1
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Han DG, Wang K, Liu W. Rectal bleeding induced by a solitary juvenile polyp. J Gastrointest Surg 2024; 28:782-783. [PMID: 38704213 DOI: 10.1016/j.gassur.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/03/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Dong-Ge Han
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
| | - Ke Wang
- Wuhan Emergency Medical Services, Wuhan, China.
| | - Wei Liu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, China; Institute of Digestive Disease, China Three Gorges University, Yichang, China; Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China.
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2
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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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3
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Tang Y, Zhong X, Cheng Z. Gastric hamartomatous inverted polyp coexisting with inflammatory fibroid polyp. Gastroenterol Hepatol 2024; 47:270-271. [PMID: 36965579 DOI: 10.1016/j.gastrohep.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Yu Tang
- Department of Gastroenterology, People's Hospital of Leshan, No. 238, White Tower Road, Leshan 614000, Sichuan, China
| | - Xianfei Zhong
- Department of Gastroenterology, People's Hospital of Leshan, No. 238, White Tower Road, Leshan 614000, Sichuan, China
| | - Zhengyu Cheng
- Department of Gastroenterology, People's Hospital of Leshan, No. 238, White Tower Road, Leshan 614000, Sichuan, China.
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Mongardini FM, Nazzaro L, Fuschillo G, D'Alelio A, Gambardella C, Docimo L, Lauro A, Landolfi V. Gentle Giant? Giant Gastric Solitary Peutz-Jeghers Polyp. Dig Dis Sci 2024; 69:349-354. [PMID: 38183558 DOI: 10.1007/s10620-023-08240-5] [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: 11/15/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
Solitary hamartomatous polyps with identical pathological features of the typical hamartomas of the Peutz-Jegher syndrome are extremely rare. These solitary lesions lack the associated intestinal polyposis, classic mucocutaneous pigmentation, and family history typifying the Peutz-Jegher syndrome. We describe the case of a 31-year-old woman with a giant solitary gastric hamartoma endoscopically diagnosed and laparoscopically resected.
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Affiliation(s)
- F M Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy.
| | - L Nazzaro
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - G Fuschillo
- Department of Advanced Medical and Surgical Sciences, Colorectal Surgery, University of Study of Campania «Luigi Vanvitelli», 80131, Naples, Italy
| | - A D'Alelio
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - C Gambardella
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - L Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - A Lauro
- Department of Surgery, Sapienza University, 00185, Rome, Italy
| | - V Landolfi
- General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, 83100, Avellino, Italy
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5
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Jenkin A, Cao AMY, Moloney J. Surgical polypectomy for small bowel hamartomas in Peutz-Jegher syndrome. ANZ J Surg 2023; 93:2997-2998. [PMID: 37553843 DOI: 10.1111/ans.18654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Ashley Jenkin
- Colorectal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Jayson Moloney
- Colorectal Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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6
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Kudoh M, Kakiuchi T, Yoshiura M, Esaki M, Matsuo M. Fecal calprotectin measurement to detect recurrence of solitary juvenile polyps: A case report. Medicine (Baltimore) 2023; 102:e35448. [PMID: 37904372 PMCID: PMC10615447 DOI: 10.1097/md.0000000000035448] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/31/2023] [Indexed: 11/01/2023] Open
Abstract
RATIONALE Juvenile polyps (JPs) are the most common polyp type and can be observed in 1% of all preschoolers. The peak incidence is observed at ages 3 to 5 years, constituting 90% of all polyps in children. Elevated levels of fecal calprotectin (FC) are often seen in children with JPs. PATIENT CONCERNS A 15-month-old girl was referred to our hospital for blood on the stool surface persisting for 3 months. She was healthy, with no abdominal pain, diarrhea, anorexia, or weight loss and no complaints other than hematochezia. Her physical examination, vital signs and laboratory date were unremarkable. DIAGNOSIS JPs. INTERVENTION Total colonoscopy for her found 2 JPs in the sigmoid colon, which were subsequently resected endoscopically. OUTCOMES At the age of 5 years, this patient again had bloody stools. Her FC measurement at that time was 1020 mg/kg, which normalized to 42 mg/kg 3 months after her second resection. LESSONS Single or multiple solitary JPs require follow-up that fully considers the possibility of recurrence. Establishing a method for early confirmation of JP recurrence based on bloody stools, fecal occult blood testing, and FC measurement is necessary.
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Affiliation(s)
- Maika Kudoh
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | - Toshihiko Kakiuchi
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | - Masato Yoshiura
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Muneaki Matsuo
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
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Jurca CM, Frățilă O, Iliaș T, Jurca A, Cătana A, Moisa C, Jurca AD. A New Frameshift Mutation of PTEN Gene Associated with Cowden Syndrome-Case Report and Brief Review of the Literature. Genes (Basel) 2023; 14:1909. [PMID: 37895258 PMCID: PMC10606311 DOI: 10.3390/genes14101909] [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: 08/11/2023] [Revised: 09/15/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Cowden syndrome (CS) is a rare disease that was first described in 1963 and later included in the large group of genodermatoses. It is the most common syndrome among the PTEN-associated hamartomatous tumor syndromes (PHTS). CS has an autosomal dominant inheritance pattern, with increased penetrance and variable expressivity, making early diagnosis difficult. Mutations in the PTEN gene (phosphatase and TENsin homolog) are involved in its pathogenesis, involving many organs and systems originating in the three embryonic layers (ectodermum, endodermum, and mesodermum). The consequence is the development of hamartomatous lesions in various organs (brain, intestines, thyroid, oropharyngeal cavity, colon, rectum, etc.). Multiple intestinal polyps are common in patients with CS, being identified in over 95% of patients undergoing colonoscopy. The authors describe the case of a patient who presented the first signs of the disease at 3 ½ years (tonsil polyp) but was diagnosed only at the age of 20 following a colonoscopy that revealed hundreds of intestinal polyps, suggesting further molecular testing. A heterozygous frameshift mutation was identified in the PTEN gene, classified as a potentially pathogenic variant (c.762del.p(Val255*)). The authors present this case to highlight the path taken by the patient from the first symptoms to the diagnosis and to emphasize the clinical aspects of this mutational variant that have still not been identified in other patients with this syndrome.
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Affiliation(s)
- Claudia Maria Jurca
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania; (C.M.J.); (A.D.J.)
- Regional Center of Medical Genetics Bihor, County Emergency Clinical Hospital Oradea (Part of ERN-ITHACA), 410469 Oradea, Romania
| | - Ovidiu Frățilă
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania;
| | - Tiberia Iliaș
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania;
| | - Aurora Jurca
- Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania;
| | - Andreea Cătana
- Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj Napoca, Romania
| | - Corina Moisa
- Department of Pharmacy Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania;
| | - Alexandru Daniel Jurca
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410081 Oradea, Romania; (C.M.J.); (A.D.J.)
