republic of China
- Peking University Third Hospital, Research Center of Clinical Epidemiology, Beijing, People’s Republic of China
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24
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Latrille A, Grellet R, Moreno-Lopez N. Ileocolic intussusception. J Visc Surg 2023; 160:477-478. [PMID: 37783614 DOI: 10.1016/j.jviscsurg.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Antoine Latrille
- Department of Digestive and Oncological Surgery, University Hospital Center of Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - Robin Grellet
- Department of Digestive and Oncological Surgery, University Hospital Center of Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - Nathan Moreno-Lopez
- Department of Digestive and Oncological Surgery, University Hospital Center of Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
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25
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Meshaka R, Müller LSO, Stafrace S, Abella SF, Sofia C, Calder A, Petit P, Perucca G. Intussusception reduction methods in daily practice-a survey by the European Society of Paediatric Radiology Abdominal Imaging Taskforce. Pediatr Radiol 2023:10.1007/s00247-023-05798-0. [PMID: 37993547 DOI: 10.1007/s00247-023-05798-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Image-guided intussusception reduction has been practised internationally for many decades. The use of different modalities, delayed repeat attempts, and sedation/anaesthesia are unknown. OBJECTIVE To survey the practice of image-guided intussusception reduction. MATERIALS AND METHODS A 20-point questionnaire created by the European Society of Paediatric Radiology (ESPR) Abdominal Imaging Taskforce was distributed via the ESPR members' mailing list and shared on social media between 28 March and 1 May 2023. RESULTS There were 69 responses from 65 worldwide institutions, with a mean of 18 intussusception reductions performed per year: 55/69 (80%) from 52 European institutions and 14/69 (20%) from 13 institutions outside of Europe. European centres reported using 19/52 (37%) fluoroscopy, 18/52 (35%) ultrasound, and 15/52 (28%) a mixture of both, with 30/52 (58%) offering a delayed repeat at 15 min to 24 h. Non-European centres reported using 5/13 (39%) fluoroscopy, 6/13 ultrasound (46%), and 2/13 (15%) a mixture of both, with 9/13 (69%) offering a delayed repeat attempt. Sedation or analgesia was used in 35/52 (67%) of European and 2/13 (15%) non-European institutions. CONCLUSION There is wide variation in how image-guided intussusception reduction is performed, and in the use of sedation/anaesthesia.
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Affiliation(s)
- Riwa Meshaka
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1H 3JH, UK.
| | - Lil-Sofie Ording Müller
- Division of Radiology and Nuclear Medicine, Department of Paediatric Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Samuel Stafrace
- Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Stéphanie Franchi Abella
- Department of Pediatric Radiology, Hôpital Bicêtre, Hôpitaux Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Alistair Calder
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1H 3JH, UK
| | - Philippe Petit
- Pediatric and Prenatal Imaging Unit, Aix Marseille University, La Timone-Enfants Hospital, Marseille, France
| | - Giulia Perucca
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1H 3JH, UK
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Burnett E, Riaz A, Anwari P, Myat TW, Chavers TP, Talat N, Safi N, Aung NNT, Cortese MM, Sultana S, Samsor A, Thu HM, Saddal NS, Safi S, Lin H, Qazi SH, Safi H, Ali A, Parashar UD, Tate JE. Intussusception risk following oral monovalent rotavirus vaccination in 3 Asian countries: A self-control case series evaluation. Vaccine 2023; 41:7220-7225. [PMID: 37884416 PMCID: PMC10929074 DOI: 10.1016/j.vaccine.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
Rotavirus vaccines have substantially decreased rotavirus hospitalizations in countries where they have been implemented. In some high- and middle-income countries, a low-level of increased risk of intussusception, a type of acute bowel obstruction, has been detected following rotavirus vaccination. However, no increased risk of intussusception was found in India, South Africa, or a network of 7 other African countries. We assessed the association between a 2-dose monovalent rotavirus vaccine (Rotarix) and intussusception in 3 early-adopter low-income Asian countries -- Afghanistan, Myanmar, and Pakistan. Children <12 months of age admitted to a sentinel surveillance hospital with Brighton level 1 intussusception were eligible for enrollment. We collected information about each child's vaccination status and used the self-controlled case series method to calculate the relative incidence of intussusception 1-7 days, 8-21 days, and 1-21 days following each dose of vaccine and derived confidence intervals with bootstrapping. Of the 585 children meeting the analytic criteria, the median age at intussusception symptom onset was 24 weeks (IQR: 19-29). Overall, 494 (84 %) children received the first Rotarix dose and 398 (68 %) received the second dose. There was no increased intussusception risk during any of the risk periods following the first (1-7 days: 1.01 (95 %CI: 0.39, 2.60); 8-21 days: 1.37 (95 %CI: 0.81, 2.32); 1-21 days: 1.28 (95 %CI: 0.78, 2.11)) or second (1-7 days: 0.81 (95 %CI: 0.42, 1.54); 8-21 days: 0.77 (95 %CI: 0.53, 1.16); 1-21 days: 0.78 (95 %CI: 0.53, 1.16)) rotavirus vaccine dose. Our findings are consistent with other data showing no increased intussusception risk with rotavirus vaccination in low-income countries and add to the growing body of evidence demonstrating safety of rotavirus vaccines.
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Affiliation(s)
| | - Atif Riaz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Theingi Win Myat
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | | | - Nabila Talat
- Pediatric Surgery Unit, University of Child Health Sciences and Children Hospital, Lahore, Pakistan
| | | | | | | | - Shazia Sultana
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Hlaing Myat Thu
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | | | | | - Htin Lin
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Saqib Hamid Qazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Girish N, Thomas N, Natraj G, Kumar KVS, John N. Unusual Presentation of Ileal Intussusception Due to Submucosal Lipoma in a Child and its Management. J Indian Assoc Pediatr Surg 2023; 28:517-519. [PMID: 38173626 PMCID: PMC10760612 DOI: 10.4103/jiaps.jiaps_56_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 01/05/2024] Open
Abstract
Idiopathic intussusception is the most common form of intussusception in infants and young children. In older children and adults, intussusception being rare, the lead point is usually an underlying bowel pathology (Meckel's diverticulum, hemangioma, carcinoids, polyps, submucous lipomas, etc.) and these are called pathological lead points (PLP's). The management of an obese child with recurrent abdominal pain for over 2 years, diagnosed with ileo-ileal intussusception due to submucosal lipoma is reported here.
