BACKGROUND Intussusception is the invagination of a segment of the bowel into an adjacent segment.It is the most common cause of intestinal obstruction in children,but in adults,it is rare,accounting for 1%of all inte...BACKGROUND Intussusception is the invagination of a segment of the bowel into an adjacent segment.It is the most common cause of intestinal obstruction in children,but in adults,it is rare,accounting for 1%of all intestinal obstructions and 5%of all intussusceptions,with malignancy being the most common cause.In the past,it was typically diagnosed intraoperatively.However,with the availability of computed tomography for abdominal imaging,recognizing the condition's signs has become crucial.Surgical intervention is essential for managing neoplastic cases and their complications.CASE SUMMARY A 45-year-old female presented with severe abdominal pain encompassing her entire abdomen,abdominal distension,vomiting,and persistent constipation.Over the past two months,she has also experienced considerable weight loss.After an initial history review,examination,and imaging investigations,the patient was diagnosed with ileo cecal intussusception resulting from a colo rectal mass located in the cecum and ascending colon.This condition was surgically managed through an extended right hemi colectomy.CONCLUSION Intussusception is uncommon in adults,but it should be considered in patients with intestinal obstruction.Surgical intervention is essential.展开更多
BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated b...BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated by appendiceal mucinous tumor,supplemented by a review of 10 previously reported cases to distill diagnostic and therapeutic insights.CASE SUMMARY A 74-year-old male patient presented with abdominal pain.Abdominal contrastenhanced computed tomography(CECT)initially suggested a colonic tumor with intussusception.Colonoscopy identified a mass in the colon 60 cm from the anus.Intraoperative exploration confirmed CAI secondary to an appendiceal neoplasm.The patient underwent laparoscopic right hemicolectomy with regional lymphadenectomy under general anesthesia.Postoperative recovery was uneventful,and the patient was discharged 9 days post-surgery.Twelve-month follow-up revealed no evidence of recurrence or metastasis.CONCLUSION Plain abdominal computed tomography may underestimate the presence of CAI and appendiceal mucinous tumor,whereas CECT significantly improves diagnostic accuracy.Preoperative suspicion of appendiceal malignancy should be entertained in cases of CAI.In the absence of definitive biopsy results,intraoperative frozen section analysis is recommended to guide radical resection.展开更多
BACKGROUND Pneumatosis cystoides intestinalis(PCI),characterized by a collection of gas-filled cysts in the intestinal wall,is an uncommon but well-known condition in gastroenterology.Abdominal pain is the most freque...BACKGROUND Pneumatosis cystoides intestinalis(PCI),characterized by a collection of gas-filled cysts in the intestinal wall,is an uncommon but well-known condition in gastroenterology.Abdominal pain is the most frequent symptom associated with PCI.Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation.However,the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood.CASE SUMMARY A 52-year-old male,known with idiopathic PCI,presented seventeen months after initial diagnosis with a new right upper quadrant pain.A computed tomographyscan demonstrated a colonic intussusception at the hepatic flexure.PCI did not progress compared with initial investigation.The patient underwent an emergency right hemicolectomy.CONCLUSION Resection was recommended in this case because PCI proved to be persisting with no identified curable cause.Surgery allowed to address the underlying pathology,the potential relapse of intussusception,and the likely cause of recurrent abdominal pain,either invagination or PCI itself.展开更多
AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with r...AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.展开更多
Postoperative intussusception is an unusual clinical entity in adults,and is rarely encountered as a complication following gastric surgery.The most common type after gastric surgery is retrograde jejunogastric intuss...Postoperative intussusception is an unusual clinical entity in adults,and is rarely encountered as a complication following gastric surgery.The most common type after gastric surgery is retrograde jejunogastric intussusception,and jejunojejunal intussusception has been rarely reported.We report a case of anterograde jejunojejunal intussusception after radical subtotal gastrectomy with Billroth Ⅱ anastomosis in a 38-year-old Korean woman with early gastric cancer,and include a review of the literature on this unusual complication.展开更多