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8
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Güzel G, Ergenç M. Recurrent Ileo-ileal Intussusception Caused by Inflammatory Fibroid Polyp: A Rare Case Report. Arch Iran Med 2023; 26:355-357. [PMID: 38310437 PMCID: PMC10685829 DOI: 10.34172/aim.2023.53] [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: 01/04/2023] [Accepted: 05/02/2023] [Indexed: 02/05/2024]
Abstract
An inflammatory fibroid polyp is a rare benign lesion of the gastrointestinal tract, which can cause obstruction or intussusception when it reaches a large diameter. We present a case of a 46-year-old female admitted to our clinic with recurrent ileus attacks. We performed segmental resection of the small bowel due to a 3-cm pedunculated polypoid lesion located in the terminal ileum that caused ileo-ileal intussusception and whose pathology was reported as an inflammatory fibroid polyp. In adults presenting with ileus, the possibility of intussusception should be kept in mind.
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Affiliation(s)
- Gökmen Güzel
- Department of General Surgery, Serik State Hospital, Antalya, Turkey
| | - Muhammer Ergenç
- Department of General Surgery, Istanbul Sultanbeyli State Hospital, Istanbul, Turkey
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9
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Wang FF, Fang Y, Ren XX, Yang HB, Ge KK, Zhang HH, Wang H, Sun LN. [Analysis of clinical and endoscopic characteristics of colorectal polyps in children]. Zhonghua Yu Fang Yi Xue Za Zhi 2022; 56:1327-1332. [PMID: 36207899 DOI: 10.3760/cma.j.cn112150-20220117-00061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
To analyze the clinical and endoscopic characteristics of colorectal polyps in children, and to explore the detection rate, age and gender distribution characteristics, endoscopic treatment effect and follow-up monitoring of colorectal polyps in children, so as to provide reference for disease management of colorectal polyps in children. The clinical and endoscopic characteristics of children with colorectal polyps in Xi 'an Children's Hospital from January 2019 to December 2019 were retrospectively analyzed. The patients were divided into 5 groups according to age (y): 0<y<1 years, 1≤ y<4 years, 4≤ y<7 years, 7≤ y<12 years, and 12≤ y ≤18 years. Independent sample t test, Pearson Chi-square test (χ2) were used to compare groups' differences. The results showed that a total of 724 colonoscopies were completed in 2019, and 160 colorectal polyps were diagnosed, with a detection rate of 22.10%. Among the children with colorectal polyps, 105 were males, accounting for 65.62%, and 55 were females, accounting for 34.38%. The detection rate of male colorectal polyps was 22.68%, and the detection rate of female colorectal polyps was 21.08%. There was no significant difference in the detection rate of colorectal polyps between males and females (χ2 = 0.25, P =0.617). Children with colorectal polyps were most common in the age group of 1≤ y<4 years, 72 cases, accounting for 41.14%(72/175). The detection rate of colorectal polyps in different age groups was statistically significant (χ2=73.929, P<0.05). The main symptom of children with colorectal polyps was hematochezia, accounting for 87.5% (140/160). Colorectal polyps were mainly single polyps in 140 patients, accounting for 87.50%, 15 patients had 2-4 polyps, accounting for 9.38%, and 5 patients had 5 or more polyps, accounting for 3.12%. A total of 210 polyps were removed, and the most common site of polyps was rectum, 123 polyps, accounting for 58.57% (123/210). 111 (52.86%, 111/210) of them were 1 cm to 2 cm in diameter. The Yamada classification was mainly type Ⅲ, 114 pieces, accounting for 54.29% (114/210). Among the 210 polyps with diameter ≥0.5 cm, 165 were removed by endoscopic mucosal resection, accounting for 78.57% (165/210). There were 23 patients with postoperative complications, including hematochezia, abdominal pain, fever, vomiting, diarrhea, dizziness, and no gastrointestinal perforation. Juvenile polyps were the main pathological type, accounting for 88.13% (141/160). The children with juvenile polyps were followed up for 3-30 months, and recurrence was considered in 2 of them. In conclusion, the detection rate of colorectal polyps in children aged 1≤ y<4 years is high, and hematochezia is the main clinical manifestation. Standardized endoscopic treatment and follow-up monitoring are very important for children with colorectal polyps.
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Affiliation(s)
- F F Wang
- Department of Gastroenterology, Xi' an Children' s Hospital, Xi'an 710003, China
| | - Y Fang
- Department of Gastroenterology, Xi' an Children' s Hospital, Xi'an 710003, China
| | - X X Ren
- Department of Gastroenterology, Xi' an Children' s Hospital, Xi'an 710003, China
| | - H B Yang
- Department of Gastroenterology, Xi' an Children' s Hospital, Xi'an 710003, China
| | - K K Ge
- Department of Gastroenterology, Xi' an Children' s Hospital, Xi'an 710003, China
| | - H H Zhang
- Department of Gastroenterology, Xi' an Children' s Hospital, Xi'an 710003, China
| | - H Wang
- Department of Gastroenterology, Xi' an Children' s Hospital, Xi'an 710003, China
| | - L N Sun
- Department of Gastroenterology, Xi' an Children' s Hospital, Xi'an 710003, China
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10
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Boland CR, Idos GE, Durno C, Giardiello FM, Anderson JC, Burke CA, Dominitz JA, Gross S, Gupta S, Jacobson BC, Patel SG, Shaukat A, Syngal S, Robertson DJ. Diagnosis and management of cancer risk in the gastrointestinal hamartomatous polyposis syndromes: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2022; 95:1025-1047. [PMID: 35487765 DOI: 10.1016/j.gie.2022.02.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The gastrointestinal hamartomatous polyposis syndromes are rare, autosomal dominant disorders associated with an increased risk of benign and malignant intestinal and extraintestinal tumors. They include Peutz-Jeghers syndrome, juvenile polyposis syndrome, the PTEN hamartoma tumor syndrome (including Cowden's syndrome and Bannayan-Riley-Ruvalcaba syndrome), and hereditary mixed polyposis syndrome. Diagnoses are based on clinical criteria and, in some cases, confirmed by demonstrating the presence of a germline pathogenic variant. The best understood hamartomatous polyposis syndrome is Peutz-Jeghers syndrome, caused by germline pathogenic variants in the STK11 gene. The management is focused on prevention of bleeding and mechanical obstruction of the small bowel by polyps and surveillance of organs at increased risk for cancer. Juvenile polyposis syndrome is caused by a germline pathogenic variant in either the SMAD4 or BMPR1A genes, with differing clinical courses. Patients with SMAD4 pathogenic variants may have massive gastric polyposis, which can result in gastrointestinal bleeding and/or protein-losing gastropathy. Patients with SMAD4 mutations usually have the simultaneous occurrence of hereditary hemorrhagic telangiectasia (juvenile polyposis syndrome-hereditary hemorrhagic telangiectasia overlap syndrome) that can result in epistaxis, gastrointestinal bleeding from mucocutaneous telangiectasias, and arteriovenous malformations. Germline pathogenic variants in the PTEN gene cause overlapping clinical phenotypes (known as the PTEN hamartoma tumor syndromes), including Cowden's syndrome and related disorders that are associated with an increased risk of gastrointestinal and colonic polyposis, colon cancer, and other extraintestinal manifestations and cancers. Due to the relative rarity of the hamartomatous polyposis syndromes, recommendations for management are based on few studies. This U.S. Multi-Society Task Force on Colorectal Cancer consensus statement summarizes the clinical features, assesses the current literature, and provides guidance for diagnosis, assessment, and management of patients with the hamartomatous polyposis syndromes, with a focus on endoscopic management.
