Post Colonoscopy Colonic Intussusception Reduced via a Laparoscopic Approach

Intussusception occurs when a mass in the bowel is pulled forward by normal peristalsis, with resultant invagination of the involved bowel wall. In the absence of a mass, intussusception may be caused by functional disturbances without gross mural abnormality. Colo-colonic intussusception in adult is relatively rare and usually secondary to a definable lesion, the majority of which are malignant in nature. Idiopathic intussusception in adults is rare and its pathogenesis is poorly understood.We present a case report of an adult colo-colonic intussusception occurring after colonoscopy, which was treated successfully with laparoscopic reduction. We speculate that the intussusception was induced by post-polypectomy mucosal edema acting as a lead point and therefore can be treated without resection.     

Caeco-colic intussusception in an adult: a rare case report

Intussusception is common in children but rare in adults. Caeco-colic intussusception is an uncommon cause of intestinal obstruction in adults. Very limited information is available about the role of colonoscopy in diagnosis of intussusception in the literature. We present a case of caeco-colic intussusception in a 50-year-old male who presented with the complaints of pain in abdomen and a lump in the right hypochondrium. Colonoscopy and contrast studies revealed the diagnosis of intussusception. Abdominal computed tomography (CT scan) is considered as the most sensitive investigation to diagnose intussusception at present, whereas colonoscopy is sparingly used to diagnose intussusception. In this patient, colonoscopy not only established the diagnosis and malignant nature of the lead point, but also guided the definitive extent of surgical resection. CT scan offers a presumptive diagnosis as compared to the definitive diagnosis of intussusception by colonoscopy. In adult intussusception, colonoscopy can be considered as a complimentary investigation to other diagnostic modalities. Hence regular use of colonoscopy in adult intussusception should be encouraged where presentation is either subacute or chronic.     

Controversy in the treatment of adult long ileocolic intussusception: case report

Adult intussusception is an unusual cause of intestinal obstruction. In contrast to children, intussusception in adults is usually due to an identifiable cause. We present a case of an 81-year-old female who was diagnosed with a long intussusception on CT scan of the abdomen. Because of the likelihood of neoplasia, a right hemicolectomy was undertaken, after which the patient recovered well. The correct treatment of adult intussusception is not unanimously agreed upon. We present a case of long intussusception in which partial reduction of viable small bowel before the resection was done by applying gentle traction. This provided sufficient small bowel mesentery length, preventing any damage to superior mesenteric vessels and avoiding unnecessary excision of healthy bowel.     

Adult intussusception due to a malignant polyp: a case report

Intussusception is primarily a disease of childhood; only about 5 to 10 per cent of cases occur in adults. In contrast to childhood intussusception 90 per cent of adults have an associated pathologic process, usually a malignant lesion. Adult cases do not have the classical symptoms and diagnosis may be difficult. CT scan and barium studies are the most useful diagnostic methods. We report a very rare case of adult ileocecocolic intussusception caused by a pedunculated malignant polyp of the cecum and review the clinical features of intussusception.     

Laparoscopy-assisted resection of ileoileal intussusception caused by intestinal lipoma

Intussusception is the second most common abdominal emergency in children. In contrast, it is rare in adults. Adult intussusception represents only 1%-3% of patients with bowel obstruction. Although 95% of intussusception in children is idiopathic, merely 7% of adult intussusception is considered idiopathic. Owing to vague symptoms and signs, the preoperative diagnosis of adult intussusception is difficult. Once adult intussusception is diagnosed, surgical intervention is indicated because about half of both colonic and small intestinal intussusceptions are caused by malignant lesions. In this paper, we describe a case of ileoileal intussusception caused by an intestinal lipoma that was diagnosed preoperatively by computed tomography scans and was treated successfully by laparoscopy-assisted surgery. The patient was discharged uneventfully 4 days after the operation. We recommend laparoscopy-assisted surgery as a feasible therapeutic option for adult intussusception.     

