Lipomatous polyp causing colo-colic intussusception

A lipoma is a benign tumour that arises from an adipose tissue. It is the leading benign soft tissue tumour. It can occur anywhere in the human body. Lipomas in the gastrointestinal tract are quite rare and usually asymptomatic. We report a 70 years old male patient who presented with crampy abdominal pain. CT scan of the abdomen showed colo-colic intussusception. The patient was explored and the finding was colo-colic intussusception with a mass as a leading point. En-block resection done. Histology confirmed the mass as a lipoma

A Clinical Analysis of Acute Small Bowel Obstruction – A Review of Sixty-four Patients in a Tertiary Hospital

Background: Acute small bowel obstruction (SBO) is an ever increasing clinical problem. Successful management depends on comprehensive knowledge of the aetiology and patho-physiology of SBO, familiarity with imaging methods, good clinical judgment, and sound technical skills. Aim of the Study: To study the incidence, clinical features, and operative findings of small bowel obstruction in a Tertiary Hospital of Kerala. Materials and Methods: Aprospective cross-sectional analytical study was conducted in the Department of General Surgery, Medical College, Kerala, including 64 patients. Inclusion criteria: (1) Patients aged between 18 and 87 years were included in the study. (2) Patients with complaints of vomiting, pain in the abdomen, fever, and abdominal distension were included. (3) Patients who had hernia with recent onset of irreducibility, pain, vomiting, and constipation were included in the study. Exclusion criteria: (1) Patients who were aged below 18 and above 80 years were excluded from the study. (2) Patients with signs and symptoms of subacute intestinal obstruction (IO) and paralytic ileus were excluded from the study. The following data were collected: Adetailed record of the patient’s history, physical examination, and necessary investigations such as baseline, X-ray abdomen erect and supine in all cases, and ultrasound abdomen was recorded based on the requirement for each case. The pro forma was used to record the age, sex, and symptom duration, past surgical and medical history of all patients. All patients were subjected to surgery as their clinical presentation was of acute nature. The patients were stabilized from shock, fluid-electrolyte imbalances, and nasogastric aspiration before taking them to the operation theater. All the patients were followed postoperatively for 2–4 months from the time of discharge. The events of post-operative period and complications were noted and tabulated. All the data were analyzed using standard statistical methods. Observations and Results: A total of 64 patients presenting with acute IO were included in the study. Among the 64 patients, there were 49 male (76.56%) and 15 female (23.43%) with a male to female ratio of 3.26:1. The mean age of the patients was 49.36 ± 3.14 years. The youngest patient was aged 19 years and the eldest one was 76 years. It was observed that pain in the abdomen accounted for the most common symptom with 60/64 patients presenting with the symptom, followed by abdominal distension 49/64 (76.56%), vomiting in 43/64 (66.15%), and absent bowel sounds in 28/64 (43.75%) of the patients. Among the causes for small bowel obstruction (50/64), intussusceptions were noted in 13/64 (20.31%), volvulus in 10/64 (15.62%), adhesions in 8/64 (12.50%), hernia in 7/64 (10.93%), appendicitis in 6/64 (9.37%), and intestinal tuberculosis in 6/64 (9.37%) of the patients. Among the large bowel obstructions, volvulus was noted in 7/64 (10.93%), intussusceptions in 4/64 (06.25%), and large bowel tumor in 3/64 (4.68%) of the patients. Paralytic ileus was noted in 10/64 (15.62%) of the patients. Conclusions: Acute IO is a common surgical emergency requiring timely intervention to reduce morbidity and mortality. Acute IO is more common in small bowel when compared to large bowel. Males are more commonly affected than females. The clinical presentation varies on the level of obstruction and hence the incidence of symptoms varies from study to study. Intussusceptions, volvulus, herniae, and adhesions account for more than 50% of the causes of IO. Laparotomy was the most common means of IO management, while bowel resection and anastomosis were the most common intraoperative procedure. Early recognition and timely intervention are important to prevent the bowel going for gangrenous changes. Mortality increases with the delay in the institution of surgical or medical treatment.

