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: 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
AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI).METHODS:A retrospective review of the clinical features,diagnosis,management and pathology 41 adult patients with postop...AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI).METHODS:A retrospective review of the clinical features,diagnosis,management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted.RESULTS:Forty-one patients with 44 intussusceptions were operated on,24.4% had acute symptoms,24.4% had subacute symptoms,and 51.2% had chronic symptoms.70.7% of the patients presented with intestinal obstruction.There were 20 enteric,15 ileocolic,eight colocolonic and one sigmoidorectal intussusceptions.65.9% of intussusceptions were diagnosed preoperatively using a computed tomography (CT) scan (90.5% accurate) and ultrasonography (60.0% accurate,rising to 91.7% for patients who had a palpable abdominal mass).Coloscopy located the occupying lesions of the lead point of ileocolic,colocolonic and sigmoidorectal intussusceptions.Four intussusceptions in three patients were simply reduced.Twenty-one patients underwent resection after primary reduction.There was no mortality and anastomosis leakage perioperatively.Except for one patient with multiple small bowel adenomas,which recurred 5 mo after surgery,no patients were recurrent within 6 mo.Pathologically,54.5% of the intussusceptions had a tumor,of which 27.3% were malignant.9.1% comprised nontumorous polyps.Four intussusceptions had a gastrojejunostomy with intestinal intubation,and four intussusceptions had no organic lesion.CONCLUSION:CT is the most effective and accurate diagnostic technique.Colonoscopy can detect most lead point lesions of non-enteric intussusceptions.Intestinal intubation should be avoided.展开更多
Jejunogastric intussusception is a rare long term complication of Billroth Ⅱ gastrectomy. The case reported here is a 50 year old man with history of a Billroth Ⅱ gastrectomy and Braun's side-to-side jejunojejun...Jejunogastric intussusception is a rare long term complication of Billroth Ⅱ gastrectomy. The case reported here is a 50 year old man with history of a Billroth Ⅱ gastrectomy and Braun's side-to-side jejunojejunal anastomosis who presented with hematemesis. On abdominal examination, there was a mass in the left iliac fossa. Computed tomography scan showed a retrograde jejunogastric intussusception across the gastrojejunostomy. On laparotomy, a retrograde intussusception of the distal jejunum through the jejunojejunal anastomosis and across the gastrojejunostomy with a gangrenous intussusceptum was found. The jejunojejunal anastomosis was taken down, the gangrenous segment was resected and bowel continuity was restored with two jejunojejunal anastomoses, proximal and distal to the gastrojejunostomy. The gastrojejunostomy was preserved. This case brings out an unusual type of retrograde gangrenous intussusception which occurred at two points of a previous anastomosis, i.e., jejunojejunostomy and gastrojejunostomy simultaneously, which could be managed with jejunal resection.展开更多
Duplication of alimentary tract(DAT) presenting as an ileoileal intussusception is a very rare clinical entity.Herein,a case of an ileoileal intussusception due to DAT is presented.A 32-year-old woman was hospitalized...Duplication of alimentary tract(DAT) presenting as an ileoileal intussusception is a very rare clinical entity.Herein,a case of an ileoileal intussusception due to DAT is presented.A 32-year-old woman was hospitalized due to diffuse,intermittent abdominal pain,vomiting and constipation for 3 d associated with abdominal distention.Plain abdominal X-ray revealed dilated small bowel.Abdominal computed tomography showed grossly dilated small bowel with "sausage" and "doughnut" signs of small bowel intussusception.She underwent laparotomy,with findings of ileoileal intussusception due to a cystic lesion adjacent to the mesenteric side.Resection of the cystic lesion along with the affected segment of intestine,with an end to end anastomosis was performed.The histopathology was consistent with enteric duplication cyst.This case highlights the DAT,although,an uncommon cause of adult ileoileal intussusception should be considered in the differential diagnosis of intussusception in adults,particularly when the leading point is a cystic lesion.展开更多
Primary cardiac liposarcoma is exceedingly rare and its metastatic potential varies based on the actual tumor subclass. Intestinal intussusception is also an uncommon cause of abdominal pain and bowel obstruction in a...Primary cardiac liposarcoma is exceedingly rare and its metastatic potential varies based on the actual tumor subclass. Intestinal intussusception is also an uncommon cause of abdominal pain and bowel obstruction in adults and it usually generates at a malignant lead point in this age group. We report a case of a primary cardiac dedifferentiated liposarcoma in a pregnant woman causing small bowel seeding leading to bowel intussusception.展开更多