Dünndarminvagination beim Erwachsenen

The diagnosis of enteric intussusception is rare in adults but not in children. The clinical picture often takes an insidious course. Acute abdomen may also be caused by enteric intussusception. We report on three patients with enteric intussusception and acute abdomen. In two cases, a CT led to the diagnosis of invagination of the small intestine. In one patient, invagination of the terminal ileum was detected during coloscopy. All patients were submitted to limited segment resection and end-to-end anastomosis. In all three cases, the invagination was caused by benign pathological changes. Enteric intussusception in adults always requires surgery. In more than 95% of the cases, pathological findings are obtained intraoperatively, which are benign in the small intestine in 85-95% of the cases.     

Laparoscopic reduction of appendicocecal intussusception due to mucinous cystadenoma in an adult.

OBJECTIVE: Laparoscopic reduction of appendicocecal intussusception due to mucinous cystadenoma is herein described. METHODS: A 32-year-old female had intermittent abdominal pain and nonbloody diarrhea. The preoperative diagnosis was intussusception of the colon with a benign tumor by CT-scan findings. RESULTS: Laparoscopic reduction of intussusception and ileocecal resection were successfully performed. Gauze sponge sticks were used to provide compression from the distal colon. This maneuver was very effective to reduce the intussusception. CONCLUSION: Laparoscopic reduction of intussusception due to a benign tumor is feasible and safe even in adults. Mucinous cystadenoma is one of the causes of intussusception in adults and a good indication for the laparoscopic approach.     

Jejuno-jejunale Invagination nach Dennis-Sonden-Einlage wegen Ileus – eine seltene Komplikation

In contrast to childhood intussusception, the clinical signs of intussusception in adults are nonspecific. Generally organic alterations of the small bowel cause intussusception in adults. In this case report on a retrograde jejunojejunal intussusception in a 61-year-old male, following removal of an intraoperatively placed intestinal tube for ileus therapy, the clinical symptoms, diagnostic methods and therapy for intussusception are described. Sonography is not only the diagnostic tool of choice in children, but also led to the correct diagnosis in this case. In contrast to childhood intussusception, operative treatment is preferred in adults.     

Two unusual cases of adult intussusception

Adult intussusception is very rare. We report 2 unusual cases, a 58-year-old man with a transverse colo-colonic intussusception caused by a malignant sessile polyp that also had an asymptomatic synchronous neoplasm of the kidney, and an 18-year-old female with an ileocecolic intussusception caused by acute appendicitis. This report stresses the point that intussusception in adults may represent an underlying malignancy. The age of the patient and the anatomic location of the intussusception provide significant input as to the etiology and hence the most appropriate surgical procedure.     

Occult gastrointestinal bleeding and abdominal pain due to entero-enteric intussusception caused by splenosis

Intussusception is rare in adults. We report the first known case of adult intussusception caused by splenosis. The patient had chronic gastrointestinal bleeding and intermittent abdominal pain. The diagnosis of entero-enteric intussusception was made by CT scan. A laparoscopic-assisted small bowel resection was performed, leading to resolution of the symptoms.     

Intussusception secondary to endometriosis of the cecum

INTRODUCTION

Intussusception in adults is a rare cause of bowel obstruction. Endometriosis of the bowel is also a rare entity that can be the cause of bowel obstruction. Here, we report a rare case of intussusception secondary to endometriosis of the cecum.

PRESENTATION OF CASE

A 40-year-old woman presented to the hospital with a one-week history of intermittent epigastric pain. On physical examination, there was a soft, round non-tender palpable mass in the right flank and abdominal computed tomography scan revealed an intussusception. We made the diagnosis of ileo-colic intussusception and performed ileocecal resection. The surgical specimen revealed a round submucosal cystic mass in the cecum and the histology showed endometriosis of the cecum.

DISCUSSION

Intussusception in adults is a rare entity present in just 1% of all patients with bowel obstruction, and 5% of all intussusceptions. In general, intussusception in adults has a pathologic lesion as the lead point and the lesion is a malignancy in 20–50% of the cases. Thus, the treatment of an intussusception in adults should be operative. Endometriosis of the bowel is a rare cause of intussusception. Small endometriosis lesions of the bowel are unlikely to cause symptoms; however, in patients presenting with bowel obstruction, urgent treatment is indicated.