Study of arborizing clinical pathway in pediatric intussusceptions and appendicitis / 中华医院管理杂志

Objective@#To evaluate the feasibility and efficacy of a self-made arborizing clinical pathway(ACP)in acute pediatric intussusceptions and appendicitis.@*Methods@#Based on the clinical pathway(CP)-node concept, an ACP electronic template with some CP branches for dealing with significant variations was made, using a doctor-advices package in the CP program of the Clinical Information System in our hospital.From February 2018 through January 2019, children inpatients diagnosed with acute intussusceptions at our hospital accepted the ACP or the conventional CP management respectively according to parity of admitted order.@*Results@#426 children diagnosed with intussusceptions and 612 children diagnosed with appendicitis were included. After excluding some unqualified samples, 216 intussusception and 302 appendicitis children were enrolled in the observation group respectively which was subject to the ACP, 210 and 310 in the control group subject to the conventional CP. There were no significant differences between the observation and control groups in both diseases about patient demographics and therapeutic approach. The CP implementation-quality differences between the two groups in both diseases were observed and compared. Significant differences were found between the two groups in both diseases about CP completion rate(97.2% versus 90.5% and 97.7% versus 90.1%), the rate of outside-CP doctor′s orders((4.6±1.3)% versus (19.3±5.3)%and(6.1±1.7)%versus (20.3±5.1)%), the hospitalized period((2.7±0.3)d versus (3.2±0.4)d and(5.6±0.4)d versus (6.2±0.5)d), the hospitalization costs and the satisfaction rate.@*Conclusions@#ACP belongs to one of compound CPs, is appropriate to use in these solitary diseases with significant variations. ACP can deal with the CP problem of significant variations rooted in the diseases or treatments, thus contributing to promotion and application of CP.

Study of arborizing clinical pathway in pediatric intussusceptions and appendicitis / 中华医院管理杂志

Objective To evaluate the feasibility and efficacy of a self-made arborizing clinical pathway( ACP ) in acute pediatric intussusceptions and appendicitis. Methods Based on the clinical pathway(CP)-node concept, an ACP electronic template with some CP branches for dealing with significant variations was made, using a doctor-advices package in the CP program of the Clinical Information System in our hospital. From February 2018 through January 2019, children inpatients diagnosed with acute intussusceptions at our hospital accepted the ACP or the conventional CP management respectively according to parity of admitted order. Results 426 children diagnosed with intussusceptions and 612 children diagnosed with appendicitis were included. After excluding some unqualified samples, 216 intussusception and 302 appendicitis children were enrolled in the observation group respectively which was subject to the ACP, 210 and 310 in the control group subject to the conventional CP. There were no significant differences between the observation and control groups in both diseases about patient demographics and therapeutic approach. The CP implementation-quality differences between the two groups in both diseases were observed and compared. Significant differences were found between the two groups in both diseases about CP completion rate(97.2% versus 90.5% and 97.7% versus 90.1% ), the rate of outside-CP doctor′s orders ((4.6 ± 1.3)% versus (19.3 ± 5.3)% and ( 6.1 ± 1.7 )% versus (20.3 ± 5.1 )% ), the hospitalized period((2.7 ± 0.3)d versus (3.2 ± 0.4)d and(5.6 ± 0.4) d versus (6.2 ± 0.5) d), the hospitalization costs and the satisfaction rate.Conclusions ACP belongs to one of compound CPs, is appropriate to use in these solitary diseases with significant variations. ACP can deal with the CP problem of significant variations rooted in the diseases or treatments, thus contributing to promotion and application of CP.

Diagnosis and treatment of adult intussusception / 中华普通外科杂志

Objective To analyze the clinical characteristics of adult intussusception and improve its diagnostic and treatment levels.Methods Data of 80 cases of adult intussusception treated in the First Affiliated Hospital of China Mdeical Unuversity between January 2001 and December 2015 were reviewed retrospectively.Results 95％ patients had abdominal pain,34％ had bloody stool and 24％ had abdominal mass,8％ presented a triad of abdominal pain,bloody stool and abdominal mass.As confirmed by laparotomy 48％ were enteric intussusception,40％ were ileocolic intussusception,and 12％ colocolonic intussusception.The diagnosis rate of abdominal uhrasonography was 60％;CT established the diagnosis in 97％ cases.74％ underwent malignant or benign tumor resection,10％ underwent intestinal resection for inflammatory bowel disease.10％ were cured by simple reduction.4 cases received intussusception reduction and appendectomy.Conclusions Tumors were causes of adult intussusception in most case.CT is most accurate in diagnosis.Laparoscopy can be used for difficult diagnosis.

Peutz-Jeghers syndrome with germline mutation of STK11

Peutz-Jeghers syndrome (PJS), also known as periorificial lentiginosis, is a rare autosomal dominant inherited disease with an incidence of 1/200,000 live-borns. Mutations in the serine-threonine kinase 11 (STK11) gene are considered the major cause of PJS. The most frequent complication at young age is recurrent intussusception due to multiple hamartomatous polyps, primarily in the small intestine. Although extremely rare, the small bowel should be fully examined to be certain additional intussusceptions are not present. Herein, we report on a case of PJS with germline mutation of STK11 in a 12-year-old young girl who presented as a rare case of two small intestinal intussusceptions and review the literature.

