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Qiu X, Gao J, Gao J. Ovarian teratoma leading to colonic intussusception: a case report. Front Oncol 2025; 15:1555443. [PMID: 40376581 PMCID: PMC12078161 DOI: 10.3389/fonc.2025.1555443] [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: 04/08/2025] [Indexed: 05/18/2025] Open
Abstract
Intussusception in adults is relatively rare compared to that in children and is typically caused by underlying benign or malignant intestinal diseases. We report a case of a 40-year-old female who presented with colonic intussusception and obstruction caused by an ovarian teratoma invading a segment of the colon. Contrast-enhanced CT imaging revealed a soft tissue mass within the colon, and colonoscopy identified a large cystic lesion approximately 6.0 × 6.0 cm in size located 20 cm from the anal verge. This lesion obstructed the lumen, causing significant narrowing. Preoperatively, the condition was misdiagnosed as intussusception caused by a colonic diverticulum. During laparoscopic exploration, a left ovarian tumor invading the colon was identified as the cause of the intussusception and obstruction. Consequently, partial colectomy and left oophorectomy were performed. Histopathological examination confirmed the diagnosis of a mature ovarian teratoma. The postoperative recovery was uneventful, and the patient was discharged in good health. This case report presents a rare instance of intussusception, highlighting the challenges associated with achieving an accurate preoperative diagnosis. Surgical intervention remains the primary treatment modality for patients with this condition.
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Affiliation(s)
- Xiujuan Qiu
- Department of Oncology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jiahao Gao
- Department of General Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jun Gao
- Department of General Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
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Harada T, Sakamoto Y, Ishikawa T, Shoji H, Toda K, Muranaka T, Taketomi A. Avoiding unnecessary bowel resection in adult intussusception: a case report in a patient with multiple prior surgeries utilizing intraoperative enteroscopy. Clin J Gastroenterol 2025:10.1007/s12328-025-02138-7. [PMID: 40293656 DOI: 10.1007/s12328-025-02138-7] [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: 03/14/2025] [Accepted: 04/15/2025] [Indexed: 04/30/2025]
Abstract
Intussusception is a rare condition in adults, accounting for approximately 5% of all cases. Unlike pediatric intussusception, which is typically idiopathic, the adult cases are usually associated with an underlying pathology, most commonly malignancies. The surgical intervention is often required, but in small bowel cases, where malignancy is less frequent than in colonic intussusception, the decision regarding resection requires careful consideration. There are no prior reports on the use of intraoperative enteroscopy for small bowel intussusception evaluation. We report the case of a 78-year-old woman who presented with acute abdominal pain, nausea, and bilious vomiting. She had a history of distal gastrectomy with gastroduodenostomy (Billroth-I) and total gastrectomy with Roux-en-Y for gastric ulcer and residual stomach cancer, respectively. Abdominal computed tomography (CT) revealed small bowel intussusception without clear evidence of a lead point lesion. The emergency laparotomy confirmed intussusception 15 cm distal to the Roux-en-Y anastomosis, which was manually reduced. The intraoperative enteroscopy revealed inflammatory changes but no malignancy or structural abnormalities. Given the absence of a lead point lesion and the viability of the bowel, resection was avoided. The patient had an uneventful postoperative course and was discharged without complications. Adult intussusception is frequently associated with malignancy, yet cases without a lead point lesion pose a diagnostic and therapeutic challenge. The surgical history, including prior anastomotic procedures, may contribute to the pathogenesis through disrupted intestinal pacemaker activity and retrograde contractions. While second-look surgery can aid in bowel viability assessment, it carries a high complication rate. This case highlights the potential role of intraoperative enteroscopy in evaluating small bowel viability, minimizing unnecessary resection, and improving surgical decision-making. Although further studies are needed to assess its role in optimizing surgical outcomes, intraoperative enteroscopy may be a valuable adjunct in cases of adult small bowel intussusception without an apparent lead point.
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Affiliation(s)
- Takuya Harada
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yuzuru Sakamoto
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
- Department of Surgery, Wakkanai City Hospital, Chuo 4-Chome 11-6, Wakkanai, Hokkaido, 097-8555, Japan.
| | - Takaya Ishikawa
- Department of Surgery, Wakkanai City Hospital, Chuo 4-Chome 11-6, Wakkanai, Hokkaido, 097-8555, Japan
| | - Hirotaka Shoji
- Department of Surgery, Wakkanai City Hospital, Chuo 4-Chome 11-6, Wakkanai, Hokkaido, 097-8555, Japan
| | - Kiko Toda
- Department of Internal Medicine, Wakkanai City Hospital, Chuo 4-Chome 11-6, Wakkanai, Hokkaido, 097-8555, Japan
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Tetsuhito Muranaka
- Department of Internal Medicine, Wakkanai City Hospital, Chuo 4-Chome 11-6, Wakkanai, Hokkaido, 097-8555, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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Khursheed A, Rizvi SAA, Ali WM, Hassan MJ, Ahmad M, Ali I. Ascending colon carcinoma presenting as ileocecal intussusception in an adult-a case report with review of literature. J Surg Case Rep 2025; 2025:rjaf110. [PMID: 40051806 PMCID: PMC11881689 DOI: 10.1093/jscr/rjaf110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Accepted: 02/10/2025] [Indexed: 03/09/2025] Open
Abstract
Intussusception is telescoping of a proximal segment of gastrointestinal tract within the lumen of another. Intussusception is a common presentation in pediatric population and present with a classic triad of abdominal pain, bloody diarrhea and a palpable mass. However, intussusception in adults is a rare entity accounting for only 5% of the total cases and is the underlying cause for 1%-5% of all the cases of intestinal obstruction. The adult population caters a varied nonspecific symptoms making diagnosis challenging. We present the case of 32-year-old woman who presented with abdominal pain, altered bowel habits and weight loss. The patient's clinical presentation, familial history of colonic malignancy underscores the importance of considering malignancy as the underlying cause. A contrast enhanced computed tomography (CECT) whole abdomen was done to diagnose the condition. The patient underwent right hemicolectomy and had an uneventful postoperative period. Histopathological findings were consistent with mucinous adenocarcinoma of the caecum.
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Affiliation(s)
- Areeba Khursheed
- Department of General Surgery, JNMCH, AMU, Uttar Pradesh 202002, India
| | - Syed A A Rizvi
- Department of General Surgery, JNMCH, AMU, Uttar Pradesh 202002, India
| | - Wasif M Ali
- Department of General Surgery, JNMCH, AMU, Uttar Pradesh 202002, India
| | - Mohammad J Hassan
- Department of General Surgery, JNMCH, AMU, Uttar Pradesh 202002, India
| | - Manzoor Ahmad
- Department of General Surgery, JNMCH, AMU, Uttar Pradesh 202002, India
| | - Imad Ali
- Department of General Surgery, JNMCH, AMU, Uttar Pradesh 202002, India
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Kitahata S, Nakamura A, Kimura Y, Fukumoto M, Matsuoka K, Matsuda T, Murakawa K, Murakami T, Onishi K, Izumoto H, Kanemitsu‐Okada K, Kawamura T, Kuroda T, Matsuoka J, Tada F, Miyata H, Hiraoka A, Tange K, Yamamoto Y, Takeshita E, Ikeda Y, Furukawa S, Tsubouchi E, Ninomiya T, Hiasa Y. Characteristics of Adult Intussusception due to Malignancy in Japanese Patients. JGH Open 2025; 9:e70118. [PMID: 39981119 PMCID: PMC11840692 DOI: 10.1002/jgh3.70118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 01/09/2025] [Accepted: 02/03/2025] [Indexed: 02/22/2025]
Abstract
Aims Adult intussusception (AI) is often associated with organic diseases. However, few studies have examined the causes of AI in Japanese patients. This study aimed to elucidate the clinical characteristics of AI due to malignancy in Japanese patients. Methods and Results From 2013 to 2021, 54 Japanese patients with AI (≥ 20 years) diagnosed at our hospital were enrolled and divided into two groups according to the cause of AI (malignancy group, n = 26; other diseases group, n = 28). The patients' clinical characteristics were retrospectively evaluated. Patients in the malignancy group were significantly older than those in the other diseases group (p < 0.001). The cutoff value for age as a factor associated with AI due to malignancy was 64 years (area under the curve: 0.78, 95% confidence interval [CI]: 0.65-0.90). The frequency of chronic symptoms (> 14 days) in AI due to malignancy was significantly higher than the frequencies of acute (≤ 4 days) and subacute (4-14 days) symptoms (p = 0.010 and p = 0.027, respectively). The colonic type of AI was significantly more common than the small intestinal and ileocecal types in the malignancy group (both p < 0.001). Multivariate analysis showed that age of ≥ 64 years, chronic symptoms, and the colonic type were independently associated with AI due to malignancy (adjusted odds ratio [OR] 16.00, 95% CI 1.23-208.00; adjusted OR 32.70, 95% CI 1.50-712.00; adjusted OR 31.20, 95% CI 2.68-363.00, respectively). Conclusion Advanced age (≥ 64 years), chronic symptoms, and AI in the colon are characteristics of AI due to malignancy.