BACKGROUND While in children intussusception is often idiopathic,in adults it is commonly caused by a pathologic condition functioning as a lead point.It is important to note that a variety of pathologic conditions ma...BACKGROUND While in children intussusception is often idiopathic,in adults it is commonly caused by a pathologic condition functioning as a lead point.It is important to note that a variety of pathologic conditions may trigger intussusception,with malignancy being a relatively frequent culprit in adults;this should be considered high on the differential diagnosis during evaluation.CASE SUMMARY This is a case of a 40-year-old female presenting to the emergency department(ED)with three days of acute on chronic,peri-umbilical abdominal pain described as waxing and waning,and pressure-like in nature.Initial computed tomography(CT)of the abdomen and pelvis with contrast in the ED(after her pain had resolved)re-demonstrated a previously noted 13 mm lesion in the gastric antrum but no clear cause of the pain.Endoscopic ultrasound was pursued,and the mass lesion was sampled via fine needle biopsy.Post-procedure the patient experienced another episode of severe pain which prompted a repeat stat CT abdomen and pelvis with contrast;this re-demonstrated the 13 mm antral lesion and in addition was remarkable for a gastro-gastric intussusception.An upper gastrointestinal gastrograffin series was ordered(completed only after the pain had subsided)and showed resolution of the intussusception.Histopathology was consistent with a diagnosis of low-grade neuroendocrine tumor(NET).Surgery was initially deferred during the hospitilization given the low grade pathology of the lesion;however further multidisciplinary discussion between Surgery,Oncology,and Gastroenterology recommended resection given the patient’s recurrent abdominal pain with the NET functioning as a lead point for further intussusception,and the patient thus underwent robotically-assisted wedge resection.CONCLUSION We present a unique case of severe,intermittent,peri-umbilical pain related to gastro-gastric intussusception caused by an antral NET lead point.The case highlights the importance of considering neoplasms as the cause of intussusception in adults and the greater diagnostic yield when imaging is obtained while symptoms(in this case severe,episodic abdominal pain)are most apparent.展开更多
Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated ...Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated factors of intussusception in under-five children in Enugu, Southeast, Nigeria. Methods: This was a retrospective descriptive study involving the sixty reported cases of intussusception in under-five children admitted in a hospital in Enugu between 2007 and 2012. Cases of intussusception were selected using the Brighton collaboration intussusception working group level I diagnostic criteria. Information sought from the patients’ folders included demographic characteristics and clinical manifestations including history of previous rotavirus vaccination, duration of illness prior to presentation, diarrhoea, vomiting, passage of red currant jelly-like stool, abdominal mass and distension, method of diagnosis, treatment option(s) employed and their outcomes. The data was analyzed using SPSS version 17.0. Results: The majority of the cases were aged less than one year (53;88.3%) while the average incidence of intussusception was 0.1 per 1000. None of the cases had received rotavirus vaccinations. The common clinical presentations were vomiting, 55 (17.2%), passage of red currant stool 50 (15.6%), fever 50 (15.6%) and abnormal/absent bowel sound 43 (15.9%). Diagnosis was essentially with the aid of abdominal ultrasonography, 38 (63.3%) while surgery (laparotomy) was the treatment of choice in most cases 48 (80.0%). The case fatality rate was 3 (5.0%). Conclusion: None of the cases studied could be directly linked to rotavirus vaccinations. But seasonal peak incidence coincided with rotavirus diarrhea peak incidence. Efforts should be made to institute post-rotavirus vaccine licensure prospective surveillance study in order to fully determine any relationship between rotavirus vaccination and intussusception in Enugu, South east, Nigeria.展开更多
Hepatocellular carcinoma （HCC） is a so highly invasive tumor that metastasizes hematogenously and lymphogenously to distant site. Frequent sites are lung, regional lymph node, bone, and adrenal gland. But metastasis...Hepatocellular carcinoma （HCC） is a so highly invasive tumor that metastasizes hematogenously and lymphogenously to distant site. Frequent sites are lung, regional lymph node, bone, and adrenal gland. But metastasis to the gastrointestinal （GI） tract is rare, and most common site is stomach. Metastasis to the small intestine is extremely rare. Moreover, metastatic HCC of the small bowel causing intussusception has not been reported until now. Here, we report a case of metastasis of HCC to the small bowel manifested by intussusception.展开更多
The original online version of this article (Tagbo, B. N., et al. 2014 “Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria”, 2014, 4, 123-132, http://dx.doi.org/10.4236/wjv.2014.43015) was...The original online version of this article (Tagbo, B. N., et al. 2014 “Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria”, 2014, 4, 123-132, http://dx.doi.org/10.4236/wjv.2014.43015) was published in August 2014. The author wishes to correct the author’s name and the Table 3 in the text.展开更多
