Intussusception in the older child- suspect lymphosarcoma.

Examination of the records of 378 children with intussusception at our institution revealed that 29 cases were caused by an identifiable intestinal lesion. A Meckel's diverticulum was the causative agent in 21 children, all of whom were under 2 yr of age. A previously undiagnosed ileal lymphosarcoma produced the intussusception in six other children, all between 6 1/2 and 9 yr of age. Our experience indicates that any child over 6 yr of age with the clinical findings of colicky abdominal pain, bloody stools, and a palpable mass plus the radiographic evidence of intussusception must be considered to have ileal lymphosarcoma until proven otherwise. Hydrostatic reduction of the intussusception must be accompanied by extensive small bowel reflux of barium in order to effectively rule out a small intestinal lesion. If this is not accomplished, surgery should be planned with the suspicion that a malignancy may be present. If this suspicion is confirmed by frozen section, the operation procedure should include wide surgical excision of the lesion along with the regional lymph nodes.     

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.     

Chronic intussusception in children

Nine children presented with intussusception lasting for 14 days or more. Their mean age was 8.5 years. Diagnosis of intussusception was delayed considerably, probably due to an unusual presentation. Compared with acute intussusception, symptoms consist of infrequent attacks of abdominal pain, sporadic vomiting and no, or small, changes in defecation. Marked weight loss and an abdominal mass assume diagnostic significance, in contradiction to bloody stools. Ultrasonography can be of diagnostic value. An attempt at hydrostatic reduction is often unsuccessful. A high frequency of organic lesions precipitating intussusception warrants early surgical intervention.     

A special type of postoperative intussusception: ileoileal intussusception after surgical reduction of ileocolic intussusception in infants and children

Background

Postoperative ileoileal intussusception after surgical reduction of ileocolic intussusception in infants and children is extremely rare, and no reports of this special type of postoperative small bowel intussusception have been found in the literature.

Methods

We retrospectively reviewed the clinical charts of 6 infants and children with postoperative ileoileal intussusception that occurred after surgical reduction of ileocolic intussusception between January 1994 and December 2006. Clinical features, diagnostic strategy, operative findings, and outcome were analyzed.

Results

All 6 cases of postoperative ileoileal intussusception after surgery for ileocolic intussusception occurred within 1 week after the initial operation. The clinical manifestation was intestinal obstruction without abdominal palpable mass or bloody stool. Abdominal ultrasound examination revealed the target sign in 5 cases. Manual reduction of the intussusception was performed successfully at reoperation in each instance.

Conclusions

The clinical symptoms of postoperative ileoileal intussusception after operations for ileocolic intussusception are not typical. A second postoperative (ileoileal) intussusception should be kept in mind after surgical reduction of the first (ileocolic) intussusception in children. In any atypical postoperative ileus, a sonographic study should be done to rule out the diagnosis of postoperative intussusception. Once this condition is diagnosed, surgical treatment should be performed as soon as possible.     

26例儿童术后肠套叠的临床研究

目的探讨儿童术后肠套叠的特点诊断、治疗。方法回顾性分析我科在1999年1月-2009年12月期26例术后肠套叠和1416例原发性肠套叠的临床资料。结果本组病人住院术后肠套叠好发于6个月～3岁患儿；88％发生于术后14d内，其中92％为小肠套叠：其手术前诊断率为61％，误诊率为38％。术后肠套叠的临床表现以腹痛、呕吐、腹胀、肛门停止排气和排便为主，血便和腹部包块发生率较原发性肠套叠低（P〈O．01）。26例均接受手术治疗，22例行肠套叠徒手整复术，4例行肠切除吻合术，患儿全部痊愈出院，无1例复发。结论儿童术后肠套叠常发生于腹膜后手术及肠管暴露时间长的手术后，临床症状不典型，其术前误诊率高，确诊后需手术治疗，早期诊断和手术可以减少肠坏死切除的机会。     

Nonischemic intussusception in childhood.