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Affiliation(s)
- Shogo Kitahata
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Ayaka Nakamura
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Yuka Kimura
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Mai Fukumoto
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Kana Matsuoka
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Takuya Matsuda
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Kazuya Murakawa
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Taisei Murakami
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Kei Onishi
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Hirofumi Izumoto
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | | | - Tomoe Kawamura
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Taira Kuroda
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Junko Matsuoka
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Fujimasa Tada
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Hideki Miyata
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Atsushi Hiraoka
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Kazuhiro Tange
- Department of Inflammatory Bowel Diseases and TherapeuticsEhime University Graduate School of MedicineMatsuyamaEhimeJapan
| | - Yasunori Yamamoto
- Endoscopy CenterEhime University Graduate School of MedicineMatsuyamaEhimeJapan
| | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and TherapeuticsEhime University Graduate School of MedicineMatsuyamaEhimeJapan
| | - Yoshiou Ikeda
- Endoscopy CenterEhime University Graduate School of MedicineMatsuyamaEhimeJapan
| | | | - Eiji Tsubouchi
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Tomoyuki Ninomiya
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaEhimeJapan
| | - Yoichi Hiasa
- Department of Gastroenterology and MetabologyEhime University Graduate School of MedicineMatsuyamaEhimeJapan
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Tran AT, Tran THN, Tran VTM, Thi HN. Colocolic intussusception causing by a large lipoma of the ascending colon: A rare case report. Radiol Case Rep 2025; 20:136-139. [PMID: 39469599 PMCID: PMC11513680 DOI: 10.1016/j.radcr.2024.09.121] [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: 06/16/2024] [Revised: 09/21/2024] [Accepted: 09/23/2024] [Indexed: 10/30/2024] Open
Abstract
Intussusception is a rare condition in adults that occurs when a segment of the bowel telescopes into the lumen of the more distal segment. Colocolic intussusception accounts for only 8.3-38% of all intussusception cases in adults, the majority due to malignant causes such as adenocarcinoma, lymphoma, leiomyosarcoma, undifferentiated carcinoma... Lipoma is the most common benign cause, followed by gastrointestinal stromal tumors and adenomatous polyps. Surgery is the recommended treatment for colonic lipoma-induced intussusception. In this report, we describe a rare case of a 52-year-old female patient with colocolic intussusception due to an ascending colon lipoma which was diagnosed by ultrasound and computed tomography.
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Affiliation(s)
- Anh Tuan Tran
- Radiology Center, Bach Mai hospital, Hanoi, Vietnam
- Stroke and Brain Vascular Disease, University of Medicine and Pharmacy (VNU-UMP), Vietnam National University, Hanoi, Vietnam
- Department of Radiology, University of Medicine and Pharmacy (VNU-UMP), Vietnam National University, Hanoi, Vietnam
| | - Thi Hong Nhung Tran
- Department of Radiology, Vinmec Times City International Hospital, Hanoi, Vietnam
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6
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Chang H, Kang J, Pu T, Su R, Chen C, Hu J. Diffuse large B-cell lymphoma-induced intussusception: A case report and literature review. Clin Case Rep 2024; 12:e9046. [PMID: 38895050 PMCID: PMC11183938 DOI: 10.1002/ccr3.9046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/21/2024] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Adult intussusception necessitates early surgical intervention. We emphasis the significance of considering diffuse large B-Cell lymphoma in differential diagnoses for adult intussusception, particularly in the colon, to ensure precise diagnosis and optimal management.
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Affiliation(s)
- Hao‐Cheng Chang
- Department of Surgery, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Jung‐Cheng Kang
- Department of Surgery, Division of Colon and Rectal SurgeryTaiwan Adventist HospitalTaipeiTaiwan
| | - Ta‐Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri‐Service General Hospital Songshan BranchNational Defense Medical CenterTaipeiTaiwan
- Division of Colon and Rectal Surgery, Department of Surgery, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Ruei‐Yu Su
- Department of Pathology, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
- Department of Pathology and Laboratory MedicineTaoyuan Armed Forces General HospitalTaoyuanTaiwan
| | - Chao‐Young Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Je‐Ming Hu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
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7
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Sciberras N, Zammit SC, Sidhu R. Small bowel intussusception - aetiology & management. Curr Opin Gastroenterol 2024; 40:175-182. [PMID: 38190421 DOI: 10.1097/mog.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Adult small bowel intussusception (SBI) differs in incidence, symptomatology and management from the more commonly encountered paediatric intussusception. This review spans across the multitude of causes of adult SBI, and summarises the diagnostic work-up and management options according to recent literature. RECENT FINDINGS There has been an increase in use of small bowel capsule endoscopy and point-of-care ultrasound for the diagnosis of acute adult SBI. SUMMARY A high degree of suspicion of a malignant cause of SBI is required in the adult population. Alarm clinical features include weight loss, history of malignancy, and iron deficiency anaemia. CT remains the gold standard imaging technique as it may identify the lead point and thus aid in endoscopic or surgical management. If malignancy is excluded and no lead point is identified, serology and histology may be helpful to look for inflammatory, infective and autoimmune aetiology.
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Affiliation(s)
| | | | - Reena Sidhu
- Department of Gastroenterology, Sheffield Teaching Hospital NHS Foundation Trust, Department of Infection, Immunity & Cardiovascular Diseases, University of Sheffield, UK
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8
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Greer D, Fernandez A. A case report of impacted fecalith within mucosal pouch: an unusual cause of colocolic intussusception. Ann Coloproctol 2024; 40:S15-S17. [PMID: 34788981 PMCID: PMC11162846 DOI: 10.3393/ac.2021.00724.0103] [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: 08/10/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022] Open
Abstract
Intussusception involving the colon is unusual in adults and when present is managed with resection due to the risk of malignancy. We present an unusual case where the intussusceptum was impacted stool in a mucosal pouch in the transverse colon. The patient presented with bleeding per rectum and abdominal pain and was found to have a colocolic intussusception on computed tomography. Colonoscopy showed an ulcerated mass in the transverse colon. A laparoscopic right hemicolectomy was performed. Histopathology demonstrated known chronic lymphocytic leukemia, but not solid malignancy. A large fecalith impacted within a mucosal pouch had acted as the lead point. This represents a highly unusual but benign cause of intussusception.
