Adult intussusception: 5-year experience in Sarawak

Adult intussusception is rare. It represents only 5% of all intussusceptions and 1% of bowel obstruction. Clinical presentations are usually variable with a variety of acute, intermittent and chronic symptoms. It is associated with an underlying pathologic process in 90% of cases. A lack of Malaysia data prompted review of the Sarawak experience with this uncommon entity, focusing on the clinical features, diagnostic procedure and treatment. During the last 5 years, there were 14 cases of surgically proven adult intussusception. Mean age was 45.9 years. There were 9 enteric and 5 colonic intussusceptions. Ninety-three percent of the intussusceptions were associated with a pathologic lesion. Thirty-three percent of the enteric lesions were malignant and 67% were benign. Eighty percent of the colonic lesions were malignant and 20% were benign. Computed tomography scan has a good diagnostic accuracy of 83% and should be considered for all patients with nonspecific abdominal symptoms or suspected bowel obstruction. Treatment of choice for colonic intussusception in adults is en bloc resection without reduction whenever possible, whereas a more selective approach for enteric lesions.     

小儿急性肠套叠196例临床诊治分析

目的：探讨早期诊治小儿急性肠套叠的方法。方法：回顾性分析本院小儿外科2005年至2009年诊治的196例小儿急性肠套叠病例,对其临床诊断和治疗方法进行回顾分析。结果：196例病例中,空气灌肠复位176例,手术治疗20例,全部治愈,无死亡病例。结论：腹部B超及诊断性空气灌肠是早期诊断小儿急性肠套叠的方法,空气灌肠复位是治疗急性肠套叠的主要方法。     

胃切除术后小肠套叠的危险因素分析

目的 分析成人胃切除术后小肠套叠的危险因素。方法 选择2010年1月至2018年12月安徽医科大学第一附属医院普外科确诊为胃部疾病并行手术的患者9 825例作为研究对象。将术后发生小肠套叠的9例患者作为病例组,从其余患者中选择36例患者（1：4）作为对照组,要求性别相同、年龄相差不超过1岁。分析术后小肠套叠与性别、体质指数（BMI）、吻合方式等因素的关系。结果 病例组患者中位BMI为21.67（19.81,23.09）kg/m²,低于对照组,差异有统计学意义（P<0.05）。病例组3例（33.33%）患者发生术中吻合器上肠管套叠,对照组2例（5.56%）,两组患者术中吻合器上肠管套叠发生率的差异有统计学意义（P<0.05）。多因素logistics回归分析显示,术中吻合器上肠管套叠是胃切除术后小肠套叠的危险因素（OR=7.508）,而BMI则是术后小肠套叠的保护因素（OR=0.609）,差异均有统计学意义（P<0.05）。结论 术前BMI高的患者术后发生小肠套叠的风险更低,而术中吻合器上肠管套叠的患者更容易出现术后小肠套叠。     

The obstructed intussusception in childhood

In intussusception in early childhood, reduction by barium enema is the treatment of choice. In late cases when there is air and fluid distension of the small bowel on plain x-ray, barium enema is less useful. Generally 20-25% of childhood intussusception presents in this way. We have reviewed the experience of 65 intussusceptions at the Royal Belfast Hospital for Sick Children over the past 5 years and found only one successful barium enema reduction in 22 obstructed intussusceptions.     

高频彩超在小儿肠套叠诊断中的临床价值

目的探讨高频彩超在小儿肠套叠诊断中的临床价值。方法对经过临床确诊的48例小儿急性肠套叠患者的声像图资料进行回顾性分析,包括肿块的形态、内部回声、典型特征及彩色血流情况等,并归纳其声像图特点。结果在48例肠套叠患儿中超声检出47例,诊断符合率97.9%;误诊1例,误诊率2.1%。结论高频彩色超声对小儿肠套叠的诊断有极高的临床价值,可作为小儿肠套叠的首选影像学检查方法。     