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Affiliation(s)
- C Richard Boland
- Division of Gastroenterology, University of California-San Diego School of Medicine, San Diego, California.
| | - Gregory E Idos
- Divisions of Gastroenterology and Clinical Cancer Genomics, Center for Precision Medicine, City of Hope National Medical Center, Duarte, California
| | - Carol Durno
- The Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Francis M Giardiello
- Division of Gastroenterology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; University of Connecticut, Farmington, Connecticut
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Jason A Dominitz
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Seth Gross
- Division of Gastroenterology and Hepatology, New York University Langone Health, New York, New York
| | - Samir Gupta
- Veterans Affairs Medical Center, San Diego, California; University of California San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Brian C Jacobson
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Swati G Patel
- University of Colorado School of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Aasma Shaukat
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Sapna Syngal
- Brigham and Women's Hospital, Boston Massachusetts; Dana-Farber Cancer Institute, Boston Massachusetts; Harvard Medical School, Boston Massachusetts
| | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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11
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Souiki T, Mazaz K. Inflammatory fibroid polyp causing ileo-ileal intussusception. Pan Afr Med J 2022; 42:36. [PMID: 35910066 PMCID: PMC9288115 DOI: 10.11604/pamj.2022.42.36.35280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Tarik Souiki
- Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
- Department of Visceral Surgery, University Hospital Hassan II, Fez, Morocco
- Corresponding author: Tarik Souiki, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
| | - Khalid Mazaz
- Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
- Department of Visceral Surgery, University Hospital Hassan II, Fez, Morocco
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12
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Reiner H, Mia I, Coetzee WC, Lambrechts A, Hofmeyr S. Duodenojejunal intussusception due to an inflammatory fibroid polyp: a mimic of acute pancreatitis. S AFR J SURG 2021; 59:69a-69c. [PMID: 34212578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This report describes an extremely unusual cause of acute pancreatitis. It highlights the value of cross-sectional imaging, in the absence of alcohol and gallstone aetiology, to establish a diagnosis and direct management. Computed tomography (CT) revealed a duodenal jejunal intussusception. A benign inflammatory fibroid tumour, acting as a lead point, was surgically resected and the patient made an unremarkable recovery without further episodes of acute pancreatitis.
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Affiliation(s)
- H Reiner
- Division of Surgery, Tygerberg Academic Hospital, University of Stellenbosch, South Africa
| | - I Mia
- Division of Surgery, Tygerberg Academic Hospital, University of Stellenbosch, South Africa
| | - W C Coetzee
- Division of Surgery, Tygerberg Academic Hospital, University of Stellenbosch, South Africa
| | - A Lambrechts
- Division of Surgery, Tygerberg Academic Hospital, University of Stellenbosch, South Africa
| | - S Hofmeyr
- Division of Surgery, Tygerberg Academic Hospital, University of Stellenbosch, South Africa
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13
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Mashiko T, Sakoda N, Nakano A, Masuoka Y, Hirabayashi K, Yamamoto S, Nakagohri T, Ozawa S. Adult Ileo-ileal Intussusception Due to Inflammatory Fibroid Polyp: A Case Report. Tokai J Exp Clin Med 2020; 45:202-206. [PMID: 33300591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/20/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Intussusception occurs when one part of the intestines slides into the adjacent intestine resulting in bowel obstruction. It is a rare condition in adults, accounting for only 5% of all intussusceptions. It has multiple causes, with inflammatory fibroid polyps (IFPs) very infrequently being the cause. We present a rare case of intussusception in an adult due to an IFP. CASE PRESENTATION A 72-year-old woman visited our hospital complaining of abdominal pain. Abdominal contrast-enhanced computed tomography (CT) demonstrated an ileo-ileal intussusception due to a round mass. An emergency surgery involving a partial ileal resection with laparoscopic assistance was performed. Pathological findings of the tumor showed proliferation of spindle-shaped cells, edematous stroma, dilation of lymphatic vessels, and infiltration of inflammatory cells, which were mainly eosinophils. Immunohistochemistry was positive for vimentin and SMA and negative for CD117, CD34, S-100, and desmin. Based on these findings, the tumor was diagnosed as an IFP. CONCLUSION Bowel obstruction in adults due to intussusception is rare, and those due to IFPs are even more rare. Preoperative diagnosis of IFP is difficult, but surgeons must keep in mind that it can be a cause of adult intussusception.
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Affiliation(s)
- Taro Mashiko
- Department of gastroenterological surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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14
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Abstract
RATIONALE Intussusception is defined as the invagination or telescoping of a proximal portion of the intestine into the distal portion of the intestine. Intussusception can occur at any age but is more common among children. Most cases of intussusception in adults have a pathological lead point. Inflammatory fibroid polyp (IFP) is a rare benign tumor-like lesion arising from the submucosa of the gastrointestinal tract that can cause intussusception in adults. Here, we report a case of adult intussusception due to IFP. We also present a literature review of 31 reports including 34 cases between 2012 and December 2019, which shows a mean age of 45.4 ± 14.2 years and female dominance (23/34) of intussusception due to IFP. PATIENT CONCERNS A 47-year-old man presented with a half-day history of epigastric abdominal pain. Physical examination revealed distension and tenderness of the upper abdomen. Computed tomography (CT) of the abdomen and pelvis demonstrated intussusception of the jejunum along with a suspicious jejunal mass associated with mesenteric lymphadenopathies. DIAGNOSIS Intussusception of the jejunum along with a suspicious jejunal mass, and histopathological examination of the resected specimen showed IFP. INTERVENTIONS The patient underwent emergency laparotomy. The intussusception was resected without attempts for reduction. OUTCOMES The postoperative period was uneventful, and the patient was discharged on the fourth postoperative day. LESSONS Intussusception in adults is rare, especially that secondary to IFP. The most commonly used diagnostic tool for adult intussusception is abdominal CT, and the optimal management is resection of the involved bowel segment without reduction if malignancy cannot be ruled out.
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Affiliation(s)
| | - Jian-Han Chen
- Bariatric and Metabolism International Surgery Center
- Division of General Surgery, E-Da Hospital
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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Kim YK. Single-incision laparoscopic surgery for jejuno-jejunal intussusception caused by an angiolipomatous polyp in an adult: A case report. Medicine (Baltimore) 2019; 98:e18280. [PMID: 31852102 PMCID: PMC6922439 DOI: 10.1097/md.0000000000018280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Small bowel intussusception in adults is rare but is more likely to occur in the presence of a lead point. Surgical intervention is necessary in most cases, even if there is successful nonsurgical reduction of the intussusception. PATIENT CONCERNS A 54-year-old woman who was transferred to our emergency room with complaints of intermittent cramping pain of 4 days' duration. DIAGNOSIS Abdominal contrast-enhanced computed tomography revealed a jejuno-jejunal intussusception due to an angiolipomatous polyp. INTERVENTION A single-incision laparoscopic surgery (SILS) was performed without the need for any additional incisions. OUTCOMES She was uneventfully discharged on postoperative day 4. LESSONS The SILS procedure with adequate preoperative diagnosis by CT, with or without US, can offer good clinical outcomes for small bowel intussusception. Even surgeons who have little experience with laparoscopic intestinal anastomosis can consider SILS to treat small bowel intussusception in adults.
