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Adhikari D, Kamal M, Paudel R, Tiwari S, Dahal S, Bika B. Adult ileocecocolic intussusception with mucocele of the appendix: a rare presentation. Ann Med Surg (Lond) 2025; 87:2500-2503. [PMID: 40212186 PMCID: PMC11981465 DOI: 10.1097/ms9.0000000000003185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Accepted: 03/06/2025] [Indexed: 04/13/2025] Open
Abstract
Introduction and importance Intussusception is a condition in which part of the intestine telescopes into an adjacent segment, causing bowel obstruction. It is common in children but rare in adults, comprising only 5% of all intussusceptions and 1-5% of adult intestinal obstructions. Adult cases often have identifiable causes, making early diagnosis and intervention crucial. Appendiceal mucocele is an exceptionally rare lead point for intussusception. Case presentation A 53-year-old male presented with abdominal distension and severe periumbilical pain, accompanied by nausea and vomiting. Physical examination revealed tenderness but no mass. Imaging studies identified ileocecocolic intussusception with an appendiceal mucocele as the lead point. Exploratory laparotomy and right limited hemicolectomy were performed. Histopathology confirmed a low-grade appendiceal mucinous neoplasm. The patient recovered uneventfully and was discharged in stable condition. Clinical discussion Adult intussusception is often triggered by bowel wall lesions or luminal irritants that disrupt normal peristaltic activity. Diagnosis is challenging due to non-specific symptoms and requires advanced imaging techniques. Surgical intervention is crucial, especially when there are concerns about malignancy. Prompt treatment is essential to prevent severe complications. Appendiceal mucocele, a rare lead point, necessitates careful surgical management to avoid rupture and ensure successful outcomes. Conclusion This case emphasizes the rarity and complexity of ileocecocolic intussusception with an appendiceal mucocele, highlighting the need for prompt diagnosis and surgical intervention. Early detection is crucial to prevent serious complications and improve patient outcomes.
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Affiliation(s)
| | - Meraj Kamal
- Department of Radio-diagnosis and medical imaging, B.P. Koirala Institute of Health sciences, Dharan, Nepal
| | - Rajesh Paudel
- Department of Radio-diagnosis and medical imaging, B.P. Koirala Institute of Health sciences, Dharan, Nepal
| | - Suraj Tiwari
- Department of Radio-diagnosis and medical imaging, B.P. Koirala Institute of Health sciences, Dharan, Nepal
| | - Sanju Dahal
- Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
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2
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Ziaziaris WA, Brown K, Byrne CM. Complete sigmoidorectal intussusception secondary to colonic lipoma. ANZ J Surg 2024; 94:2269-2270. [PMID: 39417241 DOI: 10.1111/ans.19275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 09/23/2024] [Accepted: 10/02/2024] [Indexed: 10/19/2024]
Affiliation(s)
- William A Ziaziaris
- Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kilian Brown
- Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher M Byrne
- Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The University of Sydney Surgical Outcomes Research Centre, Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Institute of Academic Surgery, Sydney, New South Wales, Australia
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3
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Kada A, Sekkat H, Bahij M, Raiss M, Sabbah F, Hrora A. The management of colo-colic intussusception on left colon tumor in an adult: Case presentation and review of the literature. Int J Surg Case Rep 2024; 125:110578. [PMID: 39566425 PMCID: PMC11617890 DOI: 10.1016/j.ijscr.2024.110578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 11/07/2024] [Accepted: 11/08/2024] [Indexed: 11/22/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intestinal intussusception is rare in adults and often associated with underlying malignancies. In this case, a colo-colic intussusception involving the descending colon caused acute obstruction, ischemic pain, and carried a high risk for peritonitis, necessitating urgent surgical intervention to prevent severe complications. CASE PRESENTATION We report the case of a 50-year-old male who presented with acute abdominal obtruction and a three-day history of fecal vomiting, left-sided abdominal pain, and recent rectal bleeding. Imaging revealed colo-colic intussusception of the descending colon due to a colonic tumor. Immediate surgical intervention was performed with an oncologic resection of the invaginated segment, including a left hemicolectomy with lymph node dissection. A diversionary left iliac colostomy was conducted, ensuring clear resection margins and reducing the risk of postoperative complications. CLINICAL DISCUSSION Intussusception in adults, while rare, frequently indicates a malignant etiology, and prompt diagnosis and management are essential. In this case, rapid surgical intervention allowed successful removal of the tumor with favorable oncologic outcomes and no recurrence at two-year follow-up. This case highlights the complexity of diagnosing intussusception in adults, where symptoms may mimic other gastrointestinal conditions and are often nonspecific. CONCLUSION This case underscores the critical importance of early detection and intervention for intussusception in adults. Awareness among physicians should be heightened to consider intussusception in adult patients presenting with symptoms such as ischemic pain or a palpable mass with associated pain, as timely intervention can lead to improved outcomes and reduce morbidity.
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Affiliation(s)
- Ali Kada
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy,. Mohammed V University in Rabat, Morocco.
| | - Hamza Sekkat
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy,. Mohammed V University in Rabat, Morocco
| | - Mahdi Bahij
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy,. Mohammed V University in Rabat, Morocco
| | - Mohammed Raiss
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy,. Mohammed V University in Rabat, Morocco
| | - Farid Sabbah
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy,. Mohammed V University in Rabat, Morocco
| | - Abdelmalek Hrora
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy,. Mohammed V University in Rabat, Morocco
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Armağan C, Ulusoy E, Ulusoy O, Duman M, Yılmaz D. Beyond the Expected: Importance of Recognizing Intussusception in Diabetic Ketoacidosis. TURKISH JOURNAL OF PEDIATRIC EMERGENCY AND INTENSIVE CARE MEDICINE 2024. [DOI: 10.4274/cayd.galenos.2024.10437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Hussein AA, Suliman AG. Adult Ileocolic Intussusception Following Appendectomy: A Case Report of a Rare Sonographic Finding. Cureus 2024; 16:e54195. [PMID: 38496095 PMCID: PMC10942116 DOI: 10.7759/cureus.54195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Adult intussusception is a rare condition characterized by the telescoping of one segment of the intestine into an adjacent segment. Prompt recognition and intervention are crucial due to the potential for serious complications. The present case is of adult ileocolic intussusception in a 47-year-old male patient who underwent appendectomy three weeks prior. The patient presented with constipation, lower abdominal pain, and vomiting. A transabdominal ultrasound revealed characteristic sonographic features, including a target appearance at the transverse view and the pseudokidney sign of the longitudinal view associated with the presence of reactive lymph nodes. Doppler ultrasound indicated no internal flow, suggesting possible ischemia. This case highlights the role of ultrasound in the initial evaluation of adult intussusception and emphasizes the need for further imaging modalities for detailed anatomical evaluation and lesion identification.
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Affiliation(s)
- Abdulaziz A Hussein
- College of Medicine, University of Medical Science and Technology, Khartoum, SDN
| | - Awadia G Suliman
- Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum, SDN
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawarah, SAU
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6
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Hassan M, Bryant SV, Saad AA, Shah S. Intussusception in Incisional Hernia: A Case Report and Literature Review. Cureus 2023; 15:e49346. [PMID: 38143605 PMCID: PMC10748933 DOI: 10.7759/cureus.49346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Intussusception in adults is a rare condition. Most frequently, intussusception involves the small intestine and, very rarely, the large intestine. In this report, we present the case of a 79-year-old male who was admitted with symptoms and signs of bowel obstruction due to an incarcerated incisional hernia (a tender irreducible incisional hernia associated with nausea and vomiting). His CT scan confirmed intussusception in his incisional hernia, showing the target sign. An emergency laparotomy, small bowel resection, and anastomosis were done. The histopathology report revealed the cause of intussusception to be a polypoid small bowel B cell lymphoma. It is necessary to excise the affected bowel segment in order to treat adult intussusception because it is commonly associated with malignant organic lesions. Computed tomography is the most sensitive imaging modality for intussusception; thus, we must consider a low threshold for a scan for patients presenting with abdominal pain.