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Affiliation(s)
- Douglas Greer
- Department of Surgery, South East Regional Hospital, Bega, NSW, Australia
| | - Adrian Fernandez
- Department of Surgery, South East Regional Hospital, Bega, NSW, Australia
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9
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Heng V, Oh S, Leng H, Chhun V, Lee YD. Adult colorectal intussusception caused by giant lipoma-A case report. Clin Case Rep 2024; 12:e8682. [PMID: 38562575 PMCID: PMC10982120 DOI: 10.1002/ccr3.8682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 04/04/2024] Open
Abstract
Key Clinical Message Adult intussusception commonly has a leading point. In the colon, malignancy is a prevalent etiology for the leading point; however, benign tumors should also be considered. We present a case of colorectal intussusception caused by a giant lipoma. Abstract Intussusception in adults is comparatively infrequent in contrast to children, and in adult colonic intussusception, malignancy is the predominant cause of the leading point. Lipoma, an uncommon tumor in the gastrointestinal tract, rarely induces colonic intussusception in adults. We present the case of a 55-year-old Cambodian man experiencing cramping abdominal pain. He presented with mild abdominal distension with tenderness in the lower abdomen. On the rectal examination a large palpable mass was detected three to four centimeters from the anal verge. Abdominal computerized tomography revealed a collapsed sigmoid colon with mesenteric fat invaginated into the lumen of the upper rectum. Emergency laparotomy was performed and during the surgery the sigmoid intussusception spontaneously reduced. A mass was identified in the mid-sigmoid colon, leading to the decision for segmental resection of the sigmoid colon with the mass and subsequent end-to-end anastomosis. Histological examination results confirmed the mass as a lipoma. Colorectal intussusception in adults due to a lipoma is a relatively rare, with only a few reported cases in the literature.
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Affiliation(s)
- Vouchly Heng
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Suk‐Kyu Oh
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Hour Leng
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
| | - Vireak Chhun
- Department of PathologyHebron Medical CenterPhnom PenhCambodia
| | - Young Don Lee
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
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10
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Turco J. Synchronous intussusception with primary neuroendocrine tumour in an adult. J Surg Case Rep 2024; 2024:rjae128. [PMID: 38463738 PMCID: PMC10924722 DOI: 10.1093/jscr/rjae128] [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: 01/12/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Intussusception in adults is rare. There are only a few cases in the literature that report two lead points resulting in double or synchronous intussusception. We present a case of synchronous intussusception in a 45 year old man with neuroendocrine tumour of the ileocaecal valve and lipomatous polyp of the jejunum.
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Affiliation(s)
- Jennifer Turco
- Department of General Surgery, St John of God Public and Private Hospitals, 1 Clayton street, Midland 6056, Australia
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11
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Mesa N, Rodriguez LO, Lacey M, Seetharamaiah R. Unveiling the Enigma of a Colonic Neuroendocrine Tumor Causing Ileocolic Intussusception: A Case Report. Cureus 2024; 16:e54823. [PMID: 38529438 PMCID: PMC10962868 DOI: 10.7759/cureus.54823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Intussusception in adults is rare and is often associated with a pathologic lead point. While colonic adenocarcinoma is a common cause, well-differentiated colonic neuroendocrine tumors are exceedingly rare. We present a unique case of an ileocolic intussusception due to a distal ascending colonic neuroendocrine tumor, emphasizing the diagnostic challenges and importance of prompt intervention. A 60-year-old male with a previous screening colonoscopy in June of 2022 presented to the Emergency Department with two days of cramping, right upper abdominal pain with associated nausea and two episodes of emesis. A Computed Tomography (CT) scan of the abdomen and pelvis revealed an ileocolic intussusception noted at the level of the hepatic flexure with a lead point. Emergent surgical intervention identified a mass in the distal ascending colon, and a right hemicolectomy with successful side-to-side functional end-to-end anastomosis was performed. Final pathology confirmed a well-differentiated stage III colonic neuroendocrine tumor. After a successful postoperative recovery, a full body Positron Emission Tomography (PET) scan was completed and resulted in no evidence of avid metastatic disease. The patient was placed in cancer remission. Intussusceptions in the adult population are uncommon, and the etiology typically involves a pathologic lead point causing intestinal invagination. In this case, prompt diagnosis and management resulted in successful health outcomes with reduced mortality and morbidity, as untreated intussusception can have devastating results. Given this patient's colonoscopy was approximately one year ago, the probability of a colonic neoplasm acting as the lead point was low. However, identification of the intussusception resulted in a timely and lifesaving emergent right hemicolectomy, as this stage III tumor has a five-year median survival rate of only 50% if left untreated. This case report highlights a rare case of adult ileocolic intussusception involving a lead point at the distal ascending colon identified as an uncommon, well-differentiated stage III neuroendocrine tumor. It showcases the importance of considering intussusception as a diagnosis when evaluating adults with abdominal pain for prompt and adequate intervention, especially when malignant lead points and bowel necrosis are suspected.
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Affiliation(s)
- Natalie Mesa
- General Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Lizis O Rodriguez
- General Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Mitchel Lacey
- General Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Rupa Seetharamaiah
- Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
- Department of Surgery, Baptist Hospital of Miami, Miami, USA
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12
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Borré CI, Boyle B, Lynch K, Kanaparthi A, Csizmar CM, Larson DP, Braithwaite MD, Johnson IM, Witzig TE, Suarez DA. Burkitt Lymphoma Presenting as Ileocolic Intussusception in an Adult. OPEN JOURNAL OF BLOOD DISEASES 2023; 13:121-132. [PMID: 38361601 PMCID: PMC10868555 DOI: 10.4236/ojbd.2023.134014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Adult intussusception is rare, highly associated with a malignant lead point, and often requires emergent surgical management. We report the case of a 44-year-old male who presented with generalized abdominal pain and was found to have early ileocolic intussusception secondary to a large ileocecal mass. Biopsies of the mass and an enlarged cardiophrenic lymph node, as well as pleural fluid cytology were all consistent with Burkitt lymphoma (BL). Curiously, the patient's abdominal exam was reassuring, and the intussusception and malignant bowel obstruction resolved over 36 hours with conservative management alone. With a Burkitt lymphoma international prognostic index (BL-IPI) score of 2, the patient proceeded to treatment with combination chemoimmunotherapy and attained a complete response after four cycles. There was no bowel perforation or recurrent intussusception throughout treatment. Thus, this report marks the first reported case of adult BL-associated intussusception to resolve with non-invasive management and establishes a precedent for conservative management in select patients.
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Affiliation(s)
| | | | - Kelsey Lynch
- Department of Medicine, Mayo Clinic, Rochester, USA
| | | | | | - Daniel Philip Larson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | | | | | | | - Diego Armando Suarez
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, USA
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13
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Sadeghi MS, Haghshenas N, Khanghah AS. Synchronous colonal and jejunal adenocarcinomas leading to intussusception in an adult female suffering from celiac disease. J Surg Case Rep 2023; 2023:rjad635. [PMID: 38026748 PMCID: PMC10663067 DOI: 10.1093/jscr/rjad635] [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: 09/04/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Coeliac disease, a relatively rare gluten-sensitive enteropathy, correlates with small intestinal malignancies, especially lymphoma and adenocarcinoma. Any kind of masses, whether malignant or benign, in the way of natural peristaltic action may increase the probability of intussusception, telescoping invagination of the proximal segment into the distal one causing an obstruction. We report a case of synchronous adenocarcinomas of the colon and jejunum in a 3-year-old female presenting as bowel obstruction. She also had coeliac disease. During laparotomy, the surgical team encountered jejunojejunal intussusception as the cause of obstruction. There are direct relationships among coeliac disease, increased risk of adenocarcinoma, and repeated intussusceptions in the absence of mass in adults. The intussusception phenomenon in an adult necessitates investigating a more severe lead point than simple mesenteric lymphadenopathy.
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Affiliation(s)
- Mirsalim Seyyed Sadeghi
- Department of Surgery, Fatemi Hospital, Ardabil University of Medical Sciences, Ardabil 5613754497, Iran
| | - Negin Haghshenas
- Department of Anaesthesiology, Fatemi Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Samady Khanghah
- Department of Surgery, Fatemi Hospital, Ardabil University of Medical Sciences, Ardabil 5613754497, Iran
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Fu K, Montesino B, Seetharamaiah R. Ileocecal Intussusception and Obstruction Secondary to Metastatic Melanoma: A Case Report. Cureus 2023; 15:e46036. [PMID: 37900408 PMCID: PMC10603218 DOI: 10.7759/cureus.46036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Intussusception is an uncommon cause of bowel obstruction in adults. Most cases are associated with a pathologic lead point, commonly attributable to benign or malignant tumors. Malignant skin melanoma can metastasize to the gastrointestinal tract and lead to significant morbidity and mortality if left undiagnosed or untreated. In this article, we present the case of a 43-year-old Hispanic female with a history of stage III melanoma on her neck removed four years ago who presented with three weeks of lower abdominal pain, nausea, and vomiting. Abdominal and pelvic imaging showed a high-grade small bowel obstruction with a transition point at the mid-ileum. Diagnostic laparoscopy confirmed an ileocecal intussusception secondary to a 5 cm mass at the lead point. The patient underwent successful resection of the ileum 5 cm from the intussusception and the ascending colon due to the high risk of malignancy. Pathology of the mass was found to be malignant melanoma, but the resected lymph nodes and omentum did not contain any malignancy. The patient tolerated the procedure well and is currently undergoing chemotherapy. This case demonstrates metastatic melanoma as a rare cause of intussusceptions in adults. It emphasizes the importance of considering intussusception when evaluating adult patients with classic lower abdominal pain. Prompt surgical intervention is recommended in suspected cases to address the significant likelihood of malignancy, especially in patients with an oncological history.
