Prolapse of intussusceptum through a perforated intussuscipiens

Two patients with prolapse of an intususceptum through a perforation in the intussuscipiens are described. There was little peritonitis at exploration. Prolapse of an intussusceptum is an occasional operative finding in patients with perforated intussusception.     

Enema reduction of intussusception with a small dose of iopamidol may have advantages over barium

Barium enema (B-enema) has been the standard method for hydrostatic reduction of intussusception, although recently air enema has been used due to the lower risk when perforation occurs. Recently, we have administered a small dose of iopamidol during enema reduction (I-enema) in children with intussusception. From November 1989 to December 1993, we treated 50 children with intussusception at Kiyama Hospital. Barium was used in the first half of the period, and iopamidol in the second half. Reduction was successful in 22 of 24 patients with barium (92%) and 23 of 26 with iopamidol (88%); 25 children had the ileocolic type and 25 the ileoileocolic (-cecal) type of intussusception. Operations were carried out in 3 patients from each group. I-enema avoids some of the drawbacks of barium and air enemas. It is a new method of enema reduction, as a contrast medium is injected first. It is possible to obtain a good image of the advanced portion with a small dose of contrast medium, which is important for treatment. For institutions performing B-enemas, I-enemas can be performed easily with the same equipment and technique. It causes less contamination upon leakage than a B-enema, and also has less influence on the intestinal membrane with very few risks if perforation occurs. Better images are obtained than with air. A large dose of contrast medium is not needed, thereby reducing medical expenses to a minimum. Iopamidol can be used safely for enema reduction of intussusception with an expected high success rate.     

Ileocolic intussusception mimicking the imaging appearance of midgut volvulus as a result of extrinsic duodenal obstruction

Duodenal obstruction caused by ileocolic intussusception in the absence of intestinal malrotation is extremely rare. We present and discuss the imaging findings in an infant with an intussusception secondary to a duplication cyst in whom sonography also showed inversion of the orientation of the mesenteric vessels and a distended stomach. A contrast medium study revealed a proximal duodenal obstruction with a beak appearance suggestive of midgut volvulus. At surgery, an ileocolic intussusception causing duodenal obstruction without concomitant malrotation or volvulus was found. The combination of duodenal obstruction and abnormal relationship of the mesenteric vessels as a result of ileocolic intussusception has not previously been reported in the literature.This paper was presented at the 42nd Annual Congress of the European Society of Pediatric Radiology, Dublin, Ireland, in June 2005.     

Ileoileal intussusception in children: ultrasonographic differentiation from ileocolic intussusception

Background The treatment of ileoileal intussusception in children differs from that of ileocolic intussusception. Objective To differentiate ileoileal intussusception from ileocolic intussusception using ultrasonography. Materials and methods We reviewed the clinical and ultrasonographic findings in 27 patients with intussusception between September 2003 and July 2005. For statistical analysis the Mann-Whitney test was applied. Results Regarding ileoileal intussusceptions, 11 were documented in ten patients (seven boys, three girls; mean age 3.1 years). Symptoms suggestive of intussusception were present in nine patients. The mean diameter was 1.5 cm (range 1.1–2.5 cm) and length 2.5 cm (range 1.5–6.0 cm). The intussusceptions were located in the paraumbilical region (n=6), the right upper quadrant (n=2), the right lower quadrant (n=2), and the left lower quadrant (n=1). Regarding ileocolic intussusceptions, 16 were documented in 14 patients (13 boys, 1 girl; mean age 1.9 years). All patients had symptoms suggestive of intussusception. The mean diameter was 3.7 cm (range 3.0–5.5 cm) and mean length was 8.2 cm (range 5.0–12.5 cm). All intussusceptions were located in the right side of the abdomen. The difference in diameter and length between ileoileal and ileocolic intussusceptions was statistically significant (P<0.05). Conclusion Unlike clinical symptoms, ultrasonography can differentiate between ileoileal and ileocolic intussusception. The diameter and length of the intussusception are the main criteria.     