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Affiliation(s)
- Mohamed Hassan
- General Surgery, Maidstone and Tunbridge Wells NHS Trust, Kent, GBR
| | - Shelby V Bryant
- Orthogeriatrics, Maidstone and Tunbridge Wells NHS Trust, Kent, GBR
| | - Ahmed A Saad
- General Surgery, Maidstone and Tunbridge Wells NHS Trust, Kent, GBR
| | - Syed Shah
- General Surgery, Maidstone and Tunbridge Wells NHS Trust, Kent, GBR
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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. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 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] [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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8
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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: 0.5] [Reference Citation Analysis] [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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9
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Jastaniah A, AlBusaidi N, Bandegi P, Grushka J. Intussusception after colonoscopic polypectomy: a rare complication. BMJ Case Rep 2023; 16:e255048. [PMID: 37270178 PMCID: PMC10254697 DOI: 10.1136/bcr-2023-255048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
We present a patient who developed an ileocolic intussusception within a few hours of undergoing an endoscopic polypectomy found on screening colonoscopy. She underwent a laparoscopic right hemicolectomy with intracorporeal anastomosis. Final histopathological examination showed no evidence of malignancy. Intussusception after colonoscopy is a rare complication, and only 11 cases have been reported prior to this case. Laparoscopic resection with intracorporeal anastomosis is a safe and feasible option in patients who are not candidates or failed conservative management.
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Affiliation(s)
- Atif Jastaniah
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Nasra AlBusaidi
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Pouya Bandegi
- Department of Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Jeremy Grushka
- Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
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10
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Tempel DG, Balk DS, Schafer JM, Hoffmann B. A brief review of diagnostic properties of point-of-care ultrasound for adult bowel intussusception: Making the case for ultrasound. J Ultrason 2023; 23:e90-e96. [PMID: 37520744 PMCID: PMC10379853 DOI: 10.15557/jou.2023.0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/30/2023] [Indexed: 08/01/2023] Open
Abstract
Undifferentiated abdominal pain in adults is a common chief complaint in acute care clinics and emergency departments worldwide, representing up to 10% of visits to emergency departments. Many patients have a non-specific presentation and an initial workup with labwork, urine analysis or X-ray might not reveal a specific diagnosis. Although bowel intussusception is a primarily pediatric disease, adult intussusception is a recognized but rare cause of bowel obstruction often requiring surgical intervention. However, recent data from advanced multi-detector computed tomography imaging shows that milder or recurring cases in adults have been underrecognized. Multi-detector computed tomography is still the imaging gold standard for detecting intussusception in adults, but new data showed that sonographers with basic training using the point-of-care ultrasound approach have a reasonable accuracy in detecting this pathology. As the point-of-care ultrasound for undifferentiated abdominal pain is an emerging core skill in the acute care setting, knowledge of sonographic signs of intestinal intussusception should be included in the skill set of physicians. Sonographic findings in adults mimic pediatric cases, but different location patterns and higher malignancy rates exist in adults. In this manuscript, we will review the current literature on adult intussusception and summarize key knowledge of intestinal intussusception in adults. We will present four adult patients diagnosed with different types of adult acute bowel intussusception using the point-of-care ultrasound and describe a focused scanning approach with typical sonographic findings.
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Affiliation(s)
- David G. Tempel
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Daniel S. Balk
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jesse M. Schafer
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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11
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Dwivedi D, Inturi R, Jayakar S, Nichkaode P. Calcified Fibrous Tumor of Jejunum: A Rare Case Report. Cureus 2023; 15:e38230. [PMID: 37252528 PMCID: PMC10225024 DOI: 10.7759/cureus.38230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
A calcifying fibrous tumor (CFT) is a benign fibroblastic tumor of soft tissues occurring at all ages with no gender predilection. Earlier, it was called a pseudotumor. It may or may not present with symptoms. It can occur anywhere in the body - the most common sites are the stomach, pleura, and intestines. Our study is presented as a case of Intussusception in a young male with symptoms of pain, abdomen, and nausea. The patient underwent an excision of the tumor, and the tumor was examined histo-pathologically and immunohistochemically, showing spindle-shaped cells in dense collagenous tissue with mild inflammation. In this case, a study we are explaining the Clinical and morphological features of the CFT and how to differentiate it from other mesenchymal tumors.
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12
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Kaspar K, Jackson A, Hunt CM, Williams S, Trudeau D, Mohammed R. Inflammatory Myofibroblastic Tumor Presenting as a Partial Bowel Obstruction: A Case Report. Cureus 2023; 15:e36798. [PMID: 37123715 PMCID: PMC10134782 DOI: 10.7759/cureus.36798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Intussusception, or telescoping of the bowel, is a rare condition in the adult population that can lead to serious complications, such as obstruction or ischemia. Most cases of intussusception are idiopathic and present with a pathognomonic "target sign" on imaging. Rarely, in adults, intussusceptions can be found with lead points, some of which may be neoplastic. Treatments for intussusception include air enemas or surgical intervention if enemas are unsuccessful in resolving the telescoped bowel. This case report discusses an atypical presentation of intussusception in an adult female with a "whirlpool sign" on imaging rather than the typical "target sign." She was found to have incorporation of mesenteric fat into telescoping bowel causing edema and partial bowel obstruction. The affected bowel was removed laparoscopically, and an end-to-end anastomosis was formed. Pathology of the resected bowel revealed a non-immunoreactive inflammatory myofibroblastic neoplasm as the lead point. Most inflammatory myofibroblastic tumors stain positive for desmin, smooth muscle actin, and anaplastic lymphoma kinase (ALK), whereas this patient was non-immunoreactive. The patient tolerated surgery well and is now pain-free with normal gastrointestinal function. This case report hopes to heighten awareness of atypical presentations of intussusceptions, the use of imaging to help aid in uncertain diagnoses, and the appropriate surgical treatment for symptomatic patients.
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Xiao N, Zhang T, Zhang J, Zhang J, Li H, Ning S. Proposal of a Risk Scoring System to Facilitate the Treatment of Enteroenteric Intussusception in Peutz-Jeghers Syndrome. Gut Liver 2023; 17:259-266. [PMID: 36424719 PMCID: PMC10018310 DOI: 10.5009/gnl210390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background/Aims Enteroenteric intussusception in Peutz-Jeghers syndrome (EI-PJS) is traditionally treated by surgery. However, enteroscopic treatment is a minimally invasive approach worth attempting. We aimed to develop a risk scoring system to facilitate decision-making in the treatment of EI-PJS. Methods This was a single-center case-control study, including 80 patients diagnosed with PJS and coexisting intussusception between January 2015 and January 2021 in Air Force Medical Center. We performed logistic regression analysis to identify independent risk factors and allocated different points to each subcategory of risk factors; the total score of individuals ranged from 0 to 9 points. Then, we constructed a risk stratification system based on the possibility of requiring surgery: 0-3 points for "low-risk," 4-6 points for "moderate-risk," and 7-9 points for "high-risk." Results Sixty-one patients (76.25%) were successfully treated with enteroscopy. Sixteen patients (20.0%) failed enteroscopic treatment and subsequently underwent surgery, and three patients (3.75%) received surgery directly. Abdominal pain, the diameter of the responsible polyp, and the length of intussusception were independent risk factors for predicting the possibility of requiring surgery. According to the risk scoring system, the incidence rates of surgery were 4.44% in the low-risk tier, 30.43% in the moderate-risk tier, and 83.33% in the high-risk tier. From low- to high-risk tiers, the trend of increasing risk was significant (p<0.001). Conclusions We developed a risk scoring system based on abdominal pain, diameter of the responsible polyps, and length of intussusception. It can preoperatively stratify patients according to the risk of requiring surgery for EI-PJS to facilitate treatment decision-making.
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Affiliation(s)
- Nianjun Xiao
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Tongzhen Zhang
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Jing Zhang
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Jinlong Zhang
- Department of Radiology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Hao Li
- Department of General Surgery, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Shoubin Ning
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing, China
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14
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Hashem A, Ismayl A, Mahmoud AA, Khalouf A, Mohammed MR. Atypical Peutz-Jeghers Syndrome Presenting With a Huge Jejunojejunal Intussusception in a Young Male: A Case Report. Cureus 2023; 15:e36107. [PMID: 37065405 PMCID: PMC10098220 DOI: 10.7759/cureus.36107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/16/2023] Open
Abstract
Intussusception is considered one of the rare causes of intestinal obstruction in adults compared to pediatric patients. It usually presents with non-specific clinical manifestations ranging from mild recurrent abdominal pain to severe acute abdominal pain. The non-specificity of its symptoms makes it difficult to diagnose preoperatively. As 90% of adult intussusceptions are due to a pathological lead point, this prompts the underlying medical condition to be identified. We herein report a rare case of a 21-year-old male with atypical clinical features of Peutz-Jegher syndrome (PJS), presenting with jejunojejunal intussusception as a result of a hamartomatous intestinal polyp. A preliminary diagnosis of intussusception was made after an abdominal computed tomography (CT) scan and was confirmed intraoperatively. Postoperatively, the patient's condition improved steadily, and he was discharged with a referral to the gastroenterologist for further assessment.