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16
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Tanner RM, Hunt DJ. An Unusual Cause of Intussusception. Am Surg 2019; 85:e476-e478. [PMID: 31638544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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17
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18
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Definition, recognition, documentation, strategic planning and treatment. Colorectal Dis 2019; 21 Suppl 1:65. [PMID: 30809913 DOI: 10.1111/codi.14589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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19
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Li Z, Sun M, Song B, Shu Z. Gastrointestinal hemorrhage caused by adult intussusception secondary to small intestinal tumors: Two case reports. Medicine (Baltimore) 2018; 97:e12053. [PMID: 30142859 PMCID: PMC6112951 DOI: 10.1097/md.0000000000012053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/02/2018] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Adult intussusception is rarely observed, and the clinical manifestations are very atypical. The most common symptom is abdominal pain, while the incidence of hematochezia is relatively low. We report two cases of adult intussusception secondary to small intestinal tumors with gastrointestinal hemorrhage as the main symptom. PATIENT CONCERNS Two men aged 19 and 54 years were successively referred to our department due to intermittent hematochezia. The hemoglobin levels of the two patients declined progressively, and conservative treatment was ineffective. DIAGNOSES The first patient underwent an abdominal computed tomography angiography examination, which showed that the intestine and its mesentery were tortuous, suggesting an intra-abdominal hernia or intussusception. The second patient underwent an abdominal computed tomography examination, which suggested a high possibility of an intussusception. The two patients were diagnosed as adult intussusception caused by small intestinal tumors. INTERVENTIONS Emergency laparoscopic explorations were performed. Enteroenteric intussusceptions caused by ileal tumors were found during surgery. Reduction of the intussusceptions and resection of the ileal tumors were performed. OUTCOMES The patients recovered well after surgery, and postoperative pathology showed that the tumors were a vascular hamartoma polyp and a lipoma. LESSONS Adult intussusception is very rare, particularly with gastrointestinal hemorrhage as the main symptom. Isolated hamartoma polyp is a rare cause of intussusception in adults. The clinical manifestations of adult intussusception are very atypical, and thus, making a preoperative diagnosis is difficult. Abdominal CT or CTA is an effective diagnostic method for adult intussusception. For adult patients with gastrointestinal hemorrhage caused by intussusceptions, active surgery should be performed when conservative treatment is not effective. Laparoscopic surgery is a safe and effective treatment for adult intussusceptions caused by benign diseases.
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Al-Radaideh AM, Omari HZ, Bani-Hani KE. Adult intussusception : A 14-year retrospective study of clinical assessment and computed tomography diagnosis. Acta Gastroenterol Belg 2018; 81:367-372. [PMID: 30350523] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Intussusception in adults often remains unrecognized. Our aim was to report our experience with this entity to determine the usefulness of CT scan in its preoperative diagnosis. PATIENTS AND METHODS The medical records and imaging studies of all patients ≥16 years of age with intussusception, who were managed at our hospitals, were retrospectively reviewed. RESULTS 17 cases of adult intussusception (7 males, 10 females; mean age 35.9 years; age range of 16-78) were identified. The diagnosis was possible in all patients using CT scan. The underlying etiologies were colon cancer (n=2), lymphoma (n=2), small bowel polyps (n=2), jejunal lipoma (n=1), metastatic melanoma (n=1), Meckel's diverticulum (MD) (n=1) and idiopathic (n=1). In the remaining 7 patients, the intussusceptions were of the transitory form and were treated conservatively and no significant sequela occurred after a follow-up of 2-60 months. CT scan findings in transient cases characteristically showed that the intussusception was localized to the proximal intestine and all of them had a short segment (2-4 cm) of intussusception. CONCLUSIONS The important role of the CT in the preoperative diagnosis of intussusception and characterizing its causes cannot be overemphasized. All transient cases had a short segment of intussusception.
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Affiliation(s)
- A M Al-Radaideh
- Department of Medical Imaging, Faculty of Allied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - H Z Omari
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - K E Bani-Hani
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
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Lenci I, Milana M, Toti L, Palmieri G, Manzia TM, Angelico M, Tisone G, Baiocchi L. An unusual duodenal polyp causing anemia in a liver-transplanted patient. Am J Gastroenterol 2018; 113:918-919. [PMID: 29686271 DOI: 10.1038/s41395-018-0046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/28/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Ilaria Lenci
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Martina Milana
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Luca Toti
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Giampiero Palmieri
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Tommaso Maria Manzia
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Mario Angelico
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Leonardo Baiocchi
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
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22
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Kalliakmanis V, Perysinakis I, Koutsouvas K, Karras P, Margaris E, Angelakis C. Massive intussusception caused by a solitary Peutz-Jeghers type hamartomatous polyp. Ann R Coll Surg Engl 2018; 100:e91-e93. [PMID: 29484932 PMCID: PMC5958860 DOI: 10.1308/rcsann.2018.0019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Accepted: 11/06/2017] [Indexed: 02/01/2023] Open
Abstract
Intussusception is a rare cause of intestinal obstruction in adults and represents a diagnostic challenge for the surgeon. In the majority of cases, presenting symptoms are not specific, making preoperative diagnosis difficult. Several medical conditions may cause intestinal intussusception. We present the case of a 16-year-old female patient with intussusception due to a hamartomatous Peutz-Jeghers type polyp. This is an extremely rare case in which the first manifestation of the intestinal polyp was jejunojejunal intussusception very close to the duodenojejunal junction, with a necrotic intussusceptum about 50 cm long. The patient was treated successfully with enterectomy and end-to-end anastomosis. Postoperative course was uneventful and the patient is currently under gastroenterological and genetic investigation to exclude the diagnosis of Peutz-Jeghers syndrome.