Twenty-one cases of small bowel intussusception: the pathophysiology of idiopathic intussusception and the concept of benign small bowel intussusception

Ultrasonography (US) was used to study intussusceptions prospectively at Kiyama Hospital in 1999 and 2000 under the classification of small bowel intussusception (SBI) and large bowel or ileo-ileo-colic intussusception (LBI). The clinical features, management, outcome and etiology were analyzed. All LBIs and SBIs with ischemic symptoms and SBIs complicated by LBI were treated by enema reduction, whereas SBIs considered to be nonischemic were observed. SBI was seen in 21 patients with a mean age of 62.6±31.2 months. Four cases (19.0%) were diagnosed during the course of LBI. US showed mesenteric lymphoid hyperplasia in 15 (71.4%). Hydrostatic enema reduction was successful in 9/9, and SBI reduced naturally in the other 12 (benign SBI). LBI occurred in 38 patients with a mean age of 27.8±21.2 months. Mesenteric lymphoid hyperplasia was observed in 29 (76.3%). Hydrostatic enema reduction was successful in 37/38. SBI occurs more frequently and in a wider age group than previously considered. Many SBIs reduced naturally, suggesting that they were only transient invagination phenomena and should be called benign SBI. The frequent association of SBI with LBI and also the frequent association of mesenteric lymphoid hyperplasia with both SBI and LBI seem the key to the pathophysiology of intussusception.     

Postoperative intussusception: a diagnostic dilemma

Intussusception as a cause of intestinal obstruction in the postoperative period is still a perplexing problem to most surgeons. From 1980 to 1988, four cases of postoperative intussusception (POI) were seen at the Kobe Children's Hospital, representing 5.4% of all intussusceptions managed during this period. There were two females and two males, ages ranging from 1 to 18 months. In two, the initial operation was nephrectomy; one had operative reduction of an ileocolic intussusception (postoperative intussusception was ileo-ileal); and the fourth had a laparotomy performed for suspected pyloric stenosis. All four presented with bilious vomiting, abdominal distension, and increasing bile-stained aspirate via a nasogastric tube during the 1st week following surgery. Radiological and laboratory parameters were not helpful in arriving at a correct diagnosis. Ileo-ileal intussusception was found at operation in all four, with no evidence of a pathological lead point. In all cases manual reduction was carried out successfully and the convalescence was unevenful. In view of the difficulty in establishing the diagnosis of POI, a literature review has been made that enables a common pattern of symptomatology to be identified. It is hoped that this will serve as a guide permitting earlier recognition of this postoperative complication.This paper is partially supported by a Hyogo Prefectural Grant Offprint request to: C. Tsugawa     

Management and outcomes of paediatric ileocolic intussusception at a paediatric tertiary care hospital: A retrospective cohort study

BackgroundRapid reduction of ileocolic intussusception is important to minimize the compromise in blood flow to the affected bowel segment. This study aimed to quantify the potentially modifiable time between diagnosis and initiation of pneumatic reduction, identify factors associated with delays, and characterize the outcomes of pneumatic reduction in a recent cohort.MethodsThis retrospective observational study occurred at a tertiary care paediatric hospital with a consecutive sample of all children with ileocolic intussusception September 2015 through September 2018. The primary outcome was the time between ultrasound diagnosis of intussusception and the beginning of pneumatic reduction. Independent variables were age of the patient, time of day of arrival, transfer from another facility, and intravenous access prior to ultrasound. Outcomes of pneumatic reduction were expressed as proportions.ResultsThere were 103 cases of ileocolic intussusception (among 257,282 visits) during the study period. The median time between diagnostic confirmation and initiation of reduction was 36 minutes. This was shorter for transferred patients and children with intravenous access prior to ultrasound. One perforation was identified at the beginning of reduction, without hemodynamic instability. Six children (5.8%) underwent either open (n=4) or laparoscopic surgery (n=2) for reduction failure.ConclusionThe median delay between diagnosis and initiation of reduction at this paediatric hospital was short, especially among patients transferred with a suspicion of intussusception and children with intravenous access prior to diagnosis. Complications from pneumatic reduction were infrequent.     