Schwannomas are rarely observed in the gastrointestinal tract.The most common symptoms of a gastric schwannoma are abdominal pain or dyspepsia,gastrointestinal bleeding,and an abdominal mass.Many gastric schwannomas a...Schwannomas are rarely observed in the gastrointestinal tract.The most common symptoms of a gastric schwannoma are abdominal pain or dyspepsia,gastrointestinal bleeding,and an abdominal mass.Many gastric schwannomas are asymptomatic and are discovered incidentally or at postmortem.The diagnosis of a schwannoma is based on immunohistochemical positivity for S-100 protein.Wepresent a case report of a rare complication of gastric schwannoma causing gastroduodenal intussusception that was successfully managed by a BillrothⅡdistal gastrectomy.In this rare case,the patient had intermittent,colicky abdominal pain,nausea,and vomiting for over 4wk accompanied by a weight loss.A diagnosis of gastric intussusception was made by computed tomography.A BillrothⅡdistal gastrectomy was then performed,and complete en bloc removal(R0 resection)was achieved.Pathology confirmed a gastric schwannoma through positive immunohistochemical staining for S-100 protein.展开更多
Primary malignant melanoma originating in the colon is an extremely rare disease.Herein,we report a case of primary melanoma of the ascending colon.The patient was a 57-year-old male who was admitted to our hospital f...Primary malignant melanoma originating in the colon is an extremely rare disease.Herein,we report a case of primary melanoma of the ascending colon.The patient was a 57-year-old male who was admitted to our hospital for persistent abdominal pain and episodes of bloody stool,nausea and vomiting.A computed tomography scan revealed lower intestinal intussusception and enlarged lymph nodes in the abdominal cavity and retroperitoneum.During laparoscopic operation,multiple enlarged lymph nodes were found.Several segments of the proximal small intestine were incarcerated into the distal small intestine,forming an internal hernia and obstruction.The necrotic terminal ileum was invaginated into the ascending cecum.Subsequently,adhesive internal hernia reduction and palliative right hemicolectomy were performed.Pathologic examination of the excised specimen revealed a polypoid mass in the ascending colon.Histological examination showed epithelioid and spindle tumor cells with obvious cytoplasmic melanin deposition.Immunohistochemical staining revealed that the tumor cells were positive for S-100,HmB-45 and vimentin,confirming the diagnosis of melanoma.The patient history and a thorough postoperative investigation excluded the preexistence or coexistence of a primary lesion elsewhere in the skin,anus or oculus or at other sites.Thus,we consider our case to represent an aggressive primary colon melanoma presenting as ileocecal intussusception and intestinal obstruction.展开更多
Adult intussusception due to Meckel’s diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity...Adult intussusception due to Meckel’s diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report two cases of intussusception due to MD in adults. A diverticulectomy using a TA stapler was performed in the first patient. In the second patient extensive fibrosis of the adjacent mesentery and thickening of jejunal mucosa were observed, so a segmental resection of the small bowel or affected ileal part and a hand-sewn anastomosis was performed. The postoperative period along with the long term follow-up was uneventful for both patients. The decision between diverticulectomy vs bowel resection can be based on the intussuscepted bowel condition. Early surgical intervention may ensure a favorable outcome.展开更多
Inflammatory fibroid polyp(IFP) is a rare,idiopathic pseudotumorous lesion of the gastrointestinal tract.While mostly reported as solitary gastric lesions,multiple cases of small bowel IFPs are also reported.It is a d...Inflammatory fibroid polyp(IFP) is a rare,idiopathic pseudotumorous lesion of the gastrointestinal tract.While mostly reported as solitary gastric lesions,multiple cases of small bowel IFPs are also reported.It is a documented cause of intussusception in adults.In the case reports of ileal inflammatory fibroid polyps with intussusception,an emergent presentation with small bowel obstruction has been most often described.Here we depict a case of ileal inflammatory fibroid polyp presenting with chronic intermittent ileocolic intussusception,anemia and weight loss with an endoscopic appearance mimicking necrotic cecal carcinoma.展开更多
The occurrence of intussusception in adults is rare,accounting for less than 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction.The condition is found in less than 1 in 1300 abdominal operations...The occurrence of intussusception in adults is rare,accounting for less than 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction.The condition is found in less than 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction.The child to adult ratio is more than 20:1.We report a rare case of ileocolic intussusception in an adult secondary to an ileal lipoma.展开更多
A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal...A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.展开更多