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15
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Chu A, McDonald C, Lau SYC, Stupart DA. Recto-sigmoid intussusception in a 90-year-old lady presenting with colonic obstruction. ANZ J Surg 2023; 93:359-360. [PMID: 35532149 DOI: 10.1111/ans.17760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Alex Chu
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Conor McDonald
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Steve Yee Chiang Lau
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Victoria, Geelong, Australia
| | - Douglas A Stupart
- Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Victoria, Geelong, Australia
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16
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Yang W, Cai Z, Nie P, Yuan T, Zhou H, Du Q, Qiu S, Zhang J, Yang L. Case report and literature review: Small bowel intussusception due to solitary metachronous metastasis from renal cell carcinoma. Front Oncol 2022; 12:1072485. [PMID: 36601471 PMCID: PMC9806257 DOI: 10.3389/fonc.2022.1072485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Solitary metachronous small bowel metastasis from renal cell carcinoma (RCC) is rare. In contrast to idiopathic intussusception frequently occurring in children, adult intussusception is fairly uncommon and usually indicates a malignancy. CASE PRESENTATION We presented an 84-year-old man with small bowel intussusception and obstruction due to a solitary metachronous metastasis from RCC. Computed tomography with intravenous contrast revealed small bowel obstruction and a 4 × 4 cm intraluminal soft-tissue mass with moderate enhancement. During urgent exploratory laparotomy, a pedunculated tumor of the distal ileum was found to be the lead point of intussusception. Hence, reduction of the intestinal invagination and segmental resection of the ileum with functional end-to-end anastomosis were performed. Histological examination finally confirmed the diagnosis. The postoperative recovery was uneventful. The patient was discharged without any complications on postoperative day 6. CONCLUSION The case report highlights the rarity of solitary metachronous small bowel metastases from RCC and suggests that life-long follow-up of RCC patients is critical due to its unpredictable behavior and the possibility of a long period of dormancy. Complete surgical resection remains the mainstay treatment for such patients.
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Affiliation(s)
- Wenming Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Pan Nie
- Department of Gastrointestinal Surgery, The Third People’s Hospital of Chengdu, Chengdu, China
| | - Tao Yuan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Zhou
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Du
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Siyuan Qiu
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianhao Zhang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lie Yang
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
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17
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Unique long-term simultaneous complications of conventional Roux-en-Y gastric bypass after 27 years: A case report. Int J Surg Case Rep 2022; 101:107787. [PMID: 36434869 PMCID: PMC9685287 DOI: 10.1016/j.ijscr.2022.107787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We report a case of late concomitant complications caused by conventional Roux-en-Y gastric bypaas and its managements. PRESENTATION OF CASE A 62-year-old male presented 27 years after conventional gastric bypass Y-de-Roux (BGYR) with, sudden, moderate intensity abdominal pain, nausea, biliary vomiting and hyporexia. Persistent abdominal pain was constant, so a thoracoabdominal tomography was requested by the surgeon. It confirmed the presence of intestinal intussusception associated with lithiasis and cholecystitis. The patient reported having lost 45 kg since the BGYR. He goes to the operating room for definitive management. DISCUSSION The etiology of post-BGYR intussusception is largely unknown, and multiple hypotheses have been created, such as the iatrogenic stitch created by the suture line in the entero-enteric anastomosis and the most common pattern found is antegrade. The use of contrasted CT as the most reliable diagnostic method. CONCLUSION The importance of taking into account the possible complications existing in bariatric patients and their frequency gives us the opportunity to suspect and detect them in time and in the most cases the management must be surgical.
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18
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Waack A, Nandwani S, Kolisetty K, Vattipally V. Lipoma lead point intussusception in an adult: A case report. Radiol Case Rep 2022; 17:4907-4910. [PMID: 36281283 PMCID: PMC9586856 DOI: 10.1016/j.radcr.2022.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Intussusception has been considered a rare phenomenon in adults, with most cases occurring secondary to lead points. Most adult cases of intussusception occur secondary to lead points. Lead point intussusceptions typically require surgical intervention, whereas non-lead point intussusceptions are often transient and resolve without surgery. Therefore, accurate identification of the etiology of the intussusception guides subsequent treatment. Lipomas are an uncommon type of lead point. We present a case of intussusception secondary to a lipomatous lead point and describe the radiological diagnosis and surgical management.
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Affiliation(s)
- Andrew Waack
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614, USA,Corresponding author.
| | - Swamroop Nandwani
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Karthik Kolisetty
- Wayne State University School of Medicine, 540 Canfield St, Detroit, MI 48201, USA
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19
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Kijima T, Ishida S, Kishi T, Yamaguchi M. Bowel intussusception and adhesive intestinal obstruction in neurofibromatosis type 1. J Gen Fam Med 2022; 23:354-355. [PMID: 36093221 PMCID: PMC9444018 DOI: 10.1002/jgf2.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/23/2022] [Accepted: 04/03/2022] [Indexed: 11/09/2022] Open
Abstract
We report the case that a patient with Neurofibromatosis type 1 experienced bowel intussusception and adhesive intestinal obstruction. Bowel intussusception was considered to be due to long intestinal tube and multiple intraabdominal lesions including gastrointestinal stromal tumors (GISTs).
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Affiliation(s)
- Tsunetaka Kijima
- Oda Municipal Hospital, Oda Training Center of General PracticeFaculty of Medicine, Shimane UniversityOda cityJapan
| | - Shuko Ishida
- Department of Internal Medicine, Ohda Municipal HospitalOda cityJapan
| | - Takashi Kishi
- Department of Surgery, Ohda Municipal HospitalOda cityJapan
| | - Minekazu Yamaguchi
- Oda Municipal Hospital, Oda Training Center of General PracticeFaculty of Medicine, Shimane UniversityOda cityJapan
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20
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Wong CSL, Ramadan M. Recurrent retrograde intussusception in patient with previous gastric bypass surgery. J Surg Case Rep 2022; 2022:rjac414. [PMID: 36131804 PMCID: PMC9486586 DOI: 10.1093/jscr/rjac414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
Retrograde intussusception (RI) is a rare long-term complication of gastric bypass surgery, which usually happens within the first few years after operation. The clinical presentation is vague with overlapping symptoms of bowel obstruction or ischemia. This is a case of a 37-year-old lady who presented with severe abdominal pain. She has background of Roux-en-Y gastric bypass surgery 23 years ago. She underwent emergency laparotomy, bowel resection and Roux-en-Y reconstruction due to finding of ischemic bowel segment. Unfortunately, she had recurrent presentation of RI after 6 months and similar operation was necessitated. She recovered well post-operatively, but there was no definitive cause established for the recurrence. While RI remains a rare diagnosis, clinicians should have high index of suspicion in encountering patients with acute abdomen post gastric bypass surgery. Early imaging is required for the diagnosis and surgical intervention is often warranted.
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Affiliation(s)
- Cindy Siaw Lin Wong
- Department of General Surgery, Rotherham General Hospital , Rotherham, South Yorkshire , UK
| | - Mohamed Ramadan
- Department of General Surgery, Rotherham General Hospital , Rotherham, South Yorkshire , UK
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21
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Hejazi P, Yousefi S, Hemmati H, Faraji N, Mohammadyari F. Intussusception of the bowel in a young woman: A case report. Clin Case Rep 2022; 10:e6309. [PMID: 36177073 PMCID: PMC9478627 DOI: 10.1002/ccr3.6309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/11/2022] [Accepted: 08/25/2022] [Indexed: 12/05/2022] Open
Abstract
Intussusception is a condition in which a segment of the gastrointestinal tract invaginates into the lumen of another segment. Adult intussusception is less common than juvenile intussusception in terms of cause, appearance, and treatment. Because the clinical picture can be quite atypical and difficult to interpret, it is frequently misdiagnosed at first. Herein, we report the case of a previously healthy 23-year-old female patient who presented to the Emergency Department (ED) with acute abdominal pain, vomiting, and diarrhea for 1 day following her last menstrual period. Ileocecal intussusception was discovered throughout the investigation. She was rushed for open abdominal surgery. Meckel's diverticulum was found as a pathologic lead point in the resected specimen, with no evidence of malignancy. Although intussusception is rare in adults, it should be considered in patients who have nonspecific stomach pain.