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Affiliation(s)
- V Kalliakmanis
- Surgical Department, General Hospital of Agrinio, Agrinio, Aitoloakarnania, Greece
| | - I Perysinakis
- Third Surgical Department, Hygeia Hospital, Athens, Greece
| | - K Koutsouvas
- Surgical Department, General Hospital of Agrinio, Agrinio, Aitoloakarnania, Greece
| | - P Karras
- Surgical Department, General Hospital of Agrinio, Agrinio, Aitoloakarnania, Greece
| | - E Margaris
- Third Surgical Department, G Gennimatas General Hospital, Athens, Greece
| | - C Angelakis
- Surgical Department, General Hospital of Agrinio, Agrinio, Aitoloakarnania, Greece
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23
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Affiliation(s)
- P E Stevens
- Department of Renal Medicine, Princess Mary's RAF Hospital, Aylesbury, Bucks
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24
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Grover AS, Kumar M, Yadav R, Sharma A, Chowdhary K, Zaman M, Chowdhary A, Bawa A. Intussusception of Small Intestine as a Result of Inflammatory Fibroid Polyp Causing Small Bowel Obstruction in an Adult Patient. Kathmandu Univ Med J (KUMJ) 2017; 15:352-354. [PMID: 30580357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intussusception is the telescoping of one segment of bowel into the adjacent segment. It is more commonly seen in children,however rarely encountered in adult patients. Proximal segment of bowel is called intussusceptum which is intussuscepted into the lumen of the adjacent distal segment known as intussuscipiens. There is always a lead point causing this disorder especially in adults. We presented a case of a 45 year old man who presented in emergency department of our institute with history and clinical features of acute intestinal obstruction since 10 days. Patient was resuscitated, investigated and taken for exploratory laparotomy under General anaesthesia. Segment of involved small gut was resected and well circumscribed polypoidal mass was found in intussuscepted bowel. Histopathological examination of the specimen revealed the features of inflammatory fibroid polyp.
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Affiliation(s)
- A S Grover
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences (MMIMSR), Mullana, Ambala, Hayrana, India
| | - M Kumar
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences (MMIMSR), Mullana, Ambala, Hayrana, India
| | - R Yadav
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences (MMIMSR), Mullana, Ambala, Hayrana, India
| | - A Sharma
- Department of Pathology, Maharishi Markandeshwar Institute of Medical Sciences (MMIMSR), Mullana, Ambala, Hayrana, India
| | - K Chowdhary
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences (MMIMSR), Mullana, Ambala, Hayrana, India
| | - M Zaman
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences (MMIMSR), Mullana, Ambala, Hayrana, India
| | - A Chowdhary
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences (MMIMSR), Mullana, Ambala, Hayrana, India
| | - A Bawa
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences (MMIMSR), Mullana, Ambala, Hayrana, India
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25
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Basara I, Canda AE, Sagol O, Obuz F, Secil M. Intussusception and perforation due to an inflammatory fibroid polyp located in the ileum. Wien Klin Wochenschr 2016; 128:731-734. [PMID: 27637204 DOI: 10.1007/s00508-016-1073-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 08/05/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Isil Basara
- Department of Radiology, Dokuz Eylul University School of Medicine, Mithatpasa Street 1606, 35340, Izmir, Turkey.
| | - Aras Emre Canda
- Department of General Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ozgul Sagol
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Funda Obuz
- Department of Radiology, Dokuz Eylul University School of Medicine, Mithatpasa Street 1606, 35340, Izmir, Turkey
| | - Mustafa Secil
- Department of Radiology, Dokuz Eylul University School of Medicine, Mithatpasa Street 1606, 35340, Izmir, Turkey
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26
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Genna AD. [Inflammatory fibroid polyp as the cause of upper gastrointestinal bleeding.]. Acta Gastroenterol Latinoam 2016; 46:48-51. [PMID: 29470885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The inflammatory fibroid polyp or Vanek's tumor is a benign polypoid lesion that can be found in any section of the digestive tract. It is most frequently located in the stomach and when found in this organ, the symptoms include upper gastrointestinal bleeding (often silent), anemia and melena. The case described below, on the contrary, presents a gastric inflammatory fibroid polyp which developed acute upper gastrointestinal bleeding and required surgical treatment.
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27
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Smith-Chakmakova F, Liu YJ, Karamchandani DM. Inflammatory Fibroid Polyp of the Ileocecal Valve: Case Report, Review, and Recent Advances. Ann Clin Lab Sci 2015; 45:441-445. [PMID: 26275697] [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: 06/04/2023]
Abstract
We report a case of a 72-year-old woman who underwent a right hemicolectomy for a near-obstructing mass in the ileocecal valve. The histologic diagnosis was inflammatory fibroid polyp (IFP). IFPs are rare mesenchymal lesions that can arise throughout the gastrointestinal tract. Originally considered reactive or inflammatory, recent studies report activating mutations of platelet derived growth factor receptor-alpha (PDGFRA) in IFPs, suggesting that these may in fact be neoplastic. Nonetheless, these are benign lesions cured by local excision and typically do not recur or metastasize. Our patient also had no evidence of local recurrence one year after the surgery. Hence, the clinical importance lies in distinguishing these lesions from other benign and malignant mesenchymal proliferative lesions both on a biopsy and resection specimen. We review the literature on clinicopathologic features, immunohistochemical profile, pathogenesis, recent advances, differential diagnosis, prognosis, and treatment of these uncommon lesions.
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Affiliation(s)
- Faye Smith-Chakmakova
- Department of Pathology, Lebanon Pathology Associates, Good Samaritan Hospital, 4 and Walnut Streets, Lebanon, PA, USA
| | - Yong-Jun Liu
- Department of Pathology, Penn State Milton S. Hershey Medical Center & Penn State College of Medicine, Hershey, PA, USA
| | - Dipti M Karamchandani
- Department of Pathology, Penn State Milton S. Hershey Medical Center & Penn State College of Medicine, Hershey, PA, USA
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28
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Sánchez-Cifuentes Á, González-Valverde FM, Ruiz-Marín M, Peña-Ros E, Vicente-Ruiz M, Martínez-Sanz N, Escamilla-Segade C, Pastor-Quirante F, Albarracín-Marín-Blázquez A. Inflammatory fibroid polyp of the appendix or Vanek's tumor. Rev Esp Enferm Dig 2015; 107:37-38. [PMID: 25603330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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29
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Agrawala RK, Choudhury AK, Mohanty BK, Baliarsinha AK. Berardinelli-Seip congenital lipodystrophy: an autosomal recessive disorder with rare association of duodenocolonic polyps. J Pediatr Endocrinol Metab 2014; 27:989-91. [PMID: 24825083 DOI: 10.1515/jpem-2013-0399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/31/2014] [Indexed: 11/15/2022]
Abstract
Berardinelli-Seip congenital lipodystrophy (BSCL) is a rare autosomal recessive disorder characterized by a nearly complete absence of adipose tissue and generalized muscular appearance. This condition is associated with various dermatological and systemic manifestations. We report a 5-year-old boy, with clinical and metabolic presentation resembling BSCL and unusual features, such as diabetes detected at an early age and multiple duodenal and colonic polyps.
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30
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Choi CI, Kim DH, Jeon TY, Kim DH, Shin NR, Park DY. Solitary Peutz-Jeghers-type appendiceal hamartomatous polyp growing into the terminal ileum. World J Gastroenterol 2014; 20:4822-4826. [PMID: 24782638 PMCID: PMC4000522 DOI: 10.3748/wjg.v20.i16.4822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 12/31/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Solitary Peutz-Jeghers type hamartomatous polyp is rare. It is considered to be related to a variant Peutz-Jeghers syndrome (PJS) and may be a separate disease entity. A 50-year-old man was referred to our hospital with a diagnosis of intussusception in the terminal ileum and underwent segmental ileal resection with appendectomy. We identified a 3.5-cm diameter polyp arising from the appendix with ingrowth into the terminal ileum. The polyp was confirmed to be a hamartomatous polyp of Peutz-Jeghers-type, histologically. However, the patient had no characteristic manifestations of PJS such as mucocutaneous pigmentation and family history. There are few reports of appendiceal hamartomatous polyp in PJS patients and solitary appendiceal hamartomatous polyp is even rarer. Also, rather than telescoping, ours is the first reported intussuscepted lesion, to the best of our knowledge.