Intussusception of the bowel is defined as the telescop-ing of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment.This condi-tion is frequent in children and presents with the cl...Intussusception of the bowel is defined as the telescop-ing of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment.This condi-tion is frequent in children and presents with the classic triad of cramping abdominal pain,bloody diarrhea and a palpable tender mass.However,bowel intussusception in adults is considered a rare condition,accounting for 5% of all cases of intussusceptions and almost 1%-5%of bowel obstruction.Eight to twenty percent of cases are idiopathic,without a lead point lesion.Secondary intus-susception is caused by organic lesions,such as inflam-matory bowel disease,postoperative adhesions,Meckel's diverticulum,benign and malignant lesions,metastatic neoplasms or even iatrogenically,due to the presence of intestinal tubes,jejunostomy feeding tubes or after gas-tric surgery.Computed tomography is the most sensitive diagnostic modality and can distinguish between intus-susceptions with and without a lead point.Surgery is the definitive treatment of adult intussusceptions.Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected.Reduction of the intussuscepted bowel is considered safe for benign lesions in order to limit the extent of resection or to avoid the short bowel syndrome in certain circumstances.展开更多
Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception ...Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.展开更多
BACKGROUND: Ultrasound diagnosis of pediatric intussusception is feasible with limited operator training. The authors report the test characteristics of bedside ultrasound(BUS) for the diagnosis of pediatric intussusc...BACKGROUND: Ultrasound diagnosis of pediatric intussusception is feasible with limited operator training. The authors report the test characteristics of bedside ultrasound(BUS) for the diagnosis of pediatric intussusception at a single institution.METHODS: Inclusion criteria were: 1) patients of 0–18 years old were seen in the pediatric emergency department(ED) with a clinical presentation suspicious for intussusception; 2) BUS was performed to identify intussusception and bedside impression documented in the medical record; 3) a "formal" diagnostic study(such as computed tomography, ultrasound, or barium enema) was performed by the radiology department after BUS was completed. Electronic medical record and ED BUS archive were screened for potentially eligible ED visits between January 1st 2009 to October 3rd 2012. These records were then reviewed to identify patients for inclusion in the study. All emergency physicians who performed the BUS had undergone a minimum of 1-hour didactic training on the use of BUS to diagnose pediatric intussusception.RESULTS: A total of 1 631 charts were reviewed, with 49 meeting inclusion criteria. Five of those were later excluded for incomplete documentation or lack of saved BUS images. The prevalence of intussusception was 23%. The mean age of the subjects was 31 months. BUS was 100% sensitive(95%CI 66%–100%) and 94% specifi c(95%CI 79%–99%) for detection of pediatric intussusception compared to radiology study results. Positive and negative likelihood ratios were 16.5(95%CI 4.30%–63.21%) and 0(95%CI 0–0) respectively.CONCLUSIONS: BUS is an accurate means of diagnosing acute intussusception in pediatric patients. Further study might be indicated to confi rm such benefi ts.展开更多
Postoperative intussusception is an uncommon but serious condition in infants and children. Here, we report seven cases of postoperative intussusception in infants and children who were seen at our institution over th...Postoperative intussusception is an uncommon but serious condition in infants and children. Here, we report seven cases of postoperative intussusception in infants and children who were seen at our institution over the last 13 y. The patients showed increased nasogastfic drainage, vomiting, lack of stool, and/or growing abdominal dis- tension 2 to 9 d following abdominal surgery. Manual reduction was successful in five cases. In two cases, necro- sis was found and intestinal resection and anastomosis were carded out, No recurrence was observed at six months of follow-up. Postoperative intussusception should be suspected in pediatric surgical patients who showed signs of intestinal obstruction in the early postoperative period.展开更多
AIM： To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. METHODS： A retrospective review of patients aged 〉 18 years with a dia...AIM： To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. METHODS： A retrospective review of patients aged 〉 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. RESULTS： There were 20 rases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine （85%）. There were three （15%） cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. CONCLUSION： Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.展开更多