BACKGROUND Melanoma is the most aggressive form of skin cancer,with a tendency to metastasize to any organ.Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide.Small intestine cancers ...BACKGROUND Melanoma is the most aggressive form of skin cancer,with a tendency to metastasize to any organ.Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide.Small intestine cancers especially small intestine metastases are relatively rare.Small intestine metastases are seldom described and likely underdiagnosed.Intussusception is most common in pediatric age,and in adults are almost 5%of all cases.CASE SUMMARY A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital,complaining of intermittent melena for 1 mo.Magnetic resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass,indicating a neoplastic lesion with jejunojejunal intussusception.The patient underwent partial small bowel resection.Pathological findings and immunohistochemical staining indicated small intestine metastatic melanoma.The patient refused further anti-tumor treatment after the surgery.Ten months after the first surgery,the patient presented with melena again.Computed tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall,and routine conservative treatment was given.Three months later,the patient developed melena again.The patient underwent a second surgery,and multiple metastatic melanoma lesions were found.The patient refused adjuvant anti-tumor treatment and was alive at the latest follow-up.CONCLUSION Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.展开更多
Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening. Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature. We des...Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening. Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature. We describe a case of retrograde intussusception, associated with the use of a Foley catheter as a replacement gastrostomy tube, presenting with upper gastrointestinal bleeding. To our knowledge, this is the first reported case of PEG-related retrograde intussusception successfully managed in a non-surgical manner. Retrograde intussusception likely occurred due to migration of the replacement tube with resultant securing and invagination of the proximal jejunum when the gastrostomy tube was anchored to the abdominal wall.展开更多
BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma(HCC)are the lungs,bones,adrenal glands,and regional lymph nodes.Hematogenous metastasis to the gastrointestinal(GI)tract is a rar...BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma(HCC)are the lungs,bones,adrenal glands,and regional lymph nodes.Hematogenous metastasis to the gastrointestinal(GI)tract is a rare condition in patients with HCC,and the prognosis is usually poor.We report,herein,an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy.CASE SUMMARY The patient was a 71-year-old man with a history of chronic hepatitis B,who had undergone three surgeries for HCC.He was treated with sorafenib for peritoneal metastases of HCC.He was admitted to our hospital with chief complaints of abdominal pain and vomiting.Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor,presenting with intussusception and small bowel obstruction.Conservative treatment was started,but due to repeated exacerbation of symptoms,surgery was planned on the 28th d of hospitalization.Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed.On histological examination,tumor cells were not observed on the serosal surface,but intravascular invasion of tumor cells was seen.Immunohistochemistry was positive for immunohistochemical markers,and a diagnosis of hematogenous metastasis of HCC to the ileum was made.He remains alive 82 mo after the first surgery.CONCLUSION Prognosis of HCC patients with GI tract metastasis is usually poor,but in some cases,multidisciplinary therapy may prolong survival.展开更多
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
Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local r...Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a "target sign" over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small intestine and colon and a segmental resection of metastatic lesions was performed. Unfortunately, the patient died of sepsis despite successful surgical intervention. Though local recurrence is more frequent in LMPM, the possibility of distant metastasis should not be ignored in patients with non-specifi c abdominal pain.展开更多
