Intususcepción intestinal en adultos. Un desafío para el cirujano general. Reporte de caso / Intestinal Intussusception in Adults. A Challenge for the General Surgeon: Case Report

Resumen La intususcepción intestinal es la invaginación de un segmento de intestino en el interior de otro segmento inmediato, asociado a una alteración en la pared intestinal, siendo en intestino delgado más común por patologías benignas y en intestino grueso por patologías malignas. Presentamos caso de paciente femenino de 30 años, con dolor abdominal de 1 semana de evolución y datos de oclusión intestinal, se somete a laparotomía de urgencia, donde se encuentra intususcepción intestinal en íleon terminal. La intususcepción intestinal generalmente se va a presentar como un cuadro de obstrucción intestinal. El tratamiento es la resección del segmento afectado.

Abstract The intestinal intussusception is the invagination of one segment of the bowel into an immediately adjacent segment, associated to an alteration into the wall, the small intestinal is the most associated a benign pathology and large intestinal by malignant pathologies. We present the case of a 30-year-old female patient, who came to the emergency room due to intense abdominal pain of 1 week of evolution and evidence of intestinal occlusion, who underwent emergency laparotomy, where intestinal intussusception was found in the terminal ileum. Generally, the clinical presentation like an intestinal obstruction. Treatment is resection of the affected segment.

Invaginación intestinal como signo guía de enfermedad celíaca. Un caso clínico pediátrico / Intestinal intussusception as a key sign of Celiac Disease. A pediatric case report

La invaginación intestinal es la causa más frecuente de obstrucción intestinal entre los 6 y los 36 meses de edad. La mayoría son idiopáticas. Se ha descrito la asociación entre la enfermedad celíaca y la invaginación intestinal en la población pediátrica. Se presenta el caso de un varón de 23 meses ingresado por estancamiento ponderal en cuyo estudio ecográfico se observaron invaginaciones íleo-ileales asintomáticas repetidas.

Intestinal intussusception is the most frequent cause of intestinal obstruction between 6 and 36 months of age, the majority being idiopathic. The association between celiac disease and intestinal intussusception in the pediatric population has been described. We present the case of a 23-month-old male admitted due to a failure to thrive. In his ultrasound study recurrent asymptomatic ileo-ileal invaginations were found

One case of blue rubber bleb nevus syndrome with intestinal intussusception / 中华内分泌外科杂志

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease, which is characterized by multiple hemangiomas of the skin and gastrointestinal tract. We once treated a case with intussusception requiring surgery. The purpose of this article is to improve our understanding of this disease.

One case of blue rubber bleb nevus syndrome with intestinal intussusception / 中华内分泌外科杂志

Blue rubber bleb nevus syndrome(BRBNS)is a rare disease, which is characterized by multiple hemangiomas of the skin and gastrointestinal tract. We once treated a case with intussusception requiring surgery. The purpose of this article is to improve our understanding of this disease.

Síndrome de Peutz-Jeghers como causa de invaginación intestinal en niño / Peutz-Jeghers syndrome as a cause of intestinal intussusception in children

La invaginación intestinal se presenta con mayor frecuencia en el lactante menor de 2 años, con un pico entre los 5 y 9 meses de edad. En la gran mayoría de los casos es idiopática o de causa desconocida, probablemente secundaria a una infección viral que provoca un crecimiento del tejido linfático intestinal. Sólo en un 2-8% de los pacientes se demuestra una alteración anatómica como causa de la intususcepción (divertículo de Meckel, pólipo). Es la llamada invaginación intestinal secundaria, que suele presentarse en los menores de 3 meses o mayores de 3 años. El síndrome de Peutz-Jeguers (SPJ) es una condición rara y su frecuencia es probablemente inferior a 1/50,000. Se caracteriza por la presencia de pólipos hamartomatosos potencialmente malignos en el tracto digestivo asociada a pigmentaciones mucocutáneas características. Los datos actuales sugieren la existencia de al menos 2 genes implicados: STK11 (19p13.3), identi cado recientemente, es el responsable de la enfermedad en el 70% de las familias. Se describe el caso de dos adolescentes con cuadro de Intususcepción intestinal con diagnóstico de poliposis familiar de Peutz-Jeghers, requiriendo ambas procedimiento quirúrgico