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31
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Feldis M, Dilly M, Marty M, Laurent F, Cassinotto C. An inflammatory fibroid polyp responsible for an ileal intussusception discovered on an MRI. Diagn Interv Imaging 2014; 96:89-92. [PMID: 24618561 DOI: 10.1016/j.diii.2014.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 12/27/2022]
Affiliation(s)
- M Feldis
- Diagnostic and Interventional Radiology Department, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France.
| | - M Dilly
- Department of Pathological Anatomy, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
| | - M Marty
- Department of Pathological Anatomy, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
| | - F Laurent
- Diagnostic and Interventional Radiology Department, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
| | - C Cassinotto
- Diagnostic and Interventional Radiology Department, Hôpital du Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
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32
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Indemans FA, Ruijter E, Feith GW. [A woman with ongoing anaemia]. Ned Tijdschr Geneeskd 2014; 158:A7107. [PMID: 24423491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In a 65-year-old female with iron deficiency anaemia, video capsule endoscopy showed an ulcerative polyp in the proximal ileum. After histological examination we made the diagnosis 'granuloma pyogenicum', a rare cause of gastrointestinal bleeding. After partial resection of the small intestine, the anaemia was cured.
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Abstract
Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into an adjacent distal segment. This rare form of bowel obstruction occurs infrequently in adults. We report a case of small bowel intussusception in an adult male patient. We have also performed a literature review of this rare condition.
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Affiliation(s)
- J Potts
- South Tyneside NHS Foundation Trust, UK
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34
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Vittar N, Corti M, Solari R, Carolis LD, Figueiras O, Velásquez J, Maronna E. [Brunner's gland adenoma: a rare tumor as cause of pyloric syndrome in an AIDS patient]. Acta Gastroenterol Latinoam 2014; 44:260-264. [PMID: 26742301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Brunner's gland adenoma is a rare neoplasm that accounts for only the 0.008% of all benign duodenal tumors. Here we describe the case ofan HIV-seropositive man who developed a severe pyloric stenosis due to a Brunner's adenoma of the bulb and the first duodenal portion. Gastroduodenoscopy showed a large polypoid tumor that obstructed the pyloric region. The lesion was resected by surgery and a gastroduodenal anastomosis was made. The histopathologic examination of the surgical specimen showed a large proliferation of Brunner's glands into a large pedunculated polyp that confirmed the diagnosis of this hamartoma.
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35
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Park MS, Lee BJ, Gu DH, Pyo JH, Kim KJ, Lee YH, Joo MK, Park JJ, Kim JS, Bak YT. Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy. World J Gastroenterol 2013; 19:8440-8444. [PMID: 24363538 PMCID: PMC3857470 DOI: 10.3748/wjg.v19.i45.8440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/04/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage. It causes protein-losing enteropathy and may lead to gastrointestinal bleeding. Commonly, lymphangiectasia presents as whitish spots or specks. To our knowledge, small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported. Here, we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature. An 80-year-old woman was hospitalized for melena. Esophagogastroduodenoscopy could not identify the source of bleeding. Subsequent colonoscopy showed fresh bloody material gushing from the small bowel. An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings. Video capsule endoscopy showed evidence of active and recent bleeding in the ileum. To localize the bleeding site, we performed double balloon enteroscopy by the anal approach. A small, bleeding, polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery.
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Yu L, Wang J. Malignant paraganglioma of the rectum: The first case report and a review of the literature. World J Gastroenterol 2013; 19:8151-8155. [PMID: 24307812 PMCID: PMC3848166 DOI: 10.3748/wjg.v19.i44.8151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 09/27/2013] [Accepted: 10/14/2013] [Indexed: 02/06/2023] Open
Abstract
Paragangliomas typically develop in the extra-adrenal sites along the sympathetic and/or the parasympathetic chain. Occasionally, the tumors may arise in some exotic sites, including the head and neck region and the urogenital tract. Paraganglioma presenting as a primary rectal neoplasm has not been well described in the literature. Here, we report the first case of malignant paraganglioma arising in the rectum of a 37-year-old male. He presented to the clinic because of hematochezia with tenesmus. The anorectal digital examination and colonoscopic examination revealed a polypoid mass of the rectum, measuring approximately 4 cm in diameter. The overall morphology and immunophenotype were consistent with a typical paraganglioma. However, the tumor exhibited features suggestive of malignant potential, including local extension into adjacent adipose tissue, nuclear pleomorphism, confluent tumor necrosis, vascular invasion and metastases to regional lymph nodes. In conclusion, we present the first case of rectal malignant paraganglioma. Due to the unexpected occurrence in this region, malignant paraganglioma may be misdiagnosed as other tumors with overlapping features; in particular, a neuroendocrine tumor of epithelial origin. Because of the differences in treatment, separating paraganglioma from its mimics is imperative. Combination of morphology with judicious immunohistochemical study is helpful in obtaining the correct diagnosis.
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Arikanoglu Z, Onder A, Taskesen F, Aliosmanoglu I, Gul M, Gumus H, Tas I, Girgin S. Surgical alternatives in the treatment of intestinal intussusceptions resulting from polyps in adults. Am Surg 2013; 79:933-938. [PMID: 24069994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Adult intussusception is an uncommon disease requiring surgical intervention. The aim of this study is to discuss the surgical alternatives and share our experience in the treatment of adult patients with intussusceptions formed as a result of polyps. The retrospective study included 16 adult patients who underwent surgery after the diagnosis of intestinal invaginations resulting from polyps between the years 2000 and 2011. Sixteen patients (seven males and nine females; mean age, 48.18 years; range, 18 to 76 years) presented with intestinal intussusceptions. Although a preoperative diagnosis was carried out in 11 (68.75%) patients, the diagnosis was made intraoperatively in five patients (31.25%). Among the patients, seven (43.8%) had undergone emergency surgeries and nine (52.8) had elective surgery. The invagination in 12 patients (75%) was located in the small intestine, in two patients (12.5%) in the colon, and in a further two patients (12.5%), it was ileocecally located. Ten patients (62.5%) had segmental resection + anastomosis; three patients underwent (18.8%) segmental resection + enterostomy, and three (18.8%) received hemicolectomies. In adults, surgical treatment is always the primary option in intussusceptions resulting from polyps. Although the surgical method of choice in colonically located ones is en bloc resection without reduction, because the polyps located in the small intestine are usually of a benign nature, segmental resection with reduction should be performed in elective surgery and segmental resection without reduction should be performed in emergency cases.