Pneumatosis intestinalis(PI) often represents a benign condition that should not be considered as an argument for surgery. We report a patient with PI and obstructing intussusception who underwent urgent colectomy and...Pneumatosis intestinalis(PI) often represents a benign condition that should not be considered as an argument for surgery. We report a patient with PI and obstructing intussusception who underwent urgent colectomy and review the literatures regarding PI with intussusception. A 20-year-old man presented at our hospital with a 3-d intermittent lower abdominal pain history. He underwent steroid therapy for membranoproliferative glomerulonephritis for 4 years. Computed tomography revealed ascending colon intussusception with air within the wall. Intraoperative colonoscopy revealed numerous soft polypoid masses with normal overlying mucosa and right hemicolectomy was performed. Histological examination of colonic wall sections revealed large cysts in the submucosal layer. The pathological diagnosis was PI. Nine cases of intussusception associated with primary PI have been reported. Although primary PI often represents a benign condition that should not be considered as an argument for surgery,if the case involves intussusception and obstruction,emergent laparotomy should be considered.展开更多
We report an extremely rare case of adult intussusception caused by anisakiasis. A 41-year-old man was admitted into our hospital for right lower abdominal colicky pain. Ultrasonography and computed tomography reveale...We report an extremely rare case of adult intussusception caused by anisakiasis. A 41-year-old man was admitted into our hospital for right lower abdominal colicky pain. Ultrasonography and computed tomography revealed the presence of intussusception. As pneumodynamic resolution by colonoscopy failed, surgery was performed. The anisakis body was found in the submucosal layer of the resection specimen. The patient was discharged 9 d after the operation. Anisakiasis may cause intussusception in any country where sushi or sashimi now exists as a popular food. If suspicious, detailed clinical interview as to food intake prior to symptom development is crucial.展开更多
Inflammatory pseudotumor(IPT) is a rare spaceoccupying lesion of unknown etiology that can mimic malignancy on clinic-radiological and pathological examination. We describe a rare case of ileocecal intussusception fro...Inflammatory pseudotumor(IPT) is a rare spaceoccupying lesion of unknown etiology that can mimic malignancy on clinic-radiological and pathological examination. We describe a rare case of ileocecal intussusception from clinically suspected malignancy of the right colon where the patient underwent righthemicolectomy. Histopathology of the resected specimen confirmed IPT of the colon. This patient was observed to have abnormally elevated total leukocyte count and platelets before and after surgery. In an adult with intussusception associated with an abdominal mass, the possibility of IPT of the colon should be considered. Considering the abnormally high total leukocyte and platelet counts and colonic IPT, it is necessary to prevent postoperative adverse effects due to these changes. Although IPT of the colon is usually a benign process, controversy regarding its management still exists. We consider hemicolectomy as a safe treatment approach for colonic IPT and review the existing literature.展开更多
Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04% to 4.5%.Because the lipomas are diffusely distributed in the intestine,most patients are symptom-free,and invasive intervention ...Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04% to 4.5%.Because the lipomas are diffusely distributed in the intestine,most patients are symptom-free,and invasive intervention is not advised by most doctors.Here,we describe a case with intussusception due to small-bowel lipomatosis.Partial small bowel resection and anastomosis were performed because the intestinal wall was on the verge of perforation.This case indicates that regular followup is necessary and endoscopic treatment should be considered to avoid surgical procedures if the lipoma is large enough to cause intestinal obstruction.展开更多
文摘BACKGROUND Intussusception is the invagination of a segment of the bowel into an adjacent segment.It is the most common cause of intestinal obstruction in children,but in adults,it is rare,accounting for 1%of all intestinal obstructions and 5%of all intussusceptions,with malignancy being the most common cause.In the past,it was typically diagnosed intraoperatively.However,with the availability of computed tomography for abdominal imaging,recognizing the condition's signs has become crucial.Surgical intervention is essential for managing neoplastic cases and their complications.CASE SUMMARY A 45-year-old female presented with severe abdominal pain encompassing her entire abdomen,abdominal distension,vomiting,and persistent constipation.Over the past two months,she has also experienced considerable weight loss.After an initial history review,examination,and imaging investigations,the patient was diagnosed with ileo cecal intussusception resulting from a colo rectal mass located in the cecum and ascending colon.This condition was surgically managed through an extended right hemi colectomy.CONCLUSION Intussusception is uncommon in adults,but it should be considered in patients with intestinal obstruction.Surgical intervention is essential.