Ultrasonographic findings of pylorogastric intussusceptions in two dogs

A Yorkshire terrier (case 1) and a Miniature Schnauzer (case 2) were diagnosed with pylorogastric intussusceptions (PGIs). Both cases showed acute vomiting and had previous histories of laparotomy. In case 1, the invaginated pyloric wall was thickened unevenly containing multiple hypoechoic areas and had indistinct wall layering on ultrasonography. PGI with diffuse gastric edema and necrosis was confirmed on laparotomy. The dog recovered completely after gastrectomy and a Y-U plasty. Case 2 had uniformly thickened walls of invaginated gastric pylorus with the distinct wall layering. PGI was reduced spontaneously the next day.

Intususcepción eecocólica e invaginación del ciego en un canino: reporte de caso / Cecocolic intusuusception and invagination of the cecum in a dog: case report

Se expone el caso de un perro mestizo de Fox Terrier que presentaba diarrea sanguinolenta que no mejoró al tratamiento inicial; se detectó a la palpación una masa a nivel del colon, que se confirmó con un estudio radiográfico de tránsito intestinal; también, se diagnosticó un megacolon. Se decidió realizar una laparotomía exploratoria donde se encontró una intususcepción cecocólica y la invaginación del ciego, el procedimiento quirúrgico realizado consistió en hacer tiflectomia y enteroanastomosis término-terminal; luego de este procedimiento, el paciente se recuperó completamente del cuadro intestinal que presentaba.

A case is presented of a mestizo Fox Terrier dog than presented diarrhea with blood and the initial treatment didn't achieved any improve; with palpation it was determinate a mass to the colon, which was confirmed after performing the routine clinical testing and radiographic studies of intestinal transit; also, megacolon is diagnosed. Exploratory laparotomy was performed at it was found cecocolic intussusepction and the cecum invagination, the surgical procedure developed was typhlectomy and of end-to-end intestinal anastomoses; after the procedure, the patient was completely recovered to the intestinal disease.

Sand Bezoar: A Very Rare Cause of Intussusception

Intussusception is the most common cause of intestinal obstruction in the first two years of life. The cause is not apparent in most of the cases. Associated conditions that can result in intussusception include polyps, Meckel‟s diverticulum, Henoch-Schonlein purpura, lymphoma, lipoma, parasites, foreign bodies and viral enteritis with hypertrophy of Payer‟s patches. We hereby describe a rare case of sand bezoar induced intussusception in a 9-year-old school girl with pica (geophagia). A description of her presentation and management, along with a review of literature is being presented.

Barium enema reduction of intussusception in a developing country / Reducción de la intususcepción mediante enema de bario en un país en vías de desarrollo

OBJECTIVE: To determine the current success rate of barium enema reduction of intussusception and to investigate the factors affecting successful reduction. DESIGN AND METHODS: All patients admitted to the Eric Williams Medical Sciences Complex during the 8-year period from January 1, 2000 to December 31, 2007 with a diagnosis of intussusception were included. Patients' demographics, date and time of admission, clinical features, success of barium reduction, surgical findings and length of stay were recorded. The SPSS 12.0 programme was used for data analysis. RESULTS: There were 65 cases of intussusception. Vomiting and rectal bleeding were the most common presenting symptoms (55, 85% / 49, 75%). Fifty-eight patients underwent barium enema reduction with 41.4% (24/58) having successful reduction. Factors which significantly increased the success rate included males older than 12 months, non-opioid analgesia or no analgesia and an admission to enema reduction time of less than 6 hours. CONCLUSION: The successful reduction rate is relatively low (41%). A higher index of suspicion is needed in order to make a timely diagnosis and institute appropriate treatment quickly.

OBJETIVO: Determinar la tasa de éxito actual de reducción de la intususcepción por edema de bario e investigar los factores que afectan la reducción exitosa. PLAN Y MÉTODOS: Todos los pacientes ingresados en el Complejo de Ciencias Médicas Eric Williams por el período de 8 años que va del 1ero de enero de 2000 al 31 de diciembre de 2007 con diagnóstico de intususcepción, fueron incluidos. Se registró toda la información relacionada con los datos demográficos de los pacientes, fecha y tiempo de ingreso, características clínicas, éxito de la reducción por bario, resultados quirúrgicos, y duración de la hospitalización. Se usó el programa SPSS 12.0 para el análisis de los datos. RESULTADOS: Se produjeron 65 casos de intususcepción. Los vómitos y el sangramiento rectal fueron los síntomas presentes más comunes (55, 85%/49, 75%). A cincuenta y ocho pacientes se les practicó la reducción por enema de bario, logrando 41.4% (24/58) una reducción exitosa. Los factores que aumentaron la tasa de éxito de manera significativa fueron los varones con más de 12 meses, la analgesia no-opioide o ninguna analgesia, y un tiempo de ingreso para la reducción por enema, de menos de 6 horas. CONCLUSIÓN: La tasa de reducción exitosa es relativamente baja (41%). Se requiere un índice más alto de sospecha para hacer un diagnóstico oportuno e iniciar un tratamiento apropiado rápidamente.

