Clinical analysis of 23 cases with adult intussusception / 国际外科学杂志

Objective To analyze the pathogenesis,type,diagnosis and surgical methods of adult intussusception.Methods The clinical presentation,diagnosis and therapeutic management of 23 patients admitted with the diagnosis of intussusception in Kunshan First People's Hospital Affiliated to Jiangsu University from January 2014 to March 2017 were reviewed retrospectively.Results For all patients,Symptom included paroxysmal bellyache (22/23),abdominal mass (7/23),nausea and vomit (2/23).Twenty one patients received operation,and all discharged from hospital.Malignant neoplasm,benign tumor,diverticulum,inflammation and fecal stone were main cause for intussusception.Conclusion Most of adult intussusceptions are secondary lesions,with complex pathologic condition and non-specific symptoms.CT scanning has been proved to be the most useful diagnostic radiologic method.Surgery is the main treatment of adult intussusception.As for patients recevied conservative treatment and intraoperative exploration with no obvious lesions,endoscopy is necessary postoperative.

Salmonella enteritis: A Rare Cause of Adult Intussusception

Intussusception is a relatively rare condition in the adult population and is commonly secondary to a malignant process. Eight to twenty percent of cases of adult intussusception are thought to be idiopathic. In children, infection has been proven to precipitate intussusception in the absence of any other cause. We present a rare case of intussusception in a healthy adult patient secondary to salmonella infection and discuss infection as a potential explanation for a proportion of the cases of adult intussusception that are thought to be idiopathic. We recommend testing for infective causes of intussusception in adults when more common causes, such as malignancy, have been excluded.

Salmonella enteritis: A Rare Cause of Adult Intussusception

Intussusception is a relatively rare condition in the adult population and is commonly secondary to a malignant process. Eight to twenty percent of cases of adult intussusception are thought to be idiopathic. In children, infection has been proven to precipitate intussusception in the absence of any other cause. We present a rare case of intussusception in a healthy adult patient secondary to salmonella infection and discuss infection as a potential explanation for a proportion of the cases of adult intussusception that are thought to be idiopathic. We recommend testing for infective causes of intussusception in adults when more common causes, such as malignancy, have been excluded.

Clinics in diagnostic imaging (172). Colocolic intussusception with a lipoma as the lead point

A 50-year-old Chinese man presented with abdominal pain associated with bloody mucoid stools, loss of appetite and weight loss. Contrast-enhanced computed tomography of the abdomen and pelvis revealed a colocolic intussusception secondary to a lipoma. The patient subsequently underwent a left hemicolectomy. Clinical and imaging findings of intussusception in adults are discussed in this article.

Adult intussusceptions: preoperative predictive factors for malignant lead point

PURPOSE: Adult intussusception is uncommon, but an organic lesion is found to be the lead point in 75% to 90% of the cases. This study was designed to review our experience with adult intussusception and to determine if there are any preoperative predictive factors for a malignant lead point. METHODS: Thirty-three patients over 15 years of age were diagnosed with intussusceptions through operative finding over a period of 20 years. We reviewed the medical records of these patients retrospectively, and preoperative predictive factors of malignant lead points were analyzed. RESULTS: The preoperative diagnosis of intussusception had been made correctly in 86% of the cases, and computed tomography could find a lead point in 79%. A causative organic lesion was found in 29 patients (88%) pathologically; 16 cases (48%) were due to benign tumors, and 13 (39%) were due to malignant tumors. A malignant lead point was present in four of 21 enteric (20%) versus nine of 13 colonic intussusceptions (75%). The period from symptom appearance to hospital visit showed a more chronic nature in malignant neoplasm than in benign neoplasm (P = 0.006), and the location of causative organic lesion showed significant difference between benign and malignant groups (P = 0.003). CONCLUSION: Adult intussusceptions are commonly secondary to a pathologic lead point, and a computed tomography is an effective diagnostic tool for finding a lead point preoperatively. The chronic nature of the disease presentation and colonic location of the lead point may suggest a malignant neoplasm.

Intususcepción intestinal por pólipo fibroide inflamatorio en una anciana / Small bowel intussusception and Vanek's tumor in an elderly woman

El pólipo fibroide inflamatorio es un tumor benigno poco frecuente del tubo digestivo, descripto por Vanek en 1949. Son lesiones de etiología desconocida, originadas en la submucosa. Están formadas por células mononucleares y mesenquimatosas con citoplasma fusocelular, con una importante proporción de eosinófilos. Sus síntomas son variables, dependiendo de su localización, y son una r ara causa de intususcepción intestinal en adultos. Presentamos el caso de una mujer de 82 años, que sufrió una rara intususcepción de intestino delgado, originada en un pólipo fibroide inflamatorio.