文摘BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated by appendiceal mucinous tumor,supplemented by a review of 10 previously reported cases to distill diagnostic and therapeutic insights.CASE SUMMARY A 74-year-old male patient presented with abdominal pain.Abdominal contrastenhanced computed tomography(CECT)initially suggested a colonic tumor with intussusception.Colonoscopy identified a mass in the colon 60 cm from the anus.Intraoperative exploration confirmed CAI secondary to an appendiceal neoplasm.The patient underwent laparoscopic right hemicolectomy with regional lymphadenectomy under general anesthesia.Postoperative recovery was uneventful,and the patient was discharged 9 days post-surgery.Twelve-month follow-up revealed no evidence of recurrence or metastasis.CONCLUSION Plain abdominal computed tomography may underestimate the presence of CAI and appendiceal mucinous tumor,whereas CECT significantly improves diagnostic accuracy.Preoperative suspicion of appendiceal malignancy should be entertained in cases of CAI.In the absence of definitive biopsy results,intraoperative frozen section analysis is recommended to guide radical resection.
文摘BACKGROUND Pneumatosis cystoides intestinalis(PCI),characterized by a collection of gas-filled cysts in the intestinal wall,is an uncommon but well-known condition in gastroenterology.Abdominal pain is the most frequent symptom associated with PCI.Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation.However,the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood.CASE SUMMARY A 52-year-old male,known with idiopathic PCI,presented seventeen months after initial diagnosis with a new right upper quadrant pain.A computed tomographyscan demonstrated a colonic intussusception at the hepatic flexure.PCI did not progress compared with initial investigation.The patient underwent an emergency right hemicolectomy.CONCLUSION Resection was recommended in this case because PCI proved to be persisting with no identified curable cause.Surgery allowed to address the underlying pathology,the potential relapse of intussusception,and the likely cause of recurrent abdominal pain,either invagination or PCI itself.
文摘AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.
文摘Postoperative intussusception is an unusual clinical entity in adults,and is rarely encountered as a complication following gastric surgery.The most common type after gastric surgery is retrograde jejunogastric intussusception,and jejunojejunal intussusception has been rarely reported.We report a case of anterograde jejunojejunal intussusception after radical subtotal gastrectomy with Billroth Ⅱ anastomosis in a 38-year-old Korean woman with early gastric cancer,and include a review of the literature on this unusual complication.
基金Supported by Department of General Surgery,Putuo Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai,China
文摘Schwannomas are rarely observed in the gastrointestinal tract.The most common symptoms of a gastric schwannoma are abdominal pain or dyspepsia,gastrointestinal bleeding,and an abdominal mass.Many gastric schwannomas are asymptomatic and are discovered incidentally or at postmortem.The diagnosis of a schwannoma is based on immunohistochemical positivity for S-100 protein.Wepresent a case report of a rare complication of gastric schwannoma causing gastroduodenal intussusception that was successfully managed by a BillrothⅡdistal gastrectomy.In this rare case,the patient had intermittent,colicky abdominal pain,nausea,and vomiting for over 4wk accompanied by a weight loss.A diagnosis of gastric intussusception was made by computed tomography.A BillrothⅡdistal gastrectomy was then performed,and complete en bloc removal(R0 resection)was achieved.Pathology confirmed a gastric schwannoma through positive immunohistochemical staining for S-100 protein.
文摘Primary malignant melanoma originating in the colon is an extremely rare disease.Herein,we report a case of primary melanoma of the ascending colon.The patient was a 57-year-old male who was admitted to our hospital for persistent abdominal pain and episodes of bloody stool,nausea and vomiting.A computed tomography scan revealed lower intestinal intussusception and enlarged lymph nodes in the abdominal cavity and retroperitoneum.During laparoscopic operation,multiple enlarged lymph nodes were found.Several segments of the proximal small intestine were incarcerated into the distal small intestine,forming an internal hernia and obstruction.The necrotic terminal ileum was invaginated into the ascending cecum.Subsequently,adhesive internal hernia reduction and palliative right hemicolectomy were performed.Pathologic examination of the excised specimen revealed a polypoid mass in the ascending colon.Histological examination showed epithelioid and spindle tumor cells with obvious cytoplasmic melanin deposition.Immunohistochemical staining revealed that the tumor cells were positive for S-100,HmB-45 and vimentin,confirming the diagnosis of melanoma.The patient history and a thorough postoperative investigation excluded the preexistence or coexistence of a primary lesion elsewhere in the skin,anus or oculus or at other sites.Thus,we consider our case to represent an aggressive primary colon melanoma presenting as ileocecal intussusception and intestinal obstruction.