The classical presentation of intussusception consisting of severe abdominal pain, bloody stool, and a palpable abdominal mass leads to the correct diagnosis in majority of the patients. However, an atypical presentation often results in a delayed diagnosis as is commonly seen in nonischemic intussusception. The nonischemic intussusception is a distinct clinical entity that is characterized by a long history of less severe symptoms commonly noticed in older children. The incidence of diarrhea in this group is higher than in the acute variety of intussusception. This variant of intussusception requires a high degree of suspicion for the diagnosis in atypical clinical presentation. The present study summarises our experience treating 31 such cases of nonischemic intussusception during a period of 25 years from 1966 to July 1990.     

Postoperative intussusception: experience with 36 cases in children

Intestinal obstruction is a common postoperative complication and is usually related to peritoneal adhesion formation. A less well-recognized cause is postoperative intussusception (POI). Thirty-six instances of POI in children (aged 1 month to 18 years) were treated between 1970 and 1987. POI followed Nissen fundoplication in 9 patients, neuroblastoma resection in 5, small-bowel procedures in 4, inguinal herniorrhaphy in 3, pull-through procedures in 3, ureterostomy in 2, thoracic procedures in 2, ventral hernia in 1, nephrectomy in 1, hepatic resection in 1, Heller myotomy in 1, ventriculo-atrial shunt in 1, and gastrocystoplasty in 1. Initial symptoms included bilious vomiting or increased nasogastric drainage (after initial return of gut function) in 26 patients, abdominal distension in 24, irritability in 10, intermittent pain in 7, palpable abdominal mass in 2, rectal bleeding in 2, and lethargy in 1. The symptoms occurred 1 to 24 days (mean, 8 days) after the initial surgery. Plain abdominal radiographs revealed multiple air-fluid levels in 31 and an "adynamic ileus" in five patients. Barium contrast techniques could successfully reduce two ileocolic and one distal ileo-ileal lesions. The remainder necessitated operative management. Manual reduction was possible in 29 cases, and four children with diagnostic delay required bowel resection and an anastomosis for intestinal necrosis. The site of intussusception was ileo-ileal in 23 patients, jejunojejunal in 6, ileocolic in 5, and jejuno-ileal in 2. The diagnosis of POI should be considered in children with signs of bowel dysfunction in the early postoperative period. Contrast studies are of limited value, since most cases are confined to the small bowel. A high index of suspicion and prompt laparotomy will usually allow manual reduction of the lesion. Diagnostic delay may result in bowel necrosis.     

Enteritis Cystica Profunda Presenting as Ileoileal Intussusception in a Child: Report of a Case

We report the case of a 3-month-old male infant with small bowel intussusception caused by enteritis cystica profunda (ECP). The baby was admitted because he was refusing to feed, and was passing redcurrant jelly -like stools. A palpable mass was identified, and abdominal ultrasonography showed a mass with a lumen and lumen appearance. We performed laparotomy and resected the segment of bowel containing the mass. The resected segment had enteritis cystica profunda, which was considered to have precipitated the intussusception. A review of the English medical literature revealed only three other cases of children with similar symptoms in the last 30 years.     

Nonischemic intussusception

Nonischemic intussusception is defined as a variant of acute intussusception exhibiting less acute symptoms of abdominal pain, vomiting, and diarrhea in the older child, longer duration of symptoms (usually 4–14 days), signs of incomplete bowel obstruction, and absence of intestinal ischemia. Over a 10 yr period (1964–1973) 20 children with this disease were treated without mortality or recurrence at three children's hospitals in Chicago, illinois. The higher incidence of diarrhea, the lower incidence, of a palpable abdominal mass, and the lower incidence of blood per rectum in nonischemic intussusception predispose to diagnostic errors and delays in treatment. Despite the longer duration of symptoms, this variant of intussusception can be treated initially with a careful attempt at barium hydrostatic reduction. If this fails, easy operative manual reduction is the rule.     