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Affiliation(s)
- Nisha Girish
- Department of Pathology, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Naveen Thomas
- Department of Pathology, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Gayathri Natraj
- Department of Pathology, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - K. V. Satish Kumar
- Department of Pathology, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Neena John
- Department of Pathology, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
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28
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Alomar K, Alhariri A, Alloun M, Dawarah M, Alkader MA, Qatleesh S. A unique case of enteric duplication cyst in the cecum presenting as ileocolic intussusception in a 3-year-old child: Case report and review of the literature. Int J Surg Case Rep 2023; 112:108935. [PMID: 37856968 PMCID: PMC10667737 DOI: 10.1016/j.ijscr.2023.108935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION AND SIGNIFICANCE This is a rare case of enteric duplication cyst presenting as ileocolic intussusception in a child. The literature review found that there have been only a few other reported cases of this condition. In most cases, enteric duplication cysts are asymptomatic and are found incidentally. However, in some cases, they can cause symptoms such as abdominal pain, vomiting, constipation, and diarrhea. Intussusception is a rare complication of enteric duplication cysts. CASE PRESENTATION We present a case of a enteric duplication cyst in the cecum that was discovered through its association with a ileocolic intussusception that reached the anus. We diagnosed the ileocolic intussusception through an ultrasound, and during surgery, we discovered the presence of the enteric duplication cyst in the cecum. We resected it and performed a ileocolic anastomosis. CLINICAL DISCUSSION The treatment for enteric duplication cysts that are causing symptoms is surgery. During surgery, the cyst is removed and the intestine is repaired. CONCLUSION This case report highlights the importance of considering enteric duplication cyst as a possible cause of ileocolic intussusception in children.
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Affiliation(s)
- Khaled Alomar
- Damascus University- University pediatrics' Hospital, Syria.
| | - Ahed Alhariri
- Damascus University- University pediatrics' Hospital, Syria
| | - Maher Alloun
- Damascus University- University pediatrics' Hospital, Syria
| | - Methad Dawarah
- Damascus University- University pediatrics' Hospital, Syria
| | | | - Safaa Qatleesh
- Damascus University- Al Assad University Hospital, Syria
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29
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Vakaki M, Sfakiotaki R, Liasi S, Hountala A, Koutrouveli E, Vraka I, Zouridaki C, Koumanidou C. Ultrasound-guided pneumatic reduction of intussusception in children: 15-year experience in a tertiary children's hospital. Pediatr Radiol 2023; 53:2436-2445. [PMID: 37665367 DOI: 10.1007/s00247-023-05730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND International practice regarding the method used to nonoperatively reduce pediatric intussusception is variable. OBJECTIVE To provide an overview of ultrasound-guided pneumatic intussusception reduction and assess its safety and effectiveness. MATERIALS AND METHODS A single-center prospective study was conducted in a tertiary referral pediatric hospital during the 15-year period between January 2008 and February 2023. All patients with ileocolic intussusception underwent abdominal sonographic examination for diagnosis. An ultrasound-guided pneumatic reduction of intussusception was then attempted. Children who were hemodynamically unstable, with signs of peritonitis or bowel perforation and those with sonographically detected pathologic lead points were excluded. RESULTS A total of 131 children (age range 2 months to 6 years) were enrolled in this study. Pneumatic intussusception reduction was successful in 128 patients (overall success rate 97.7%). In 117 patients, the intussusception was reduced on the first attempt and in the remaining on the second. In three cases, after three consecutive attempts, the intussusception was only partially reduced. As subsequently surgically proven, two of them were idiopathic and the third was secondary to an ileal polyp. No bowel perforation occurred during the reduction attempts. There was recurrence of intussusception in three patients within 24 h after initial reduction which were again reduced by the same method. CONCLUSION Ultrasound-guided pneumatic intussusception reduction is a well-tolerated, simple, safe and effective technique with a high success rate, no complications and no ionizing radiation exposure. It may be adopted as the first-line nonsurgical treatment of pediatric intussusception.
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Affiliation(s)
- Marina Vakaki
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece.
| | - Rodanthi Sfakiotaki
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Sergia Liasi
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Anna Hountala
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Eleni Koutrouveli
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Irene Vraka
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Christina Zouridaki
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
| | - Chrysoula Koumanidou
- Radiology Department, Children's Hospital P. & A. Kyriakou, Thivon & Livadias, Ampelokipi, 11527, Athens, Greece
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30
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Hasnaoui A, Trigui R, Ben Hassine M, Haggari A, Bellamine H. Sigmoid-rectal intussusception in an elderly patient: A case report of an unusual presentation of intestinal obstruction. Int J Surg Case Rep 2023; 112:109018. [PMID: 37931504 PMCID: PMC10667941 DOI: 10.1016/j.ijscr.2023.109018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Sigmoid-rectal intussusception or invagination is an infrequently documented condition in the adult population, with only a handful of cases reported in the medical literature. The underlying pathological mechanism involves impaired peristalsis, often attributed to a malignant tumor. CASE PRESENTATION A 78-year-old patient, with a history of abdominal pain and lower gastrointestinal bleeding, sought care at our emergency department with evident symptoms indicative of large bowel obstruction. Abdominal examination revealed distension and rectal examination found a mass mimicking an internal rectal prolapse. Subsequently, imaging studies confirmed the diagnosis of sigmoid-rectal intussusception. The patient underwent an emergency open sigmoid resection with Hartman's procedure. The postoperative course was uneventful. Anatomopathological analysis revealed the presence of stage I adenocarcinoma. A restoration of digestive continuity was scheduled six months later. One-year follow-up assessments showed no indications of local recurrence or distant metastasis. DISCUSSION Sigmoid rectal intussusception stands as a unique and infrequently reported medical entity. The absence of distinct clinical symptoms often renders diagnosis a challenging task, with confirmation typically relying on radiological findings. In contrast to the non-surgical approaches employed in pediatric cases, intussusception in adults necessitates surgical intervention due to its predominantly malignant underpinnings. CONCLUSION While sigmoid-rectal intussusception is an exceedingly rare occurrence, its manifestation with a multitude of non-specific symptoms can complicate clinical recognition. Nevertheless, it should be duly considered as a potential etiological factor in cases of large bowel obstruction, particularly when suggestive signs are found on rectal examination.