Background: Intussusception is defined as a telescoping of a proximal gastrointestinal segment with its mesentery to a distal one, only 5% occur in adults and in colon the probability that it is caused by a malignant ...Background: Intussusception is defined as a telescoping of a proximal gastrointestinal segment with its mesentery to a distal one, only 5% occur in adults and in colon the probability that it is caused by a malignant disease is up to 65%. Only 1% occurs in a retrograde manner, the rest occur in an anterograde manner. Aim: Describe the clinical presentation of an intussusception in the adult patient as well as its most frequent causes and possible complications that influence decision making for a definitive treatment. Case Presentation: A 66-year-old woman diagnosed with colon adenocarcinoma who underwent elective transverse colectomy and colonic anastomosis with an incidental finding of a transverse colon tumor in a retrograde intussusception was studied. Conclusion: In any adult patient with an intussusception especially in colon a neoplasia should be suspected and the affected segment should be resected without being reduced due to the risk of perforation and tumor dissemination.展开更多
Background: Accurate estimates of the baseline incidence of childhood intussusception could help safety monitoring after introduction of rotavirus vaccines. Therefore, we studied the incidence of intussusception in th...Background: Accurate estimates of the baseline incidence of childhood intussusception could help safety monitoring after introduction of rotavirus vaccines. Therefore, we studied the incidence of intussusception in the state ofQatar. Methods: We retrospectively reviewed cases of intussusception in children younger than 14 years. Children were treated between 2002 and 2012 at a single hospital inQatar. We analyzed information according to age, sex, clinical signs, diagnostic- and treatment-related characteristics, and length of stay. We calculated the national incidence of intussusception using census data. Results: A total of 106 children were diagnosed and treated for intussusception over 11 years. The male to female ratio of intussusception was 1.4:1. The most common symptom was bleeding per rectum (37%). One hundred andfour children with intussusception underwent diagnostic and therapeutic contrast enema, and 31.7% of patients underwent operative management. The length of stay was longer in patients who underwent operative reduction thanthat in those who did not. Conclusions: This is the first study to estimate the incidence of childhood intussusception prior to introduction of rotavirus vaccination in Qatar. A prospective surveillance system using a standardized case definition would be useful for examining the occurrence of intussusception in theArabicGulfarea and developing countries.展开更多
Aim: To delineate the factors associated with operative reduction of intussusception, in contrast to enema reduction only without surgical intervention, in children aged less than 14 years. Methods: We retrospectively...Aim: To delineate the factors associated with operative reduction of intussusception, in contrast to enema reduction only without surgical intervention, in children aged less than 14 years. Methods: We retrospectively reviewed the records of all children aged <14 years who experienced intussusception between 2002 and 2012 and were treated at a single hospital in Qatar. Clinical outcomes were correlated with age, sex, clinical symptoms, diagnosticand treatmentrelated characteristics, and length of hospital stay. Results: A total of 141 children were diagnosed and treated for intussusception over 11 years. The male to female ratio of intussusception was 1.4:1. The length of hospital stay was longer in patients who underwent operative reduction than those that did not. Conclusion: Delay in presentation did not decrease the success of radiologic reduction and did not increase the risk of operative intervention and bowel resection.展开更多
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: 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.
文摘AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI).METHODS:A retrospective review of the clinical features,diagnosis,management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted.RESULTS:Forty-one patients with 44 intussusceptions were operated on,24.4% had acute symptoms,24.4% had subacute symptoms,and 51.2% had chronic symptoms.70.7% of the patients presented with intestinal obstruction.There were 20 enteric,15 ileocolic,eight colocolonic and one sigmoidorectal intussusceptions.65.9% of intussusceptions were diagnosed preoperatively using a computed tomography (CT) scan (90.5% accurate) and ultrasonography (60.0% accurate,rising to 91.7% for patients who had a palpable abdominal mass).Coloscopy located the occupying lesions of the lead point of ileocolic,colocolonic and sigmoidorectal intussusceptions.Four intussusceptions in three patients were simply reduced.Twenty-one patients underwent resection after primary reduction.There was no mortality and anastomosis leakage perioperatively.Except for one patient with multiple small bowel adenomas,which recurred 5 mo after surgery,no patients were recurrent within 6 mo.Pathologically,54.5% of the intussusceptions had a tumor,of which 27.3% were malignant.9.1% comprised nontumorous polyps.Four intussusceptions had a gastrojejunostomy with intestinal intubation,and four intussusceptions had no organic lesion.CONCLUSION:CT is the most effective and accurate diagnostic technique.Colonoscopy can detect most lead point lesions of non-enteric intussusceptions.Intestinal intubation should be avoided.