Intussusception: is floating caecum a causative factor? Analysis of 10 cases

Ten consecutive cases of intussusceptions treated by the authors at the University of Port Harcourt Teaching Hospital (UPTH) in a five year period are analysed. The median age of occurrence was nine months; average 5.2 years; range: one month to 25 years. The male to female ratio was 2:3. Five patients had ileocaecal, two ileoileal, two colocolic and one ileocolic intussusceptions. Of the two patients with ileoileal intussusceptions one had antegrade with Meckel's diverticulum and the other retrograde with lipoma as lead-points. The two patients with colocolic intussusceptions had mesenteric and mesocolic lymph nodes hypertrophy. The remaining six patients had freely mobile caecum anchored to the posterior peritoneum by a long mesocaecum and such arrangement was believed to be the cause of the intussusceptions. In addition to intraoperative reduction in five cases and resection with end to end ileoileal anastomosis in one, each of these six patients had the caecum fixed to the posterior abdominal wall to prevent recurrence of the intussusception.     

成人肠套叠25例临床分析

目的:探讨成人肠套叠的发病机制及诊断和治疗方法。方法:分析25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,16例有腹部肿物,15例有呕吐。引起套叠的原因主要是炎性水肿与良、恶性肿瘤。23例接受手术治疗。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。     

Adult rectosigmoid junction intussusception presenting with rectal prolapse

Most cases of intussusception in adults present with chronic and nonspecifi c symptoms, and can sometimes be challenging to diagnose. We herein report on a patient w ith the rare symptom of colonic intussusceptions presenting with rectal prolapse and review the existing literature of similar case reports to discuss how to reach an accurate diagnosis. A 75-year-old woman with dementia presented with per rectal bleeding, rectal prolapse and lower abdominal pain. An operation was scheduled and a large sigmoid intussusception with a polyp as a leading point was found intraoperatively. She subsequently recovered well and was discharged. As large sigmoid intussusceptions may present as rectal prolapse, intussusception should be considered as a differential diagnosis for immobile patients, especially when the leading point is a lesion.     

Total Jejunoileal Intussusception: A Case Report and Literature review

Small bowel intussusceptions are much less common than the ileocolic type, with jejunoileal intussusceptions being amongst the most rare¹. We review the literature on small bowel intussuception, using a case of an 11-year-old girl with a jejunoileal intussusception involving the whole of the small bowel, from the level of the duodenojejunal flexure to the ileocaecal valve, as an illustrative history. The typical CT features of an intussusception and value of CT with regard to identification of complications are highlighted.     

空气灌肠整复小儿急性肠套叠139例分析

目的:观察间歇性空气灌肠在小儿急性肠套叠的应用效果,探讨影响其整复成功率的因素。方法:对139例应用空气灌肠整复肠套叠患儿的临床资料进行回顾性分析。结果:整复成功127例,不成功12例。一次整复成功113例,二次整复成功11例,三次整复成功7例,其中6例发生肠复套4例整复成功。病程24 h、24～48 h、48 h者整复率分别为96.55%、72.22%和2/5,套头位于肝曲近侧者、横结肠中段至脾曲者和降结肠至乙状结肠者的整复率分别97.56%、87.50%和70.59%,差异均有统计学意义(P0.01)。结论:空气灌肠是小儿急性肠套叠主要的诊治方法,疗效安全、可靠,整复成功率随病程的延长、套叠程度的加深而降低。     

成人肠套叠9例临床分析

目的 探讨成人肠套叠的发病机制,诊断和外科治疗.方法 对2000年1月-2007年2月期间我院收治的9例成人肠套叠临床资料进行回顾性分析.结果 7例慢性肠套叠者表现为不全性肠梗阻.引起套叠主要原因是良性肿瘤(3例),恶性肿瘤(2例),炎性水肿(1例),盲肠憩室(1例)及不明原因(1例)等.本组9例均行手术治疗,治愈9例.结论 成人肠套叠多有病理因素存在,诊断依据主要是临床表现和辅助检查.治疗首选外科手术.肠切除术是根除病因,防止复发的主要手段.     