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Affiliation(s)
- Peyman Hejazi
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of MedicalRashtIran
| | - Saeed Yousefi
- Department of General Surgery, School of Medicine Road Trauma Research Center, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Hossein Hemmati
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of MedicalRashtIran
- Department of General Surgery, School of Medicine Road Trauma Research Center, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Niloofar Faraji
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of MedicalRashtIran
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22
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Chirihan A, Ezzaky S, Eloual I, Madani A, Jroundi L, Laamrani F. Jejunal intussusception on jejunostomy tube: A rare cause of occlusion in adults. Int J Surg Case Rep 2022; 97:107447. [PMID: 35905677 PMCID: PMC9403279 DOI: 10.1016/j.ijscr.2022.107447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Acute intestinal intussusception (AI) in adults secondary to jejunostomy is a rare complication and a surgical emergency requiring early diagnosis and treatment. PRESENTATION OF CASE We report the case of a 44-year-old patient, without medical history, who presented dysphagia after caustic ingestion. The patient underwent a Witzel feeding jejunostomy. The evolution was marked by the installation of abdominal distension with vomiting and alteration of the general state, the diagnosis of an intussusception in the jejunostomy tube was made in the abdominal CT scan, which required a surgical intervention, and reduction of intussusception, with simple after effects. DISCUSSION Acute intestinal intussusception (IIA) secondary to jejunostomy tube placement is a rare abdominal emergency. It manifests with signs of upper gastrointestinal obstruction. Diagnosis is based on abdominal imaging by ultrasound or CT scan. Treatment is most often surgical (Chavrier et al., 1992) [1]. CONCLUSION We present a very rare example of acute intestinal intussusception in adults, complicating jejunostomy, with non-specific clinical signs, which needed an early radiological diagnosis for adequate management.
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Affiliation(s)
- A. Chirihan
- Radiology Department, Hospital Ibn Sina, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco,Corresponding author at: Emergency Radiology Department, Hospital Ibn Sina, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
| | - S. Ezzaky
- Radiology Department, Hospital Ibn Sina, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - I. Eloual
- Radiology Department, Hospital Ibn Sina, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - A. Madani
- Department of General Surgery, CHU Mohamed VI, Oujda, Morocco
| | - L. Jroundi
- Radiology Department, Hospital Ibn Sina, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - F.Z. Laamrani
- Radiology Department, Hospital Ibn Sina, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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23
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Guerci C, Colombo F, Goi G, Zerbi P, Pirrò B, Danelli P. Case Report: Ileo-Ileal Intussusception Secondary to Inflammatory Fibroid Polyp: A Rare Cause of Intestinal Obstruction. Front Surg 2022; 9:876396. [PMID: 35495766 PMCID: PMC9051068 DOI: 10.3389/fsurg.2022.876396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Intussusception is a telescoping of a bowel segment into another and it can be a surgical urgency. Most adult intussusceptions arise from a lead point which can be benign or malignant. For this reason, intussusception in adults should undergo surgery. Here we describe a case of ileal inflammatory fibroid polyp (IFP), presenting with ileo-ileal intussusception and obstruction. Case report A 54-year-old Caucasian woman presented for acute abdominal pain. A radiography and a CT of the abdomen were performed, which showed signs of occlusion due to an ileo-ileal intussusception. An urgent laparoscopy was performed, the intussusception was extracorporeally reduced, the ileal segment involved was resected, and an ileo-ileal anastomosis was performed. The intussusception seemed to be caused by a 3-cm intra-mural lesion. Discussion Intussusception is a surgical concern. While most cases are idiopathic in children, 90% of adult intussusceptions are caused by underlying diseases. Therefore, intussusception in adults should undergo surgery. Radiology is necessary for the diagnosis: the CT scan helps localizing the lesion and shows pathognomonic signs. This case report analyzes an intussusception caused by an inflammatory fibroid polyp. Accurate diagnosis of IFP is only possible with histopathological examination, helped by immunohistochemistry. The differential diagnosis is important because some lesions are malignant. Conclusion We reported a case of intussusception caused by an IFP. The diagnosis was made with a CT scan together with intraoperative findings and histopathological examination, which excluded potential differential diagnoses. The patient underwent an explorative laparoscopy, with an ileal resection and anastomosis. Due to the risk of malignancy, surgery is mandatory.
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Affiliation(s)
- Claudio Guerci
- Department of General Surgery, Department of Biomedical and Clinical Sciences “Luigi Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
- *Correspondence: Claudio Guerci ;
| | - Francesco Colombo
- Department of General Surgery, Department of Biomedical and Clinical Sciences “Luigi Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
- Francesco Colombo
| | - Gloria Goi
- Department of General Surgery, Department of Biomedical and Clinical Sciences “Luigi Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Pietro Zerbi
- Pathology Unit, Department of Biomedical and Clinical Sciences “L. Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Barbara Pirrò
- Department of Radiology, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
| | - Piergiorgio Danelli
- Department of General Surgery, Department of Biomedical and Clinical Sciences “Luigi Sacco”, “Luigi Sacco” University Hospital, Università degli Studi di Milano, Milan, Italy
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24
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Al-Roubaie A, Withanage I. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac232. [PMID: 35599996 PMCID: PMC9116576 DOI: 10.1093/jscr/rjac232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aymen Al-Roubaie
- Correspondence address. Geraldton Hospital, Western Australia, 6530, Australia. Tel: 0061899562222; E-mail:
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25
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Mahajan A, Padashetty S, Shukla S, Agarwal U. Bowel wobble that boggles. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_275_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Qiryaqoz ZA, Katiyar U, Shebrain S. Recurrent Right Upper Quadrant Pain Masquerading an Underlying Colon Adenocarcinoma-Induced Intussusception. Case Rep Gastroenterol 2021; 15:501-506. [PMID: 34616247 PMCID: PMC8454228 DOI: 10.1159/000516863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022] Open
Abstract
Intussusception in adults is a challenging diagnosis that often requires a high degree of suspicion. In adults presenting with symptoms, almost 90% have underlying neoplasms. Most frequently, the presentation will include nonspecific abdominal pain, vomiting, and mucoid hematochezia. In this case, we present a 39-year-old female with a rare presentation of chronic, recurrent right upper quadrant abdominal pain over a 5-month interval. The misleading presentation with which the patient presented led to a delay in diagnosis and treatment of colon malignancy and serves to advocate for intussusception as a differential for adult patients presenting with obstructive symptoms of unknown origin and recurrent abdominal pain. Such cases should persuade physicians to plan prompt surgical intervention as to not delay optimal diagnostic and therapeutic outcomes.
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Affiliation(s)
- Zeena Ayad Qiryaqoz
- Western Michigan University Homer Stryker, School of Medicine, Kalamazoo, Michigan, USA
| | | | - Saad Shebrain
- Bronson Methodist Hospital, Kalamazoo, Michigan, USA
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27
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Pham HD, Nguyen THT, Tran TQ, Bui VG. Multidetector Computed Tomography Findings of Acute Abdominal Intussusception Due to Peutz-Jeghers Syndrome. Cureus 2021; 13:e16401. [PMID: 34401210 PMCID: PMC8363990 DOI: 10.7759/cureus.16401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/29/2022] Open
Abstract
Peutz-Jeghers syndrome (PJS) is an autosomal dominant inheritance characterized by intestinal hamartomatous polyps and hyperpigmented mucocutaneous macules. Bleeding, bowel obstruction, and intussusception are the most common complications in PJS patients. Individuals are infrequently present for the first time with bowel obstruction secondary to intussusception. Intestinal intussusception presentation is often observed clearly on multidetector computed tomography (MDCT) with characteristic findings, such as “target” and “pseudo-kidney” signs, and sometimes shows the cause of lead-point polyp. A complemental examination is needed to attain more diagnostic symptoms of this disorder, including pigmented spots on the oral cavity and lips, family history with multiple gastrointestinal polyps. Here, we report a case of a 17-year-old male who showed traits of Peutz-Jeghers syndrome. However, the diagnosis was not made until he later developed bowel obstruction caused by an ileo-ileal intussusception manifestation on MDCT and eventually proved in typical hamartoma on postoperative histopathology.