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Affiliation(s)
- Kai Fu
- General Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Brittany Montesino
- General Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Rupa Seetharamaiah
- Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
- Surgery, Baptist Hospital of Miami, Miami, USA
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15
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Fiordaliso M, De Marco FA, Costantini R, Panaccio P, Chiesa PL. Adenocarcinoma of the sigmoid colon causing sigmoido-rectal intussusception: A rare entity in adults. Int J Surg Case Rep 2023; 107:108331. [PMID: 37210804 DOI: 10.1016/j.ijscr.2023.108331] [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: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Intussusception occurs when a more proximal portion of the bowel (intussusceptum) invaginates into the more distal bowel (intussuscipiens). The pathomechanism is thought to involve altered bowel peristalsis at the intraluminal lesion, which is then a lead point for the intussusceptum. Intestinal intussusception is rare in adults, accounting for approximately 1 % of all bowel obstructions. We report a unique case in which a partially obstructing sigmoid cancer caused full thickness rectal prolapse requiring surgical intervention. PRESENTATION OF CASE A 75-year-old male presented in the emergency department due to anal haemorrhage for 5 days. On clinical examination his abdomen was distended with signs of peritoneal irritation in the right quadrants. The CT scan showed sigmoid-rectal intussusception with an sigmoid colonic tumour. The patient underwent emergency anterior resection of the rectum without reduction of the intussusception. Histological examination revealed a sigmoid adenocarcinoma. DISCUSSION Intussusception is the most common urgent situation among the pediatric population but its incidence in adults is very rare. The diagnosis is difficult to establish with history and physical exam findings alone. Since in adults, unlike children, in most cases a malignant pathology acts as a lead point, the treatment of this pathology still reserves doubts. Recognizing and understanding pertinent signs, symptoms, and imaging findings is essential to the early diagnosis and appropriate management of adult intussusception. CONCLUSION The appropriate management of adult intussusception is not always clear cut. There is controversy about the reduction before resection in cases of sigmoidorectal intussusception.
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Affiliation(s)
| | | | - Raffaele Costantini
- Institute of Surgical Pathology, Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Italy.
| | - Paolo Panaccio
- General Surgery Unit, Renzetti Hospital, Lanciano, Italy
| | - Pierluigi Lelli Chiesa
- Pediatric Surgery Unit, Hospital "Santo Spirito" of Pescara and University "G. d'Annunzio" of Chieti Pescara, Pescara, Italy
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16
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González-Carreró Sixto C, Baleato-González S, García Palacios JD, Sánchez Bernal S, Junquera Olay S, Bravo González M, García Figueiras R. Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management. RADIOLOGIA 2023; 65:213-221. [PMID: 37268363 DOI: 10.1016/j.rxeng.2022.10.005] [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: 12/02/2020] [Accepted: 06/30/2021] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged <16 years. Thus, 21 cases in adults (mean age, 57 years) were analyzed. RESULTS The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumours were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its aetiology and therapeutic management.
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Affiliation(s)
| | - S Baleato-González
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - S Sánchez Bernal
- Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - S Junquera Olay
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - M Bravo González
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - R García Figueiras
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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17
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Hubbard G, Wood K, Vudayagiri L, Chong H, Gemma R. Colonic Intussusception Due to a Cecal Tumor: A Representative Case. Cureus 2023; 15:e36338. [PMID: 37077612 PMCID: PMC10108979 DOI: 10.7759/cureus.36338] [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: 03/17/2023] [Indexed: 04/21/2023] Open
Abstract
We present a case of ileo-colic intussusception in a 58-year-old female, with representative clinical features and useful intraoperative images. These cases are relatively rare in adults and should always be concerning for underlying malignancy, as was seen in our patient's case. In recent years, there has been a slight shift in the management of this pathology, and we present our arguments in agreement with these changes.
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Affiliation(s)
- Grant Hubbard
- General Surgery, Western Reserve Hospital, Cuyahoga Falls, USA
| | - Keaton Wood
- General Surgery, Western Reserve Hospital, Cuyahoga Falls, USA
| | | | - Hannah Chong
- General Surgery, Rocky Vista University College of Osteopathic Medicine, Greenwood Village, USA
| | - Rick Gemma
- General Surgery, Western Reserve Hospital, Cuyahoga Falls, USA
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18
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Zhao G, Meng W, Bai L, Li Q. Case report: An adult intussusception caused by ascending colon cancer. Front Surg 2022; 9:984853. [PMID: 36157411 PMCID: PMC9500318 DOI: 10.3389/fsurg.2022.984853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Adults with bowel intussusception caused by malignant tumors are fairly uncommon. We presented a case of a 64-year-old woman whose intussusception was secondary to ascending colon cancer. A color Doppler ultrasonography of the abdomen revealed a low echo mass in the right middle abdomen. Physical examination and digital rectal examination were both unremarkable. Computed tomography (CT) revealed a concentric circle change in the colon, as well as the mesenterium and arteries. Electronic colonoscopy discovered the colonic giant proliferative lesions and stenosis. Adenocarcinoma with moderate differentiation was discovered after a biopsy. Then laparotomy showed intussusception and the tumor was located in the ascending colon. The postoperative pathological test revealed moderately differentiated adenocarcinoma in the right colon invaded the whole layer. After hospitalization, the patient was discharged without any complications. This case highlights that rational use of CT, endoscopy, and timely surgery combines an effective strategy for the treatment of adult intussusception.
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Affiliation(s)
- Guowei Zhao
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Wenjun Meng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lian Bai
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Qigang Li
- Department of Gastrointestinal Surgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
- Correspondence: Qigang Li
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19
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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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20
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Ileocolic intussusception caused by giant submucosal colonic lipoma: A rare case report. Int J Surg Case Rep 2022; 97:107451. [PMID: 35932712 PMCID: PMC9403280 DOI: 10.1016/j.ijscr.2022.107451] [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] [Received: 05/23/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION An adult intussusception is associated with a pathological lesion involving a lead point, such as a benign polyp, enlarged mesenteric lymph node, lipoma, Meckel's diverticulum, lymphoma, gastrointestinal stromal tumor, primary, or metastatic adenocarcinoma. A lipoma is usually asymptomatic, however, lipomas >2 cm may cause intussusception by forming a lead point. PRESENTATION OF CASE A 46-year-old South Korean man was admitted and presented with a two-week history of intermittent abdominal pain and discomfort. Abdominal pelvic computed tomography scan revealed that about 6.5 cm of fat attenuation mass is present in the ascending colonic loop with about 15 cm of ileal loop pulled into the ascending colonic loop through the ileocecal valve. Mechanical obstruction with ileocolic intussusception was found in distal ileum. The colonoscopy detected a huge mass in the mid-ascending colon blocking the passage of the colonoscope. The patient was diagnosed with an ileocolic intussusception which was suspected to be a huge lipoma. Laparoscopic assisted right hemicolectomy was performed and the follow-up pathologic examination showed that it is a submucosal lipoma. CONCLUSION The present case report concerns a 46-year-old male with a long segment ileocolic intussusception due to a giant lipoma arising from the ascending colon and whose intussusception was surgically resected.
