Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania,trichophagia and gastric dysmotility.Long standing bezoars may extend into the small intestine le...Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania,trichophagia and gastric dysmotility.Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome.Diagnosis can be established by endoscopy,ultrasonography and computed tomography scan.Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy.Psychiatric consultation is necessary to treat and prevent relapse.We report a case of Rapunzel syndrome in a 16-yearold girl with trichotillomania.She presented with history of epigastric mass for three months and recent onset of pain abdomen,vomiting and early satiety.Skiagram of abdomen was showing distended stomach and endoscopy revealed trichobezoar.At laparotomy,stomach was distended with trichobezoar and there were multiple small intestinal intussusceptions.Gastrotomy and manual reduction of intussusceptions with the removal of trichobezoar with its tail was done.Patient recovered completely after the procedure.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 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
Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The...Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The causes of ODS include structural abnormalities such as rectocele,enterocele,intussusception,and pelvic floor descent,as well as functional disorders like anismus.Accurate diagnosis is crucial for effective management due to the high risk of treatment failure associated with inaccurate findings.Various imaging modalities are used to assess pelvic floor disorders,including fluoroscopic defecography(FD),mag-netic resonance defecography(MRD),pelvic floor ultrasound(PFUS),and echode-fecography(EDF).FD is the most commonly performed test worldwide,offering high accuracy in diagnosing pelvic floor disorders.It provides dynamic visual-ization of defecation mechanics but involves radiation exposure.MRD offers ex-cellent soft tissue detail and multiplanar imaging without radiation,making it particularly useful for multicompartment disorders;however,it is associated with high procedural costs and limited availability.Both PFUS and EDF are minimally invasive and avoid radiation exposure.PFUS shows promise as a valuable screening tool that could help minimize the need for advanced imaging if findings are normal.EDF is also promising but requires specialized training and remains less widely available.This review evaluates the accuracy,advantages,and limitations of various diagnostic modalities for pelvic floor disorders,aiming to guide optimal clinical decision-making.展开更多
Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate...Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.展开更多
BACKGROUND Complications arising from the polyps in Peutz-Jeghers syndrome(PJS)have historically been addressed through surgical treatment.Enteroscopic poly-pectomy is hypothesized to reduce the risk of surgery in PJS...BACKGROUND Complications arising from the polyps in Peutz-Jeghers syndrome(PJS)have historically been addressed through surgical treatment.Enteroscopic poly-pectomy is hypothesized to reduce the risk of surgery in PJS.However,the optimal timing for polyp screening and preventive intervention using entero-scopic polypectomy remains uncertain.This is primarily due to the extremely low incidence of the condition and the paucity of data regarding the natural risk of requiring surgery and its age distribution in PJS patients.In order to develop recommendations on the appropriate timing of polyp screening and preventive intervention in PJS,a comprehensive understanding of the natural surgical risks AIM To investigate the natural surgical risks associated with polyps in PJS and to clarify their age distribution.METHODS A web-based open survey was launched to collect information from Chinese individuals suspected of having PJS.The questionnaire was distributed to the PJS instant messaging groups using a quick response code method.The data were analyzed using descriptive statistical methods,and the cumulative incidence of surgery was calculated using the Kaplan-Meier method.RESULTS Of the 442 patients enrolled,301(68.10%)had undergone 506 surgical procedures prior to enteroscopy or the survey deadline.Among the 506 surgical procedures,388(76.68%)were performed on patients aged between 6 and 25 years.The cumulative incidence rates of the first surgical procedure at 5,10,15,20,25,and 30 years of age were 5.0%(95%confidence interval[CI]:2.9%-7.0%),20.6%(95%CI:16.6%-24.4%),40.5%(95%CI:35.5%-45.1%),58.0%(95%CI:52.7%-62.7%),72.6%(95%CI:67.3%-77.0%),and 82.4%(95%CI:77.0%-86.5%),respectively.The primary indications for the first surgical procedures were intussusception(81.40%),obstruction(13.95%),and gas-trointestinal bleeding(4.65%).The cumulative incidence rates of requiring a second surgical procedure within 1,3,5,10 and 15 years following the first surgical procedure were 3.7%(95%CI:1.5%-5.8%),12.5%(95%CI:8.6%-16.2%),20.3%(95%CI:15.6%-24.8%),37.0%(95%CI:33.1%-45.3%),54.2%(95%CI:46.8%-60.5%),respectively.Patients who underwent their first surgical procedure at the age of nine years or younger presented an elevated risk of requiring a second surgical procedure(P<0.01).CONCLUSION Chinese patients with PJS have a high natural risk of undergoing surgery.Without preventive intervention,these procedures may become necessary at an early age and may be repeated.Early screening and regular surveillance,with preventive intervention if necessary,should commence at six years of age.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