Intestinal intussusception occurs more frequently in the infant younger than 2 years, with a peak between 5 and 9 months of age. In the vast majority of cases it is idiopathic or of unknown cause, probably secondary to a viral infection that causes a growth of the intestinal lymphatic tissue. Only in 2-8% of the patients an anatomical alteration as cause of the intussusception is demonstrated (Meckel's diverticulum, polyp). It is called secondary intestinal invagination, which usually occurs in children under 3 months or older than 3 years. Peutz-Jeguers syndrome (SPJ) is a rare condition and its frequency is probably less than 1 / 50,000. It is characterized by the presence of potentially malignant hamartomatous polyps throughout the digestive tract associated with characteristic mucocutaneous pigmentations. Current data suggest the existence of at least 2 genes involved: STK11 (19p13.3), recently identi ed, is responsible for the disease in 70% of families. We describe the case of two adolescents with intestinal intussusception with a diagnosis of familial polyposis of Peutz Jeghers, requiring both surgical procedures

Intestinal intussusception secondary to enteritis caused by Pythium insidiosum in a bitch: case report / Intussuscepção intestinal secundária à enterite causada por Pythium insidiosum em uma cadela: relato de caso

We report a case of intestinal intussusception secondary to enteritis caused by Pythium insidiosum infection in a 1-year-old mixed breed bitch that died after a 30-day history of bloody diarrhea, anorexia, weight loss, listlessness, dehydration, and pale mucous membranes. Necropsy revealed two areas of intussusception, one jejunum-jejunal and one ileum-cecum-colic. The first intussusception showed slight congestion of the intestinal loop, which was resolved by manual traction, while the second intussusception exhibited thickening, irregular yellow spots, and transmural congestion. Histologically, the jejunum-jejunal segment had ischemic lesions secondary and ileum-cecum-colic intussusception there was also necrotizing, pyogranulomatous enteritis associated with negative images of intralesional fungal hyphae that were well visualized by silver impregnation. Immunohistochemistry identified the hyphae as Pythium insidiosum. The diagnosis was made based on the histological changes and confirmed by immunohistochemistry. We can conclude that enteritis by P. insidiosum in dogs can occasionally cause intestinal intussusception and result in acute death.(AU)

Relata-se um caso de intussuscepção intestinal secundária à enterite causada por Pythium insidiosusm em uma cadela, sem raça definida, com um ano de idade, que morreu após apresentar 30 dias de diarreia sanguinolenta, anorexia, perda de peso, apatia, desidratação e mucosas pálidas. Na necropsia verificaram-se duas áreas de intussuscepções, sendo uma jejuno-jejunal e outra íleo-ceco-cólica. Na primeira havia discreta congestão, que foi desfeita pela tração manual, e na segunda observou-se espessamento segmentar, focos amarelados irregulares e congestão transmural do intestino. Microscopicamente, no segmento jejuno-jejunal observaram-se moderadas lesões isquêmicas secundárias à intussuscepção, e no segmento íleo-ceco-cólica verificou-se enterite piogranulomatosa e necrosante, segmentar, associada a imagens negativas de hifas intralesionais, impregnadas pela prata. Pela imuno-histoquímica, as hifas foram imunomarcadas para Pythium insidiosum. O diagnóstico foi realizado com base nas características microscópicas das lesões e morfotintoriais das hifas e foi confirmado pela imuno-histoquímica. De acordo com esses dados, é possível concluir que a infecção intestinal por P. insidiosum em cães pode causar intussuscepção e morte.(AU)

Invaginación intestinal en el niño, respuesta al tratamiento médico / Intestinal intussusception in children and response to medical treatment