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Affiliation(s)
- Zulfu Arikanoglu
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakir, Turkey
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38
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Patel RV, Stanton M, Curry J, Kiely E. Laparoscopic management of Peutz-Jeghers syndrome (PJS) presenting with chronic non-ischaemic jejuno-jejunal intussusception in an adolescent girl. BMJ Case Rep 2013; 2013:bcr-2013-200939. [PMID: 23964052 PMCID: PMC3762403 DOI: 10.1136/bcr-2013-200939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK.
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39
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Abstract
AIM In a prospective study to outline the aetiology of bleeding per rectum (BPR) in Egyptian infants and children, a subsidiary aim was to define some of the clinical characteristics of the different aetiologies. SUBJECTS AND METHODS 194 children with BPR are described. The diagnostic work-up included laboratory investigations, radiological and endoscopic assessment, radio-isotope scanning, angiography and histopathological examination of mucosal biopsies, as appropriate. RESULTS Ages ranged from 3 to 192 months with a mean (SD) of 49.8 (43.5). Infectious enterocolitis was the most common cause (37.1%). Others included colorectal polyps (21.1%), chronic colitis (16%) including inflammatory bowel diseases (5.2%), allergic colitis (2.6%), solitary rectal ulcer syndrome (1.5%) and non-specific colitis (6.7%). Intussusception and Meckel's diverticulae were the cause in 7.3% and 2.6%, respectively, while other aetiologies included vascular (6.2%), systemic (3.6%), local anal (3.1%) and upper gastro-intestinal causes (1.5%). In 1.5% of cases, the cause remained 'obscure'. CONCLUSION In Egyptian children, infectious enterocolitis followed by colorectal polyps and chronic colitis are major causes of BPR.
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Affiliation(s)
- Hamed A El-Khayat
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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40
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Sweetser S, Smyrk TC, Sinicrope FA. Serrated colon polyps as precursors to colorectal cancer. Clin Gastroenterol Hepatol 2013; 11:760-7; quiz e54-5. [PMID: 23267866 PMCID: PMC3628288 DOI: 10.1016/j.cgh.2012.12.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [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: 10/25/2012] [Revised: 11/27/2012] [Accepted: 12/07/2012] [Indexed: 02/07/2023]
Abstract
Identification of the serrated neoplasia pathway has improved our understanding of the pathogenesis of colorectal cancer (CRC). Insights include an increased recognition of the malignant potential of different types of serrated polyps such as sessile and traditional serrated adenomas. Sessile serrated adenomas share molecular features with colon tumors that have microsatellite instability and a methylator phenotype, indicating that these lesions are precursors that progress via the serrated neoplasia pathway. These data have important implications for clinical practice and CRC prevention, because hyperplastic polyps were previously regarded as having no malignant potential. There is also evidence that the serrated pathway contributes to interval or missed cancers. Endoscopic detection of serrated polyps is a challenge because they are often inconspicuous with indistinct margins and are frequently covered by adherent mucus. It is important for gastroenterologists to recognize the subtle endoscopic features of serrated polyps to facilitate their detection and removal, and thereby ensure a high-quality colonoscopic examination. Recognition of the role of serrated polyps in colon carcinogenesis has led to the inclusion of these lesions in postpolypectomy surveillance guidelines. However, an enhanced effort is needed to identify and completely remove serrated adenomas, with the goal of increasing the effectiveness of colonoscopy to reduce CRC incidence.
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Affiliation(s)
- Seth Sweetser
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
| | - Thomas C. Smyrk
- Division of Anatomic Pathology, Mayo Clinic College of Medicine, Rochester, MN
| | - Frank A. Sinicrope
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
- Division of Oncology, Mayo Clinic College of Medicine, Rochester, MN
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Maya AM, Gallo A, Castelli M, Paz L, Espinosa JC, Giunippero A. [Small bowel intussusception and Vanek's tumor in an elderly woman]. Medicina (B Aires) 2013; 73:461-463. [PMID: 24152406] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Inflammatory fibroid polyps are non-frequent benign lesions, described by Vanek in 1949, originated in the sub mucosa of the gastrointestinal tract. They have an uncertain origin and they are formed of fibroblastic and mesenchymal proliferations with an important eosinophilic proportion. Depending on where are they localized, could present different type of symptoms. The inflammatory fibroid polyps are one of the rare benign conditions causing intestinal intussusception in adults. We present the case of a 82 years old woman, who presented an intestinal intussusception due to an inflammatory fibroid polyp localized in the small bowel.
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Affiliation(s)
- Antonio M Maya
- Departamento de Cirugía General, Instituto de Investigaciones Médicas Alfredo Lanari, Facultad de Medicina, Universidad de Buenos Aires. E-mail:
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Alecu L, Tulin A, Ursut B, Ursut B, Oproiu A, Obrocea F. [Unique duodenal hamartomatous polyp--case report]. Chirurgia (Bucur) 2012; 107:243-245. [PMID: 22712356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Duodenal tumors are very rare tumors, with the lower incidence among the tumors of the small bowel, whose frequence is less than 5 % of all digestive tumors. In most of the cases these tumors remain asymptomatic, sometimes the entire life. When they become symptomatic, their first manifestation is the loss of digested blood (melena), secondary anemia and obstructive symptomatology. Early diagnosis of these tumors is difficult because of the unsystematic symptomatology and becomes easy when the complications appear. In most of the cases the diagnosis is establish by the superior digestive endoscopy, followed by barium contrast studies, CT and ultrasound. We present a case of duodenal hamartomatous polip, unique, at the level of D3, in a female patient 66 years old, addressing to our service for superior digestive hemorrhage exteriorizated by melena, secondary anemia and physical asthenia; we operated the patient procedeeing a polypectomy by a duodenotomy.
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Affiliation(s)
- L Alecu
- Spitalul de Urgenţă Prof. dr. Agrippa Ionescu, Bucureşti, România.
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Das S, Mandal TS, Sinhababu AK, Chatterjee TK, Khamrui TK, Bhattacharya H. Small bowel obstruction due to inflammatory fibroid polyp. J Indian Med Assoc 2012; 110:51-52. [PMID: 23029834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Inflammatory fibroid polyp is a benign and non-neoplastic condition of the intestinal tract, commonly affecting the gastric antrum, though it can affect any part of the gastro-intestinal tract. It is a submucosal, sessile, poypoid mass composed of myofibroblast like mesenchymal cells, numerous small blood vessels and marked inflammatory cell infiltrate mainly eosinophils. It commonly presents as intestinal obstruction or intussusception. A case of recurrent partial small intestinal obstruction due to intermittent intussusception associated with inflammatory fibroid polyp of jejunum is being reported.