小儿慢性肠套叠(附15例临床分析)

目的：探讨小儿慢性肠套叠在临床表现、病理、诊断与治疗等方面的特点,提高早期诊断率。方法：总结1960－2000年收治的15例小儿慢性肠套叠病例,从临床表现、病理、诊断、治疗与结果等方面进行分析。结果：常因其临床表现不典型而误诊或漏诊,发病年龄较大,多在3岁以后。肠套叠“四大征”并不典型,而纳差与消瘦发生率高,多为继发性肠套叠。结论：小儿慢性肠套叠发生率低,临床表现不典型,发病年龄较大,多为继发性,根据其临床表现、X线检查可获诊断,治疗方法以外科手术为主。     

A Rare Cause of Jejunojejunal Intussusception in an Adult

Jejunojejunal intussusceptions are not common in adults and unlike in children, a lead point is usually found. The clinical presentation in adults tends to be more chronic or intermittent and include abdominal pain, obstructive symptoms, gastrointestinal bleeding or palpable mass. These unspecific symptoms often lead to a late diagnosis. The clinical picture is subtle and diagnosis is therefore elusive. We report a case of jejunojejunal intussusception secondary to gastrointestinal stromal tumor (GIST) in a 50 year old female.     

Ileoileal invagination without obstruction in a four-year-old boy

Intussusception is one of the most common causes of acute abdomen in the first year of life. Its clinical presentation is vomiting, bloody stools, severe colicky abdominal pain, and mass. The authors reported a case of intussusception with an inappropriate clinical picture, but both characteristic ultrasonography and computed tomography findings led to the diagnosis of ileo-ileal intussusception.     

Acute jejunogastric intussusception

Acute jejunogastric intussusception is a rare complication following gastric surgery. Three patients were treated for this condition during the past 15 years. Common presenting manifestations are vomiting, hematemesis, upper abdominal pain, and palpable abdominal mass within the left hypogastrium. The diagnosis is established by gastroscopy or upper gastrointestinal radiographs. Four categories of classification are described. Optimal operative management consists of prompt laparotomy. Manual reduction of the intussusception is followed by resection of compromised bowel. Procedures to prevent recurrence are individualized.     

成人肠套叠的诊断与治疗--附62例临床分析

目的　探讨肠套叠的发病机制及诊断和治疗方法。方法　回顾性分析了６２ 例成人肠套叠的临床表现、套叠类型、诊断以及治疗方法。结果　所有患者具有腹痛,５８ ％ 具有呕吐,６５ ％ 有腹部肿物。引起套叠的原因主要是炎性水肿与良、恶性肿瘤。５５ 例接受手术治疗。结论　成人肠套叠多有病理因素存在,但其发生是由多个因素共同作用所致;其诊断主要依据临床表现和辅助检查;成人肠套叠多有病理因素的存在,治疗以手术为主。     

Cecal-Colic Adult Intussusception as a Cause of Intestinal Obstruction in Central Africa

n = 43; 55%). The symptom complex of colicky abdominal pain and obstipation was present in 100% of the patients with intussusception. Operative repair in 90% of patients consisted of simple reduction of the intussusceptum. There were no known recurrences. The etiology of adult cecal-colic intussusception is unknown. Patients typically present with a 3- to 4-day history of abdominal pain, obstipation, and usually a palpable mass. Treatment is surgical reduction. Right colectomy is reserved for intestinal gangrene. We treated 43 cases during a 5-year period with only one death.     

Forshal type IE appendiceal intussusception: A case report

IntroductionAppendiceal intussusception is a rare condition. Clinical features are not specific for it. Patients may present with abdominal pain and vomiting. These symptoms represent a variety of abdominal pathology. Preoperative diagnosis is difficult because of the non-specific clinical features. We present a case report of a child who initially presented with ileocolic intussusception.Case presentationThis is a case report of a 5-years-old boy with abdominal pain and vomiting. He had an ileocolic intussusception 2 days back, and was successfully managed by hydrostatic reduction and discharged. On ultrasonography, an intussusception was identified in the ileocaecal region. Hydrostatic reduction failed this time and laparotomy was performed. On laparotomy, there was complete intussusception of the appendix with normal ileocaecal junction. Appendectomy was performed. Post-operative period was uneventful.DiscussionAppendiceal intussusceptions are mostly diagnosed intra-operatively. The clinical features may mimic various other acute and chronic abdominal conditions. Type IE appendiceal intussusception, as described by Forshal, is a rare condition. Appendectomy with a rim of the caecum is the procedure of choice.ConclusionThough ileocaecal intussusceptions are common in children, appendiceal intussusceptions are rare and are usually diagnosed during the operative procedure. Radiologists and pediatric surgeons should be aware of this rare entity. Appendectomy is the treatment of choice in most of the appendiceal intussusceptions.     