Meckel's diverticulum is a common asymptomatic congenital gastrointestinal anomaly,but rarely it can present with hemorrhage.Over the last few years inverted Meckel's diverticulum has been reported in the lite...Meckel's diverticulum is a common asymptomatic congenital gastrointestinal anomaly,but rarely it can present with hemorrhage.Over the last few years inverted Meckel's diverticulum has been reported in the literature with increasing frequency as an occult source of lower gastrointestinal hemorrhage.Here,we report a case of a 54-year-old male,who was referred for surgical evaluation with persistent anemia and occult blood per rectum after a work up which failed to localize the source over 12 mo,including upper and capsule endoscopy,colonoscopy,enteroclysis,Meckel scan,and tagged nuclear red blood cell scan.An abdominal computed tomography scan showed a possible mid-ileal intussusception and intraluminal mass.During the abdominal exploration,inverted Meckel's diverticulum was diagnosed and resected.We review the literature,discuss the forms in which the disease presents,the diagnostic modalities utilized,pathological findings,and treatment.Although less than 40 cases have been reported in the English literature from 1978 to 2005,19 cases have been reported in the last 6 years alone(2006-2012) due to improved diagnostic modalities.Successful diagnosis and treatment of this disease requires a high index of clinical suspicion,which is becoming increasingly relevant to general gastroenterologists.展开更多
Intussusception is a paediatric condition that rarely presents in adults. We report an exceptional case of ileocolic intussusception prolapsing from the rectum in an adult with Von Recklinghausen′s disease. A 31-year...Intussusception is a paediatric condition that rarely presents in adults. We report an exceptional case of ileocolic intussusception prolapsing from the rectum in an adult with Von Recklinghausen′s disease. A 31-year-old man with von Recklinghausen′s disease presented to emergency department with a history of severe abdominal pain, vomits and rectal bleeding. Abdominal computed tomography showed intestinal obstruction probably due to a sigmoidorectal intussusception. Ileum, appendix, cecum and ascending colon were found to be intussuscepting through transverse, descending and sigmoid colon and prolapsing from the rectum during an emergent laparotomy. A right hemicolectomy was performed. An anatomical pathology examination revealed a neurofibroma of the appendix as lead point for intussusception. Intussusception in adults requires early surgical resection regardless of the nature of the initial case. Neurofibroma of the appendix is very rare;although it is benign, prompt resection is recommended because of a high risk of appendicitis and malignant transformation.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
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
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
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
Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy （VE）. Although alternative management such as epididymal or testicular sperm aspir...Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy （VE）. Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE （LIVE） in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the oreoDerative evaluation along with the techniaues of various VE will be described in this article.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
BACKGROUND Peutz-Jeghers syndrome(PJS)is a clinically rare disease with pigmented spots on the lips and mucous membranes and extremities,scattered gastrointestinal polyps,and susceptibility to tumors as clinical manif...BACKGROUND Peutz-Jeghers syndrome(PJS)is a clinically rare disease with pigmented spots on the lips and mucous membranes and extremities,scattered gastrointestinal polyps,and susceptibility to tumors as clinical manifestations.Effective preventive and curative methods are still lacking.Here we summarize our experience with 566 Chinese patients with PJS from a Chinese medical center with regard to the clinical features,diagnosis,and treatment.AIM To explore the clinical features,diagnosis,and treatment of PJS in a Chinese medical center.METHODS The diagnosis and treatment information of 566 cases of PJS admitted to the Air Force Medical Center from January 1994 to October 2022 was summarized.A clinical database was established covering age,gender,ethnicity,family history,age at first treatment,time and sequence of appearance of mucocutaneous pigmentation,polyp distribution,quantity,and diameter,frequency of hospitalization,fre-quency of surgical operations,etc.The clinical data was retrospectively analyzed using SPSS 26.0 software,with P<0.05 considered statistically significant.RESULTS Of all the patients included,55.3%were male and 44.7%were female.Median time to the appearance of mucocutaneous pigmentation was 2 years,and median time from the appearance of mucocutaneous pigmentation to the occurrence of abdominal symptoms was 10 years.The vast majority(92.2%)of