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Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia.
| | - Racem Trigui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Mohamed Ben Hassine
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Ahmed Haggari
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Houda Bellamine
- Department of Pathology, Menzel Bourguiba hospital, 7050 Menzel Bourguiba, Bizerta, Tunisia
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31
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Eberspacher C, Arcieri S, Lauro A, Palma R, Coletta E, Arcieri FL, Mascagni D, Pontone S. Sizzling Fat-Curative Endoscopic Resection of a Giant Lipoma Causing Colo-Colic Intussusception. Dig Dis Sci 2023; 68:4123-4126. [PMID: 37733131 DOI: 10.1007/s10620-023-08087-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023]
Abstract
Giant colonic lipomas, tumors that infrequently occur in the gastrointestinal tract, can manifest as bleeding, abdominal pain and, in few cases, obstruction with intussusception. Surgery is usually the treatment of choice. We report the case of a 78 years-old woman with abdominal pain, constipation, and bleeding due to a giant lipoma of the sigmoid colon causing intussusception. After an initial diagnostic colonoscopy, the patient underwent an endoscopic mucosal resection (EMR) without complications. Even if surgery is traditionally the primary therapeutic approach for giant colonic lipomas, selected cases can be successfully treated with EMR.
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Affiliation(s)
- Chiara Eberspacher
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Stefano Arcieri
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Augusto Lauro
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy.
| | - Rossella Palma
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Enrico Coletta
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Francesco Leone Arcieri
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Domenico Mascagni
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Stefano Pontone
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
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Vu TD, Nguyen HT, Tran AL, Diem S. Intussusception following diaphragmatic rupture surgery: A rare case. Int J Surg Case Rep 2023; 112:108953. [PMID: 37856974 PMCID: PMC10667776 DOI: 10.1016/j.ijscr.2023.108953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Intussusception in adults is a rare manifestation after traumatic abdominal surgery, because after abdominal surgery patients often have functional bowel paralysis rather than increased intestinal motility. CASE PRESENTATION 39-year-old male patient with acute intussusception appeared after surgery for diaphragmatic rupture and is undergoing postoperative treatment on day 7. The patient has clinical manifestations of small bowel obstruction. Computed tomography image shows evidence of jejuno-jejunal intussusception. Exploratory laparotomy and resection of the necrotic bowel were performed. CLINICAL DISCUSSION Rare cases such as intussusception should be observed postoperatively and in similar manifestations with careful examination of the characteristic CT findings, because of early detection and surgical intervention with manual reduction can prevent the need for small bowel resection and possible unwanted complications. CONCLUSION Postoperative intussusception occurs primarily in the small intestine and should be indicated for emergency surgery in all cases, and this should be kept in mind by the surgeon and the resuscitator. The early diagnosis and intervention of patients increase the survival rate and the surgical efficiency.
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Affiliation(s)
- Tan Duy Vu
- Department of Surgery, Yen Bai Provincial General Hospital, Yen Bai, Phnom Penh, Cambodia.
| | - Hieu Trung Nguyen
- Department of Surgery, Yen Bai Provincial General Hospital, Yen Bai, Phnom Penh, Cambodia
| | - Anh Lan Tran
- Yen Bai Provincial General Hospital, Yen Bai, Phnom Penh, Cambodia
| | - Son Diem
- Yen Bai Provincial General Hospital, Yen Bai, Phnom Penh, Cambodia
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Takamoto N, Konishi T, Fujiogi M, Kutsukake M, Morita K, Hashimoto Y, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National Inpatient Database in Japan. J Pediatr Surg 2023; 58:2255-2261. [PMID: 37507337 DOI: 10.1016/j.jpedsurg.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Laparoscopic surgery for pediatric intussusception has recently become more common as an alternative to open surgery. However, the differences in outcomes between laparoscopic and open surgery remain unclear. Thus, this study aimed to compare short-term surgical outcomes and recurrence rates between patients treated with laparoscopic and open surgery for pediatric intussusception. METHODS Patients aged <18 years who underwent laparoscopic (n = 192) and open (n = 416) surgery for intussusception between April 2016 and March 2021 were retrospectively identified using a Japanese nationwide inpatient database. Propensity-score overlap weighting analyses were conducted to compare the outcomes between the laparoscopic and open surgery groups. The outcomes included in-hospital morbidity, reoperation, readmission for intussusception, bowel resection, the diagnosis of Meckel's diverticulum, duration of anesthesia, postoperative length of hospital stay, and total hospitalization costs. RESULTS The laparoscopic surgery group was older, heavier, and had fewer congenital malformations and emergency admissions than the open surgery group did. Overlap weighting analyses showed no significant differences in in-hospital morbidity (odds ratio [95% confidence interval], 0.88 [0.35-2.23]), reoperation (1.88 [0.24-14.9]), readmission for intussusception within 30 days (0.80 [0.12-5.30]) and 1 year (0.90 [0.28-2.93]), bowel resection (0.69 [0.46-1.02]), the diagnosis of Meckel's diverticulum (0.97 [0.50-1.90]), duration of anesthesia (difference, 11 [-1-24] minutes), postoperative length of stay (difference, -1.9 [-4.2-0.4] days), or total hospitalization costs (difference, 612 [ -746-1970] US dollars) between the groups. CONCLUSIONS In this large nationwide cohort, no significant differences in outcomes were observed between laparoscopic and open surgery. Laparoscopic surgery is an acceptable treatment option for pediatric intussusception. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Naohiro Takamoto
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Kutsukake
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kaori Morita
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Yang M, Xie Y, Zhuang Y, Chen Y, Lin X, Liu Z, Zhang P, Xiao W, Chen Y, Chen C, Zheng L, Duan S. Risk factors and predictive models for early recurrent intussusception in children: a retrospective cohort study. Transl Pediatr 2023; 12:1800-1809. [PMID: 37969126 PMCID: PMC10644014 DOI: 10.21037/tp-23-269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/18/2023] [Indexed: 11/17/2023] Open
Abstract
Background Early recurrent intussusception (ERI) in children is common and seriously affects the physical and mental health of the children. There are few reports discussing risk factors for ERI in children, and this study aims to identify risk factors for ERI in children and build predictive models. Methods We conducted a retrospective study of 787 children with no relapse intussusception (NRI) and 82 children with ERI between January 2011 and December 2021. Univariate and multifactorial stepwise logistic regression analysis was used to analyze the correlation between 11 factors and ERI, to determine the independent risk factors for ERI in children. The prediction model was established by independent risk factors and then verified. Results Age, vomiting, bloody stools, and monocyte ratios were independently correlated with the composite endpoint (P<0.05). A nomogram was constructed and a calibration curve was plotted, using independent risk factors. Based on the disease's diagnostic score, the predictive model's performance was validated by using logistic regression receiver operating characteristic (ROC) curve detection, with area under the curve (AUC) value of 0.883 [95% confidence interval (CI): 0.846-0.920], and the calibration curve was close to the ideal diagonal line. In addition, the decision curve analysis (DCA) showed that the model had significant net benefits. Conclusions Independent risk factors for ERI in children are age, vomiting, bloody stool, and monocyte ratio. Children older than 1 year in age, who lacked vomiting and bloody stool symptoms, and who exhibited an elevated ratio of monocytes were more likely to relapse early. The predictive model constructed herein can predict the early recurrence of children with ERI, providing a reference for clinicians' individualized judgments.