文摘Jejunogastric intussusception is a rare long term complication of Billroth Ⅱ gastrectomy. The case reported here is a 50 year old man with history of a Billroth Ⅱ gastrectomy and Braun's side-to-side jejunojejunal anastomosis who presented with hematemesis. On abdominal examination, there was a mass in the left iliac fossa. Computed tomography scan showed a retrograde jejunogastric intussusception across the gastrojejunostomy. On laparotomy, a retrograde intussusception of the distal jejunum through the jejunojejunal anastomosis and across the gastrojejunostomy with a gangrenous intussusceptum was found. The jejunojejunal anastomosis was taken down, the gangrenous segment was resected and bowel continuity was restored with two jejunojejunal anastomoses, proximal and distal to the gastrojejunostomy. The gastrojejunostomy was preserved. This case brings out an unusual type of retrograde gangrenous intussusception which occurred at two points of a previous anastomosis, i.e., jejunojejunostomy and gastrojejunostomy simultaneously, which could be managed with jejunal resection.
文摘Duplication of alimentary tract(DAT) presenting as an ileoileal intussusception is a very rare clinical entity.Herein,a case of an ileoileal intussusception due to DAT is presented.A 32-year-old woman was hospitalized due to diffuse,intermittent abdominal pain,vomiting and constipation for 3 d associated with abdominal distention.Plain abdominal X-ray revealed dilated small bowel.Abdominal computed tomography showed grossly dilated small bowel with "sausage" and "doughnut" signs of small bowel intussusception.She underwent laparotomy,with findings of ileoileal intussusception due to a cystic lesion adjacent to the mesenteric side.Resection of the cystic lesion along with the affected segment of intestine,with an end to end anastomosis was performed.The histopathology was consistent with enteric duplication cyst.This case highlights the DAT,although,an uncommon cause of adult ileoileal intussusception should be considered in the differential diagnosis of intussusception in adults,particularly when the leading point is a cystic lesion.
文摘Primary cardiac liposarcoma is exceedingly rare and its metastatic potential varies based on the actual tumor subclass. Intestinal intussusception is also an uncommon cause of abdominal pain and bowel obstruction in adults and it usually generates at a malignant lead point in this age group. We report a case of a primary cardiac dedifferentiated liposarcoma in a pregnant woman causing small bowel seeding leading to bowel intussusception.
文摘BACKGROUND While in children intussusception is often idiopathic,in adults it is commonly caused by a pathologic condition functioning as a lead point.It is important to note that a variety of pathologic conditions may trigger intussusception,with malignancy being a relatively frequent culprit in adults;this should be considered high on the differential diagnosis during evaluation.CASE SUMMARY This is a case of a 40-year-old female presenting to the emergency department(ED)with three days of acute on chronic,peri-umbilical abdominal pain described as waxing and waning,and pressure-like in nature.Initial computed tomography(CT)of the abdomen and pelvis with contrast in the ED(after her pain had resolved)re-demonstrated a previously noted 13 mm lesion in the gastric antrum but no clear cause of the pain.Endoscopic ultrasound was pursued,and the mass lesion was sampled via fine needle biopsy.Post-procedure the patient experienced another episode of severe pain which prompted a repeat stat CT abdomen and pelvis with contrast;this re-demonstrated the 13 mm antral lesion and in addition was remarkable for a gastro-gastric intussusception.An upper gastrointestinal gastrograffin series was ordered(completed only after the pain had subsided)and showed resolution of the intussusception.Histopathology was consistent with a diagnosis of low-grade neuroendocrine tumor(NET).Surgery was initially deferred during the hospitilization given the low grade pathology of the lesion;however further multidisciplinary discussion between Surgery,Oncology,and Gastroenterology recommended resection given the patient’s recurrent abdominal pain with the NET functioning as a lead point for further intussusception,and the patient thus underwent robotically-assisted wedge resection.CONCLUSION We present a unique case of severe,intermittent,peri-umbilical pain related to gastro-gastric intussusception caused by an antral NET lead point.The case highlights the importance of considering neoplasms as the cause of intussusception in adults and the greater diagnostic yield when imaging is obtained while symptoms(in this case severe,episodic abdominal pain)are most apparent.