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21
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Rodríguez-González P, Pérez-Quintero R, Cisneros-Cabello N, Balongo-García R. Invaginación sigmoidea en un adulto. ¿Está indicada la reducción endoscópica preoperatoria? REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La invaginación intestinal o intususcepción es el deslizamiento de una parte del intestino dentro de otra adyacente. Es la causa más común de obstrucción intestinal en niños entre 3 meses y 6 años de edad, con una baja incidencia en adultos, correspondiente al 1 % del total de los cuadros obstructivos en el adulto. Su localización en colon es poco frecuente, pero conviene prestar especial atención por su asociación a lesiones malignas.
Caso clínico. Varón de 39 años que acude a Urgencias con cuadro de obstrucción intestinal secundario a una invaginación en sigmoide. Se intenta reducción endoscópica, sin éxito, por lo que se indicó cirugía urgente, realizando sigmoidectomía y anastomosis colorrectal. El resultado anatomopatológico informó un adenoma de gran tamaño como causante de la invaginación.
Conclusión. Existen controversias respecto al manejo endoscópico en invaginación intestinal en los adultos, especialmente en el colon, debido al elevado porcentaje de etiología tumoral maligna, recomendándose actualmente la resección en bloque sin reducción, para minimizar el riesgo de potencial siembra tumoral.
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22
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Teixeira H, Hauswirth F, Römer N, Muller MK, Baechtold M. An ileo-colic intussusception reaching down to the descending colon - A case report. Int J Surg Case Rep 2022; 93:107009. [PMID: 35381552 PMCID: PMC8985450 DOI: 10.1016/j.ijscr.2022.107009] [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: 03/01/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Intussusception in healthy adults is rare and often associated with oncologic diseases. This case report presents a case of an ileo-colic intussusception reaching down to the descending colon in a healthy adult that required ileo-colic resection. Case presentation We present a case of a 78-year-old male patient with acute onset unspecific abdominal pain. The medical history was unremarkable. Preoperative radiologic assessments showed an invagination of the small intestine into the colon without any signs of polyps or tumours. An emergency laparotomy with resection of the affected intestine was performed. The pathologist described a 49 cm length of intussuscepted colon and an additional 7 cm intussusception of the terminal ileum. A circular area with multiple polyps extending over 8 cm in the colon could be identified. The microscopic findings showed a low-grade dysplasia within this area. Following surgery, the patient was discharged to rehabilitation after a ten-day hospitalization. Clinical discussion Intussusception in adults is rare and the clinical presentation includes unspecific symptoms making the diagnosis challenging. In 90% of the cases, a pathologic lesion is found (two-thirds are neoplasms). An intussusception involving the colon should be treated surgically without prior reduction due to the high incidence of a neoplasm and the risk for perforation and tumour dissemination. Conclusion In the literature, neoplastic disease represents the major cause for intussusception in adults. This report presents a rare case of an ileo-colic intussusception reaching down to the descending colon treated successfully with a subtotal colectomy.
Intussusception is a differential diagnosis in adults with abdominal pain. In up to 90% of the cases, an underlying disease or condition can be identified. Increasing incidental diagnosis due to better quality and availability of CT scan. If the colon is involved, the best treatment is surgical without prior reduction.
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Affiliation(s)
- Hugo Teixeira
- Department of Surgery, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland.
| | - Fabian Hauswirth
- Department of Surgery, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland.
| | - Nina Römer
- Department of Surgery, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
| | - Markus K Muller
- Department of Surgery, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland.
| | - Matthias Baechtold
- Department of Surgery, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland.
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23
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Combined Ileoileal and Ileocolic Intussusception Secondary to Inflammatory Fibroid Polyp in an Adult: A Case Report. Medicina (B Aires) 2022; 58:medicina58020310. [PMID: 35208633 PMCID: PMC8874661 DOI: 10.3390/medicina58020310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Intestinal intussusception is relatively rare in adults and accounts for approximately 5% of intestinal obstruction. Intussusception is classified into subtypes according to the location, including ileoileal, ileocolic, ileo-ileocolic, colo-colic, jejuno-ileal, or jejuno-jejunal; the ileocolic type being the most common. However, intussusception of a combination of different subtypes has rarely been reported in the available literature. Abdominal computed tomography (CT) is the most accurate tool to evaluate intestinal intussusception. The pathological lead point in the intestine typically results in adult intussusception. Surgical intervention is usually adopted in cases of adult intussusception due to a high incidence of underlying bowel malignancy. An inflammatory fibroid polyp (IFP) is one of the uncommon benign neoplasms of the gastrointestinal (GI) system, which can result in intestinal intussusception. Herein, we present a case of a 50-year-old female with combined ileoileal and ileocolic intussusception, which was initially diagnosed by abdominal CT. Therefore, laparoscopic right hemicolectomy surgery was performed, confirming the final diagnosis as ileoileal and ileocolic intussusception secondary to IFP.
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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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Mulita F, Tchabashvili L, Liolis E, Maroulis I. Transient small bowel intussusception in a 30-year-old male. PRZEGLAD GASTROENTEROLOGICZNY 2021; 16:252-253. [PMID: 34584589 PMCID: PMC8456771 DOI: 10.5114/pg.2021.108991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/07/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Francesk Mulita
- Department of General Surgery, General University Hospital, Patras, Greece
| | - Levan Tchabashvili
- Department of General Surgery, General University Hospital, Patras, Greece
| | - Elias Liolis
- Department of Internal Medicine, General University Hospital, Patras, Greece
| | - Ioannis Maroulis
- Department of General Surgery, General University Hospital, Patras, Greece
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26
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González-Carreró Sixto C, Baleato González S, García Palacios JD, Sánchez Bernal S, Junquera Olay S, Bravo González M, García Figueiras R. Intestinal intussusception in adults: location, causes, symptoms, and therapeutic management. RADIOLOGIA 2021; 65:S0033-8338(21)00119-3. [PMID: 34454717 DOI: 10.1016/j.rx.2021.06.008] [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: 12/02/2020] [Revised: 06/15/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. RESULTS The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.
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Affiliation(s)
| | - S Baleato González
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | | | - S Sánchez Bernal
- Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - S Junquera Olay
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - M Bravo González
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - R García Figueiras
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
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27
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Kim KH. Intussusception in Adults: A Retrospective Review from a Single Institution. Open Access Emerg Med 2021; 13:233-237. [PMID: 34163260 PMCID: PMC8214106 DOI: 10.2147/oaem.s313307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose Intussusception is uncommon in adults and often manifests as nonspecific symptoms. Owing to its low incidence and the lack of knowledge on the symptoms, causes, and treatment of adult intussusception (AI), many surgeons may have limited experience in the diagnosis and treatment of intussusception. This study aimed to describe the experience of AI and discuss its clinical presentation, etiology, and management. Material and Methods I retrospectively reviewed patients aged 19 years and older who were diagnosed with intussusception at a single institution between March 2010 and December 2019. Results Among 28 patients who were finally analyzed, abdominal pain was the most commonly observed symptom. Ileocolic and ileoileal intussusceptions were the most common locations, and a lead point was observed in 19 cases (68%), of which malignancy was observed in six (21%). Bowel resection was performed in 27 cases. According to the pathological findings of the tissue from the resected section, nine and three cases of small bowel intussusception (SBI) were benign and malignant, respectively, whereas 13 and three cases of colonic intussusception (CI) were benign and malignant, respectively. On comparing SBI and CI, it was observed that most variables did not significantly differ, except for the duration of symptoms. Conclusion SBI had a higher lead point than CI. The rate of malignancy in CI cases in this study was lower than that reported in other studies. En-bloc resection can be considered the first option for the treatment of AI.
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Affiliation(s)
- Ki Hoon Kim
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Panzera F, Di Venere B, Rizzi M, Biscaglia A, Praticò CA, Nasti G, Mardighian A, Nunes TF, Inchingolo R. Bowel intussusception in adult: Prevalence, diagnostic tools and therapy. World J Methodol 2021; 11:81-87. [PMID: 34026581 PMCID: PMC8127421 DOI: 10.5662/wjm.v11.i3.81] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
Intussusception is defined as invagination of one segment of the bowel into an immediately adjacent segment. The intussusception refers to the proximal segment that invaginates into the distal segment, or the intussusception (recipient segment). Intussusception, more common occur in the small bowel and rarely involve only the large bowel. In direct contrast to pediatric etiologies, adult intussusception is associated with an identifiable cause in almost all the symptomatic cases while the idiopathic causes are extremely rare. As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. In this review, we discuss the symptoms, location, etiology, characteristics, diagnostic methods and treatment strategies of this rare and enigmatic clinical entity in adult.