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Affiliation(s)
- Min Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yao Xie
- Department of Radiology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Yangmu Zhuang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yiyi Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xiaobin Lin
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhijun Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Peijian Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Wang Xiao
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yingchun Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Chunxia Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lian Zheng
- Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shouxing Duan
- Department of Pediatric Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
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Kumar S, Harisankar AG, Singh R, Kumar A, Kumar B, Mandal M. Lipoma of the gastrointestinal tract: a tertiary care centre experience. Ann R Coll Surg Engl 2023. [PMID: 37823391 DOI: 10.1308/rcsann.2023.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Gastrointestinal (GI) lipomas are rare; however, they are frequent enough to be considered in the differential diagnosis of gut tumours. Here, we present our experience with GI lipomas managed at our institute over the last three years. METHODS This is a retrospective cohort study of patients with GI lipomas managed between January, 2020 and April, 2023 at a tertiary care centre. Clinical presentation, location, and details of surgical procedure were analysed. RESULTS Ten patients were included, six of whom had lipoma in the colon, one in the stomach, and one each in the duodenum, jejunum, and ileum. The mean age at the time of presentation was 48.8 years (range, 19-77 years), and strong male preponderance (4:1) was noted. Preoperative diagnosis of lipoma on cross-sectional imaging was possible in all patients. All patients were symptomatic and were managed surgically. CONCLUSIONS While GI lipomas are generally considered to be indolent and benign tumours, they can potentially lead to severe complications. The utilisation of computed tomography and magnetic resonance imaging has brought about a significant transformation in diagnosing this condition, enabling preoperative identification in most cases. The surgery offers a definitive treatment with minimal risk of postoperative complications.
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Affiliation(s)
- S Kumar
- Indira Gandhi Institute of Medical Sciences, India
| | | | - R Singh
- Indira Gandhi Institute of Medical Sciences, India
| | - A Kumar
- BIG Apollo Spectra Hospitals, India
| | - B Kumar
- Sri Krishna Medical College and Hospital, India
| | - M Mandal
- Indira Gandhi Institute of Medical Sciences, India
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Álvarez-Bautista FE, Moctezuma-Velázquez P, Pimienta-Ibarra AS, Vergara-Fernández O, Salgado-Nesme N. Adult intussusception: still a challenging diagnosis for the surgeon. Rev Gastroenterol Mex (Engl Ed) 2023; 88:315-321. [PMID: 35810092 DOI: 10.1016/j.rgmxen.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/23/2021] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND AIM Intussusception is rare in adults and can occur in the small bowel and colon. Its atypical presentation makes the diagnosis difficult. The aim of the present study was to evaluate the causes, clinical characteristics, and treatment outcomes of adult intussusception and to determine whether there was an association between etiology and clinical presentation. MATERIALS AND METHODS A retrospective study was carried out on patients above 18 years of age that were treated for intussusception at a tertiary care hospital, between 2000 and 2020. The findings were summarized utilizing descriptive and inferential statistics. RESULTS Twenty-eight cases were identified. Median patient age was 46 years (18-80) and median symptom duration was 18 days. Abdominal pain was the most frequent symptom (96.42%). The intussusceptions registered were enteroenteric (14), ileocecal (4), ileocolonic (4), colocolonic (5), and colorrectal (1). Intussusception etiology was benign in 15 cases, 9 were associated with malignancy, and 4 were idiopathic. Surgery was performed on 11 patients with enteroenteric intussusception and on all the cases of ileocecal, ileocolonic, colocolonic, and colorectal intussusception. There were 2 events of perioperative mortality (8%) and 8 of postoperative morbidity (32%). No significant differences were found regarding symptom duration or length of hospital stay, when the etiologic groups were compared. CONCLUSIONS Intussusception is rare in adults. Diagnosis is a challenge because of the nonspecific signs and symptoms. Surgical resection should be considered in the definitive treatment and management should be individualized according to the patient's comorbidities, clinical presentation, and risk of malignancy.
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Affiliation(s)
- F E Álvarez-Bautista
- Departamento de Cirugía Colorrectal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - P Moctezuma-Velázquez
- Departamento de Cirugía Colorrectal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - A S Pimienta-Ibarra
- Departamento de Cirugía General, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - O Vergara-Fernández
- Departamento de Cirugía Colorrectal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - N Salgado-Nesme
- Departamento de Cirugía General, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico.
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Asbah M, Shrateh ON, Musleh A, Abbadi K, Amro W, Shaltaf A. Huge mesenteric inflammatory myofibroblastic tumor as a rare cause of intussusception with recurrence after 10 months: Case report and literature review. Int J Surg Case Rep 2023; 111:108871. [PMID: 37757735 PMCID: PMC10539857 DOI: 10.1016/j.ijscr.2023.108871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Inflammatory myofibroblastic tumor (IMT) is an infrequent, generally non-cancerous mesenchymal growth. IMT can affect individuals across various age groups, with a higher prevalence in children and adolescents. While it can emerge in any bodily region, it has a tendency to develop more often in the lungs and mesentery. IMT occurrence in the small bowel is exceptionally uncommon. It's a rare cause of intussusception and has unpredictable recurrence rate. CASE PRESENTATION This report highlights a unique clinical presentation involving a mesenteric IMT, which presented as small intestine intussusception in a 2-year-old child. Additionally, the patient was found to have an asymptomatic mass in the right upper quadrant, later identified as a recurrent IMT 10 months after surgical intervention for intussusception caused by the same tumor. CLINICAL DISCUSSION IMTs originate from mesenchymal tissues and encompass a blend of fibroinflammatory conditions. They exhibit a diverse combination of inflammatory and spindle cells. Diagnosing IMTs prior to surgery is intricate, as they can mimic malignant growths. Histopathology following surgery is usually needed for confirmation. Complete removal with a clear margin is the favored treatment approach. CONCLUSION Intestinal IMT is an infrequent and often overlooked condition, but it should be taken into account when diagnosing small bowel intussusception. The best chance of preventing recurrence in cases of intestinal IMT is through complete surgical removal with a negative margin. Nonetheless, the most effective approach for managing local recurrence and metastasis is still uncertain and necessitates ongoing long-term observation.