Inflammatory fibroid polyps are non-frequent benign lesions, described by Vanek in 1949, originated in the sub mucosa of the gastrointestinal tract. They have an uncertain origin and they are formed of fibroblastic and mesenchymal proliferations with an important eosinophilic proportion. Depending on where are they localized, could present different type of symptoms. The inflammatory fibroid polyps are one of the rare benign conditions causing intestinal intussusception in adults.We present the case of a 82 years old woman, who presented an intestinal intussusception due to an inflammatory fibroid polyp localized in the small bowel.

Intususcepción ileocólica en adulto secundaria a enterocilitis por Salmonella enteriditis / Ileocolic intussusception in an adult secondary to Salmonella enteriditis

Introduction: Intussusception is defined as the invagination of a segment of the gastrointestinal tract into an adjacent portion. Adult intussusception is rare accounting for only 5 percent or less of all causes of intestinal obstruction; in 90 percent of these cases a leading point will be demostrable. Case report: A female patient, 35 years-old, was admitted into our institution complaining of 5 days of colicky abdominal pain associated to diarrhea without peritoneal sing. Abdominal ultrasonography showed the classic features of intussusceotion; target or doughnut sing and the pseudokidney sing. The study was completed with a computed abdominal tomography scan, confirming the sonographic findings. The surgical exploration revealed that the terminal ileum, cecum, appendix, and 10 cm of ascending colon were intussuscepted into the remaining colon. Abdominal inflammatory free-fluid was aspirated for culture. A right hemicolectomy with primary anastomosis was performed. The culture report finding of the abdominal liquid was Salmonella enteritidis. The histology reported an edematous thickened terminal ileum wall with Peyer´s patches infiltrated by polymorphonuclear cells. Discussion: The cause of intussusception in patients with infectious enterocolitis caused by Salmonella enteritidis could be related to stimulation of the intestinal mucosa causing inflamatory changes of the Peyer´s patches resulting in an edematous mass in the terminal ileum acting as a leading point for intussusception. Although rare, Salmonella infections should be considered among the precipiting causes of adult ileocolic intussusception.

Introducción: La intususcepción se define como la invaginación de un segmento intestinal dentro otro segmento adyacente. En adultos, la intususcepción es infrecuente dando cuenta del 5 por ciento o menos de todas las causas de obstrucción intestinal; en estos casos se podrá demostrar una causa en 90 por ciento de los pacientes. Reporte de caso: Paciente femenino de 35 años de edad, hospitalizada por un cuadro clínico de 5 días de evolución con dolor abdominal cólico, diarrea y ausencia de signos de irritación peritoneal. La ecografía abdominal mostró los signos clásicos de intususcepción; el "signo del blanco o del donut" y el "signo del pseudo-riñon". El estudio se completó con una tomografía abdominal, la cual confirmó los hallazgos de la ecografía. La exploración quirúrgica demostró que el íleon terminal, ciego, apéndice y 10 cm de colon ascendente. Se encontró líquido inflamatorio que se aspiró para cultivo. La cirugía consistió en una hemicolectomía derecha con anastomosis primaria. El resultado del cultivo fue positivo para Salmonella enteritidis. La histología demostró edema y engrosamiento de la pared del íleon terminal con infiltración polimorfonuclear de las placas de Peyer. Discusión: La causa de intususcepción en pacientes con enterocolitis infecciosa por Salmonella enteritidis está relacionada con la inflamación de la mucosa intestinal y de las placas de Peyer, lo que resulta en una masa edematosa en el íleon terminal que actúa como "punto tractor" para la intususcepción. Las infecciones por Salmonella deben considerarse entre las causas precipitantes de intususcepción en adultos.

Laparoscopy-Assisted Small Bowel Resection for Treatment of Adult Small Bowel Intussusception in a Patient with Factor VII Deficiency

Factor VII deficiency is a rare congenital bleeding disorder characterized by episodes of spontaneous bleeding in severely affected individuals. It is rare intussusception due to submucosal hematoma in coagulation factor deficiency patient. We recently experienced an adult small bowel intussusception in a patient with factor VII deficiency. A 36-yr old female patient with coagulation factor VII deficiency who was referred to our hospital underwent emergency surgery for treatment of the small bowel intussusceptions. Emergency laparoscopy-assisted small bowel resection was performed for treatment of small bowel intussusception caused by submucosal hematoma. The patient was successfully treated with close laboratory monitoring and laparoscopy-assisted small bowel resection.