文摘Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated factors of intussusception in under-five children in Enugu, Southeast, Nigeria. Methods: This was a retrospective descriptive study involving the sixty reported cases of intussusception in under-five children admitted in a hospital in Enugu between 2007 and 2012. Cases of intussusception were selected using the Brighton collaboration intussusception working group level I diagnostic criteria. Information sought from the patients’ folders included demographic characteristics and clinical manifestations including history of previous rotavirus vaccination, duration of illness prior to presentation, diarrhoea, vomiting, passage of red currant jelly-like stool, abdominal mass and distension, method of diagnosis, treatment option(s) employed and their outcomes. The data was analyzed using SPSS version 17.0. Results: The majority of the cases were aged less than one year (53;88.3%) while the average incidence of intussusception was 0.1 per 1000. None of the cases had received rotavirus vaccinations. The common clinical presentations were vomiting, 55 (17.2%), passage of red currant stool 50 (15.6%), fever 50 (15.6%) and abnormal/absent bowel sound 43 (15.9%). Diagnosis was essentially with the aid of abdominal ultrasonography, 38 (63.3%) while surgery (laparotomy) was the treatment of choice in most cases 48 (80.0%). The case fatality rate was 3 (5.0%). Conclusion: None of the cases studied could be directly linked to rotavirus vaccinations. But seasonal peak incidence coincided with rotavirus diarrhea peak incidence. Efforts should be made to institute post-rotavirus vaccine licensure prospective surveillance study in order to fully determine any relationship between rotavirus vaccination and intussusception in Enugu, South east, Nigeria.
文摘Hepatocellular carcinoma （HCC） is a so highly invasive tumor that metastasizes hematogenously and lymphogenously to distant site. Frequent sites are lung, regional lymph node, bone, and adrenal gland. But metastasis to the gastrointestinal （GI） tract is rare, and most common site is stomach. Metastasis to the small intestine is extremely rare. Moreover, metastatic HCC of the small bowel causing intussusception has not been reported until now. Here, we report a case of metastasis of HCC to the small bowel manifested by intussusception.
文摘The original online version of this article (Tagbo, B. N., et al. 2014 “Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria”, 2014, 4, 123-132, http://dx.doi.org/10.4236/wjv.2014.43015) was published in August 2014. The author wishes to correct the author’s name and the Table 3 in the text.
基金Supported by National Natural Science Foundation of China,No.82100568.
文摘BACKGROUND Melanoma is the most aggressive form of skin cancer,with a tendency to metastasize to any organ.Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide.Small intestine cancers especially small intestine metastases are relatively rare.Small intestine metastases are seldom described and likely underdiagnosed.Intussusception is most common in pediatric age,and in adults are almost 5%of all cases.CASE SUMMARY A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital,complaining of intermittent melena for 1 mo.Magnetic resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass,indicating a neoplastic lesion with jejunojejunal intussusception.The patient underwent partial small bowel resection.Pathological findings and immunohistochemical staining indicated small intestine metastatic melanoma.The patient refused further anti-tumor treatment after the surgery.Ten months after the first surgery,the patient presented with melena again.Computed tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall,and routine conservative treatment was given.Three months later,the patient developed melena again.The patient underwent a second surgery,and multiple metastatic melanoma lesions were found.The patient refused adjuvant anti-tumor treatment and was alive at the latest follow-up.CONCLUSION Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.
文摘Percutaneous endoscopic gastrostomy (PEG) tube complications can be serious or life threatening. Retrograde intussusception is a very rare complication of PEG tubes with only 9 cases reported in the literature. We describe a case of retrograde intussusception, associated with the use of a Foley catheter as a replacement gastrostomy tube, presenting with upper gastrointestinal bleeding. To our knowledge, this is the first reported case of PEG-related retrograde intussusception successfully managed in a non-surgical manner. Retrograde intussusception likely occurred due to migration of the replacement tube with resultant securing and invagination of the proximal jejunum when the gastrostomy tube was anchored to the abdominal wall.