成人肠套叠的MDCT诊断价值

目的分析成人肠套叠的的MDCT影像特征。方法回顾分析手术证实为成人肠套叠的CT影像资料共48例。观察内容主要包括肠套叠部位、数目、套叠类型及CT征象、套叠处肠壁是否增厚或肿块形成、肠壁是否水肿与坏死等。结果本组48例50处肠套叠均为顺行套入,单处肠套叠46例(位于回盲部22例、回肠10例、空肠8例、升结肠4例、十二指肠空肠交界处、降结肠型及直肠各2例),多处肠套叠2例。MDCT示肠套叠3层肠壁结构及肠管内脂肪48例50处、杯口征及靶形征42例44处,彗星尾征32例34处,漩涡征24例26处。肠壁均匀增厚并水肿12例,其中考虑合并肠壁坏死4例;肠壁不均匀增厚或和肿块形成、不均匀强化14例;肠壁均匀增厚并轻中度均匀强化6例。套叠处见多发囊状低密度灶并囊壁均匀强化4例;套入远端圆形脂肪瘤合并肠壁坏死2例;小肠冗长2例;肠壁正常8例;其中合并肠梗阻12例,合并腹壁疝2例。结论成人肠套叠MDCT影像表现有一定特征,三期增强扫描结合多平面重组技术,对其诊断及选择治疗方法具有重要价值。     

Idiopathic jejunal intussusception in an adult

Background  Intussusception is a common surgical diagnosis in the paediatric population and is most commonly idiopathic. In adults a substantial proportion of patients have a malignant leading cause and surgical intervention is mandatory. Intussusception involving the small bowel is thought to be more likely benign in nature and is frequently reduced before the leading cause is excised. Aim  Review of the literature to determine the incidence of malignancy in small bowel intussusceptions and discussion of the optimal operative strategy. Methods  We describe an unusual case of adult idiopathic jejunal intussusception, which was treated with excision without reduction and present the results of a relevant literature search. Results  A number of reports have confirmed a high incidence of malignancy in small bowel intussusceptions and consequently excision without reduction should be undertaken. Conclusion  It is in the authors' view that excision without reduction should be the treatment of choice in small bowel intussusception unless preoperative imaging delineates benign leading pathology and in the rare occasion of a shortened gut.     

彩超在小儿肠套叠诊断和治疗中的临床应用

目的:探讨超声检查在小儿肠套叠诊断和治疗中的应用。方法:回顾性分析经超声诊断及在超声监视下水压灌肠复位及手术证实的小儿肠套叠127例。结果:本组患儿超声确诊率100%,超声监视下水压灌肠复位121例,成功率95.3%。结论:超声检查小儿肠套叠准确性高,可作为影像学首选的检查方法,超声引导下水压灌肠治疗小儿肠套叠方法安全有效,成功率高。     

婴幼儿急性肠套叠45例手术治疗分析

目的：探讨婴幼儿肠套叠的诊断和治疗。方法：回顾性分析我院于2010年1～12月收治的45例住院手术的肠套叠患儿的临床表现、诊断方法、手术方法等临床资料,并进行总结分析。结果：45例患儿全部治愈,无一例死亡。结论：早期诊断、合理选择辅助检查及术中、术后正确处理是成功治疗急性肠套叠、降低手术并发症的关键。     

Ileocolorectal intussusception due to caecal hamartoma

Although 75% of intussusceptions occur within the first two years of life, they can also develop in teenage years. This is a case report of a 13-year old boy with an ileocolorectal intussusception from a large caecal hamartoma (10 x 6 x 2 cm3) adjacent to the ileocaecal valve. Partial resection of the ascending colon and terminal ileum was performed, and the pathology of the resected mass revealed a hamartoma. Ileocolorectal intussusception secondary to hamartoma represents a particularly rare event in the paediatric population. With early surgical intervention, this patient's outcome was uneventful.     