文摘Adult intussusception due to Meckel’s diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report two cases of intussusception due to MD in adults. A diverticulectomy using a TA stapler was performed in the first patient. In the second patient extensive fibrosis of the adjacent mesentery and thickening of jejunal mucosa were observed, so a segmental resection of the small bowel or affected ileal part and a hand-sewn anastomosis was performed. The postoperative period along with the long term follow-up was uneventful for both patients. The decision between diverticulectomy vs bowel resection can be based on the intussuscepted bowel condition. Early surgical intervention may ensure a favorable outcome.
文摘Inflammatory fibroid polyp(IFP) is a rare,idiopathic pseudotumorous lesion of the gastrointestinal tract.While mostly reported as solitary gastric lesions,multiple cases of small bowel IFPs are also reported.It is a documented cause of intussusception in adults.In the case reports of ileal inflammatory fibroid polyps with intussusception,an emergent presentation with small bowel obstruction has been most often described.Here we depict a case of ileal inflammatory fibroid polyp presenting with chronic intermittent ileocolic intussusception,anemia and weight loss with an endoscopic appearance mimicking necrotic cecal carcinoma.
文摘The occurrence of intussusception in adults is rare,accounting for less than 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction.The condition is found in less than 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction.The child to adult ratio is more than 20:1.We report a rare case of ileocolic intussusception in an adult secondary to an ileal lipoma.
文摘A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.
文摘Intussusception of the bowel is defined as the telescop-ing of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment.This condi-tion is frequent in children and presents with the classic triad of cramping abdominal pain,bloody diarrhea and a palpable tender mass.However,bowel intussusception in adults is considered a rare condition,accounting for 5% of all cases of intussusceptions and almost 1%-5%of bowel obstruction.Eight to twenty percent of cases are idiopathic,without a lead point lesion.Secondary intus-susception is caused by organic lesions,such as inflam-matory bowel disease,postoperative adhesions,Meckel's diverticulum,benign and malignant lesions,metastatic neoplasms or even iatrogenically,due to the presence of intestinal tubes,jejunostomy feeding tubes or after gas-tric surgery.Computed tomography is the most sensitive diagnostic modality and can distinguish between intus-susceptions with and without a lead point.Surgery is the definitive treatment of adult intussusceptions.Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected.Reduction of the intussuscepted bowel is considered safe for benign lesions in order to limit the extent of resection or to avoid the short bowel syndrome in certain circumstances.
文摘Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.
文摘BACKGROUND: Ultrasound diagnosis of pediatric intussusception is feasible with limited operator training. The authors report the test characteristics of bedside ultrasound(BUS) for the diagnosis of pediatric intussusception at a single institution.METHODS: Inclusion criteria were: 1) patients of 0–18 years old were seen in the pediatric emergency department(ED) with a clinical presentation suspicious for intussusception; 2) BUS was performed to identify intussusception and bedside impression documented in the medical record; 3) a "formal" diagnostic study(such as computed tomography, ultrasound, or barium enema) was performed by the radiology department after BUS was completed. Electronic medical record and ED BUS archive were screened for potentially eligible ED visits between January 1st 2009 to October 3rd 2012. These records were then reviewed to identify patients for inclusion in the study. All emergency physicians who performed the BUS had undergone a minimum of 1-hour didactic training on the use of BUS to diagnose pediatric intussusception.RESULTS: A total of 1 631 charts were reviewed, with 49 meeting inclusion criteria. Five of those were later excluded for incomplete documentation or lack of saved BUS images. The prevalence of intussusception was 23%. The mean age of the subjects was 31 months. BUS was 100% sensitive(95%CI 66%–100%) and 94% specifi c(95%CI 79%–99%) for detection of pediatric intussusception compared to radiology study results. Positive and negative likelihood ratios were 16.5(95%CI 4.30%–63.21%) and 0(95%CI 0–0) respectively.CONCLUSIONS: BUS is an accurate means of diagnosing acute intussusception in pediatric patients. Further study might be indicated to confi rm such benefi ts.