A Case of Sigmoid Intussusception Diagnosed by Sigmoidoscopy / 대한소화기내시경학회지

Intussusception most commonly occurs in children, and in more than 90% of cases, no cause is found. In contrast, intussusception in adults is relatively rare but over 90% of patients have an organic lesion as the cause. Only 5% of cases of intussusception occur in adults and most involve the small intestine and are benign, whereas colonic intussusceptions are usually malignant. We report here a case of a 70-year-old man with intussusception who was referred with a one-day history of hematochezia and abdominal pain. The intussusception was caused by a sigmoid colonic tumor. The CT findings suggested that we could reasonably proceed to a sigmoidoscopy to confirm the site of obstruction. We speculated that the sigmoid colon tumor induced the anterograde intussusception. As with our patient, it is important to recognize the need to diagnose the primary lesion exactly and promptly.

An Adult Case of Small Bowel Intussusception Caused by Hemangioma Presenting with Intestinal Bleeding / 대한소화기학회지

Intussusception is primarily a disease of children, and is relatively rare in adults. Unlike childhood intussusception, adult intussusception has an identifiable leading lesion such as malignant or benign neoplasm. However, intussusception caused by hemangioma is very rare. There were few cases of small bowel intussusception caused by hemangioma in adults, but those reports were presented with abdominal pain. This report describes a 65-year-old female who suffered from small bowel intussusception caused by hemangioma presenting with intestinal bleeding. Upper gastrointestinal endoscopy and colonoscopy were performed, but bleeding focus was not found. Abdominal computed tomography showed the target sign of small bowel with a leading point of mass. This mass turned out to be a hemangioma after the small bowel resection. Therefore, small bowel intussusception by hemangioma should be also considered as a bleeding focus when an adult patient presented intestinal bleeding without bleeding focus in the stomach and colon. Herein we report a case of small bowel intussusception caused by hemangioma presenting with intestinal bleeding.

A Case of Adult Intussusception of the Colon Caused by Cecal Neurofibroma in a Patient with Neurofibromatosis Type 1 / 대한소화기내시경학회지

Neurofibromatosis type 1 (NF-1) is an autosomal dominant hereditary disorder and it is characterized by neurofibromas and cafe-au-lait spots on the skin. NF-1 affects the gastrointestinal tract in 25% of the cases and the stomach and jejunum are the commonly involved sites. Yet the occurrence of colon NF is very unusual. Several cases of colon involvement of NF-1 have been reported on and their clinical manifestations were massive or occult bleeding, constipation and asymptomatic rectal or perianal nodules. There was a reported case of colon-to-colon intussusception via an isolated colonic neurofibroma. However, the best of our knowledge, there has been no reported case of colon-to-colon intussusception induced by NF-1. We encountered a case of NF-1 involving the cecum that resulted in colon-to-colon intussusception and secondary acute appendicitis. The patient showed the typical skin lesions and bony abnormalities of NF. We report on this case with a review of the literature.

Intussusception in Adults

PURPOSE: Intussusception in adults is uncommon and constitutes approximately 5% of all intussusceptions. An organic lesion is found to be the lead point in 75 to 90% of the cases, so surgical intervention is necessary in most cases. This study was designed to review our experience with adult intussusception and to determine an appropriate method for diagnosis and management. METHODS: Thirteen (13) patients over 15 years of age were diagnosed as having on intussusception at our center between 1994 and 2003. We reviewed the medical records of these patients retrospectively. RESULTS: The preoperative diagnosis had been made correctly in 85% of patients (11 cases) by combined use of abdominal ultrasonography and a CT scan. The types of intussusceptions wene jejuno-jejunal in two cases, ileo-ileal in four, ileo-colic in three, and colo-colic in four. Causative organic lesion was found in all patients; seven cases (54%) were due to benign tumors, and six (46%) were due to malignant tumors. Surgical intervention was carried out in all cases; 11 patients underwent a surgical resection without manual reduction, and 2 patients underwent a surgical resection after manual reduction. CONCLUSIONS: Both abdominal ultrasonography and CT scan are effective and useful diagnostic tools in the diagnosis of adult intussusception. Since tumors, benign or malignant, are the most frequent cause of adult intussusception, surgical intervention is mandatory.