CONCLUSION

Intussusception in an adult is a rare cause of bowel obstruction and intussusception caused by endometriosis is also rare. Although rare, the diagnosis of endometriosis as a cause of intussusception must be considered as part of the differential diagnosis.     

Retrograde intussusception of the efferent limb after a pancreaticojejunostomy

Retrograde intussusception is exceedingly rare and has not been reported after a pancreaticojejunostomy. Recurrent retrograde intussusception has been reported only once before. In adults retrograde intussusception has been associated with gastric resection, gastrojejunostomy, Roux-en-Y gastric bypass, and gastrostomy tube placement. We report a case of retrograde intussusception of the efferent limb into the anastomosis of a revised Roux-en-Y bypass of the pancreas. Two long side-to-side anastomoses with plication were performed to prevent a third episode of intussusception involving this patient's Roux-en-Y.     

Minimal access surgery for adult intussusception with subacute intestinal obstruction: a single center's decade-long experience

INTRODUCTION: In adults, 1% to 5% of bowel obstruction is caused by intussusception. In adult intussusception, there will be a demonstrable cause in 90% of cases, acting as the lead point. Laparoscopy is becoming more and more popular in its management. We present our series of intussusception in adults managed laparoscopically. MATERIALS AND METHODS: Between 1996 and 2006, we have treated 12 adults with intussusception who presented with acute or subacute intestinal obstruction. Computed tomographic scan confirmed the diagnosis in all cases. Laparoscopic-assisted resection with primary anastomosis was successfully performed for all cases. RESULTS: Males were more common, average being 38 years. Two patients had colonic carcinoma, as the leading point and the rest were benign tumors. There were no conversions or anastomotic leaks in any patient. DISCUSSION: The basic principles of surgery involve straightening or removing the involved section of bowel. The outcome of surgery depends on the stage of the intussusception at diagnosis and the underlying cause. If no underlying cause is found in these cases, no specific treatment is required. With early treatment, the outcome is generally excellent. CONCLUSIONS: Laparoscopy is a valuable diagnostic and therapeutic tool in the management of adult intussusception. It provides all the benefits of minimal access surgery.     

A case of postoperative recurrent intussusception associated with indwelling bowel tube

Intussusception is quite uncommon in adults. We report a rare case of a 76-year-old man with small bowel intussusception induced by two indwelling bowel tubes, the first a jejunal feeding tube and the second an ileus tube. After complete reduction of the first intussusception caused by the jejunal feeding tube and adhesion, re-intussusception occurred due to the postoperative adhesion and ileus tube inserted into the bowel after the previous operation for intussusception. Finally, the part of the jejunum with re-intussusception and adhesion, including the place where the previous reduced intussusception had occurred, was resected. This case is a reminder that when there is no mucosal lesion other than an indwelling bowel tube or a hard adhesion/inflammation around intussusception, the patient should be operated on without delay for resection of the intussusception to prevent re-intussusception, even if the resected bowel is predicted to be long.     

Invagination of the ileum as the etiology of acute abdomen in adults

In contrast to children, intussusception is an unusual cause of an abdominal emergency in adults. We report on a 65-year-old patient who complained of inconstant crampy abdominal pain for a period of over 6 months. He was admitted to our hospital because of acute intestinal obstruction. Sonography and computer tomography suggested an intussusception. At surgery the diagnosis of an ileo-ileal invagination was confirmed and resection of a segment of the ileum was performed. As shown by macroscopic findings intussusception had existed for several days. Histologically, the underlying disease causing the intussusception was a leiomyoma arising from the submucosa.     

Intussusception in adults

Intestinal intussusception in adults is a very rare entity whose etiology differs greatly from its pediatric counterparts. Three adult patients with intestinal intussusception presented with intestinal obstruction and required surgery for its resolution. In each case a pathologic cause was found. They had intestinal polyps, two benign (lipoma and hamartomatous polyps) and one malignant (metastasis). Intestinal intussusception in adults usually has a pathologic cause. About half have a malignant etiology. Intestinal resection without reduction of the intussusception is the preferred surgical procedure.     

