Acute adult intussusception caused by primary cecal non Hodgkin lymphoma

Intussusception of the bowel is rather rare in adults and in about 80-90% of the cases is secondary to an underlying intraluminal pathology that serves as a lead point. In cases of colonic intussusception malignancy occurs in 63-66% of patients and it is usually adenocarcinoma and rarely lymphoma. The presenting symptoms are non specific and are in most cases of long duration, consistent with a chronic intussusception causing partial intestinal obstruction. We present a rare case of primary colorectal lymphoma in a 29 years old female that was complicated by acute ileocecal intussusception, treated with en bloc resection without reduction.     

Intussusceptions arising from two different sites in a child with cystic fibrosis

Abdominal pain is common in individuals with cystic fibrosis (CF). We report on a 17-year old boy with CF and two recognized intussusceptions: the first colonic intussusception was presumed due to distal intestinal obstruction syndrome, and the second enteric one due to polypoid lesions containing heterotopic gastric mucosa. The presentation, pathology, management, and a literature review of intussusception in CF are discussed.     

Adult intussusception in Asians: clinical presentations, diagnosis, and treatment

BACKGROUND: Adult intussusception is a rare clinical entity. The presentations and optimal management of adult intussusception in Asians have seldom been reported. The purpose of this study was to determine the causes and management of adult intussusception in Taiwan. METHODS: A retrospective review performed at four medical centers in Taiwan identified 46 patients, at least 18 years old, with a diagnosis of intestinal intussusception from January 1992 to December 2005. Data related to presentations, diagnosis, treatment, and pathology were analyzed. RESULTS: There were 28 men and 18 women with a mean age of 58 (range 19-83) years. Twenty-five patients were diagnosed with enteric intussusception and 21 patients with colonic intussusception. Disease in 35 (76.1%) patients was caused by a benign lead point. The most common symptom was abdominal pain, which was seen in all patients. Twenty-five patients presented with acute symptoms that they experienced over a period of less than 3 days. The preoperative diagnosis was 89.1% because of the wide use of abdominal computed tomography (CT). The most sensitive diagnostic modality was abdominal CT (88.6%). For all patients, 76% with enteric intussusception and 28.6% with colonic intussusception underwent operative reduction. At the time of writing, 71.7% patients were still alive. Only two patients died of postoperative complications. CONCLUSIONS: Most patients with adult intussusception in our series were men, and most intussusceptions were benign and of enteric origin. The most sensitive diagnostic modality is abdominal CT scan. Operative reduction is recommended for enteric intussusceptions but not for colonic intussusceptions. The prognosis of adult intussusception after surgery is good except for malignant intussusception.     

Intussusception due to inflammatory fibroid polyp: A case report and comprehensive literature review

AIM:To give an overview of the literature on intussusception due to inflammatory fibroid polyp(IFP).METHODS:We present a new case of ileal intussusception due to IFP and a literature review of studies published in English language on intussusception due to IFP,accessed via PubMed and Google Scholar databases.For the search,the keywords used were:intussusception,IFP,intussusception and IFP,intussusception due to IFP,and IFP presenting as intussusception.The search covered all articles from 1976 to November 2011.RESULTS:We present a 38-year-old woman who was admitted 10 d after experiencing abdominal pain,vomiting,and nausea.Ultrasonography demonstrated small bowel intussusception.An ileal intussusception due to a mass lesion 50 cm proximal to the ileocecal junction was found during laparotomy.Partial ileal resection and anastomosis were performed.A diagnosis of ileal IFP was made based on the immunohistochemical findings.In addition,a total of 56 reports concerning 85 cases of intussusception due to IFP meeting the aforementioned criteria was included in the literature review.The patients were aged 4 to 81 years(mean,49 ± 16.2 years);44 were women(mean,51.8 ± 14.3 years) and 41 were men(mean,46 ± 17.5 years).According to the location of the IFP,ileal intussusception was found in 63 patients,while 17 had jejunal,three had colonic,and two had ileojejunal intussusception.CONCLUSION:Although IFPs are rare and benign,surgery is the only solution in case of intestinal obstruction.Differential diagnosis should be made via immunohistochemical examination.     

Lipoma of the large intestine: A review of 45 cases

Conclusion We have reported the cases of 45 patients treated for lipoma of the colon in a 20-year period. We recommend surgical intervention in all cases, primarily to establish the differential diagnosis from the more common primary colonic carcinoma or adenomatous polyp, and secondarily to obviate possible intussusception or obstruction.     