基金supported by a grant from Nanjing Health Department of China (No.ZKM06041)
文摘Postoperative intussusception is an uncommon but serious condition in infants and children. Here, we report seven cases of postoperative intussusception in infants and children who were seen at our institution over the last 13 y. The patients showed increased nasogastfic drainage, vomiting, lack of stool, and/or growing abdominal dis- tension 2 to 9 d following abdominal surgery. Manual reduction was successful in five cases. In two cases, necro- sis was found and intestinal resection and anastomosis were carded out, No recurrence was observed at six months of follow-up. Postoperative intussusception should be suspected in pediatric surgical patients who showed signs of intestinal obstruction in the early postoperative period.
文摘AIM： To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. METHODS： A retrospective review of patients aged 〉 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. RESULTS： There were 20 rases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine （85%）. There were three （15%） cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. CONCLUSION： Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.
文摘Pneumatosis intestinalis(PI) often represents a benign condition that should not be considered as an argument for surgery. We report a patient with PI and obstructing intussusception who underwent urgent colectomy and review the literatures regarding PI with intussusception. A 20-year-old man presented at our hospital with a 3-d intermittent lower abdominal pain history. He underwent steroid therapy for membranoproliferative glomerulonephritis for 4 years. Computed tomography revealed ascending colon intussusception with air within the wall. Intraoperative colonoscopy revealed numerous soft polypoid masses with normal overlying mucosa and right hemicolectomy was performed. Histological examination of colonic wall sections revealed large cysts in the submucosal layer. The pathological diagnosis was PI. Nine cases of intussusception associated with primary PI have been reported. Although primary PI often represents a benign condition that should not be considered as an argument for surgery,if the case involves intussusception and obstruction,emergent laparotomy should be considered.
文摘We report an extremely rare case of adult intussusception caused by anisakiasis. A 41-year-old man was admitted into our hospital for right lower abdominal colicky pain. Ultrasonography and computed tomography revealed the presence of intussusception. As pneumodynamic resolution by colonoscopy failed, surgery was performed. The anisakis body was found in the submucosal layer of the resection specimen. The patient was discharged 9 d after the operation. Anisakiasis may cause intussusception in any country where sushi or sashimi now exists as a popular food. If suspicious, detailed clinical interview as to food intake prior to symptom development is crucial.
文摘Inflammatory pseudotumor(IPT) is a rare spaceoccupying lesion of unknown etiology that can mimic malignancy on clinic-radiological and pathological examination. We describe a rare case of ileocecal intussusception from clinically suspected malignancy of the right colon where the patient underwent righthemicolectomy. Histopathology of the resected specimen confirmed IPT of the colon. This patient was observed to have abnormally elevated total leukocyte count and platelets before and after surgery. In an adult with intussusception associated with an abdominal mass, the possibility of IPT of the colon should be considered. Considering the abnormally high total leukocyte and platelet counts and colonic IPT, it is necessary to prevent postoperative adverse effects due to these changes. Although IPT of the colon is usually a benign process, controversy regarding its management still exists. We consider hemicolectomy as a safe treatment approach for colonic IPT and review the existing literature.
基金Supported by Beijing Medicine Research and Development Fund,No.20092029the Health Industry Scientific Research Fund of China,No.201002015
文摘Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04% to 4.5%.Because the lipomas are diffusely distributed in the intestine,most patients are symptom-free,and invasive intervention is not advised by most doctors.Here,we describe a case with intussusception due to small-bowel lipomatosis.Partial small bowel resection and anastomosis were performed because the intestinal wall was on the verge of perforation.This case indicates that regular followup is necessary and endoscopic treatment should be considered to avoid surgical procedures if the lipoma is large enough to cause intestinal obstruction.