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Affiliation(s)
- Hong Duc Pham
- Radiology, Hanoi Medical University, Ha Noi, VNM.,Radiology, Saint Paul Hospital, Ha Noi, VNM
| | | | | | - Van Giang Bui
- Radiology, Vietnam National Cancer Hospital, Ha Noi, VNM
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28
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Marcoe JP, Chau WY. Intussusception after open Roux-en-Y gastric bypass managed with laparoscopic reduction. J Surg Case Rep 2021; 2021:rjab339. [PMID: 34386192 PMCID: PMC8354676 DOI: 10.1093/jscr/rjab339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/16/2021] [Indexed: 01/01/2023] Open
Abstract
Intussusception is a rare long-term complication following bariatric surgery. With unclear risk factors and a variable presentation, intussusception is often diagnosed in emergency departments on cross-sectional imaging. Due to the nature of the disease process, prompt involvement of a bariatric surgeon and operative intervention offers the best outcome. Here, we discuss two similar cases of jejunojejunal intussusception following open Roux-en-Y gastric bypass and abdominoplasty that were managed with operative reduction of the involved bowel.
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Affiliation(s)
- Jeffrey P Marcoe
- Department of Surgery, Penn Medicine Princeton Health, Plainsboro, NJ, USA
| | - Wai Yip Chau
- Department of Surgery, Penn Medicine Princeton Health, Plainsboro, NJ, USA
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29
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Al Zaabi AHY, Al Janahi JA, Alremeithi SN, Qayyum H. Jejunojejunal intussusception in an adult: a rare presentation of abdominal pain in the emergency department. BMJ Case Rep 2021; 14:14/7/e243787. [PMID: 34281946 DOI: 10.1136/bcr-2021-243787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abdominal pain is a common presentation to the emergency department (ED) and the differential diagnoses is broad. Intussusception is more common in children, with only 5% of cases reported in adults. 80%-90% of adult intussusception is due to a well-defined lesion resulting in a lead point, whereas in children, most cases are idiopathic. The most common site of involvement in adults is the small bowel. Treatment in adults is generally operative management whereas in children, a more conservative approach is taken with non-operative reduction. We present a case of a 54-year-old woman who presented to our ED with severe abdominal pain and vomiting. CT of the abdomen revealed a jejunojejunal intussusception. The patient had an urgent laparoscopy and small bowel resection of the intussusception segment was performed. Histopathological examination of the resected specimen found no pathologic lead point and, therefore, the intussusception was determined to be idiopathic.
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Affiliation(s)
- Ahmed Hasan Yousef Al Zaabi
- Emergency Department, Shaikh Shakhbout Medical City, Abu Dhabi, Abu Dhabi, UAE.,Emergency Department, Zayed Military Hospital, Abu Dhabi, Abu Dhabi, UAE
| | | | | | - Hasan Qayyum
- Emergency Department, Shaikh Shakhbout Medical City, Abu Dhabi, Abu Dhabi, UAE
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30
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Gilani M, Iskaros M, Nahidi SM, Mehta N, Ahmed L. Appendiceal carcinoma presenting as a rapidly enlarging abdominal mass. Int J Surg Case Rep 2021; 84:106148. [PMID: 34218018 PMCID: PMC8258854 DOI: 10.1016/j.ijscr.2021.106148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/26/2021] [Accepted: 06/26/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Appendiceal adenocarcinomas, although rare, usually present as slow-growing masses. Rarely, do they rapidly enlarge into large abdominal masses over a short period of time. Generally, we attribute rapidly growing abdominal masses to sarcomas, desmoid tumors, or gynecological masses. We present a case of a rapidly growing appendiceal adenocarcinoma in an elderly patient. Case presentation We report a case of an 83-year-old-male who presented with a one-month history of abdominal pain. A computer tomography (CT) scan identified a lower pelvic mass measuring 7.39 cm × 5.40 cm. A biopsy was done which revealed appendiceal carcinoma. A plan for radiotherapy to reduce the tumor size was made and the patient was discharged. However, the patient returned after three weeks due to worsening abdominal pain and a CT scan identified a significant enhancement in the tumor size. The patient underwent debulking surgery. Pathology of the specimen identified adenocarcinoma of the appendix. Discussion A rapidly growing carcinoma of the appendix is rare as they are known to have a slow growth rate. A swift diagnosis and intervention are required as these rapidly enhancing neoplasms in the abdomen can become unresectable and metastasize. Although there are various methods of treatment for appendiceal carcinomas, the rapid growth rate and lack of response to radiation required debulking surgery. Conclusion There exist a myriad of differential diagnoses for a rapidly growing mass in the abdomen. We are presenting the first documented case of a rapidly growing appendiceal adenocarcinoma. Surgeons should be aware of the variety of differentials in such cases.
Appendiceal carcinomas with such a rapid enhancement in size are quite rare. Having an appendiceal carcinoma for a rapid gastrointestinal tumor can facilitate immediate management in such cases. The array of differentials in such cases could lead to delays in management and treatment.
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Affiliation(s)
- Mohammad Gilani
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn 11237, NY, USA
| | - Mina Iskaros
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn 11237, NY, USA
| | | | - Nisarg Mehta
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn 11237, NY, USA
| | - Leaque Ahmed
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn 11237, NY, USA
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31
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Reddy KM, Maduke T, Wade F, Hachem C. Primary jejunal amelanotic melanoma: case report and review of literature. Clin J Gastroenterol 2021; 14:1376-1380. [PMID: 34081261 DOI: 10.1007/s12328-021-01446-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
Intussusception more commonly occurs in pediatrics but is a rare cause of bowel obstruction and gastrointestinal bleeding in adults. It typically occurs in adults due to a malignancy, which serves as a pathologic lead point. We present a case of a 64-year-old female with nausea, vomiting, and melena who was found to have intussusception associated with a primary jejunal amelanotic melanoma. Both intussusception and primary small bowel melanomas are rare causes of obstruction and bleeding. Intussusception occurring as a result of a primary small bowel amelanotic melanoma is exceedingly rare with very few reported cases. We provide a case report and review of the literature.
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Affiliation(s)
- Kavya M Reddy
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 2780 Skypark Dr., St 125, Los Angeles, CA, 90505, USA.
| | - Tinashe Maduke
- Division of Pulmonary and Critical Care, University of Missouri School of Medicine, 1 Hospital Drive, Columbia, MO, 65212, USA
| | - Francis Wade
- Department of Internal Medicine, Saint Louis University School of Medicine, 1008 South Spring Ave, Saint Louis, MO, 63110, USA
| | - Christine Hachem
- Department of Internal Medicine, Saint Louis University School of Medicine, 1008 South Spring Ave, Saint Louis, MO, 63110, USA.,Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, 1008 South Spring Ave, Saint Louis, MO, 63110, USA
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Zanni M, Vaccari S, Lauro A, Marino IR, Cervellera M, D'Andrea V, Tonini V. Bleeding Edge Therapy: Ileocolic Intussusception Due to Ileocecal Valve Adenocarcinoma and Its Management in an Adult Patient-Case Report and Literature Review. Dig Dis Sci 2021; 66:1436-1440. [PMID: 33511490 DOI: 10.1007/s10620-021-06849-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 02/08/2023]
Abstract
Adenocarcinoma as the primary cause of bowel intussusception is uncommon. We describe the case of a 86-year-old patient admitted for ileocecal intussusception due to the presence of adenocarcinoma, located in the ileocecal valve and right colon. The etiologies of intussusception, its diagnosis, and conservative or surgical treatments are discussed, with attention placed on the indications for reduction of the invagination prior to surgical resection.
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Affiliation(s)
- M Zanni
- Emergency Surgery Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - S Vaccari
- Department of Surgical Sciences, La Sapienza University Hospital, Rome, Italy
| | - A Lauro
- Emergency Surgery Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy.