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Affiliation(s)
- Francesco Panzera
- Department of Endoscopy, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Beatrice Di Venere
- Department of Surgery, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Marina Rizzi
- Department of Endoscopy, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Assunta Biscaglia
- Department of Radiology, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | | | - Gennaro Nasti
- Department of Surgery, "Madonna delle Grazie" Hospital, Matera 75100, Italy
| | - Andrea Mardighian
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Thiago Franchi Nunes
- Department of Radiology, Santa Casa de Campo Grande, Campo Grande 79010-050, Brazil
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
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Ayyanar P, Behera G, Mishra TS, Purkait S, Patra S, Mitra S. The Clinico-histopathological Spectrum of Tumors and Tumor-Like Lesions in Adult Intussusception. J Gastrointest Cancer 2021; 53:511-519. [PMID: 34014410 DOI: 10.1007/s12029-021-00647-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intussusception is an uncommon cause of intestinal obstruction in adults. The etiology of this disease differs from the children. Thus, its management depends on the possible etiology and is different from pediatric cases. AIMS We aimed to study the clinico-histopathological spectrum of the tumors and tumor-like lesions in the intussusception in adults. MATERIAL AND METHODS A retrospective review of the adult (> 18 years) intussusception cases was performed. The clinical data and follow-up were obtained. The histopathology was reviewed along with the special stains and immunohistochemistry for ascertaining a histopathological diagnosis. RESULTS Fifteen cases of adult intussusception were identified from 107 resected specimens of adult intestinal obstruction. The mean age was 44.5 years with a male/female ratio of 1.1:1. A definitive pathology could be ascertained in 80% of the cases (n = 12/15). Eight cases had benign non-neoplastic etiology (53.3%) (33.3% tumor-like lesions) while seven cases (46.7%) had neoplastic etiology (20% benign neoplastic; 26.7% malignant neoplastic). All cases of colonic or enterocolic intussusceptions were associated with neoplasia whereas 90% of the enteric intussusceptions occurred due to benign non-neoplastic causes. CONCLUSIONS: Non-neoplastic causes are predominant in the enteric intussusceptions while neoplastic causes are more commonly associated with colonic or enterocolic intussusceptions. The post-operative histopathological examination concludes on the adequacy of the index surgery or the provision of further management if required.
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Affiliation(s)
- Pavithra Ayyanar
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | - Gayatri Behera
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | | | - Suvendu Purkait
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | - Susama Patra
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India
| | - Suvradeep Mitra
- Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India.
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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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31
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Wen J, Sharma VK, Lwin A, Beh JCY. Clinics in diagnostic imaging (204). Gastro-gastric intussusception due to gastric gastrointestinal stromal tumour (GIST). Singapore Med J 2021; 61:69-74. [PMID: 32152639 DOI: 10.11622/smedj.2020015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 95-year-old woman presented with abdominal bloating and anorexia of one week's duration. Contrast-enhanced computed tomography (CT) revealed features in keeping with gastro-gastric intussusception with a lead mass. Oesophagogastroduodenoscopy demonstrated a large 5-cm pedunculated fundal mass intussuscepted into the distal stomach. The patient subsequently underwent endoscopic polypectomy and open gastrostomy. Histological evaluation of the gastric mass revealed a gastrointestinal stromal tumour. Her postoperative course was uneventful. We herein describe the radiological features of adult intussusception and illustrate the usefulness of CT in the detection and characterisation of lead masses.
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Affiliation(s)
- Jinhang Wen
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Vasu Keshav Sharma
- Department of Diagnostic Imaging, Ng Teng Fong General Hospital, Singapore
| | - Aung Lwin
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore
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32
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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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Ileocecal Intussusception of the Adult Induced By the Gastrointestinal Stromal Tumor of the Ileocecal Valve – A Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2020-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Adult intussusception is a rare entity which is distinct from paediatric cases in incidence, aetiology, and management. It represents 5% of all intussusceptions and is the cause of 1% of all intestinal obstructions, 0,08% of all abdominal surgeries and 0,003-0,02% of all hospital admissions. Ileocolic intussusception in adults is a unique variant in which nearly 100% of cases have a malignant lead point. In our report, we described a case of a patient with ileocecal intussusception caused by a rare type of the gastrointestinal tumor. The female patient was admitted to hospital for occasional pain in the lower right quadrant of the abdomen followed by abdominal discomfort and appearance of blood in the stool. The result of CT scan of the abdomen and pelvis showed a tumor mass and intussusception at the ileocecal junction, which was confirmed peroperatively. Open right hemicolectomy was performed adhering to oncological principles. The final pathologic diagnosis indicated the gastrointestinal stromal tumor of the ileocecal valvе. The diagnosis of intussusception in adults is delicate, and timely surgical treatment can be vital. Patients with the palpable abdominal mass, digestive tract obstruction, gastrointestinal bleeding, or lead point computed tomography must undergo a surgical examination. Given a high risk of malignancy, primary surgical resection using oncologic principles presents the best option for the treatment of ileocecal intussusception in adults.
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34
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Sharma A, Thakur A. Ileocolic intussusception due to intestinal lipoma in an adult patient. Clin Case Rep 2021; 9:1524-1528. [PMID: 33768881 PMCID: PMC7981757 DOI: 10.1002/ccr3.3825] [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] [Received: 07/20/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 01/01/2023] Open
Abstract
Intestinal obstruction due to intussusception caused by intestinal lipomas is a rare condition in adults that needs urgent treatment. CT (Computerised Tomography) is the radiologic modality of choice for diagnosis. Surgery is the treatment of choice and has excellent outcome.
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35
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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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36
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Ebrahimi N, Yeh YT. Insidious presentation of intussusception with appendicitis. J Surg Case Rep 2021; 2021:rjaa578. [PMID: 33505664 PMCID: PMC7816850 DOI: 10.1093/jscr/rjaa578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/15/2020] [Indexed: 11/12/2022] Open
Abstract
Intussusception in relation to appendicitis is an uncommon occurrence and is rarely described in the literature. We describe a case of diagnostic uncertainty and finding of ileocolic intussusception associated with appendicitis in a 22-year-old male. The patient presented with a history of acute right-sided abdominal pain. He underwent a computed tomography scan showing ileocolic intussusception following an operation with the finding of an inflamed appendix, which was likely to have served as a mechanical lead point of the intussusception. Due to the presence of ischaemia of the right colon, he underwent a right hemicolectomy.
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Affiliation(s)
| | - Yu-Ting Yeh
- General Surgery, Blacktown Hospital, Blacktown, Australia
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37
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Kang S, Lee SI, Min BW, Lee TH, Baek SJ, Kwak JM, Kim J, Kim SH, Kim JS, Ji WB, Um JW, Hong KD. A multicentre comparative study between laparoscopic and open surgery for intussusception in adults. Colorectal Dis 2020; 22:1415-1421. [PMID: 32356391 DOI: 10.1111/codi.15102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/10/2020] [Indexed: 02/08/2023]
Abstract
AIM Intussusception in adults is rare and requires surgery in most cases. While abdominal laparoscopic surgery (LS) is becoming more popular, there are few reports on the outcomes of adult intussusception treated with LS. This study compared the feasibility of LS vs open surgery (OS) for adult intussusception. METHOD We reviewed retrospectively the medical records of adult patients with intussusception from three tertiary hospitals between 2000 and 2016. The patients were divided into LS and OS groups, and their surgical outcomes were compared. RESULTS Surgery was indicated in 71 patients with intussusception (41 LS and 30 OS). The median age of the patients was 49.0 and 51.5 years in the LS and OS groups, respectively (P = 0.930). Overall, nine (12.7%) patients had a negative laparotomy or laparoscopy with spontaneous reduction of the intussusception. Conversion to OS from LS was necessary in one patient (2.4%). The operative time and intra-operative and postoperative complication rates were not significantly different. However, there were more serious complications such as bowel perforation and major vessel injury in the LS group. The patients in the LS group had a shorter time to first food intake and hospital stay vs patients in the OS group (4.0 vs 6.0 days, P < 0.001, and 7.0 vs 10.5 days, P < 0.001, respectively). CONCLUSION LS may be feasible for adult intussusception; there may be more severe intra-operative complications than in OS.