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Affiliation(s)
- Malvina Asbah
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Asil Musleh
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Khaled Abbadi
- Department of General Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine.
| | - Wael Amro
- Department of Pediatric Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
| | - Ahmad Shaltaf
- Department of Pediatric Surgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
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Xie X, Gao X, Chen X, Wang S, Wang J, Pei G. An intussusception caused by a rare transverse colon lipoma: Case report. Int J Surg Case Rep 2023; 110:108668. [PMID: 37603912 PMCID: PMC10469518 DOI: 10.1016/j.ijscr.2023.108668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Intestinal lipoma is a rare benign tumor with a reported incidence of 0.2 % to 4.4 %. It is seen mainly in patients aged 50 to 70 years. Intestinal lipoma as a pathological lead point of intussusception is rare. There are few reports of colic lipoma in children. PRESENTATION OF CASE We reported a 7-year-old girl with a 4-year history of intermittent abdominal pain. Ultrasound examination showed a homogeneous hyperechoic mass near the distal transverse colon, which was similar to the surrounding lipid tissue. Histopathological examination confirmed the diagnosis of intestinal lipoma. DISCUSSION Colonic lipoma is very rare in children. If intussusception occurs repeatedly, or if it occurs in older children, we should consider the presence of pathological lead point. Early diagnosis and immediate surgical intervention are the key factors to a successful outcome. CONCLUSION In this case we report a pediatric case of intussusception secondary to colonic lipoma, and describe imaging and pathologic signs suggestive of intestinal lipoma.
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Affiliation(s)
- Xiaoying Xie
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Department of Ultrasound, Tianjin Children's Hospital, Tianjin, China
| | - Xinfeng Gao
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Emergency Surgery, Tianjin Children's Hospital, Tianjin, China
| | - Xiaofang Chen
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Shicheng Wang
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Department of Ultrasound, Tianjin Children's Hospital, Tianjin, China
| | - Jizhong Wang
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Emergency Surgery, Tianjin Children's Hospital, Tianjin, China.
| | - Guanghua Pei
- Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China; Department of Ultrasound, Tianjin Children's Hospital, Tianjin, China.
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Zhang J, Dong Q, Su X, Long J. Factors associated with in-hospital recurrence of intestinal intussusception in children. BMC Pediatr 2023; 23:428. [PMID: 37633888 PMCID: PMC10464288 DOI: 10.1186/s12887-023-04267-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND A minority of children experience in-hospital recurrence of intestinal intussusception after treatment. This study investigated the factors associated with in-hospital recurrence of intussusception in pediatric patients in China. METHODS This retrospective study included patients aged 0-18 years-old with intestinal intussusception treated at Hainan Women and Children's Medical Center between January 2019 and December 2019. Demographic and clinical characteristics were extracted from the medical records. Factors associated with in-hospital recurrence of intussusception were identified by logistic regression analysis. RESULTS The analysis included 624 children (400 boys) with a median age of 1.8 years (range, 2 months and 6 days to 9 years). Seventy-three children (11.7%) had in-hospital recurrence of intussusception after successful reduction with air enema. Multivariate logistic regression analysis identified age > 1 year-old (odds ratio [OR]: 7.65; 95% confidence interval [95%CI]: 2.70-21.71; P < 0.001), secondary intestinal intussusception (OR: 14.40; 95%CI: 4.31-48.14; P < 0.001) and mesenteric lymph node enlargement (OR: 1.90; 95%CI: 1.13-3.18; P = 0.015) as factors independently associated with in-hospital recurrence of intussusception. CONCLUSIONS Age > 1 year-old, secondary intussusception and mesenteric lymph node enlargement were independently associated with increased odds of in-hospital recurrence of intussusception after successful reduction with air enema.
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Affiliation(s)
- Jing Zhang
- Department of General Surgery, Hainan Women and Children's Medical Center, Haikou, 570100, China
| | - Qi Dong
- Department of General Surgery, Hainan Women and Children's Medical Center, Haikou, 570100, China.
| | - Xiaoxia Su
- Department of General Surgery, Hainan Women and Children's Medical Center, Haikou, 570100, China
| | - Junshan Long
- Department of General Surgery, Hainan Women and Children's Medical Center, Haikou, 570100, China
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Niazi SAK, Raza MS, Mukhtar MU, Hassan R, Nasir MU. Colonic lipoma mimicking malignancy and presenting as an intussusception: A rare case report. Int J Surg Case Rep 2023; 109:108611. [PMID: 37566987 PMCID: PMC10425391 DOI: 10.1016/j.ijscr.2023.108611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Lipomas of the gastrointestinal tract are a rare entity compared to the more common tumors of the gut, such as adenomatous polyps and carcinomas. They were first described by Bauer in 1757. Gastrointestinal lipomas can grow in all segments of the gut, with the highest frequency in the colon. In this case report, we present a rare case of gastrointestinal lipoma mimicking colonic malignancy and causing intussusception, necessitating emergent surgery. This paper highlights the potential diagnostic challenges and therapeutic interventions associated with GI lipomas. CASE PRESENTATION A 28-year-old female presented with symptoms of abdominal pain, weight loss, vomiting, and changes in bowel habits. Initially, she received a misdiagnosis of Irritable Bowel Syndrome. Subsequent investigations indicated the possibility of colonic malignancy. During the intra-operative biopsy, it was ultimately discovered that she had a colonic lipoma. CLINICAL DISCUSSION CT revealed an abdominal mass and an intussusception, indicating the need for surgical intervention. A laparoscopic procedure was performed to remove the mass, which alleviated the symptoms. Subsequently, a histological examination confirmed the mass to be a lipoma. CONCLUSION Differentiating a gastrointestinal lipoma from malignancy is crucial, and careful investigation is necessary to determine if a local excision can be performed instead of a wide excision.