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Emergency Surgery Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University Hospital, Rome, Italy
| | - V Tonini
- Emergency Surgery Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
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Yeap PM, Szewczyk-Bieda M, Zealley I. Findings beyond Crohn's disease encountered on magnetic resonance enterography: a pictorial review of diseases inside and outside the bowel. Singapore Med J 2021; 62:173-181. [PMID: 33948670 DOI: 10.11622/smedj.2021038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Phey Ming Yeap
- Department of Radiology, Sengkang General Hospital, Singapore
| | | | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
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Tarchouli M, Ait Ali A. Adult Intussusception: An Uncommon Condition and Challenging Management. Visc Med 2021; 37:120-127. [PMID: 33981752 PMCID: PMC8077547 DOI: 10.1159/000507380] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/19/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Intussusception is a rare condition in adults. A pathological lesion is usually found with a significant percentage of malignancy. The optimal treatment is still not universally clear. METHODS This is a retrospective review of adult patients with a diagnosis of intestinal intussusception and surgically treated at our institution from January 2009 to December 2018. Clinical, operative, and histological details were collected and analyzed. RESULTS A total of 26 cases, 16 males and 10 females, were diagnosed with surgically proven intussusception during the 10-year period. The mean age was 45 years (range 21-70). Using ultrasound and/or computed tomography as imaging study, the preoperative diagnosis was made in 21/26 (81%) patients. Five intussusceptions were discovered only upon exploratory laparotomy for intestinal obstruction. There were 19 (73%) cases of enteric and 7 (27%) cases of colonic intussusceptions. All patients underwent surgical exploration. Intestinal resection with immediate anastomosis was the technique of choice for most patients. A single patient underwent stoma for peritonitis secondary to intestinal perforation. An organic cause has been systematically revealed, and no idiopathic intussusception was detected. Etiology was malignant in 9 (35%) cases. CONCLUSION Adult intussusception should be considered in any patient with subacute abdominal pain. Considering the high rate of malignancy, intestinal resection without attempting reduction is highly recommended for colonic intussusceptions. However, a more selective approach can be adopted for enteric intussusceptions.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Surgery, First Medical and Surgical Center, Agadir, Morocco
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Abdelmounaim Ait Ali
- Department of Visceral Surgery, Mohammed V Military Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Dutta S, Gaur NK, Reddy A, Jain A, Nelamangala Ramakrishnaiah VP. Antegrade Jejunojejunal Intussusception: An Unusual Complication Following Feeding Jejunostomy. Cureus 2021; 13:e13264. [PMID: 33728200 PMCID: PMC7948317 DOI: 10.7759/cureus.13264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Feeding jejunostomy (FJ) is a simple surgical procedure for enteral nutrition. But it can develop complications that may require re-exploration and can be life-threatening. Common complications include mechanical ones such as tube migration or dislocation, infection, gastrointestinal symptoms and fluid and electrolyte imbalances. However, intussusception is a rare complication of FJ. A 54-year-old gentleman underwent a D2 subtotal gastrectomy with Roux-en-Y gastrojejunostomy with FJ. On the sixth postoperative day, he developed severe colicky pain associated with abdominal distension and bilious vomiting. Ultrasonography and computed tomography revealed a 10-cm long jejunojejunal intussusception with the FJ tube at the center of the intussusception with proximal jejunal loops' distension. The patient was taken up for a re-exploratory laparotomy with manual reduction of the intussusception and a new FJ insertion distal to the previous enterotomy site. The patient had an uneventful postoperative recovery.
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Affiliation(s)
- Souradeep Dutta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Naveen Kumar Gaur
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ankit Jain
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Oor JE, Goense L, Wiezer MJ, Derksen WJM. Incidence and treatment of intussusception following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Obes Relat Dis 2021; 17:1017-1028. [PMID: 33632616 DOI: 10.1016/j.soard.2021.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/08/2020] [Accepted: 01/11/2021] [Indexed: 11/15/2022]
Abstract
Intussusception is a rare yet potentially life-threatening complication following Roux-en-Y gastric bypass (RYGB). Multiple case reports have described this complication, and recently, several retrospective studies have been published describing the surgical treatment of intussusception. The aim of this study was to determine the incidence of intussusception following RYGB and provide insight into outcomes of subsequent operative treatment. A systematic search was performed using the PubMed and Cochrane databases. Article selection was performed using the preferred reporting items for systematic reviews and meta-analyses criteria, and selecting articles describing the incidence of intussusception following RYGB. Data was pooled only when 3 or more comparable studies reported on the same outcome. The incidence of intussusception and outcomes of subsequent treatment were analyzed. Furthermore, all published case reports describing intussusception following RYGB were analyzed. A total of 74 studies published between 1991 and 2020 were included, describing 191 patients who underwent RYGB and developed intussusception. We retrieved 68 case reports, including 84 patients, and 6 retrospective studies describing outcomes of surgical treatment in 107 patients, which were used to pool data. There was a predominance of females among the included patients (85%-98%), and patients had significant weight loss following RYGB. The pooled incidence of intussusception following RYGB was .64%. Resection of the affected segment was performed in 34% of the patients. A pooled recurrence rate of 22% was found during follow-up. Resection and reconstruction of the jejunojejunostomy appears to be associated with the lowest risk of recurrence and acceptable complication rates. The pooled incidence of intussusception following RYGB is 0.64%. Typically, patients are female with significant weight loss after RYGB. Symptoms include abdominal pain, nausea, and vomiting. Diagnosis is based on clinical findings and computed tomography scans, warranting early surgical exploration due to the high risk for ischemia. Resection of the jejunojejunostomy appears to be associated with the lowest recurrence rates and acceptable complication rates.
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Affiliation(s)
- Jelmer E Oor
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Lucas Goense
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wouter J M Derksen
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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Gange ER, Grieco MA, Myers SD, Guenther TM. Idiopathic adult intestinal intussusception: a rare cause of an acute surgical abdomen. J Surg Case Rep 2020; 2020:rjaa542. [PMID: 33425320 PMCID: PMC7778519 DOI: 10.1093/jscr/rjaa542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
Intussusception is uncommon among adults. The condition, which is defined as a telescoping of a proximal portion of the small or large bowel into the lumen of an adjacent segment of bowel, is most commonly seen in children. Among pediatric cases, the majority is benign and treated non-operatively. However, in adults, intussusception is the result of pathologic and often malignant lead points in the majority of cases. This makes surgical resection and tissue diagnosis the only definitive treatment option. While the majority of adult intussusception cases involves a pathologic lead point, a small percentage is idiopathic, without an identifiable lead point. We present a 32-year-old man with acute on chronic abdominal pain and cross-sectional imaging that identified jejunal intussusception, which was confirmed in operating room and resected. Interestingly, no pathologic lead point was identified on pathologic review. We discuss our diagnostic approach, surgical decision making and final tissue diagnosis.
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Affiliation(s)
- Eliot R Gange
- Department of Surgery, University of California Davis, Sacramento, CA 95817, USA
| | - Marco A Grieco
- Department of Surgery, University of California Davis, Sacramento, CA 95817, USA
| | - Scott D Myers
- Department of Radiology, David Grant USAF Medical Center, CA 95433, USA
| | - Timothy M Guenther
- Department of Surgery, University of California Davis, Sacramento, CA 95817, USA
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Tatsuta K, Sakata M, Sugiyama K, Akai T, Suzuki K, Suzuki Y, Kawamura T, Morita Y, Kikuchi H, Hiramatsu Y, Kurachi K, Takeuchi H. Successful laparoscopic approach for idiopathic adult colo-colonic intussusception: a case report. Surg Case Rep 2020; 6:300. [PMID: 33237497 PMCID: PMC7688730 DOI: 10.1186/s40792-020-01077-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background Adult intussusception is recognized as an abdominal emergency. More than 90% of adult patients with intussusception have distinct causes that are related to benign or malignant tumors. In contrast, idiopathic intussusceptions, which are observed in children, are rare conditions in adult. Especially, colo-colonic idiopathic intussusceptions are rare among them. Surgery is traditionally considered the primary treatment option. Recently, laparoscopic surgery has been reported to be safe and feasible. However, laparoscopic surgical reduction, which is a common procedure in pediatric surgery, is not common in adult intussusception. Case presentation We report a 34-year-old man who presented with sudden abdominal pain. Computed tomography revealed the target sign in the transverse colon. There was no evidence of bowel obstruction, bowel wall edema, or tumor. We diagnosed idiopathic intussusception and selected laparoscopic procedure because of the strong abdominal pain experienced by the patient. There were no signs of perforation, bowel wall ischemia, or tumor in abdominal cavity. We confirmed idiopathic colo-colonic anterograde intussusception. Laparoscopic surgical reduction was achieved by a combination of delicate direct pressure on the anal side of the transverse colon and gentle pulling on the oral side. The patient’s postoperative course was uneventful. Conclusions We achieved successful surgical reduction laparoscopically because of an accurate preoperative diagnosis based on characteristic computed tomography features and appropriate surgical technique. Laparoscopic procedure and surgical reduction is considered to be an effective treatment strategy for adult idiopathic intussusceptions with severe symptoms.