Idiopathic adult colo-colonic intussusception: Case report and review of the literature

INTRODUCTIONAcute colonic intussusception occurring in the absence of organic cause is uncommon in adults.PRESENTATION OF CASEWe report acute colonic intussusception in a 46-year-old female; clinical evidence of a palpable mass, abdominal pain and bloody mucoid stools appeared a few hours after hospital admission. Multislice CT-scan confirmed the clinical diagnosis and surgical exploration revealed right colonic obstruction caused by intussusception of the cecum into the ascending colon. Right hemicolectomy was performed and histopathological examination did not reveal any causative pathology.DISCUSSIONIntussusception remains a rare condition in adults, representing 1–5% of bowel obstruction and accounting for 0.003–0.02% of all hospital admissions. Intussusception occurs more frequently in the small (50–80%) than in the large bowel (12–50%). It is estimated that approximately 90% of intussusceptions in adults are secondary to an anatomical or pathological condition, of which more than half are malignant. Idiopathic cases are the exception in adults. The clinical presentation of adult intussusception differs considerably from the classic pediatric presentation of abdominal pain, palpable mass, and blood per rectum, which is rarely seen in adults. A pre-operative CT-scan showed a 10 cm intussuscepted segment of right colon. Surgical resection was considered mandatory because of severe bowel obstruction, and the theoretical possibility of occult malignancy. This approach was vindicated by the presence of widespread ischemic lesions in the wall of the resected bowel, without any obvious lead point.CONCLUSIONThere are few reports in the medical literature of acute colonic intussusception occurring in the absence of organic cause in adults.     

Laparoscopic reduction of an ileoileal intussusception and resection of an inverted Meckel's diverticulum in an adult

Intussusception occurs commonly in children, but rarely is observed in adults. Whereas the hydrostatic pressure of a contrast enema often proves diagnostic as well as therapeutic in infants and children, resection usually is required for an underlying bowel pathology in older children and adults. Conventionally, the resection is accomplished at laparotomy. We report the case of a 20-year-old woman who presented with diarrhea and vomiting of 1 week duration. She was found unexpectedly to have intussusception on abdominal ultrasonography. The intussusception was laparoscopically reduced, and a segment of the middle small bowel that harbored an inverted Meckels diverticulum was resected laparoscopically, after which an intracorporeal anastomosis was fashioned. The ileus resolved on postoperative day 4, and the patient was discharged from hospital on postoperative day 5. The role of the laparoscopic approach in the management of intussusception is discussed.     

Adult jejunojejunal intussusception caused by metastasized pleomorphic carcinoma of the lung: Report of a case

Adult small-intestinal intussusception is rare and very different from childhood intussusception. Both benign and malignant pathologies can underlie small intestinal intussusception in adults, but malignancy is much less frequent. We report a case of jejunojejunal intussusception caused by an intestinal metastasis of the sarcomatoid component of pleomorphic carcinoma of the right lung. The patient, a 61-year-old man, underwent successful segmental jejunal resection. Adult small bowel intussusception, though an unusual cause of acute abdomen, requires early diagnosis and timely management. To our knowledge, this is the first report of adult jejunojejunal double intussusception caused by metastatic sarcomatoid carcinoma of the lung.     

Adult suprapatellar pleiomorphic rhabdomyosarcoma with jejunal metastasis causing intussusception: a case report

Jejuno-jejunal intussusception is rarely encountered in adults. Management depends on the viability of the involved bowel. Exploration is favored because in adults generally an underlying ‘lead point’ is found to be present. Pleimorphic rhabdomyosarcoma (pRMS) arises from striated muscle cells. They are usually diagnosed during childhood and can occur virtually all over the body, controversially in places were few striated cells are found. In adults, these tumors are rare and are mostly encountered in the head-and-neck region. We present the case of a 48-year-old woman with a jejunal metastasis from a suprapatellar pRMS diagnosed 2.5 years earlier resulting in a jejuno-jejunal intussusception.