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Hayati F, Mohd Zuki A, Lim MC, Chandran PC, Azizan N, Hameed Sultan MA, Muhamad Zin MH, Abdul Karim K. A peculiar case of intususception in a pregnant woman: A diagnostic challenge. Radiol Case Rep 2023; 18:2836-2839. [PMID: 37388266 PMCID: PMC10300483 DOI: 10.1016/j.radcr.2023.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 07/01/2023] Open
Abstract
Adult intussusception presents a diagnostic challenge given its non-specific symptoms. It is not as common as in infants and young children. Traditionally, diagnostic steps are invariably fit for normal adults, but not in pregnancy which faces certain limitations. A 40-year-old pregnant mother, gravida 9 para 8 at 34-week gestation, complained of intermittent epigastric pain for 2 days, requiring hospitalization. She soon developed minimal per rectal bleeding that was ruled out as hemorrhoid. Imaging was limited due to her pregnancy status. She later developed spontaneous delivery to a premature baby. Computed tomography (CT) revealed an ileocolic intussusception, which was confirmed via exploratory laparotomy. Histology was consistent with inflammatory fibroid polyp. Acute abdomen in pregnancy can be due to various causes, thus a high index of suspicion and early CT abdomen might help in early diagnosis and treatment. The benefit of doing CT on the mother and the risk of CT on the fetus is to be weighed as the timely diagnosis can prevent bowel ischemia and reduce maternal morbidity and mortality. Surgery remains the definite management in adult intussusception and an exact diagnosis can be made during the operation.
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Affiliation(s)
- Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, 88450, Malaysia
| | - Asyraf Mohd Zuki
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ming Chin Lim
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Pradeep Chand Chandran
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Nornazirah Azizan
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Mohamed Arif Hameed Sultan
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, 88450, Malaysia
| | - Muhamad Hud Muhamad Zin
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, 88450, Malaysia
| | - Khasnizal Abdul Karim
- Department of Surgery, Teluk Intan Hospital, Ministry of Health Malaysia, Teluk Intan, Perak, Malaysia
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Rukwong P, Wangviwat N, Phewplung T, Sintusek P. Cohort analysis of pediatric intussusception score to diagnose intussusception. World J Clin Cases 2023; 11:5014-5022. [PMID: 37583866 PMCID: PMC10424024 DOI: 10.12998/wjcc.v11.i21.5014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Intussusception is a primary cause of intestinal obstruction in young children. Delayed diagnosis is associated with increased morbidity. Ultrasonography (USG) is the gold standard for diagnosis, but it is operator dependent and often unavailable in limited resource areas. AIM To study the clinical characteristics of intussusception including management and evaluation of the diagnostic accuracy of abdominal radiography (AR) and the promising parameters found in the pediatric intussusception score (PIS). METHODS Children with suspected intussusception in our center from 2006 to 2018 were recruited. Clinical manifestations, investigations, and treatment outcomes were recorded. AR images were interpreted by a pediatric radiologist. Diagnosis of intussusception was composed of compatible USG and response with reduction. The diagnostic value of the proposed PIS was evaluated. RESULTS Ninety-seven children were diagnosed with intussusception (2.06 ± 2.67 years, 62.9% male), of whom 74% were < 2 years old and 37.1% were referrals. The common manifestations of intussusception were irritability or abdominal pain (86.7%) and vomiting (59.2%). Children aged 6 mo to 2 years, pallor, palpable abdominal mass, and positive AR were the parameters that could discriminate intussusception from other mimics (P < 0.05). Referral case was the only significant parameter for failure to reduce intussusception (P < 0.05). AR to diagnose intussusception had a sensitivity of 59.2%. The proposed PIS, a combination of clinical irritability or abdominal pain, children aged 6 mo to 2 years, and compatible AR, had a sensitivity of 85.7%. CONCLUSION AR alone provides poor screening for intussusception. The proposed PIS in combination with common manifestations and AR data was shown to increase the diagnostic sensitivity, leading to timely clinical management.
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Affiliation(s)
- Punwadee Rukwong
- Department of Pediatrics, Phrapokklao Hospital, Chantaburi 22000, Meuang, Thailand
| | - Nathawit Wangviwat
- Division of Laboratory Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Teerasak Phewplung
- Department of Radiology, Chulalongkorn University, Bangkok 10330, Thailand
| | - Palittiya Sintusek
- Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
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Ali MOM, Mohamed NIA, Ahmed AAE, Basher MOS, Mohamed SAA, Elgemaabi OM. Intussusception revealing right colonic adenocarcinoma in a 61-year-old woman: a case report. J Med Case Rep 2023; 17:299. [PMID: 37443097 DOI: 10.1186/s13256-023-04027-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Adult Intussusception is an uncommon diagnosis, with one to three cases occurring in a population of 1,000,000 per year, primarily due to underlying pathological lead points, of which 70% are malignant. Lipoma is the most common benign tumour, and primary adenocarcinoma is the most common malignant one. Early diagnosis and treatment are essential to reducing poor outcomes, including ischemia, perforation, and sepsis. Computed tomography imaging is a modality of choice for diagnosis. With a diagnostic accuracy of up to 100% and a specificity of up to 71%. Surgical intervention is the definitive treatment, and the decision is taken according to the situation. CASE PRESENTATION A 61-year-old Black African female presented to our surgical casualty with intermittent colicky abdominal pain for 1 month. After that, she started to experience abdominal swelling in the right iliac fossa. A CT scan confirmed the presence of colo-colic Intussusception, cecum-ascending-transverse colon. Laparotomy was scheduled, and a right hemicolectomy was done accordingly. Diagnosis of adenocarcinoma (Dukes stage B2) was made histologically. CONCLUSION Intussusception in adults is a challenging diagnosis requiring high clinical suspicion and has a high incidence of fatal complications. Colonic cancer can be worsening by any infection and chronic medical problem. CT imaging is the lifesaving modality of choice for diagnosis. Good patient outcomes depend on timely diagnosis and recruitment of a multi-disciplinary team.