patients underwent small bowel endoscopy and treatment,with 2.3%having serious complications.There was a statistically significant difference in the number of enteroscopies between patients with and without canceration(P=0.004,Z=-2.882);71.2%of patients underwent surgical operation,75.6%of patients underwent surgical operation before the age of 35 years,and there was a statistically significant difference in the frequency of surgical operations between patients with and without cancer(P=0.000,Z=-5.127).At 40 years of age,the cumulative risk of intussusception in PJS was approximately 72.0%,and at 50 years,the cumulative risk of intussusception in PJS was approximately 89.6%.At 50 years of age,the cumulative risk of cancer in PJS was approximately 49.3%,and at 60 years of age,the cumulative risk of cancer in PJS was approximately 71.7%.CONCLUSION The risk of intussusception and cancer of PJS polyps increases with age.PJS patients≥10 years old should undergo annual enteroscopy.Endoscopic treatment has a good safety profile and can reduce the occurrence of polyps intussusception and cancer.Surgery should be conducted to protect the gastrointestinal system by removing polyps.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
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
Colonic intussusception and gastrointestinal duplication are diseases that arise in young children. The clinical presentation of adult cases of intussusception and enteric duplication is non-specific and thus poses a ...Colonic intussusception and gastrointestinal duplication are diseases that arise in young children. The clinical presentation of adult cases of intussusception and enteric duplication is non-specific and thus poses a diagnostic challenge. A computed tomography (CT) scan is recommended in adult cases as the most sensitive diagnostic tool and the pathognomonic finding of outer intussuscepiens and central intussusceptum is diagnostic. A septum of a duplicated colon in a non-intussuscepted segment has been rarely reported in the literature. With advancements in radiological imaging technology and the increased availability of CT scanners, the capacity for a correct pre-operative diagnosis has been significantly enhanced. Our current case report illustrates the importance of considering an uncommon etiology for enteric intussusception and duplication as a differential diagnosis of acute abdomen in an adult patient. Our analyses of this patient also highlight the successful use of CT scanning to make this diagnosis.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
文摘Bezoars are usually confined to the stomach which is seen in individuals with psychiatric illness like trichotillomania,trichophagia and gastric dysmotility.Long standing bezoars may extend into the small intestine leading to a condition known as Rapunzel syndrome.Diagnosis can be established by endoscopy,ultrasonography and computed tomography scan.Treatment includes improvement of general condition and removal of bezoar by laparoscopic approach or laparotomy.Psychiatric consultation is necessary to treat and prevent relapse.We report a case of Rapunzel syndrome in a 16-yearold girl with trichotillomania.She presented with history of epigastric mass for three months and recent onset of pain abdomen,vomiting and early satiety.Skiagram of abdomen was showing distended stomach and endoscopy revealed trichobezoar.At laparotomy,stomach was distended with trichobezoar and there were multiple small intestinal intussusceptions.Gastrotomy and manual reduction of intussusceptions with the removal of trichobezoar with its tail was done.Patient recovered completely after the procedure.
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 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Obstructed defecation syndrome(ODS)is a complex defecatory disorder asso-ciated with pelvic floor dysfunction.It affects approximately 50%of women over the age of 50 and significantly impacts their quality of life.The causes of ODS include structural abnormalities such as rectocele,enterocele,intussusception,and pelvic floor descent,as well as functional disorders like anismus.Accurate diagnosis is crucial for effective management due to the high risk of treatment failure associated with inaccurate findings.Various imaging modalities are used to assess pelvic floor disorders,including fluoroscopic defecography(FD),mag-netic resonance defecography(MRD),pelvic floor ultrasound(PFUS),and echode-fecography(EDF).FD is the most commonly performed test worldwide,offering high accuracy in diagnosing pelvic floor disorders.It provides dynamic visual-ization of defecation mechanics but involves radiation exposure.MRD offers ex-cellent soft tissue detail and multiplanar imaging without radiation,making it particularly useful for multicompartment disorders;however,it is associated with high procedural costs and limited availability.Both PFUS and EDF are minimally invasive and avoid radiation exposure.PFUS shows promise as a valuable screening tool that could help minimize the need for advanced imaging if findings are normal.EDF is also promising but requires specialized training and remains less widely available.This review evaluates the accuracy,advantages,and limitations of various diagnostic modalities for pelvic floor disorders,aiming to guide optimal clinical decision-making.