文摘BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma(HCC)are the lungs,bones,adrenal glands,and regional lymph nodes.Hematogenous metastasis to the gastrointestinal(GI)tract is a rare condition in patients with HCC,and the prognosis is usually poor.We report,herein,an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy.CASE SUMMARY The patient was a 71-year-old man with a history of chronic hepatitis B,who had undergone three surgeries for HCC.He was treated with sorafenib for peritoneal metastases of HCC.He was admitted to our hospital with chief complaints of abdominal pain and vomiting.Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor,presenting with intussusception and small bowel obstruction.Conservative treatment was started,but due to repeated exacerbation of symptoms,surgery was planned on the 28th d of hospitalization.Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed.On histological examination,tumor cells were not observed on the serosal surface,but intravascular invasion of tumor cells was seen.Immunohistochemistry was positive for immunohistochemical markers,and a diagnosis of hematogenous metastasis of HCC to the ileum was made.He remains alive 82 mo after the first surgery.CONCLUSION Prognosis of HCC patients with GI tract metastasis is usually poor,but in some cases,multidisciplinary therapy may prolong survival.
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Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a "target sign" over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small intestine and colon and a segmental resection of metastatic lesions was performed. Unfortunately, the patient died of sepsis despite successful surgical intervention. Though local recurrence is more frequent in LMPM, the possibility of distant metastasis should not be ignored in patients with non-specifi c abdominal pain.
文摘Background: Intussusception is defined as a telescoping of a proximal gastrointestinal segment with its mesentery to a distal one, only 5% occur in adults and in colon the probability that it is caused by a malignant disease is up to 65%. Only 1% occurs in a retrograde manner, the rest occur in an anterograde manner. Aim: Describe the clinical presentation of an intussusception in the adult patient as well as its most frequent causes and possible complications that influence decision making for a definitive treatment. Case Presentation: A 66-year-old woman diagnosed with colon adenocarcinoma who underwent elective transverse colectomy and colonic anastomosis with an incidental finding of a transverse colon tumor in a retrograde intussusception was studied. Conclusion: In any adult patient with an intussusception especially in colon a neoplasia should be suspected and the affected segment should be resected without being reduced due to the risk of perforation and tumor dissemination.
文摘Background: Accurate estimates of the baseline incidence of childhood intussusception could help safety monitoring after introduction of rotavirus vaccines. Therefore, we studied the incidence of intussusception in the state ofQatar. Methods: We retrospectively reviewed cases of intussusception in children younger than 14 years. Children were treated between 2002 and 2012 at a single hospital inQatar. We analyzed information according to age, sex, clinical signs, diagnostic- and treatment-related characteristics, and length of stay. We calculated the national incidence of intussusception using census data. Results: A total of 106 children were diagnosed and treated for intussusception over 11 years. The male to female ratio of intussusception was 1.4:1. The most common symptom was bleeding per rectum (37%). One hundred andfour children with intussusception underwent diagnostic and therapeutic contrast enema, and 31.7% of patients underwent operative management. The length of stay was longer in patients who underwent operative reduction thanthat in those who did not. Conclusions: This is the first study to estimate the incidence of childhood intussusception prior to introduction of rotavirus vaccination in Qatar. A prospective surveillance system using a standardized case definition would be useful for examining the occurrence of intussusception in theArabicGulfarea and developing countries.
文摘Aim: To delineate the factors associated with operative reduction of intussusception, in contrast to enema reduction only without surgical intervention, in children aged less than 14 years. Methods: We retrospectively reviewed the records of all children aged <14 years who experienced intussusception between 2002 and 2012 and were treated at a single hospital in Qatar. Clinical outcomes were correlated with age, sex, clinical symptoms, diagnosticand treatmentrelated characteristics, and length of hospital stay. Results: A total of 141 children were diagnosed and treated for intussusception over 11 years. The male to female ratio of intussusception was 1.4:1. The length of hospital stay was longer in patients who underwent operative reduction than those that did not. Conclusion: Delay in presentation did not decrease the success of radiologic reduction and did not increase the risk of operative intervention and bowel resection.