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Affiliation(s)
- Kyota Tatsuta
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Mayu Sakata
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kosuke Sugiyama
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Toshiya Akai
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Katsunori Suzuki
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yuhi Suzuki
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Takafumi Kawamura
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kiyotaka Kurachi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Jejunojejunal intussusception following jejunostomy closure: A case report. Int J Surg Case Rep 2020; 76:446-449. [PMID: 33207409 PMCID: PMC7599362 DOI: 10.1016/j.ijscr.2020.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intussusception can occur anywhere in the small and large bowel, ileocolic intussusception is the most common type in adult and there are few reported cases of jejunojejunal intussusception. Here we report a case of jejunojejunal intussusception due to an iatrogenic lead point at the feeding jejunostomy closure site. CASE PRESENTATION In 2019 we received a 63-year-old female complaining of abdominal pain, constipation, and repeated vomiting for five days. On physical examination, she was dehydrated, in pain, and had a nasogastric tube that was draining bilious fluid. The abdomen was tender, there was a long midline incision with tension sutures at the lower of incision. CT of the abdomen showed ileoileal intussusception. Proper resuscitation and preoperative preparation were done. During exploratory laparotomy, there was jejunojejunal intussusception. The intussusception was reduced gently and completely. Resection of the lead point segment done with end to end anastomosis. The patient recovered uneventfully and discharged home on the 5th postoperative day. The patient followed up after one and three months with no complications. CONCLUSION During the closure of the feeding jejunostomy site by hand-sewn technique, over invagination of the second (seromuscular) layer of the wall of the jejunum might become so thick at the site of the closure that it acts as a lead point for intussusception. We reported a case of such a scenario.
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Abramov R, Mansour S, Hallon K, Bishara B, Khuri S. Synchronous Colon Cancer Presenting as a Different Concomitant Surgical Emergency; Case Report and Literature Review. HELLENIC JOURNAL OF SURGERY 2020; 92:182-185. [DOI: 10.1007/s13126-020-0572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/02/2020] [Accepted: 09/02/2020] [Indexed: 10/21/2022]
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Akashige T, Sato K, Odajima H, Yamazaki S. A case report of recurrent intussusception caused by small bowel lymphangioma in an adult. Int J Surg Case Rep 2020; 75:126-130. [PMID: 32950942 PMCID: PMC7508682 DOI: 10.1016/j.ijscr.2020.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/05/2020] [Indexed: 11/30/2022] Open
Abstract
Lymphangioma is a benign tumor that rarely arises in gastrointestinal tract. Small bowel lymphangioma can cause intussusception in adults. The symptoms of small bowel intussusception in adults resemble those of adhesive small bowel obstruction. Reduction is not sufficient and surgical resection of affected bowel should be performed. Introduction Adult intussusception and lymphangioma in gastrointestinal tract are uncommon entities respectively. Recurrent intussusception due to lymphangioma of the small intestine is extremely rare and mimics adhesive small bowel obstruction (SBO). Presentation of case A 37 year old man presented with acute abdominal pain and vomiting. He had been admitted several times for adhesive SBO after laparoscopic cholecystectomy at age 21. He was initially managed with a long tube placement, with which he used to get well. This time, the symptoms once relieved but soon relapsed, so an exploratory laparotomy was performed. Intraabdominal adhesiolysis was performed alongside the excision of a small segment of damaged jejunum. Intussusception of jejunum was noted and its reduction was also performed. Unfortunately, the symptoms continued after the operation, and computed tomography revealed a recurred intussusception of the jejunum. A reoperation with an additional resection of small intestine surrounding intussusception was performed. The symptoms subsided after the second operation and the patient was discharged. Pathological examination revealed lymphangioma within the affected lumen. Discussion Intussusception in an adult is often caused by a tumor but can be caused by postoperative adhesion. The reduction is a potential option of treatment if there is no tumor suspected, but sometimes it would be uneasy to affirm the non-existence of tumors. Conclusion We present this rare case of recurrent jejuno-jejunal intussusception caused by small bowel lymphangioma with review of literature. Taking the possibility of recurrence and malignancy into account, the resection should always be considered in such patients.
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Affiliation(s)
- Toru Akashige
- Department of Surgery, Ohta Nishinouchi General Hospital, Koriyama, Fukushima, Japan.
| | - Kota Sato
- Department of Surgery, Ohta Nishinouchi General Hospital, Koriyama, Fukushima, Japan
| | - Hajime Odajima
- Department of Pathology, Ohta Nishinouchi General Hospital, Koriyama, Fukushima, Japan
| | - Shigeru Yamazaki
- Department of Surgery, Ohta Nishinouchi General Hospital, Koriyama, Fukushima, Japan
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Abstract
RATIONALE Adult intussusception is rarely observed, accounting for about 5% of all cases of intussusception. Most ileal lipomas are asymptomatic and do not need any special treatment. Herein, we describe a case with ileocolic intussusception caused by ileal lipoma. PATIENT CONCERNS A 27-year-old woman complaints of intermittent abdominal pain for 10 days. DIAGNOSIS Abdominal computed tomography demonstrated ileocolic intussusception. Colonoscopy revealed a spherical polypoid lesion with surface capillary rising from the lateral wall of the ileum. A diagnosis of ileocolic intussusception was made. INTERVENTIONS The patient underwent primary resection of the intussuscepted intestine after which an end-to-end anastomosis was performed. OUTCOMES Histopathology report confirmed a 4.5 cm × 3.5 cm lipoma in the terminal ileum. The patient was discharged on a postoperative day 9 without complications. LESSONS We describe the difficulties in diagnosis and treatment of this rare cause of intussusception and review the literature on adult intussusceptions. The ileal lipoma is a very rare cause of ileocolic intussusception. Abdominal CT and colonoscopy are important for the diagnosis of intussusception and abdominal lipomas. Surgical resection remains the treatment of choice.
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Affiliation(s)
- Chunyu Shi
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University
| | - Lu Pan
- Department of Pediatric Immunology, Allergy and Rheumatology, The No.1 Hospital of Jilin University
| | - Bin Song
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University
| | - Yongjian Gao
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University
| | - Leichao Zhang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ye Feng
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University
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Hu L, Yin G, Zhang D, Geng Z, Bai J. Tube feeding associated postoperative intussusceptions: A single center case series study. Medicine (Baltimore) 2019; 98:e17783. [PMID: 31689848 PMCID: PMC6946534 DOI: 10.1097/md.0000000000017783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Postoperative intussusception in adults is a rare but serious complication after gastrointestinal anastomosis surgery. Postoperative intussusception in adults caused by tube feeding was rarely been reported before. The aim of the current study was to summarize the clinical data on a group of patients with tube feeding associated postoperative intussusceptions. The possible etiology and preventive measures will also be discussed. PATIENT CONCERNS During the period from May 2013 to January 2018, patients who received gastrointestinal anastomosis in our center were retrospectively reviewed. Preoperative variables including standard demographic and pathological characteristics as well as the treatment and prognosis were also analyzed. DIAGNOSES Tube feeding associated postoperative intussusceptions. INTERVENTIONS 7 patients were identified with tube feeding associated postoperative intussusceptions with a prevalence of 0.38%. Intussusceptions occurred from 10 to 69 days (median 25.7 days) postoperatively in an acute form. OUTCOMES None of the patients had spontaneous reduction and all patients underwent surgery. Antegrade efferent limb intussusceptions were found in all the cases. Intussusception occurred at efferent loop at 23.6 cm (range 15-60) from the gastrointestinal or Braun anastomosis. None of the patients was found recurrence throughout the follow-up period. LESSONS In contrast with other postoperative intussusceptions, the tube feeding associated postoperative intussusceptions have special clinical manifestations. It is more likely to occur in early period of time after the surgery and in an acute form. Surgical correction is recommended for most of patients. Several measures have been proposed to prevent such complications after gastrointestinal surgery, however more research and information are still needed.
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Balogun OS, Olajide TO, Afolayan M, Lawal A, Osinowo AO, Adesanya AA. An appraisal of the presentation and management of adult intussusception at a Nigerian Tertiary Hospital. Niger Postgrad Med J 2019; 26:169-173. [PMID: 31441455 DOI: 10.4103/npmj.npmj_47_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Intussusception in adults is considered rare in surgical practice. It is the causative lesion in a small proportion of cases of intestinal obstruction and lower gastrointestinal bleeding. In the last decade, the incidence of adult intussusception appears to be increasing at our centre. Aims This study aims to document the pattern of presentation and management outcome of adult intussusception at our institution during the last decade. We also observed the occurring trends of this lesion. Patients and Methods This was a 10-year retrospective study of consecutive adult patients with intussusception seen at our institution from July 2008 to June 2018. Information on biodata, clinicopathological features and management outcome retrieved from case notes and pathology records were analysed on a personal computer using SPSS version 23. Results Twenty adult patients who had intussusception were seen during this period. There were 9 (45%) males and 11 (55%) females giving a male-to-female ratio of 1:1.2. The mean age of presentation was 45 (range 18-66) years. Clinical features were abdominal pain (85%), abdominal distension (80%), vomiting (70%), rectal bleeding (70%) and palpable abdominal mass (35%). Majority of patients (70%) presented with features of intestinal obstruction. Idiopathic intussusception (55%) accounted for more than half of the cases with the jejunoileal variety (30%) as the most common pathological type. One patient who had intussusception in the postoperative period was treated with manual reduction at laparotomy. Bowel resections were performed in the remaining 19 (95%) patients. Conclusion Adult intussusception is still uncommon in our general surgical practice. Bowel resection is the mainstay of treatment.