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Affiliation(s)
- S Das
- Department of General Surgery, Calcutta National Medical College, Kolkata 700014
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44
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Ugajin T, Miyatani H, Matsumoto S, Takamatsu T, Fukunishi M, Yoshida Y, Dobashi Y. Regression of multiple duodenal hyperplastic polyps following Helicobacter pylori eradication. Dig Endosc 2011; 23:328. [PMID: 21951097 DOI: 10.1111/j.1443-1661.2010.01097.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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45
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Mikhaleva LM, Shapoval'iants SG, Gracheva NA, Orlov SI, Pan'kov AG, Budzinskiĭ SA, Orlova EN, Adrasenov TB. [Clinico-morphological characteristics of major duodenal papilla benign neoformations of patients with postcholecystectomy syndrome]. Arkh Patol 2011; 73:21-23. [PMID: 22288166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The article is devoted to a problem of diagnosis and treatment of postcholecystectomy syndrome caused by benign neoformations of the major duodenal papilla. The material of study was formed by 76 patients; among them 53 ones had isolated benign neoformations of the major duodenal papilla. The medical-diagnostic algorithm applied by authors for the examination of patients with postcholecystectomy syndrome is presented. It's been defined, that benign neoformations of the major duodenal papilla take an essential place in the structure of postcholecystectomy syndrome and make 13.5% of the reasons of its occurrence. Thus, the most widespread morphological substratum of these benign neoformations is the hyperplastic polyp.
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46
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Sakamoto H, Yamamoto H, Hayashi Y, Yano T, Miyata T, Nishimura N, Shinhata H, Sato H, Sunada K, Sugano K. Nonsurgical management of small-bowel polyps in Peutz-Jeghers syndrome with extensive polypectomy by using double-balloon endoscopy. Gastrointest Endosc 2011; 74:328-33. [PMID: 21704992 DOI: 10.1016/j.gie.2011.04.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 04/01/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND The major problem in the management of Peutz-Jeghers syndrome (PJS) is small-bowel polyps, which can cause intussusception and bleeding. Double-balloon endoscopy (DBE) enables endoscopic resection of small-bowel polyps. OBJECTIVE The aim of this study was to determine the efficacy and safety of endoscopic management of small-bowel polyps in PJS patients by using DBE. DESIGN Retrospective chart review. SETTING Single university hospital. PATIENTS Consecutive patients with PJS who underwent multiple sessions of DBE for evaluation or treatment of small-bowel polyps between September 2000 and April 2009. INTERVENTIONS Endoscopic resection of small-bowel polyps in PJS patients was performed by using DBE. MAIN OUTCOME MEASUREMENTS Efficacy, safety, and long-term laparotomy rate after the procedures were evaluated. RESULTS Fifteen patients (10 men, mean age 34.0 ± 15.8 years) underwent DBE for a mean 3.0 ± 1.0 sessions. The mean numbers of resected polyps larger than 20 mm significantly decreased as sessions advanced (first, 3.6; second, 1.3; third, 0.7; fourth, 0.4; and fifth, 1.0; P = .02). The mean maximum sizes of resected polyps also significantly decreased at each session: 33, 19, 12, 17, and 30 mm (P = .01). One patient had a perforation, but was managed conservatively. Other complications were pancreatitis (n = 2) and bleeding (n = 2). Only 1 patient underwent surgery for intussusception during the study period. LIMITATIONS This was a small single-center retrospective study of short duration. CONCLUSIONS Endoscopic management of small-bowel polyps in PJS patients by using DBE is safe and effective and avoids urgent laparotomy.
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Affiliation(s)
- Hirotsugu Sakamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
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Wang CQ, Shi ZX, Jiang J, Zhang JH, Zhang Y, Wang Q. [Multiple lymphomatous polyposis of intestine: report of a case]. Zhonghua Bing Li Xue Za Zhi 2011; 40:341-342. [PMID: 21756832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
MESH Headings
- Antigens, CD20/metabolism
- CD5 Antigens/metabolism
- Colonic Neoplasms/complications
- Colonic Neoplasms/metabolism
- Colonic Neoplasms/pathology
- Colonic Neoplasms/surgery
- Cyclin D1/metabolism
- Diagnosis, Differential
- Female
- Humans
- Ileal Diseases/complications
- Ileal Diseases/pathology
- Ileal Diseases/surgery
- Ileocecal Valve
- Intestinal Neoplasms/complications
- Intestinal Neoplasms/metabolism
- Intestinal Neoplasms/pathology
- Intestinal Neoplasms/surgery
- Intestinal Polyps/complications
- Intestinal Polyps/metabolism
- Intestinal Polyps/pathology
- Intestinal Polyps/surgery
- Intussusception/complications
- Intussusception/pathology
- Intussusception/surgery
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, Mantle-Cell/complications
- Lymphoma, Mantle-Cell/metabolism
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Mantle-Cell/surgery
- Middle Aged
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48
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Morales-Fuentes GA, de Ariño-Suárez M, Zárate-Osorno A, Rodríguez-Jerkov J, Terrazas-Espitia F, Pérez-Manauta J. Vanek's polyp or inflammatory fibroid polyp. Case report and review of the literature. CIR CIR 2011; 79:242-267. [PMID: 22380995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Intussusception in an adult must make us suspect the presence of a tumor (benign or potentially dangerous) as the most frequent cause. Accurate diagnosis is of great importance in order to provide appropriate treatment and improve patient prognosis. CLINICAL CASE We report the case of a 42-year-old male with abdominal pain. We performed a CT and found a small bowel intussusception. Definitive diagnosis according to the surgical specimen was inflammatory fibroid polyp (Vanek's polyp). CONCLUSIONS Vanek's polyp is a benign lesion that occurs most frequently in the stomach and secondarily in the small bowel. Generally, it is uncommon, and its etiology is not completely known. Accurate diagnosis is done with immunohistochemistry. Because of the consequences that depend on the size and location of the lesion, it may be considered a malignant lesion. Treatment is resection.
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49
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Segovia-Lohse HA. Adult intussusception with perforation and secondary peritonitis. Case report. CIR CIR 2011; 79:252-277. [PMID: 22380997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Intussuception is an uncommon condition in adults. It is usually secondary to an organic lesion that may be malignant. The most common clinical presentation is as a partial bowel obstruction that requires surgical management. Preoperative diagnosis remains difficult; therefore, this paper presents a case report and a brief review of adult intussusception. CLINICAL CASE We present the case of a 24-year-old female with a 36-h evolution of lower abdominal pain with nausea, vomiting and diarrhea and a previous episode 8 days earlier. Pneumoperitoneum was observed on chest x-ray and surgery was decided upon. Peritonitis due to ileoileal intussusception was found, caused by an inflammatory fibroid polyp with microperforations. Small bowel resection with end-to-end anastomosis was performed and the patient had an uneventful recovery. CONCLUSIONS Adult intussusception is an infrequent condition with nonspecific symptoms such as pain, nausea and vomiting. With more frequent use of tomography in patients with abdominal pain, correct diagnosis can be achieved. Treatment requires resection of the involved bowel without attempted reduction.
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50
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Sawada K, Ohtake T, Ueno N, Ishikawa C, Abe M, Miyoshi S, Suzuki Y, Tokusashi Y, Fujiya M, Kohgo Y. Multiple portal hypertensive polyps of the jejunum accompanied by anemia of unknown origin. Gastrointest Endosc 2011; 73:179-82. [PMID: 20869709 DOI: 10.1016/j.gie.2010.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 07/06/2010] [Indexed: 12/17/2022]
Affiliation(s)
- Koji Sawada
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Asahikawa, Japan
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