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Raut U, Thapa S, Shrestha G, Shah S, Karki U. Colonic pedunculated polypoid vascular ectasia mimicking ileocolic intussusception: a rare case report. Ann Med Surg (Lond) 2023; 85:3674-3678. [PMID: 37427223 PMCID: PMC10328655 DOI: 10.1097/ms9.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/14/2023] [Indexed: 07/11/2023] Open
Abstract
Vascular ectasias are characterized by abnormal blood vessel enlargement and presumed to be caused by degenerative processes. About 3% of lower gastrointestinal bleeding is caused by it. On endoscopy, colonic arteriovenous malformations are frequently solitary, sizable, flat, or raised red lesions. Conversely, colonic vascular ectasia that manifests as pedunculated polypoid lesions are rare. Case presentation A 45-year-old woman presented with hematochezia and abdominal pain. Abdominal ultrasound and Contrast enhanced computed tomography abdomen, both showed features of ileocolic intussusception. Intraoperatively, an intraluminal pedunculated polypoid growth extending up to the hepatic flexure of the colon was discovered. A right hemicolectomy was performed, removing the polypoid growth as well. After histopathological evaluation, a final diagnosis of colonic polypoid vascular ectasia was made. Clinical discussion Gastrointestinal bleeding is the common initial manifestation of vascular ectasia, while some individuals may continue to be asymptomatic. According to a study from July 2022, vascular ectasia that manifests as polypoid growth is an uncommon phenomenon that has only been documented in 17 other cases. An intussusception may have a polypoid vascular ectasia as its lead point. Conversely, a large polypoid vascular ectasia may have radiographic characteristics that resemble an intussusception. Conclusion Large colonic vascular ectasia, which tends to enlarge over time, can occasionally be misinterpreted as an intussusception due to comparable radiological appearances. In the event that a polypoid colonic vascular ectasia is misidentified for intussusception, the surgical team must be ready to adjust the treatment protocol as needed.
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Affiliation(s)
- Ujwal Raut
- B. P. Koirala Institute of Health Sciences, Dharan
| | | | | | - Sandesh Shah
- KIST Medical College and Teaching Hospital, Lalitpur
| | - Utsav Karki
- Department of Surgery, National Academy of Health Sciences, Kathmandu, Nepal
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Gatica T C, Hasson A D, Díaz A I, Barahona Z D, Chong M G. Role of imaging in the evaluation of intussusception in adults: A 10-year retrospective study. Radiologia (Engl Ed) 2023; 65:291-297. [PMID: 37516482 DOI: 10.1016/j.rxeng.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Intussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception. METHOD We retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period. RESULTS In the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically. CONCLUSION The increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously.
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Affiliation(s)
- C Gatica T
- Residente de Radiología, Departamento de Imágenes, Facultad de Medicina, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
| | - D Hasson A
- Residente de Radiología, Departamento de Imágenes, Facultad de Medicina, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - I Díaz A
- Residente de Radiología, Departamento de Imágenes, Facultad de Medicina, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - D Barahona Z
- Médico radiólogo, Departamento de Imágenes, Clínica Alemana de Santiago, Santiago, Chile
| | - G Chong M
- Médico radiólogo, Departamento de Imágenes, Clínica Alemana de Santiago, Santiago, Chile
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McCarthy C, Ware A, Redan JA. Jejunal Intussusception Secondary to Pancreatic and Gastric Heterotopia in a 23-Year-Old. CRSLS 2023; 10:e2023.00018. [PMID: 37671367 PMCID: PMC10476238 DOI: 10.4293/crsls.2023.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Introduction Pancreatic and gastric heterotopias are a rare presentation of pancreatic and gastric tissues located outside their expected location. The most common site of heterotopic pancreas is the gastric antrum, and the most common site of heterotopic gastric mucosa is the proximal esophagus. The two tissues rarely present simultaneously. Although lead-point intussusception secondary to simultaneous heterotypic gastric and pancreatic tissue is extremely rare, its management strategy is the same as other pathological lead-point intussusception. Case Description This report presents a 23-year-old female who presented to the emergency department with abdominal pain, vomiting, and gastrointestinal bleeding. Computed tomography scan revealed features of distal small bowel intussusception secondary to a solid mass lead point. Following laparoscopic assisted small bowel resection and incidental appendectomy, histopathology evaluation confirmed the diagnosis of heterotopic pancreatic and gastric tissue as the lead point. The patient had an uneventful postoperative period and was discharged in stable condition, free of symptoms. Discussion Lead point intussusception of the jejunum in adults due to combined heterotopic tissue is extremely rare, with no reported cases in the literature. Prompt diagnosis and management are essential, with delays in treatments leading to a risk of perforation and mortality. If diagnosed, minimally invasive surgical approaches can treat obstruction and improve intraoperative and postoperative outcomes.
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Affiliation(s)
- Caline McCarthy
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Amendha Ware
- Department of Surgery, AdventHealth-Celebration Health, Celebration, FL, USA
| | - Jay A Redan
- Department of Surgery, AdventHealth-Celebration Health, Celebration, FL, USA
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Domínguez Páez C, Salazar Andrade JA, Mendoza Tagle DI, Martín Pérez JA, Rodriguez Pulido JA, Cortazar Sánchez CA. Ileocecal intussusception as presentation for ascending colon carcinoma. Case report. Int J Surg Case Rep 2023; 108:108439. [PMID: 37413757 PMCID: PMC10382818 DOI: 10.1016/j.ijscr.2023.108439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Intussusception is described as invagination of a segment of the bowel into the lumen of an adjacent segment. Although it is the most frequent cause of intestine obstruction during childhood, it is unusual in adulthood, where intussusception represents 1% of all intestine obstructions and 5 % of all intussusceptions. CASE PRESENTATION A 64-year-old female presented with a history of weight loss, intermittent diarrhea, and occasional transrectal bleeding. An abdominal computed tomography (CT scan) was performed showing a neoproliferative appearance and associated intussusception of the ascending colon. Colonoscopy revealed an ileocecal intussusception and a tumor on the ascending colon. Right hemicolectomy was performed. Histopathological findings were consistent with colon adenocarcinoma. CLINICAL DISCUSSION Adults have an organic lesion within the intussusception in up to 70 % of cases. The clinical presentation of intussusception can vary significantly between children and adults, who will often exhibit chronic nonspecific symptoms including nausea, changes in bowel habits, and gastrointestinal bleeding. The imaging diagnosis of intussusception is a difficult subject, the basis for the diagnosis is a high index of clinical suspicion and noninvasive techniques. CONCLUSION Intussusception is an extremely rare condition in adults, in this age group, the malignant entity is one of the main etiologies. Intussusception continues to be a rare entity and should be considered as a differential diagnosis of chronic abdominal pain and intestinal motility disorders; the treatment of choice continues to be surgical.