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Affiliation(s)
- Olanrewaju Samuel Balogun
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Thomas O Olajide
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Michael Afolayan
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Abdulrazzak Lawal
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adedapo Olumide Osinowo
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adedoyin A Adesanya
- Department of Surgery, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
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Okal F, Allarakia J, Alghamdi A, Alqurashi Z, Aboalsamh G, Abdelhady A. A case report of retrograde intussusception 3 years post Roux-en-Y gastric bypass. J Surg Case Rep 2019; 2019:rjz238. [PMID: 31428309 PMCID: PMC6693397 DOI: 10.1093/jscr/rjz238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/15/2019] [Accepted: 07/20/2019] [Indexed: 11/14/2022] Open
Abstract
Retrograde jejuno-jejunal intussusception is a rare complication of bariatric surgeries. It causes acute sudden symptoms that require immediate surgical intervention. We report a case of a 46-year-old female who underwent Roux-en-Y gastric bypass (REYGP) 3 years prior. The patient presented to the emergency department with acute sudden abdominal pain, nausea and vomiting. Laparoscopically, intussuscepting small bowel segment was found gangrenous, and it was resected and end-to-end anastomoses were fashioned. The postoperative course was uneventful, and the patient remained asymptomatic for the 12 months of follow-up. Patients with retrograde intussusception experience an intolerable severe pain that necessitates surgical intervention. The etiology of intussusception as a complication after REYGP is unclear, yet theoretically some possible etiologies exist. The initial diagnosis of retrograde intussusception is made based on abdominal computed tomography. Early intervention significantly reduces morbidity and mortality.
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Affiliation(s)
- Fahad Okal
- College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Jawad Allarakia
- College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Amer Alghamdi
- College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Zahid Alqurashi
- College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Ghaleb Aboalsamh
- College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia.,General Surgery Section, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Ahmed Abdelhady
- General Surgery Section, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
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Zaghrine E, Algaba R, Nicolas G, Koury E, Saliba C, Osman D, Al-Shami J, Sayegh JSAA, Kfoury T. Idiopathic Ileo-Ileo-Cecal Intussuception in a 25-Year-Old Female. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:872-876. [PMID: 31217416 PMCID: PMC6598787 DOI: 10.12659/ajcr.914110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intussusception is defined as the penetration or telescoping of a segment of bowel into a more distal segment. Intussusception is a common cause of small bowel obstruction, especially in children. However, this finding is much less common in adults. Furthermore, when present in adults, intussusception is often found in association with some sort of organic mass, such as a tumor or pancreatic divisum that acts as a lead point, dragging the proximal segment into the distal one. The presence of an intussusception in an adult patient with no obvious lead point is very uncommon. CASE REPORT Here we report a case of ileo-ileo-cecal double intussusception in an adult patient that yielded no lead point on surgical exploration. The patient was a 25-year-old female who presented with symptoms of obstruction and was diagnosed with the intussusception via computed tomography scan. Surgical resection of the bowel was necessary as reduction could not be accomplished. CONCLUSIONS The finding of intussusception in an adult patient is far less common than in children, and even more rare when a lead point is not established. When surgery is required, a thorough exploration should be performed to search any signs of a potential lead point. Laparoscopy is usually preferred to laparotomy; however, in this case the degree of distention determined the surgical approach. Thus, due to severe distention, laparotomy was preferred.
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Affiliation(s)
- Elie Zaghrine
- Department of Emergency, Joseph Bracops Hospital, Bruxelles, Belgium
| | - Roberto Algaba
- Department of Digestive Surgery, Joseph Bracops Hospital, Bruxelles, Belgium
| | - Gregory Nicolas
- Department of Surgery, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Elliott Koury
- Department of Gasteroenterology, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Christian Saliba
- Department of Surgery, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Dani Osman
- Department of Surgery, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | | | | | - Tony Kfoury
- Department of Emergency, Joseph Bracops Hospital, Bruxelles, Belgium
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Harano T, Sanchez PG, Bauza G, McDyer JF, D'Cunha J. Jejuno-jejunal intussusception in a post-lung transplant patient from a gastrojejunostomy tube: A case report. Int J Surg Case Rep 2019; 55:129-131. [PMID: 30731299 PMCID: PMC6365386 DOI: 10.1016/j.ijscr.2019.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Gastro-jejunostomy tube is used for post-pyloric feeding for critical-ill patient who cannot tolerate oral alimentation. Jejuno-jejunal intussusception is a rare complication of gastrojejunostomy tube. PRESENTATION OF CASE A 39-year-old male with history of severe combined immunodeficiency, Achalasia and end-stage lung disease underwent double lung transplantation. After lung transplantation, he required gastrojejunostomy(GJ) tube placement due to his esophageal disease. Four days after gastrojejunostomy tube placement, he developed jejuno-jejunal intussusception. A 15 cm segment of thickened and enlarged bowel, which consisted of the intussusception were identified laparoscopically. Surgical reduction was performed without bowel resection. DISCUSSION Intussusception is uncommon in adults compared to pediatric population. In this rare case, the jejunal limb of the GJ tube placed in jejunum was the cause of jejunojejunal intussusception serving as the lead point. The GJ tube should not be placed farther down from ligaments of Treiz to prevent jejuno-jejunal intussusception. CONCLUSIONS A heightened index of suspicion for this rare complication should exist with a presenting patient has signs of proximal bowel obstruction and CT evidence of intussusception.
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Affiliation(s)
- Takashi Harano
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Graciela Bauza
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - John F McDyer
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
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Girón F, Báez Y, Amaya J. Autotrasplante renal por aneurisma de arteria renal en un paciente con riñón funcional único: reporte de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Syed H, Syed L, Parampalli U, Uheba M. Adult intussusception secondary to diverticular disease. BMJ Case Rep 2018; 2018:bcr-2018-226678. [PMID: 30413459 DOI: 10.1136/bcr-2018-226678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intussusception is the invagination of a proximal segment of bowel into the lumen of an adjacent distal segment. It is a common condition in the paediatric age group although it rarely occurs in adults. Organic lesions in the bowel wall are the primary cause of adult intussusceptions with malignant neoplasms being the most common. However, we present a rare case of a 92-year-old man diagnosed with an intussusception of the sigmoid-rectal colon secondary to a diverticular stricture.
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Affiliation(s)
- Habib Syed
- Medical Student, Brighton and Sussex Medical School, Brighton, UK
| | - Labib Syed
- Medical Student, Barts and The London School of Medicine and Dentistry, London, UK
| | - Umesh Parampalli
- General Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Mokhtar Uheba
- General Surgery, Royal Sussex County Hospital, Brighton, UK
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Hassan WAW, Teoh W. Intussusception after Colonoscopy: A Case Report and Review of Literature. Clin Endosc 2018; 51:591-595. [PMID: 30300987 PMCID: PMC6283765 DOI: 10.5946/ce.2018.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/21/2018] [Indexed: 11/14/2022] Open
Abstract
Intussusception after colonoscopy is an unusual complication. A MEDLINE search revealed only 7 reported cases. We present a report of a 28-year-old man who developed abdominal pain several hours after routine colonoscopy and in whom computed tomography (CT) revealed colocolic intussusception. We postulate that this condition is iatrogenic and induced by suctioning of gas on withdrawal of the colonoscope. A common observation among the reported cases was abdominal pain several hours after colonoscopy and right-sided intussusception. All cases had colonoscopy reaching the right side of the colon. Treatment for adult intussusception remains controversial with regard to reduction versus resection, especially given the high association with a pathological cause and malignancy. Among the 8 reported cases, only the current case did not require surgery. A combination of benign colonoscopy, CT, and the clinical picture should provide sufficient information to initially choose a more conservative treatment approach.
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Affiliation(s)
- Wan Amir Wan Hassan
- Colorectal Surgery, Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - William Teoh
- Colorectal Surgery, Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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