Two Cases of Adult Intussusception

Intussusception can develop at any age but about 95% of patients are children under 2 years-old. Adult intussusception is a rare condition. Unlike children, nearly all adults with intussusception have a lead point such as benign or malignant small bowel tumors, intestinal tuberculosis, or Meckel's diverticulum. First case is a 48-year-old male who was admitted with 2 days of diffuse abdominal cramping pain and no other associated gastrointestinal symptoms. Barium enema revealed ileocolic intussusception with a round cecal mass after barium reduction. An ileocecectomy was performed electively. The pathologic report was cecal cyst, which was an intraluminal structure with an epithelial lining of colonic mucosa. The second case, a 53-year-old male, was admitted with 1 week of diffuse abdominal cramping pain and watery diarrhea. Barium enema revealed ileocecal intussusception. Emergency surgery (ileocecectomy), revealed a polypoid small bowel mass. The pathologic report was lipoma. Recently, we experienced two cases of adult intussusception and report these cases with a brief review of the literature.

Etiology and Management for Adult Intussusception

PURPOSE: Intussusceptions occurring in adults are relatively rare, however, surgery is usually recommended since they frequently accompany organic lesions as predisposing factor. The purpose of this study is to analyze clinical manifestations and investigate optimal treatment principles for adult intussusception. METHODS: Clinicopathogic manifestations of 28 adult intussusception patient were analyzied, retrospectively. The types of adult intussusception were classified as enteric and colonic types. Sex ratio was 15:13 and mean age was 52 (17-80) years. RESULTS: CT scan was the most accurate tool for diagnosis of adult intussusception and detection of underlying causes. The types of adult intussusception were 4 jejuno-jejunal, 7 ileo-ileal, 15 ileo-cecal, and 2 colo-colic types. The pathologic lesions were identified in 23 out of 28 cases (82%). Malignancy was the cause of adult intussusception in 5 cases (45%) of enteric type and in 6 cases (35%) of colonic type intussusception. Operations were performed in 26 cases (93%) and resection without reduction was performed in 23 cases. CONCLUSIONS: Surgical exploration without reduction may be the treatment of choice since the majority of cases have organic lesions as the etiology, with relatively frequent association of malignancies.

A Clinical Analysis of Intussusception in Adult

PURPOSE: Adult intussusception is relatively rare and it's course is subacute or chronic course. It usually occurs secondary to tumors or other underlying cause. Especially the incidence of associated malignancy is increasing compare to the past. Purpose of this study was review of adult intussusception, our comprehension of the disease improved by and helped to plan treatments METHODS: During the past 11 yeasrs, from January, 1987 to December, 1997, 27 cases of adult intussusception at Department of Surgery, Presbyterian Medical Center were analyzed retrospectively. RESULTS: The age incidence was variable. But it occurred more frequently at 4th decades. Useful radiologic diagnostic tools were CT, U/S as well as barium enema. Nineteen instances of intussusception originating in the small bowel and 8 instances originating in the colon. The etiologic factors were found in 22 cases (74%). Of the 19 small bowel intussusception, 5 cases were associated with malignancy and 3 out of 8 colon intussusception were result from the malignancy. The common malignancy in small bowel was lymphoma and that in colon was adenocarcinoma. Surgical intervention was carried out in all of these 27 cases: 20 cases underwent surgical resection and 7 cases were reduced manually after surgical exploration; Only manually reduction was performed in 4 cases, manually reduction and cecopexy in 2 cases and manually reduction and adhesiolysis in 1 case. CONCLUSION: The malignancy was the major cause of adult intussusception. Especially in colonic intussusception, occupational percentage of malignancy was higher. The common malignancy in small bowel was lymphoma and that in colon was adenocarcinoma. So, we cosidered plans of treatments according to location, etiology and bowel state.

