Adult intussusception: still a challenging diagnosis for the surgeon

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.

The Educational Quality of Laparoscopic Right Hemicolectomy Videos on YouTube

Introduction. Surgical technique videos are an important part of surgical fellows' education. YouTube has been identified as the preferred source of educational videos among trainees. The aim of this article is to objectively evaluate the quality of the 50 most viewed videos on YouTube concerning right laparoscopic hemicolectomy using LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS). We hypothesized that the number of likes or views will not necessarily reciprocate with the educational content. Materials and methods. This observational study started with a YouTube search under the words "laparoscopic right hemicolectomy", "right colectomy", and "right hemicolectomy". The 50 most viewed videos with an English title were chosen. Video characteristics and LAP-VEGaS score were analyzed by four colorectal surgery fellows from a tertiary center in Mexico City. Results. Right hemicolectomy videos were reviewed; there was no correlation between the LAP-VEGaS score and the view ratio, the like ratio, or the video power index. The LAP-VEGaS score was significantly higher among videos uploaded by medical associations, journals, or commercial when compared with videos uploaded by doctors/physicians or academic associations. Conclusion. Educational quality in right laparoscopic hemicolectomy videos did not reciprocate with their educational quality, but it agrees significantly with the video uploading source. Low educational quality was identified among the videos underscoring the need to endorse peer-reviewed video channels.

Contrast-enhanced swallow study sensitivity for detecting esophagojejunostomy leakage

INTRODUCTION AND AIM

Sixty percent of the patients with gastric carcinomas are candidates for surgical resection through total gastrectomy and esophagojejunostomy, the latter of which is associated with leaks in up to 12.3% of cases. There is no standardized procedure for diagnosing anastomotic leaks. The aim of the present study was to establish the diagnostic sensitivity of the contrast-enhanced swallow study for detecting esophagojejunostomy leakage after total gastrectomy.

MATERIALS AND METHODS

A retrospective analysis was conducted on patients that underwent total gastrectomy due to gastric adenocarcinoma, within the time frame of 2002 and 2017. Demographic, clinical, and laboratory factors were identified, emphasizing the clinical and radiologic detection of anastomotic leaks. Descriptive statistics were carried out and the sensitivity of the contrast-enhanced swallow study for diagnosing leakage was calculated.

RESULTS

Fifty-eight patients were included in the study. Their mean age was 61.5 years. A total of 55.2% of the patients were men and 44.8% were women. Gastric adenocarcinoma was the indication for gastrectomy in 100% of the cases. Anastomotic leak presented in 31.01% of the patients. Diagnostic sensitivity of the contrast-enhanced swallow study for detecting leaks was 66%.

CONCLUSIONS

According to our analysis, the contrast-enhanced swallow study had limited diagnostic efficiency for detecting anastomotic leaks, with a sensitivity of 66%. We suggest maintaining high diagnostic suspicion in patients with studies that are initially negative and basing decisions on a more extensive approach.