成人肠套叠的诊断和治疗:附58例报告

目的 探讨成人肠套叠的发病机制及诊断和治疗方法。方法 回顾性分析58例成人肠套叠的临床表现、类型、诊断及治疗方法。结果 阵发性腹痛55例，恶心呕吐34例，腹部包块38例。引起套叠原因主要是炎性水肿(11例)、良性肿瘤(15例)和恶性肿瘤(10例)。55例接受手术治疗，3例行钡灌肠复位。58例均康复出院。结论 成人肠套叠多由器质性病变引起，其发生由多个因素共同作用所致；诊断主要依据临床表现和辅助检查；治疗以手术为主。     

Small Bowel Intussusception in Symptomatic Pediatric Patients: Experiences with 19 Surgically Proven Cases

Nineteen cases of surgically proven symptomatic pediatric small bowel intussusceptions (SBI) were retrospectively reviewed. Clinical presentations included vomiting (89.5%), abdominal pain and/or irritable crying (89.5%), fever (52.6%), bloody stools (26.3%), palpable abdominal masses (15.8%), hematemesis (10.5%), jaundice (5.3%), and seizures (5.3%). The duration between symptom onset and hospitalization ranged between 20 and 336 hours (average 75.8 hours). Two patients with suspected appendicitis and small bowel obstruction were operated on promptly. Sonograms revealed target lesions (average diameter 2.9 cm) suggestive of intussusception in 13 out of 17 patients, with 10 lesions located in the paraumbilical or left abdominal regions. Barium enemas in 12 of these 13 patients demonstrated no colonic lesions. Diagnosis and surgery were delayed in 16 patients (average delay = 32 hours). The remaining 1 patient with positive sonographic findings underwent early surgery after computed tomographic (CT) confirmation of SBI. Surgery revealed ileoileal intussusceptions in 11 patients, jejunojejunal in 4, jejunoileal in 3, and duodenojejunal in 1. Eight patients had lead points. Bowel complications (ischemia, necrosis, or perforation) occurred in 8 patients. The duration between symptom onset and surgery in patients with bowel complications was significantly longer than for patients without complications (p = 0.0026). In conclusion, delayed diagnosis and surgical treatment in symptomatic pediatric patients with SBI were common, leading to a high rate (42%) of bowel complications. Sonographic demonstration of a 2-3 cm target lesion, especially if paraumbilical or left abdominal, is suggestive of SBI and may obviate the need for a barium enema; however, CT is helpful for confirming SBI. In symptomatic SBI, once diagnosed, early surgical referral is strongly recommended.     

小儿肠套叠465例诊治体会

目的分析小儿肠套叠的临床特点、诊断及治疗。方法回顾性分析465例小儿肠套叠的临床表现、治疗效果。384例患儿空气灌肠治疗;81例手术治疗,并比较两种手术切口的愈合情况。结果465例小儿肠套叠的主要症状以腹痛、血便、呕吐和腹部肿块为主。空气灌肠法,操作简便,复位率可达82.58%以上;空气灌肠不能成功,需手术治疗,如能行麦氏切口较行腹直肌切口有优越性。结论小儿肠套叠早期诊断和治疗与预后相关。部分患儿手术可行麦氏切口。     

Pediatric Spigelian hernia: A case report

Report of a Spigelian hernia in a 13 yr old girl. The condition may well be more common than generally believed, and the diagnosis should be considered in all children with intermittent abdominal pain, even in the absence of a palpable mass.