Adult intussusception: case reports and review of literature

Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, aetiology, and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms and most cases are diagnosed at emergency laparotomy. With more frequent use of computed tomography in the evaluation of patients with abdominal pain, the condition can be diagnosed more reliably. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial, but there is a shift against this, especially in colonic cases. Surgical treatment can be difficult in gastroduodenal and coloanal intussusceptions, sometimes requiring innovative techniques. This paper presents the diagnosis and management of four cases of adult intussusception, followed by review of the literature.     

儿童急性肠套叠空气灌肠治疗及X线分析

目的 探讨腹部X线平片在评价患儿病情和肠管血运障碍中的作用.方法 回顾性分析苏州大学附属儿童医院2007年1月1日至2008年2月29日1119例儿童肠套叠不同年龄组之间空气灌肠成功率,分析190例(95例患儿空气灌肠未能复位,随机抽取同期空气灌肠成功复位患儿95例)患儿腹部X线资料,患儿腹部X线资料由两位高年资医师分别进行评价,空气灌肠未能复位者X线资料与病理结果和手术记录对照;分析患儿肠管病理改变和X线表现之间的一致性.结果 有1024例次成功复位,复位成功率为91.5%.1岁以内患儿627例,空气灌肠成功546例,空气灌肠成功率为87.1%,＞1岁患儿有492例,空气灌肠成功率为97.2%.两组间比较差异有统计学意义(x2=36.01,P＜0.01),95例儿童急性肠套叠患儿,4例合并肠重复畸形、3例合并回肠Machel憩室.术后病理分型:回回型14例、回结型25例、回回结型44例、回盲型10例、回结结型2例;其中有肠管坏死切除者11例.X线观察肠管血运障碍与病理对照,经一致性检验,kappa值为0.7128,二者之间存在一致性.肠套叠病理类型不同,腹部X线表现有所不同.190患儿中,腹部X线表现为肠管血运障碍者30例,局限性积气扩张者51例,腹部无气者36例,局限性积气合并肠管内肿块者73例.通过X线表现和发病时间双向有序关联性检验(非零相关)Nonzero Correlation=20.67(P＜0.01).结论 儿童肠套叠1岁以内患儿空气灌肠成功率较大于1岁组低,腹部X线平片对儿童急性肠套叠患儿病情评估具有一定作用,X线对于肠管的血运障碍的判断与病理具有较好的一致性.     

小儿急性肠套叠86例临床分析

目的 探讨小儿急性肠套叠的早期诊断及治疗。方法 对我院1985年1月～2003年6月间收治的86例小儿急性肠套叠临床资料进行回顾性分析。结果 本组男性多见(62．8％)，好发年龄为3～6个月，以回结型最为多见(76．7％)。空气灌肠复位成功38例，其余手术治疗治愈85例，死亡1例。结论 早期诊断、及时治疗是小儿急性肠套叠空气灌肠复位成功的关键，发病超过48h者不宜行空气灌肠。灌肠复位失败或复位后出现腹膜炎征象，发病时间长或病情较重者，必需手术治疗。     

小儿原发性肠套叠血浆胃动素水平变化研究

目的 探索原发性肠套叠患儿急性期及恢复期血浆胃动素水平的变化.方法 采用放射免疫法检测原发性肠套叠患儿在发病当日(急性期)及发病后15 d(恢复期)的血浆胃动素水平,并与对照组比较,同时检测白细胞计数做相关性分析.结果 原发性肠套叠患儿血浆胃动素水平急性期较正常儿显著升高,差异有统计学意义(P＜0.01),并与白细胞计数呈正相关(P＜0.01);恢复期迅速下降至正常水平,与对照组比较差异无统计学意义(P＞0.05).结论 血浆胃动素水平在原发性肠套叠急性期的升高是继发于疾病本身或其诱因(病毒感染)等引发的免疫炎症反应,或继发于疾病急性期的应激反应、神经反射等因素,同时升高的胃动素又可能促进了肠套叠疾病的发生发展.