文摘Obstructed defecation syndrome(ODS)represents an important cause of constipation,primarily arising from dysfunctions within the pelvic floor.Characterized by an inability to complete defecation or effectively evacuate fecal material despite the urge to defecate,ODS results in a persistent sensation of incomplete evacuation and often requires excessive straining during defecation.Conventional clinical examinations fail to adequately assess the complex dynamic dysfunctions of the pelvic floor and anorectal region.Magnetic resonance defecography(MRD),a sophisticated form of dynamic pelvic floor imaging,provides a comprehensive,non-invasive means of visualizing and quantifying various anorectal and pelvic floor abnormalities.By allowing detailed assessment of structural and functional deficits during the defecation process,MRD plays a crucial role in the diagnostic workup of ODS,enabling colorectal surgeons to formulate more precise and individualized treatment strategies.This manuscript highlights the important anatomical and functional disorders of pelvic floor that are associated with ODS.
文摘BACKGROUND Complications arising from the polyps in Peutz-Jeghers syndrome(PJS)have historically been addressed through surgical treatment.Enteroscopic poly-pectomy is hypothesized to reduce the risk of surgery in PJS.However,the optimal timing for polyp screening and preventive intervention using entero-scopic polypectomy remains uncertain.This is primarily due to the extremely low incidence of the condition and the paucity of data regarding the natural risk of requiring surgery and its age distribution in PJS patients.In order to develop recommendations on the appropriate timing of polyp screening and preventive intervention in PJS,a comprehensive understanding of the natural surgical risks AIM To investigate the natural surgical risks associated with polyps in PJS and to clarify their age distribution.METHODS A web-based open survey was launched to collect information from Chinese individuals suspected of having PJS.The questionnaire was distributed to the PJS instant messaging groups using a quick response code method.The data were analyzed using descriptive statistical methods,and the cumulative incidence of surgery was calculated using the Kaplan-Meier method.RESULTS Of the 442 patients enrolled,301(68.10%)had undergone 506 surgical procedures prior to enteroscopy or the survey deadline.Among the 506 surgical procedures,388(76.68%)were performed on patients aged between 6 and 25 years.The cumulative incidence rates of the first surgical procedure at 5,10,15,20,25,and 30 years of age were 5.0%(95%confidence interval[CI]:2.9%-7.0%),20.6%(95%CI:16.6%-24.4%),40.5%(95%CI:35.5%-45.1%),58.0%(95%CI:52.7%-62.7%),72.6%(95%CI:67.3%-77.0%),and 82.4%(95%CI:77.0%-86.5%),respectively.The primary indications for the first surgical procedures were intussusception(81.40%),obstruction(13.95%),and gas-trointestinal bleeding(4.65%).The cumulative incidence rates of requiring a second surgical procedure within 1,3,5,10 and 15 years following the first surgical procedure were 3.7%(95%CI:1.5%-5.8%),12.5%(95%CI:8.6%-16.2%),20.3%(95%CI:15.6%-24.8%),37.0%(95%CI:33.1%-45.3%),54.2%(95%CI:46.8%-60.5%),respectively.Patients who underwent their first surgical procedure at the age of nine years or younger presented an elevated risk of requiring a second surgical procedure(P<0.01).CONCLUSION Chinese patients with PJS have a high natural risk of undergoing surgery.Without preventive intervention,these procedures may become necessary at an early age and may be repeated.Early screening and regular surveillance,with preventive intervention if necessary,should commence at six years of age.
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.
基金Supported by United States National Institute of Health grants,K12HD055881 and R01CA160688,to Takabe KJapan Society for the Promotion of Science Postdoctoral Fellowship for Re-search Abroad,to Nagahashi M
文摘Meckel's diverticulum is a common asymptomatic congenital gastrointestinal anomaly,but rarely it can present with hemorrhage.Over the last few years inverted Meckel's diverticulum has been reported in the literature with increasing frequency as an occult source of lower gastrointestinal hemorrhage.Here,we report a case of a 54-year-old male,who was referred for surgical evaluation with persistent anemia and occult blood per rectum after a work up which failed to localize the source over 12 mo,including upper and capsule endoscopy,colonoscopy,enteroclysis,Meckel scan,and tagged nuclear red blood cell scan.An abdominal computed tomography scan showed a possible mid-ileal intussusception and intraluminal mass.During the abdominal exploration,inverted Meckel's diverticulum was diagnosed and resected.We review the literature,discuss the forms in which the disease presents,the diagnostic modalities utilized,pathological findings,and treatment.Although less than 40 cases have been reported in the English literature from 1978 to 2005,19 cases have been reported in the last 6 years alone(2006-2012) due to improved diagnostic modalities.Successful diagnosis and treatment of this disease requires a high index of clinical suspicion,which is becoming increasingly relevant to general gastroenterologists.