Primary malignant fibrous histiocytoma of the intestine: Intussusception of a rare neoplasm

Malignant fibrous histiocytoma, a tumor of mesenchymal tissue, is being reported with increased frequency. However, no cases of primary tumors involving the gastrointestinal tract have yet been described. This report documents a case in which the patient clinically manifested a colonic obstruction associated with intussusception. Following radical resection of the mass, close re-evaluation after one year has shown no evidence of tumor recurrence.     

Colocolic intussusception

Summary 1. Colocolic intussusception in the adult is almost always a complication of pre-existing colonic disease, usually carcinoma or polypoid tumor.2. The cupola- or meniscus-shaped deformity associated with a temporary or high-grade obstruction is the most reliable indication of colocolic intussuception. When such a deformity is encountered, the fluoroscopist should be immediately alerted to the possibility of an underlying tumor.3. The roentgenographic findings in 18 cases of colocolic intussusception are reviewed and suitably illustrated case material presented.4. Benign tumors were the cause of colocolic intussusception in 6 of the 18 cases in our series, indicating a good prognosis in a substantial percentage of cases with colocolic intussusception. Lipomas of the colon were present in 5 cases in this series. In the sixth case a benign adenoma was the underlying cause.     

A case of recurrent intestinal obstruction caused by Meckel's diverticulum]

Meckel's diverticulum is the most common anomaly of the intestine. It is usually asymptomatic but approximately 4% are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation. Gastrointestinal bleeding is the most common presenting symptoms of Meckel's diverticulum in children, however, intestinal obstruction is the most common complications in adult patients. Reported mechanism of intestinal obstruction in Meckel's diverticulum include intussusception, adhesion, and volvulus. Recently, we experienced a case with Meckel's diverticulum associated with ileal stricture causing recurrent partial intestinal obstruction in a 48-year-old man. In contrast to other published cases of small bowel obstruction in Meckel's diverticulum, this case was caused by ileal stricture associated with Meckel's diverticulum.     

Ogilvie's syndrome--acute colonic pseudo-obstruction. Case report and review of the literature

We present a rare entity of colonic pseudo-obstruction, characterised by severe colonic dilatation in absence of any organic obstacle. Clinical symptoms, diagnostic approach, and therapeutic measures are analysed and discussed. Many factors have been associated with this syndrome which include electrolyte imbalance, systemic infection, drugs, and occasionally, neurologic disease. Reported here is a case of acute colonic pseudo-obstruction which developed in a patient with restrictive respiratory dysfunction. Colonic decompression by means of colonoscopy, the most effective therapeutic approach for pseudo - obstruction failed, and surgical cecostomy was required. The acute colonic pseudo-obstruction, Ogilvie's Syndrome, most often appears as a complication of other clinical conditions. It is characterized by massive colonic dilatation in the absence of a mechanical cause and may lead to cecal perforation in absence of treatment. When colonic obstruction is suspected, one should always consider the possibility of the occurrence of Ogilvie's syndrome     

The surgical management of constipation.

The anal physiology laboratory plays a very important role in the selection of patients for surgical treatment for constipation. Any report which does not include reference to these methods of evaluation will not be helpful since there are several causes of constipation. The current recommended treatment for slow transit constipation is still total abdominal colectomy with ileorectal anastomosis. Treatment of pelvic floor outlet obstruction seems to be best accomplished using muscle/sensory retraining techniques since this is a functional disorder rather than an anatomical or physiological disorder. Combinations of colonic inertia, pelvic floor outlet obstruction and internal intussusception should be treated to correct the pelvic floor outlet obstruction initially, followed by correction of the colonic inertia. In this way failure will be avoided at the time of surgical treatment of the constipation.     

Intussusception in adults: an unusual and challenging condition for surgeons

Background and aims Intestinal intussusception in adults is a rare entity and there is an ongoing controversy regarding the optimal management of this problem. The purpose of this study was to determine the causes and management of intussusception in adults.Patients and methods A retrospective review of patients more than 18 years of age with a diagnosis of intestinal intussusception between January 1996 and December 2003 was conducted. Data related to presentation, diagnosis, treatment, and pathology were analyzed.Findings A total of 13 patients were operated on due to intestinal intussusception. There were 6 men and 7 women with a mean age of 45 years (range 24–61 years). Abdominal pain was the most common presenting complaint (100%). Eight (61.5%) patients presented with acute symptoms and underwent emergency laparotomy. The diagnosis of gastrointestinal intussusception was made preoperatively only in 4 (30.7%) patients by abdominal ultrasonography and computerized tomography. The lead point of intussusception was located in the small intestine in 10 (76.9%) patients, in the colon in 2 (15.4%), and in the ileocecal valve in 1 (7.7%). A pathologic cause for the intussusception was identified in 12 (92.3%) cases and 1 (7.7%) was idiopathic. Of the cases with a defined cause, 58% of the cases were benign and 42% were malignant. Forty percent of cases of small bowel intussusception and 33.3% of cases of colonic intussusception were due to malignant lesions. All cases of small intestinal intussusception were reduced and no perforation occurred. Segmental intestinal resection was performed in 9 patients and excision of the Meckels diverticulum was made in 1. In cases of colonic intussusception, reduction was not attempted and en-bloc resection was carried out. No perforation or spillage of the contents of the intussusception was observed. There was no surgical mortality.Conclusion Adult intussusception is an unusual and challenging condition that represents a preoperative diagnostic difficulty. We think that colonic intussusceptions should be resected in an en-bloc manner without reduction due to the risk of perforation and spillage of micro-organisms and malignant cells, whereas cases of small intestinal intussusception can be reduced without complications unless there is strangulation.     

