Colotomy with minimum resection for advanced irreducible intussusception

A patient having a resection anastomosis for advanced (apex up to midsigmoid or beyond) irreducible intussusception would end up having an ileosigmoid or ileorectal anastomosis. The outer layer of the intussusception is almost never gangrenious; this outer layer can be saved by colotomy with minimum resection. The procedure consists of a colotomy made on the outer tube just proximal to the apex, and the apex is delivered and amputated. The inner tube is pulled out, the intermediate tube is reduced, trimming off the margins of both ends and anastomosis is made between ileum and ascending colon. This method offers the advantage of conserving a major part of the large bowel.     

小肠脂肪瘤伴肠套叠一例报道

病例:男,37岁.因反复中下腹痛1个月入院.疼痛呈游走性,进食后加剧,伴恶心、呕吐及反酸.解便量少,不成形,其间曾解黑便1次.查体:体温为37.5℃,急性病容,腹软、膨隆,右下腹可扪及一7 cm×6cm包块,伴压痛,表面光滑.     

Laparoscopic-assisted extracorporeal surgery for an irreducible intussusception in a child

We describe the technique applied in an infant presenting with an intussusception secondary to a Meckel’s diverticulum who underwent a successful laparoscopic-assisted extra-corporeal resection of an irreducible intussusception and resection of the necrotic diverticulum. This umbilical approach avoided the need for a formal laparotomy, resulting in a favourable cosmetic result, and also a hastened recovery of the patient. This technique should therefore be considered as a potential option in the operative management of infants presenting with both a failed air enema and laparoscopic reduction of an intussusception.     

Intestinal intussusceptions in adults. Apropos of a case of spontaneous colo-colonic intussusception

A case of idiopathic colonic intussusception in a 39-year old woman is reported. The main features of the disease are reviewed: the clinical presentation may be subacute or chronic, diagnosis is based on ultrasonography and water-soluble contrast media enema. Because of the frequency of malignancy primary resection in the treatment of choice.     

Intestinal adaptation after small bowel resection in human infants

Purpose

In animal models, the small intestine responds to massive small bowel resection (SBR) through a compensatory process termed adaptation, characterized by increases in both villus height and crypt depth. This study seeks to determine whether similar morphologic alterations occur in humans after SBR.

Methods

Clinical data and pathologic specimens of infants who had both an SBR for necrotizing enterocolitis and an ostomy takedown from 1999 to 2009 were reviewed. Small intestine mucosal morphology was compared in the same patients at the time of SBR and at the time of ostomy takedown.

Results

For all samples, there was greater villus height (453.6 ± 20.4 vs 341.2 ± 12.4 μm, P < .0001) and crypt depth (178.6 ± 7.2 vs 152.6 ± 6 μm, P < .01) in the ostomy specimens compared with the SBR specimens. In infants with paired specimens, there was an increase of 31.7% ± 8.3% and 22.1% ± 10.0% in villus height and crypt depth, respectively. There was a significant correlation between the amount of intestine resected and the percent change in villus height (r = 0.36, P < .05).

Conclusion

Mucosal adaptation after SBR in human infants is similar to what is observed in animal models. These findings validate the use of animal models of SBR used to understand the molecular mechanisms of this important response.     

The appendix sign: a radiographic marker for irreducible intussusception

Purpose

Radiographic reduction (hydrostatic or pneumatic) of intussusception has become the standard of care in the pediatric population with success rates of more than 80%. Identification of those patients who are likely to fail nonoperative management could lead to earlier operation, a reduction in radiation exposure, and a decreased risk for complications after repeated attempts at enema reduction. During successful radiographic reduction, the small bowel is almost always visualized before the appendix. Visualization of the appendix before visualization of the small bowel during a successful reduction of an intussusception is a rare event. We report a new radiographic sign that we have termed the appendix sign (radiographic visualization of the appendix without reflux of air or contrast into the small intestine), which we hypothesize may have association with failure of nonoperative management.

Method

We performed a retrospective review of the last 12 years of irreducible intussusception. The associated studies were then reviewed to examine the incidence, sensitivity, and specificity of this radiographic finding.

Results

Ninety-one cases of intussusception were identified and had films available for review. Seventy-seven (76%) of the studies included the appropriate image. The appendix sign was visualized in 14 studies for an incidence of 18%. Of 14 patients, 10 failed enema reduction (positive predictive value, 71%). The sensitivity of the appendix sign is 43%. The specificity of the sign is 93%.

Conclusions

Our experience suggests that the presence of an appendix sign is associated with failing enema reduction of an intussusception and may be useful as a marker for determining the end point for further attempts at radiographic reduction.     

Intestinal testis tumor metastasis as a cause of intussusception: A case report

We report on an extraordinary testicular tumour causing intussusception with its intestinal metastases. This revised version was published online in August 2006 with corrections to the Cover Date.     

Intestinal intussusception due to ileal gastrointestinal stromal tumor--a case report

Intestinal occlusion due to intussusception produced by intestinal tumors is a very rare condition. Gastrointestinal stromal tumors are also rare digestive neopasias, with an impredictable malignant behavior, which are usually growing outside the intestinal wall, being rarely the initiators of an intestinal intussusception. We present the case of a 59 years old female, admitted in our hospital to elucidate the etiology of her iron deficient anaemia, which developed an intestinal occlusion at the intestinal preparation for colonoscopy. The abdominal CT scan performed in emergency conditions highlighted occlusive intestinal tumor complicated with intestinal intussusception. We performed an emergency laparotomy that revealed intestinal occlusion due to ileo-ileal intussusception produced by an ileal tumor. The surgical intervention consisted in segmental ileal enterectomy including the tumor with latero-lateral entero-enteral anastomosis. The patient recovered without complications. The histopathological and immunohisto-chemical examinations established the diagnose of gastro-intestinal stromal tumor with high risk malignant behavior, therefore the patient was guided in the oncological department for specific treatment and oncological surveillance.     

Intestinal intussusception as a complication of typhoid fever

Typhoid fever is a severe febrile illness caused by Salmonella typhi. Although ileal perforation and bleeding are seen more frequently, intestinal intussusception is a very rare complication of typhoid fever. A male patient was admitted to hospital due to abdominal distension and pain. Abdominal computerised tomography revealed ileal intussusception. The patient underwent exploratory laparotomy. Ileal intussusception was determined and segmental ileal resection was performed. Examination of the resected ileal segment revealed multiple ulcerous lesions that led to intussusception. The postoperative course was uneventful. The operative treatment is the subject of debate because of insufficient evidence. We recommend segmental bowel resection because of the underlying pathology.     

Internal herniation through the mesenteric opening after laparoscopy-assisted right colectomy: report of a case

We discuss a rare complication in a patient who underwent laparoscopic colectomy. A 69-year-old woman underwent laparoscopy-assisted right colectomy for cancer of the ascending colon. Two months after the operation, bowel obstruction developed. Decompression with a long intestinal tube failed to resolve the obstruction. Thus, surgery was performed. Abdominal exploration revealed a strangulated ileal loop caused by herniation through the mesenteric opening at the anastomotic site. The mesenterium had not been sutured during the previous operation. The anastomotic segment had twisted semicircularly and adhered to the retroperitoneum, so the mesenteric opening had narrowed.