文摘Intussusception is a paediatric condition that rarely presents in adults. We report an exceptional case of ileocolic intussusception prolapsing from the rectum in an adult with Von Recklinghausen′s disease. A 31-year-old man with von Recklinghausen′s disease presented to emergency department with a history of severe abdominal pain, vomits and rectal bleeding. Abdominal computed tomography showed intestinal obstruction probably due to a sigmoidorectal intussusception. Ileum, appendix, cecum and ascending colon were found to be intussuscepting through transverse, descending and sigmoid colon and prolapsing from the rectum during an emergent laparotomy. A right hemicolectomy was performed. An anatomical pathology examination revealed a neurofibroma of the appendix as lead point for intussusception. Intussusception in adults requires early surgical resection regardless of the nature of the initial case. Neurofibroma of the appendix is very rare;although it is benign, prompt resection is recommended because of a high risk of appendicitis and malignant transformation.
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.
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Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy （VE）. Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE （LIVE） in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the oreoDerative evaluation along with the techniaues of various VE will be described in this article.
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.
基金Supported by Beijing Capital Medical Development Research Fund,No.Shoufa2020-2-5122Outstanding Young Talents Program of Air Force Medical Center,PLA,No.22BJQN004Clinical Program of Air Force Medical University,No.Xiaoke2022-07.
文摘BACKGROUND Peutz-Jeghers syndrome(PJS)is a clinically rare disease with pigmented spots on the lips and mucous membranes and extremities,scattered gastrointestinal polyps,and susceptibility to tumors as clinical manifestations.Effective preventive and curative methods are still lacking.Here we summarize our experience with 566 Chinese patients with PJS from a Chinese medical center with regard to the clinical features,diagnosis,and treatment.AIM To explore the clinical features,diagnosis,and treatment of PJS in a Chinese medical center.METHODS The diagnosis and treatment information of 566 cases of PJS admitted to the Air Force Medical Center from January 1994 to October 2022 was summarized.A clinical database was established covering age,gender,ethnicity,family history,age at first treatment,time and sequence of appearance of mucocutaneous pigmentation,polyp distribution,quantity,and diameter,frequency of hospitalization,fre-quency of surgical operations,etc.The clinical data was retrospectively analyzed using SPSS 26.0 software,with P<0.05 considered statistically significant.RESULTS Of all the patients included,55.3%were male and 44.7%were female.Median time to the appearance of mucocutaneous pigmentation was 2 years,and median time from the appearance of mucocutaneous pigmentation to the occurrence of abdominal symptoms was 10 years.The vast majority(92.2%)of patients underwent small bowel endoscopy and treatment,with 2.3%having serious complications.There was a statistically significant difference in the number of enteroscopies between patients with and without canceration(P=0.004,Z=-2.882);71.2%of patients underwent surgical operation,75.6%of patients underwent surgical operation before the age of 35 years,and there was a statistically significant difference in the frequency of surgical operations between patients with and without cancer(P=0.000,Z=-5.127).At 40 years of age,the cumulative risk of intussusception in PJS was approximately 72.0%,and at 50 years,the cumulative risk of intussusception in PJS was approximately 89.6%.At 50 years of age,the cumulative risk of cancer in PJS was approximately 49.3%,and at 60 years of age,the cumulative risk of cancer in PJS was approximately 71.7%.CONCLUSION The risk of intussusception and cancer of PJS polyps increases with age.PJS patients≥10 years old should undergo annual enteroscopy.Endoscopic treatment has a good safety profile and can reduce the occurrence of polyps intussusception and cancer.Surgery should be conducted to protect the gastrointestinal system by removing polyps.
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.
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Colonic intussusception and gastrointestinal duplication are diseases that arise in young children. The clinical presentation of adult cases of intussusception and enteric duplication is non-specific and thus poses a diagnostic challenge. A computed tomography (CT) scan is recommended in adult cases as the most sensitive diagnostic tool and the pathognomonic finding of outer intussuscepiens and central intussusceptum is diagnostic. A septum of a duplicated colon in a non-intussuscepted segment has been rarely reported in the literature. With advancements in radiological imaging technology and the increased availability of CT scanners, the capacity for a correct pre-operative diagnosis has been significantly enhanced. Our current case report illustrates the importance of considering an uncommon etiology for enteric intussusception and duplication as a differential diagnosis of acute abdomen in an adult patient. Our analyses of this patient also highlight the successful use of CT scanning to make this diagnosis.
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.