Reducción neumática de invaginación intestinal en niños: experiencia clínica y técnica / Intussusception pneumatic reduction in children: clinical and technical experience

Objetivo: Evaluar la facilidad y efectividad de la reducción neumática de la invaginación intestinal en niños. Materiales y métodos: El grupo de estudio estuvo conformado por 14 niños y 6 niñas, entre un mes y tres años de edad, a quienes se les realizaron 21 reducciones neumáticas desde enero de 2006 a abril de 2009. La invaginación intestinal fue diagnosticada en todos los pacientes por los criterios ecográficos conocidos y a todos se les realizó la reducción bajo control fluoroscópico. Se mantuvo una presión de 120 mm Hg durante 30 segundos con guía fluoroscópica. Resultados: El índice de éxito fue del 95% (20 reducciones de 21), sin recurrencia inmediata. En un paciente no se logró la reducción por encontrársele un divertículo de Meckel, que requirió cirugía. No se presentaron perforaciones intestinales y un paciente tuvo una invaginación recurrente tardía. Conclusión: La reducción neumática de la invaginación intestinal es un método seguro y muy efectivo, con una alta tasa de éxito.

Objective: To assess the feasibility and effectiveness of pneumatic reduction as a non surgical treatment of intussusception in children. Materials and Methods: We studied retrospectively 20 consecutive patients (aged 1 month to 3 years; 14 boys, 6 girls) who underwent pneumatic reduction of intussusception from January 2006 to April 2009. Previous abdominal sonography was performedand confirmed the diagnosis of intussusception in all of them. All patients underwent pneumaticreduction under fluoroscopic guidance using the standard technique. Results: The overall success rate of pneumatic reduction in intussusception was of 95% (20 of 21 reductions), with no cases of immediate recurrence. In a patient who had a Meckel’s diverticulum, the intussusception could not be reduced. There were no cases of intestinal perforation or other complications and recurrence of intussusception occurred only in one patient. Conclusion: Pneumatic reduction is a safe, feasible and highly effective method for treatment of intussusception in children.

Intususcepción intestinal por divertículo de Meckel invertido en un adolescente: reporte de un caso / Intestinal intussusception by Meckel’s diverticulum in an adolescent: a case report

Se reporta un caso de un paciente de 16 años, con una intususcepción intestinal por un divertículo de Meckel invertido, intervenido de urgencia con el diagnóstico de obstrucción intestinal secundaria a intususcepción ileo-ileal.

Intussuscepção intestinal em adultos jovens: relato de caso e revisão de literatura / Intestinal intussusception in young adults: literature review

Embora sejam a principal causa de obstrução intestinal na população pediátrica, intussuscepções intestinais são eventos raros em adultos e quando acontecem, têm características clínicas diferentes dos seus equivalentes em crianças. O objetivo desse trabalho é de apresentar um caso de um jovem do sexo masculino, de 16 anos, previamente hígido, que procurou o serviço de emergência do Hospital Universitário da Universidade de São Paulo com um quadro de intussuscepção intestinal como primeira manifestação de um linfoma não-Hodgkin difuso de células B de alto grau, tipo Burkitt. Foi realizada uma revisão da literatura pertinente, e aspectos relevantes do caso são discutidos à luz dessas informações.

Although intussusception is the main cause of intestinal obstruction in the pediatric population, it is a rare condition in adults, and when it happens, the clinical characteristics differ a lot from the pediatric group. The purpose of this article is to report a case of a 16 years-old male that was seen at the Emergency Room of the University Hospital of São Paulo with an intestinal intussusception as the first clinical presentation of a Burkitt lymphoma. A literature review was carried out and relevant aspects of the case are discussed.

Peutz-Jeghers Syndrome with Intussusception

Peutz-Jeghers syndrome (PJS) is a rare disease of autosomal dominant inheritance, which is characterized by multiple hamartomatous polyps and mucocutaneous pigmentations. Multiple hamartomatous polyps in the gastrointestinal tract are the hallmarks of PJS, and occur most commonly in the small intestine. Complications induced by polyps include colicky abdominal pain, bleeding, bowel obstruction; rectal prolapse of polyps, and intussusceptions. A male patient visited our emergency room with colicky abdominal pain. The patient was diagnosed small intestine intussusceptions with multiple polyps. We report this case with a review of the literature.