Diagnosis and Treatment of Adult Intussusception Due to Gastrointestinal Lipoma

PURPOSE: In contrast to childhood intussusception, adult intussusception is a rare disease and usually has a specific etiology. Malignancy is the leading cause, and gastrointestinal lipoma has been infrequently reported as a cause of adult intussusception. However, GI lipoma can be easily diagnosed by current radiologic studies and can be managed less aggressively than intussusception with a malignant etiology. METHODS: 5 adult (above 16 years old) patients have been identified to be operated on from January 1990 to June 1999 in Korea University Hospital due to intussusception caused by gastrointestinal lipoma. Their preoperative radiologic findings, operative methods and clinical results were analyzed, retrospectively. RESULTS: There were 3 male and 2 female patients, and the mean age was 49. Simple abdominal X-rays were taken in all 5 patients, and mechanical obstructive patterns were present in 4 cases. Abdominal CT or ultrasonography was performed in 4 patients preoperatively and demonstrated a lipoma in 3 cases (75%). In one patient, who showed toxic signs caused by mechanical intestinal obstruction, emergency exploration was undertaken without further preoperative radiologic study. The lipoma was located at the jejunum in 1 case, at the ileum in 2 cases and at the cecum in 2 cases. Resection of the involved segment of the bowel after reduction of intussusception was done in 3 cases and resection of involved bowel without reduction was done in the remaining 2 cases. Consequently, segmental resection of the small bowel was performed in 2 cases and a right colectomy in 3 cases. There was no postoperative morbidity or mortality. CONCLUSION: Adult intussusception caused by a gastrointestinal lipoma can be easily diagnosed by using CT or ultrasonography. It can be safely managed through reduction and resection of the lesion unless there is strangulation.

Diagnosis and Management of Adult Intussusception

BACKGROUND: In contrast to childhood intussusception, the clinical features in adults are not typical, and the incidence of adult intussusception is low. This study was to evaluate the clinical features, diagnosis, and management of adult intussusception. METHODS: Thirty-seven cases of adult intussusception occurring between 1981 and 1996 in individuals older than 16 were investigated retrospectively. RESULTS: The most common age was in the 3rd decade (24.3%). Abdominal pain, nausea and vomiting, abdominal tenderness and palpable abdominal mass were common symptoms and physical findings in order of frequency. The duration of symptoms was less than 7 days in 54% of the cases. Correct preoperative diagnosis was made in 13.3% from 1981 to 1990 versus 72.7% from 1991 to 1996. This difference was caused by common use of abdominal ultrasound (US) and computed tomography (CT) during recent years. On exploration there were 27 cases of enteric (73%) and 10 cases of colonic (27%) intussusceptions and there were underlying lesions in 30 cases (81%). Two manual reductions only, 7 manual reductions and resections, including one reoperation after manual reduction only, 28 resections without manual reduction, and 1 ileocolostomy were performed. While only 2 cases (7.4%) of malignancy were identified among the enteric intussusceptions, there were 7 cases (70%) of malignancy among the colonic intussusceptions. CONCLUSIONS: With the advance of abdominal US and CT, preoperative diagnosis of adult intussusception was not so difficult. Because of high prevalence of underlying lesions in adult intussusception, operative management is mandatory. Resection without reduction is the most common method of operation and is recommended in edematous and ischemic enteric intussusceptions and in all colonic intussusceptions which have high malignant rate.

Abdominal CT Scanning in Adult Intussusception

Intussusception is a relatively common disease in children, but it is a rare clinical entity in adults. More than 80% of all patients with intussusception are less than two years of age, but adults account for only 5 to 10 percent of all intussusception cases. The significance of this disease in the aspect of statistics is mentioned as "rule of fives", which means 5% of all intussusceptions occur in adults, and it accounts for up to 5% of all cases of bowel obstruction in adults. In children, classic symptoms include episodic abdominal pain, "current-jelly" stool and a sausage-shaped abdominal mass on examination. However, in adults, it is likely to appear with non-specific gastrointestinal trouble without classic symptoms. Therefore, it is very important to use early diagnositic tool. In contrast to childhood intussusception, which is idiopathic in 90% of cases, adult intussusception has a definable lesion in more than 90% of cases 3). Tumors, both benign and malignant, are the most frequent cause of intussusecption in adults. We experienced seven cases of adult intussusception at Inha hospital from Jan. 1994 to Dec. 1997. The patients of adult intussusception are classified as three cases of ileoileal type and four ileocecal type. There were no specific signs or symptoms with patient experienced. It included abdominal pain, diarrhea and palpable mass. Their diagnosis was made in six patients using abdominal CT scan. It is difficult to define a diagnosis preoperatively, because the symptom of adult intussusception are variable and insignificant among individuals. We had been taken the final diagnostic tool with the abdominal CT scan in six of seven patients, which revealed "target lesions" in all cases. So, it is useful in the diagnosis of adult intussusception. Bowels were resected for the treatment of adult intussusception. The extent of the resection was contained the lesion and the defunctioned segments. The operations were performed as four segmental resections of small bowel and three ileocecal resections. The pathological findings were disclosed as three tumors, three lymphadenopathies and a adhesion of bowel. We concluded that the abdominal CT scanning is a usefull diagnostic tool in the diagnosis of adult intussusception.