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Affiliation(s)
- S Kang
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - S I Lee
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - B W Min
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - T H Lee
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - S-J Baek
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - J-M Kwak
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - J Kim
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - S-H Kim
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - J S Kim
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - W-B Ji
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - J W Um
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - K D Hong
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
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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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39
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Park JW, Song GA, Baek DH, Kim GH, Lee BE, Lee MW, Han SY, Park YJ, Park EY. Adult Ileocolic Intussusception Caused by Diffuse Large B Cell Lymphoma. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2020; 75:46-49. [PMID: 31986573 DOI: 10.4166/kjg.2020.75.1.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/02/2019] [Indexed: 12/22/2022]
Abstract
Intussusception is a medical condition, in which a proximal part of the intestine folds into the distal intestine. Adult intussusceptions are rare and account for approximately 5% of all cases of intussusceptions. The anatomical leading points include tumors, diverticulums, polyps, and strictures in 80-90% of adult intussusceptions, and 65% of colon intussusceptions and 30% of small bowel intussusceptions originate from malignant tumors. Treatments for adult intussusception have not been established, but most cases require surgical treatment. The gastrointestinal tract is the most common extranodal site for non-Hodgkin lymphoma. The symptoms are mostly non-specific, but they rarely lead to complications, such as bleeding, perforation, and intussusception. Furthermore, few cases of primary gastrointestinal lymphomas causing intussusception have been reported. This paper reports a case of small bowel diffuse large B cell lymphoma that caused ileocolic intussusception in a 69-year-old woman with no medical history. She underwent a small bowel resection and received six cycles of adjuvant chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. Since then, she has been in complete remission.
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Affiliation(s)
- Joon Woo Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung Yong Han
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Young Joo Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Young Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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40
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Treppiedi E, Cocchi L, Zimmitti G, Manzoni A, Seletti V, Bizzotto A, Spada C, Garatti M, Rosso E. Ileocolic invagination in adults: A totally minimally invasive endoscopic and laparoscopic staged approach. J Minim Access Surg 2020; 16:87-89. [PMID: 30777993 PMCID: PMC6945337 DOI: 10.4103/jmas.jmas_279_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/23/2018] [Indexed: 11/26/2022] Open
Abstract
Adult intussusception of the bowel is a rare clinical entity, and its management remains debated. The timing of treatment is not yet standardised, and no guidelines exist. We report a case of an 83-year-old woman presenting to the emergency department of our hospital with a history of increasing abdominal pain in the right iliac fossa. A contrast-enhanced computed tomography scan showed the presence of a large ileocolic intussusception with evidence of the terminal ileus invaginated within the right colon and the ileocolic vessels dragged and trapped into the intussusception. A colonoscopy confirmed the ileocolic invagination with a large right colonic lesion as leading point, and a partial pneumatic (carbon dioxide) and hydrostatic reduction was achieved. Subsequent laparoscopic right colectomy was performed according to oncological principles. A totally minimally invasive approach of this rare condition has been achieved but the literature lacks about the correct management of this entity.
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Affiliation(s)
- Elio Treppiedi
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Lorenzo Cocchi
- Department of General Surgery, University of Genoa, San Martino Hospital, Genova, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alberto Manzoni
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Valeria Seletti
- Department of Radiology, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alessandra Bizzotto
- Department of Digestive Endoscopy Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Cristiano Spada
- Department of Digestive Endoscopy Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Garatti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Edoardo Rosso
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
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41
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Imasato M, Kim HM, Higashi S, Kajihara J, Hatano H, Demura K, Iiboshi Y, Ito T. Laparoscopic surgery for idiopathic adult intussusception successfully reduced by colonoscopy. JOURNAL OF THE ANUS RECTUM AND COLON 2019; 3:49-52. [PMID: 31559367 PMCID: PMC6752127 DOI: 10.23922/jarc.2018-021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022]
Abstract
Most cases of adult intussusception are caused by neoplastic lesions, and idiopathic adult intussusception is very rare. We present a case in which laparoscopic surgery was performed for idiopathic adult intussusception initially reduced by colonoscopy. A 53-year-old woman presented to the emergency department of our hospital with intermittent lower abdominal pain. Contrast-enhanced computed tomography and ultrasonography of the abdomen showed a concentric structure in the ascending colon. We diagnosed intussusception. Colonoscopy achieved successful reduction before surgery. Twelve days after this reduction, laparoscopic surgery was performed. Histopathological examination did not reveal any causative pathology; therefore, idiopathic adult intussusception was diagnosed. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. Preoperative colonoscopy should be utilized to diagnose the main lesion and may be useful for reducing adult intussusception. Laparoscopic surgery is both minimally invasive and safe and can be performed following endoscopic reduction.
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Affiliation(s)
- Mitsunobu Imasato
- Department of Surgery, Rinku General Medical Center, Osaka, Japan.,Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Ho Min Kim
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | | | - Jun Kajihara
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Hisanori Hatano
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Koichi Demura
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Yasuhiko Iiboshi
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Toshikazu Ito
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
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Dragović S. COLON-COLONIC INVAGINATION CAUSED BY CECUM CANCER – A CASE REPORT. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0313] [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] Open
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Al Sulaiti MA, Darwish A, Al Khalifa K. Intussusception after laparoscopic one anastomosis gastric bypass: A rare complication. Int J Surg Case Rep 2019; 60:270-272. [PMID: 31261045 PMCID: PMC6610225 DOI: 10.1016/j.ijscr.2019.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Intussusception after one anastomosis gastric bypass is a rare postoperative complication that occurs with bowel obstruction. The diagnosis may be challenging because of long-standing, intermittent, nonspecific symptoms. Our paper describes an unusual case of antegrade intussusception that occurred 28 months after laparoscopic one anastomosis gastric bypass surgery. PRESENTATION A 30-year-old female known to have diabetes mellitus type 2, who presented with epigastric pain. A computed tomography scan revealed a jejuno-jejunal intussusception. After resection and primary end-to-end hand-sewn anastomosis of the biliary limb, the patient was discharged on the 6th day postoperatively and recovered uneventfully. We belief this is the first report describing a case of intussusception post one anastomosis gastric bypass. DISCUSSION Gastric bypass surgeries have recently become a popular method for the surgical treatment of morbid obesity worldwide. The reported intussusception incidence after Roux-en-Y gastric bypass (RYGB) is approximately 0.1-0.3%, but not described in one anastomosis gastric bypass surgery. Approximately two-thirds of patients show recurrent chronic and colicky pain. Surgical intervention is essential. CONCLUSION Clinicians should be aware of such condition in patients with history of bariatric surgery who present with long-standing, intermittent abdominal pain.
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Affiliation(s)
| | - Abdulla Darwish
- Pathology Department, Bahrain Defense Force Hospital, Bahrain.
| | - Khalid Al Khalifa
- Department of General Surgery, Bahrain Defence Force Hospital, Bahrain.