Infantile myofibromatosis: a rare presentation with intussusception

Infantile myofibromatosis (IM) is a distinct but rare clinicopathological entity occurring in neonates and infants. It probably represents a rare soft-tissue tumour made up of undifferentiated myofibroblasts. Its recognition is important since it can be mistaken for a malignancy when, in fact, it has a generally benign prognosis with spontaneous regression. We describe the first case of an infant with IM presenting with acute intussusception due to gastrointestinal as well as the typical skin involvement. Accepted: 1 May 1997     

A rare type of ileal atresia due to intrauterine intussusception

Intrauterine intussusception is an extremely rare cause of intestinal atresia. We report on a full-term neonate with clinical manifestations of intestinal obstruction two days after birth. The prenatal sonography at the late stage of pregnancy did not show any abnormality. The barium enema suggested distal intestinal obstruction. At surgery, a visible ileo-ileal intussusception resulting in ileal atresia was found. According to our knowledge, this presentation of ileal atresia did not fit into the present classification and have not yet been reported on. We present this rare type of ileal atresia due to intrauterine intussusception with operative evidence, which is the first case reported in the medical literature so far.     

Iloe-ileocolic intussusception: Radiological features and reducibility

This paper concerns ileo-ileocolic intussusception rather than the commoner ileocolic intussusception. diagnostic criteria for ileo-ileocolic intussusceptions are established by retrospective study of radiological findings in 28 surgically proven cases. Using these criteria, 11 successfully reduced cases were found in the corresponding period (28.2%). All were apparently cured after one reduction: the evidence suggests that a small but significant number of ileoileocolic intussusceptions may be safely reduced by normal methods during barium enema.     

Yersinia intussusception: Case report and review

Intussusception is a recognised paediatric presentation in emergency department and primary care settings. The aetiology of intussusception is multifactorial and largely unknown but includes infection in some cases. Yersinia has been the most frequently cited bacterial association in children. Identifying Yersinia affects the role and choice of antibiotics in a child's treatment regimen. This article reports on Australia's first proven case of Yersinia enterocolitica intussusception, and reviews the clinical epidemiology of all known reported cases world‐wide.     

Primary intussusception of the stomach in a neonate

A case of primary intussusception of the stomach is reported. Clinical, radiological, and pathological details are described and discussed. Offprint requests to: J. Bruce     

Postoperative intussusception in childhood

Over a period of 10 years, five children developed postoperative intussusception after intra-abdominal procedures at the Department of Pediatric Surgery of the Johannes Gutenberg University Mainz. Two appendectomies, one ileal resection for a Meckel's diverticulum, one operative procedure for Hirschsprung's disease plus intestinal neuronal dysplasia type B, and one hiatoplasty with jejunostomy preceded the intussusception. Three of the five children were older than 2 years. The clinical symptoms consisted primarily of abdominal distension, diffuse abdominal pain, bilious vomiting, and rectal bleeding in one case. Preoperative diagnosis was achieved in four cases by abdominal ultrasound. Plain abdominal radiographs demonstrated dilated loops of small intestine with air-fluid levels in four of the five cases. In the case without radiographic findings, the jejunojejunal intussusception was missed even by a bowel follow-through. The intussusceptions were ileocolic (3), ileoileal (1), and jejunojejunal (1). A hydrostatic procedure to reduce an ileocolic intussusception was not successful. Operative treatment of the intussusception was performed in three cases within 5 days, once at 32 days, and once 3 months after the primary operation, in all cases by laparatomy and simple manual reduction without intestinal resection. In contrast to idiopathic intussusception, noninvasive hydrostatic procedures are not indicated in postoperative intussusception, since protection of intestinal anastomoses from hydrostatic pressure and exclusion of other causes of postoperative ileus are mandatory.     