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Affiliation(s)
- Casandra Domínguez Páez
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico.
| | - Jorge Alberto Salazar Andrade
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
| | - Dafne Ivonne Mendoza Tagle
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
| | - Jesús Antonio Martín Pérez
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
| | - Jorge Armando Rodriguez Pulido
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
| | - Carlos Arturo Cortazar Sánchez
- Surgical Oncology Department, Centro Medico Nacional "20 de Noviembre", Social Services and Security Institute for the State Employees (I.S.S.S.T.E.), Mexico City, MX, Mexico
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Moges TG, Nureta TH, Mohammed TP. An inflammatory myofibroblastic tumor of the small intestine presenting as jejunojejunal intussusception; A case report. Int J Surg Case Rep 2023; 108:108404. [PMID: 37336176 PMCID: PMC10382734 DOI: 10.1016/j.ijscr.2023.108404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE An inflammatory myofibroblastic tumor (IMT) is an uncommon solid neoplasm of mesenchymal origin. They are usually seen in children and adolescents and commonly affect the lung, but they can nearly arise from every organ. The prevalence of IMT in the small bowel is very rare. The tumors have generally a benign clinical course, with some risk of local recurrence or distant metastasis. PRESENTATION OF CASE This is a 55-year-old male patient who presented with intermittent abdominal pain, vomiting of ingested matter and loss of appetite for 2 weeks duration. On physical examination, he had stable vital signs and the abdominal examination was non-revealing. Abdominal CT scan with contrast showed a long segment jejunojejunal intussusception. He underwent en-bloc resection of the mass and end-to-end anastomosis of the jejunum. CLINICAL DISCUSSION IMTs have a mesenchymal origin and are grouped into a mixture of fibroinflammatory disorders. They show a variable mix of inflammatory cells with spindle cells. The diagnosis of IMT preoperatively is challenging often mimicking malignant lesions. The diagnosis is often confirmed by histopathology after surgery. Complete excision with a negative margin is the preferred treatment. We report a rare case of jejunal IMT presenting with intussusception. CONCLUSION An intestinal IMT is a rare and an underdiagnosed entity, and should be considered in the differential diagnosis of small bowel intussusception. Surgery is still the most favored and effective treatment for intestinal IMT. Complete surgical excision with a negative margin has the least chance of disease recurrence.
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Affiliation(s)
- Tadesse Girma Moges
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia.
| | - Tilahun Habte Nureta
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia
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Miwa Y, Sato Y, Hirano K, Sunami E, Takahashi M, Kosugi SI, Suda T, Hasegawa G. An adenocarcinoma in an inverted Meckel's diverticulum with intussusception. Surg Case Rep 2023; 9:95. [PMID: 37271767 DOI: 10.1186/s40792-023-01680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/27/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Adenocarcinoma in an inverted Meckel's diverticulum with intussusception has not been reported to date. We discuss the clinical issues concerning this rare condition and review the relevant literature. CASE PRESENTATION A 71-year-old Japanese female was referred to our hospital for further investigation of severe anemia. Computed tomography revealed a tumorous lesion in the terminal ileum. Capsule endoscopy did not provide detailed images. Exploratory laparoscopy revealed intussusception in the terminal ileum. An intraluminal tumor 70 cm proximal to the ileocecal valve was observed to be the lead point. Partial resection including the tumor was performed. Macroscopically, a polypoid tumor at the tip of an inverted diverticulum-like structure was observed. The tumor was histologically composed of adenocarcinoma accompanied by gastric and pyloric gland metaplasia in the background mucosa, which was confirmed by immunohistochemical staining. Based on these characteristics, this tumor is considered to have developed from the ectopic gastric mucosa in a Meckel's diverticulum. CONCLUSIONS When we encounter patients with unfamiliar lesions in the small bowel, we need to differentiate Meckel's diverticulum related disease. Meckel's diverticulum can invert into the lumen of the small bowel and cause an intussusception, and has potential of malignant transformation.
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Affiliation(s)
- Yamato Miwa
- Department of Digestive and General Surgery, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan.
| | - Yo Sato
- Department of Digestive and General Surgery, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Kenichiro Hirano
- Department of Digestive and General Surgery, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Eiji Sunami
- Department of Digestive and General Surgery, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Motoko Takahashi
- Department of Digestive and General Surgery, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Shin-Ichi Kosugi
- Department of Digestive and General Surgery, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Takeshi Suda
- Department of Gastroenterology and Hepatology, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Go Hasegawa
- Department of Pathology, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
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Bahsas-Zaky O, Guillén-Nieto JR, Dugarte-Quintero LYP, Gómez CE, Marquina-Montilla EE, Uzcátegui-Paz E. [Epithelioid hemangioendothelioma as a cause of intestinal intussusception in an adult female patient: case report]. CIR CIR 2023. [PMID: 37169358 DOI: 10.24875/ciru.21000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Introduction Epithelioid hemangioendothelioma is a rare vascular tumor with an epithelioid and histiocytoid appearance. Intestinal intussusception can manifest as chronic abdominal pain, representing only 1-5% of intestinal obstructions in adults. Case report 65-year-old female who is attended with chronic abdominal pain. We performed a computed tomography showing the incursion of the ileum into the right colon. She was taken to the operating table, with the finding of ileo-colic intestinal intussusception due to small bowel tumor, with subsequent anatomopathological results of epithelioid hemangioendothelioma. Conclusions The diagnosis and management process with an appropriate postoperative outcome is described.
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Affiliation(s)
- Osama Bahsas-Zaky
- Servicio de Cirugía General, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Estado de Mérida, Venezuela
| | - Jorge R Guillén-Nieto
- Servicio de Cirugía General, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Estado de Mérida, Venezuela
| | - Leonardo Y P Dugarte-Quintero
- Servicio de Cirugía General, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Estado de Mérida, Venezuela
| | - Carlos E Gómez
- Servicio de Cirugía General, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Estado de Mérida, Venezuela
| | - Eduardo E Marquina-Montilla
- Servicio de Cirugía General, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Estado de Mérida, Venezuela
| | - Estrella Uzcátegui-Paz
- Servicio de Cirugía General, Instituto Autónomo Hospital Universitario de Los Andes, Universidad de Los Andes, Mérida, Estado de Mérida, Venezuela
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