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Hong KD, Kim J, Ji W, Wexner SD. Adult intussusception: a systematic review and meta-analysis. Tech Coloproctol 2019; 23:315-324. [PMID: 31011846 DOI: 10.1007/s10151-019-01980-5] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/01/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Perhaps partly because intussusception in adults is rare, optimal treatment remains controversial. The aim of this study was to determine the appropriate surgical procedure for adult intussusception. METHODS A systematic search was undertaken using PubMed, Embase, and Web of Science from 1/1980 to 12/2016. Adults (> 15 years) with intussusception treated by surgical or conservative measures were included. RESULTS One thousand two hundred twenty-nine patients were identified from 40 retrospective case series. Pooled rates of malignant and benign tumors and idiopathic etiologies were 32.9% (95% CI 28.6-37.4), 37.4% (95% CI 32.7-42.3), and 15.1% (95% CI 11.7-19.3), respectively. Pooled rates of enteric, ileocolic, and colonic location types were 49.5% (95% CI 41.8-57.2), 29.1% (95% CI 23.0-36.1), and 19.9% (95% CI 16.3-24.1), respectively. Pooled rates of malignant tumors in enteric, ileocolic, and colonic intussusception were 22.5% (95% CI 18.3-27.3), 36.9% (95% CI 27.3-47.6), and 46.5% (31.1-62.6), respectively. Metastatic carcinoma was the main cause of malignant tumor in enteric intussusception. Conversely, primary adenocarcinoma was the main cause of malignant tumor in ileocolic and colonic intussusception. Considering the high rate of malignancy of colonic intussusception the majority of the studies surveyed recommend en bloc resection without reduction to avoid potential intraluminal seeding or venous tumor dissemination. Pooled rates of postoperative complications and mortality were 22.1% (95% CI 17.5-27.5) and 5.2% (95% CI 3.7-7.4), respectively. CONCLUSION Whereas enteric intussusception can be managed by reduction followed by resection, colonic intussusception should be resected en bloc. Due to the intermediate forms between enteric and colonic intussusception, a selective approach is recommended. Surgery remains the mainstay in adult intussusception.
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Affiliation(s)
- K D Hong
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea
| | - J Kim
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea
| | - W Ji
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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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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Ermolov AS, Yartsev PA, Lebedev AG, Kirsanov II, Selina IE, Shavrina NV, Rogal MM, Kaloeva OK, Kazakova VV. [Ileocecal intussusceptions]. Khirurgiia (Mosk) 2018:77-81. [PMID: 30307427 DOI: 10.17116/hirurgia2018090177] [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: 11/18/2022]
Abstract
AIM To present treatment of patients with ileocecal intussusception. MATERIAL AND METHODS There were 3 patients with ileocecal intussusception for the period from June 2016 to August 2017. CONCLUSION Abdominal sonography is main diagnostic method for intestinal intussusception. X-ray examination including contrast-enhanced irrigography gives more complete information about suspected intussusception. It is necessary to differentiate intestinal intussusception from other diseases accompanied by abdominal pain, vomiting, bloody discharge from rectum, abdominal neoplasm. Minimally invasive laparoscopic approach is advisable for diagnosis and treatment of intestinal intussusception.
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Affiliation(s)
- A S Ermolov
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
| | - P A Yartsev
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
| | - A G Lebedev
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
| | - I I Kirsanov
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
| | - I E Selina
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
| | - N V Shavrina
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
| | - M M Rogal
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
| | - O Kh Kaloeva
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
| | - V V Kazakova
- Sklifosovsky Research Institute for Emergency Care of Moscow Healthcare Department, Moscow, Russia
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Intussusception Mimicking Acute Appendicitis in an Adult. J Emerg Med 2018; 55:714-715. [PMID: 30249346 DOI: 10.1016/j.jemermed.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/20/2018] [Accepted: 08/03/2018] [Indexed: 11/24/2022]
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Li Z, Sun M, Song B, Shu Z. Gastrointestinal hemorrhage caused by adult intussusception secondary to small intestinal tumors: Two case reports. Medicine (Baltimore) 2018; 97:e12053. [PMID: 30142859 PMCID: PMC6112951 DOI: 10.1097/md.0000000000012053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/02/2018] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Adult intussusception is rarely observed, and the clinical manifestations are very atypical. The most common symptom is abdominal pain, while the incidence of hematochezia is relatively low. We report two cases of adult intussusception secondary to small intestinal tumors with gastrointestinal hemorrhage as the main symptom. PATIENT CONCERNS Two men aged 19 and 54 years were successively referred to our department due to intermittent hematochezia. The hemoglobin levels of the two patients declined progressively, and conservative treatment was ineffective. DIAGNOSES The first patient underwent an abdominal computed tomography angiography examination, which showed that the intestine and its mesentery were tortuous, suggesting an intra-abdominal hernia or intussusception. The second patient underwent an abdominal computed tomography examination, which suggested a high possibility of an intussusception. The two patients were diagnosed as adult intussusception caused by small intestinal tumors. INTERVENTIONS Emergency laparoscopic explorations were performed. Enteroenteric intussusceptions caused by ileal tumors were found during surgery. Reduction of the intussusceptions and resection of the ileal tumors were performed. OUTCOMES The patients recovered well after surgery, and postoperative pathology showed that the tumors were a vascular hamartoma polyp and a lipoma. LESSONS Adult intussusception is very rare, particularly with gastrointestinal hemorrhage as the main symptom. Isolated hamartoma polyp is a rare cause of intussusception in adults. The clinical manifestations of adult intussusception are very atypical, and thus, making a preoperative diagnosis is difficult. Abdominal CT or CTA is an effective diagnostic method for adult intussusception. For adult patients with gastrointestinal hemorrhage caused by intussusceptions, active surgery should be performed when conservative treatment is not effective. Laparoscopic surgery is a safe and effective treatment for adult intussusceptions caused by benign diseases.
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Lee YF, Cleary RK. Synovial sarcoma of the transverse colon: a rare cause of intussusception. BMJ Case Rep 2018; 2018:bcr-2018-224198. [PMID: 29602893 DOI: 10.1136/bcr-2018-224198] [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: 12/19/2022] Open
Abstract
We report a third case of a primary intramural synovial sarcoma of the lower gastrointestinal tract. A 50-year-old woman presented with hematochezia, dizziness and shortness of breath. CT imaging revealed a transverse colo-colonic intussusception with a colonic mass serving as a lead point. A subtotal colectomy was performed with oncologic resection of a sausage-like mass in the mid-transverse colon. Pathological assessment showed a biphasic synovial sarcoma. The postoperative hospital course was without complications and the patient was discharged home with plans for postoperative surveillance.
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Affiliation(s)
- Yongjin Felix Lee
- General Surgery, St. Joseph Mercy Ann Arbor, Ypsilanti, Michigan, USA
| | - Robert K Cleary
- Colon and Rectal Surgery, St. Joseph Mercy Ann Arbor, Ypsilanti, Michigan, USA
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Wong KB, Lui CT, Fung HT. How Do Adult and Paediatric Intussusceptions Differ? a 10-Year Retrospective Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Intussusception in adult is considered to be an uncommon surgical condition. Our study aims to gather the epidemiology data of intussusception in local population and to compare the clinical characteristics, investigation and management between adult and paediatric intussusceptions. Methods This is a retrospective study of patients who were diagnosed intussusception from January 2001 to June 2011 in the study centre. Demographic data, clinical presentation, investigation and management were compared between adult and paediatric patients. Results There were 79 patients included in the study period. Twenty-two of them (27.8%) were adults (aged at least 18 years) while 57 (72.2%) of them were paediatrics patients (age <18 years). Forty-three (54.4%) of them were male and 36 (45.6%) of them were female. Mean age of intussusception in adult and paediatric groups were 56.1 years and 23.9 months respectively. The median duration of onset of the presentation of adult patient was 3.5 days which is longer than that of paediatrics group (1 day) (p<0.001), per-rectal bleeding occurred in 18.2% (4/22) of adult patients while 47.4% (27/57) of paediatric intussusception had per-rectal bleeding (p=0.017). There was also significantly more vomiting (78.9%, 45/57) in paediatric intussusception compared with 31.8% in adults (p<0.001). A total of 72.7% (16/22) of adult intussusception were diagnosed by CT scan while 94.7% (54/57) of paediatrics was diagnosed by ultrasound by radiology department. 77.3% (17/22) of the adult intussusceptions had a neoplastic leading point. All the adult intussusception required surgical management while only 21.1% (12/57) of the paediatrics group required surgical reduction with or without bowel resection. The median length of stay (LOS) of adult group was 9 days which is longer than that of the paediatrics group (4 days) (p<0.001). Conclusions Intussusception in adult patients lacks classical presentation of per-rectal bleeding and vomiting and the onset is commonly sub-acute when compared with paediatrics cases. Most of the adult intussusceptions have pathological leading points that warrant surgical management.
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