An unusual pyloric obstruction: gastroduodenal mucosal intussusception

Gastroduodenal mucosal intussusception was recently observed in a baby girl born with esophageal atresia. After ligation of the tracheoesophageal fistula, a gastrostomy tube was inserted. At 3 months of age an esophagoesophageal anastomosis was performed and oral feeding was begun that resulted in vomiting. An upper gastrointestinal endoscopy confirmed the normal viability of the esophagus and showed intussusception of gastric mucosa into the duodenum. At laparotomy, a wide pylorotomy was done and the intussuscepted mucosa was resected and a pyloroplasty performed. Ten days postoperatively oral feeding was restarted successfully. Offprint requests to: C. Del Rossi     

Length of intussusception as a function of mesenteric anatomy

Ileocolic intussusception presents with an abdominal mass or, occasionally, there may be bowel palpable in the rectum or protruding from the anus. Various factors have been proposed for the variations in the length of bowel involved. We tested the theory that the length of mesentry available to the intussusception is one of the factors limiting the length of the process. A postmortem study was carried out in eight children who died without congenital or acquired gut abnormalities. The distal ileum was intussuscepted using a blunt, flexible introducer. In nearly all cases, the distance between the proximal end of the intussusceptum and the superior mesentric trunk was significantly less than normal distance fron the cecum to the trunk. The length of the artificial intussusceptum was found to be proportional to the length of mesentery available. Points proximal to the ileocecal valve had more mesentry available and yielded longer intussuscepta. The superior mesentric trunk, the hub of the mesentery, proved to be limiting factor in all experimental intussusceptions. Correspondence to: J. M. Hutson     

A very rare cause of intestinal atresia: intrauterine intussusception due to Meckel's diverticulum

Intrauterine intussusception is one of the rare causes of intestinal atresia. Conclusion: A case of ileal atresia due to intrauterine intussusception caused by Meckel's diverticulum is reported.     

新生儿原发性肠套叠临床诊治特点浅析

目的探讨新生儿原发性肠套叠的临床表现及诊断治疗特点。方法对5例新生儿原发性肠套叠的诊治经过进行回顾性分析，探讨新生儿原发性肠套叠的诊治特点。结果5例患儿中，2例有窒息或宫内窘迫病史；5例表现为呕吐，便血3例，腹胀3例，腹壁水肿2例，包块1例；5例作X线平片检查，2例完全梗阻，3例不全梗阻；4例超声检查显示：包块3例，典型的同心圆、套筒表现1例；水压灌肠复位1例失败，全部接受手术治疗，证实为原发性肠套叠，其中小肠套叠2例，回盲型2例，回结型1例；手法复位1例，肠切除吻合4例；死亡1例。结论新生儿肠套叠可以是原发性的.临床表现不典型，可表现为新生儿肠梗阻，术前明确诊断较困难；小肠套叠相对多见；早期超声检查具有诊断意义；早期手术治疗效果满意。     

Prenatal and neonatal intussusception

Intussusception found in the 1st month of life is rare and usually discussed as one entity, neonatal intussusception, but in fact, includes the intussusceptions occurring both prenatally and neonatally, of which the clinical presentations and results are different. Four full-term babies with prenatal intussusception presenting as intestinal atresia (IA) and three premature babies with neonatal intussusception mimicking necrotizing enterocolitis (NEC) are presented. Prenatal intussusception, as one of the causes of IA produces prominent signs of intestinal obstruction immediately after birth. Preoperative evaluation usually fails to yield a definitive diagnosis, but surgery is usually performed in time and is successful. In neonatal intussusception, full-term infants usually have a pathological lead point and the colon is almost always involved. A barium enema is thus useful in diagnosis. Premature babies, on the other hand, rarely have a colonic component, and the clinical features are insidious and similar to NEC. This results in diagnostic confusion that may lead to a dangerous delay in appropriate surgical correction. A high level of suspicion about this condition in cases diagnosed presumptively with NEC is important. Serial abdominal sonograms may be helpful in the early diagnosis of neonatal intussusception.     

Preputial intussusception or acquired megaprepuce

Preputial intussusception, or acquired megaprepuce, is a clinical condition whose incidence is increasing. It results from infolding of the outer preputial skin, obstruction of urinary flow, and the development of a phimosis. With time the process continues, resulting in a distinctive clinical picture. Treatment by early circumcision cures the problem and allows resolution of the sequelae. Accepted: 3 June 1997