Colocolonic intussusception of a giant pseudopolyp in a patient with ulcerative colitis: a case report and review of the literature

Adult intussusception in the setting of inflammatory bowel disease (IBD) is a rare phenomenon. Giant pseudopolyps, while generally considered benign, may function as lead points for intussusception. Diagnosis and management of intussusception in the setting of IBD can be fraught with hazards. We report the case of a 27-year-old male, recently diagnosed with ulcerative colitis and giant pseudopolyps, who presented with colocolonic intussusception and obstruction. Diagnosis was confirmed using CT imaging and the patient underwent resection of the colocolonic intussusception without reduction. The following case underscores the challenges in managing adult intussusception in the setting of IBD and allows for a review of the literature to date. Resection of non-reduced intussusception, rather than endoscopic or enema reduction, should continue to be definitive treatment of patients presenting with this unusual problem.     

Intussusception in a child caused by capillary hemangioma of the colon

Intussusception is one of the most common abdominal emergencies in children, but identifying the cause is very difficult. Hemangioma is a common tumor of the head and neck area in children, but it rarely arises in the gastrointestinal tract. This report describes a rare occurrence of intussusception caused by capillary hemangioma of the colon that was identified by ultrasonography (US), computed tomography (CT), and colonoscopy. A male child aged 2 years and 10 months developed painful abdominal cramps and hematochezia. Abdominal US and CT revealed both target and pseudo-kidney signs in the colon, indicating colonic intussusception. An initial diagnostic and therapeutic laparotomy did not reveal any abnormalities. Seven days later, severe abdominal pain recurred. A barium enema revealed the shadow of a 25-mm mass at the hepatic flexure of the colon. Colonoscopic findings revealed a submucosal tumor in the descending colon that was moved to the cecum by compressed air introduced through the colonoscope. We considered that the mass in the cecum had caused the intussusception. The tumor was removed at a second laparotomy, and microscopic pathological examination revealed that it was a capillary hemangioma.     

Role of colonic stents in the management of colorectal cancers

Colorectal cancer is one of the commonly encountered cancers across the Western World. In United Kingdom, this constitutes third most common ranked cancer and second most common ranked cause of cancer related deaths. Its acute presentation as a malignant colonic obstruction imposes challenges in its management. Colonic stent has been used for many years to alleviate acute obstruction in such cases allowing optimisation of patient’s physiological status and adequate staging of cancer. In this review, current literature evidence regarding use of colonic stent in acute malignant colonic obstruction is critically appraised and recommendations on the use of colonic stent are advocated.     

Colonic varices as a complication of colonic surgery

Colonic varices are a rare cause of lower gastrointestinal bleeding, with approximately 40 cases reported in the literature. Portal hypertension is by far the most common cause of colonic varices, with local mesenteric vein obstruction constituting a very rare cause. We present a case of colonic varices not associated with portal hypertension but secondary to prior sigmoid resection and inferior mesenteric vein occlusion.     

Intususcepción ileocólica en un adulto causado por divertículo de Meckel invertido

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It is found in 2.00% of the population and is more frequent in children. Invagination is an unusual complication that can cause secondary intestinal intussusception. This event is extremely rare and only a few cases have been reported. We present the case of a 19-year-old male who presented with chronic abdominal pain and weight loss of 23 Kg 6 months prior to hospital admittance. The last episode manifested as intense abdominal pain, nausea, vomiting, and diarrhea with a 6-hour progression. Imaging studies established the diagnosis of bowel obstruction and ileocolic intussusception. Laparotomy with ileocolic resection was performed without reducing the intussusception. The histopathologic study reported inverted Meckel's diverticulum at the base of the ileocolic intussusception. Intestinal intussusception in adults, secondary to inverted Meckel's diverticulum is rare and should be considered in the differential diagnosis of patients presenting with abdominal pain and bowel obstruction.     

Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study

Background The preoperative diagnosis of adult intussusceptions (AIs) remains difficult, and the assessment of the radiological methods has been evaluated very little in the literature. The aim of this study was to evaluate the interest of the different imaging modalities for the preoperative diagnosis of AI and describe causes of AI.Patients and methods Consecutive patients of 15 years and older with the postoperative diagnosis of intussusception from 1979 to 2004 were reviewed retrospectively for this multicentric study. Data concerning clinical considerations, morphological examinations, surgical procedure, histological conclusions, mortality rate and recurrence were analysed.Results Forty-four patients with documented intussusception were included. The mean age was 51 years (15–93 years). The preoperative diagnosis of intussusception was made in 52% of the cases. The sensitivities of the different radiological methods were abdominal ultrasounds (35%), upper gastrointestinal barium study (33%), abdominal computed tomography (CT) (58%) and barium enema (73%). An organic lesion was identified in 95% of the cases. There was 29 enteric and 15 colonic (including appendicular) intussusceptions. Thirty-seven percent of the enteric lesions were malignant, and a bit less than 50% of them were metastatic melanomas. The benign enteric lesions were Meckel’s diverticulum and Peutz–Jeghers syndrome in half of the cases. Fifty-eight percent of the pure colonic lesions (excluding appendix) were malignant, and 85% of them were primary adenocarcinomas. The benign colonic lesions were lipomas in 80% of the cases. All patients, except one, had a surgical treatment, and 13 of them had a complete reduction of the intussusception before resection. The mortality rate was 16% and recurrence occurred in three patients; two of them had a Peutz–Jeghers syndrome.Conclusion Intussusception rarely occurs in adults, but nearly half of their causes are malignant. The CT scan is a helpful examination for enteric intussusceptions whether barium enema seems to be the most performing method for colonic lesions. Surgery is the recommended treatment, with or without a primary reduction of the intussusception. During the surgical procedure, this reduction can lead to a more limited bowel resection.     

Adult duodenal intussusception associated with congenital malrotation

Enteroenteric intussusception is a condition in which full-thickness bowel wall becomes telescoped into the lumen of distal bowel. In adults, there is usually an abnormality acting as a lead point, usually a Meckels＇ diverticulum, a hamartoma or a tumour. Duodeno- duodenal intussusception is exceptionally rare because the retroperitoneal situation fixes the duodenal wall. The aim of this report is to describe the first published case of this condition. A patient with duodeno-duodenal intussusception secondary to an ampullary lesion is reported. A 66 year-old lady presented with intermittent abdominal pain, weight loss and anaemia. Ultrasound scanning showed dilated bile and pancreatic ducts. CT scanning revealed intussusception involving the full-thickness duodenal wall. The lead point was an ampullary villous adenoma. Congenital partial （type r[） malrotation was found at operation and this abnormality permitted excessive mobility of the duodenal wall such that intussusception was possible. This condition can be diagnosed using enhanced CT. Intussusception can be complicated by bowel obstruction, ischaemia or bleeding, and therefore the underlying cause should be treated as soon as possible.     

Adult Intussusception: A Retrospective Review

Purpose Whereas intussusception is relatively common in children, it is clinically rare in adults. The condition is usually secondary to a definable lesion. This study was designed to review adult intussusception, including presentation, diagnosis, and optimal treatment. Methods A retrospective review of 22 cases of intussusception occurring in individuals older than aged 18 years encountered at two university-affiliated hospitals in Winnipeg between 1989 and 2000. The 22 cases were divided to benign and malignant enteric, ileocolic, colonic lesions respectively. The diagnosis and treatment of each case were reviewed. Results There were 22 cases of adult intussusception. Mean age was 57.1 years. Abdominal pain, nausea, and vomiting were the commonest symptoms. There were 14 enteric, 2 ileocolic, and 6 colonic intussusceptions. Eighty-six percent of adult intussusception was associated with a definable lesion. Twenty-nine percent of enteric lesions were malignant. All ileocolic lesions were malignant. Of colonic lesions, 33 percent were malignant and 67 percent were benign. All cases required surgical interventions except one. Conclusions Adult intussusception is a rare entity and requires a high index of suspicion. Our review supports that small-bowel intussusception should be reduced before resection if the underlying etiology is suspected to be benign or if the resection required without reduction is deemed to be massive. Large bowel should generally be resected without reduction because pathology is mostly malignant.     

Volvulus due to a tumor of Meckel's diverticulum

Small-bowel obstruction in an old woman was the result of a twisted Meckel's diverticulum containing a large neoplasm. As neoplasms comprise only 1.2-1.4% of the complications of the diverticulum, and generally bleed or cause intussusception, we believe that the condition described is not common.