INTRODUCCIÓN: la invaginación intestinal idiopática es la causa más frecuente de abdomen agudo en el lactante y en el transicional. El tratamiento de elección es el médico, siempre que cumpla los criterios de inclusión, por ser menos invasivo, presentar menos complicaciones, menor costo y más efectivo, al compararlo con el tratamiento quirúrgico. OBJETIVO: evaluar la efectividad del tratamiento médico en niños con invaginación intestinal. MÉTODOS: se realizó un estudio descriptivo, longitudinal y retrospectivo de 55 pacientes con el diagnóstico de invaginación intestinal idiopática con criterios de tratamiento médico, que ingresaron en el servicio de Cirugía Pediátrica del Hospital Pediátrico Universitario Centro Habana, en el período de enero de 2000 a diciembre de 2012. Los métodos de reducción empleados fueron mediante neumocolon y el colon por enema baritado. Se utilizó el test de chi cuadrado para el análisis. RESULTADOS: el tratamiento con enema de bario predominó ligeramente sobre el neumocolon (28/27) para 50,9 % y 49,1 % respectivamente. Su efectividad fue mayor para el neumocolon (77,8 %), en comparación con el enema de bario (57,1 %) (RR= 1,38, p> 0,05). La efectividad de estos procederes está en relación con el tiempo de evolución; a menor tiempo, mejores resultados. CONCLUSIONES: no se encontró una variación significativa en los resultados en los 2 procederes médicos propuestos, aunque fue más efectivo el neumocolon que el enema de bario.

INTRODUCTION: idiopathic intestinal intussusceptions are the most frequent cause of acute abdomen in the breastfed baby and in the transitional infant. The medical treatment is the choice provided that the inclusion criteria are met since it is less invasive, costly and complicated but more effective than the surgical treatment. OBJECTIVE: to evaluate the effectiveness of the medical treatment in children with intestinal intussusception. diagnosed with idiopathic intestinal intussusceptions and met the medical treatment criteria met; they had been admitted to the pediatric surgical service of Centro Habana university pediatric hospital in the period of January 2000 through December 2012. The used methods were pneumocolon and barium enema colon. Chi-square test was used for the analysis. RESULTS: the barium enema treatment slightly prevailed over pneumocolon (28 vs. 27) for 50.9 % and 49.1 %, respectively. The pneumocolon effectiveness (77.8 %) was higher than the barium enema (57.1 %) (RR= 1.38, p> 0.05). The effectiveness of both procedures depends on the time of progression of disease, which means that best results go to less time of progression. CONCLUSIONS: no significant variations were found in the results of the two suggested medical procedures, although pneumocolon was more effective than barium enema.

Intussuscepção intestinal em adulto jovem secundária à angiolipoma de cólon: relato de caso / Intestinal intusception secondary to an angiolipoma of the colon in an young adult: case report

Intussuscepção intestinal é rara em adultos. Angiolipomas são causas incomuns da doença. Manifestações clínicas inespecíficas e acurácia limitada dos exames de imagem disponíveis dificultam o diagnóstico pré-operatório. A confirmação de intussuscepção é baseada em achados cirúrgicos. Ressecção intestinal é mandatória quando o cólon é acometido devido ao alto risco de malignidade. Relatamos um caso de intussuscepção colônica em um adulto jovem, secundária à angiolipoma.

Intestinal intussusception is rare in adults. Angiolipomas are uncommon causes of disease. Nonspecific clinical manifestations and limited accuracy of imaging available hinder the preoperative diagnosis. Confirmation of intussusception is based on surgical findings. Bowel resection is mandatory when the colon is affected due to the high risk of malignancy. We report a case of colonic intussusception in a young adult, secondary to angiolipoma.

Intususcepción intestinal secundaria a divertículo de Meckel invaginado: reporte de un caso / Intussusception obstruction secondary for Meckel’s diverticulum invaginated: case report

INTRODUCCIÓN: La intususcepción intestinal se produce cuando un segmento de intestino y su mesenterio se invaginan en la luz de un segmento intestinal adyacente. La intususcepción constituye el 1 por ciento de todas las causas de oclusión intestinal en adultos. La mayoría de las intususcepciones ocurren en niños, presentándose sólo un 5 por ciento en el adulto. El divertículo de Meckel es la anomalía congénita más frecuente del tracto intestinal afectando al 2-3 por ciento de la población general, pero la intususcepción derivada de la invaginación de éste, es una de las causas más infrecuentes de obstrucción intestinal secundaria. PRESENTACIÓNDEL CASO: A continuación reportamos el caso de un paciente de 8 años con una obstrucción intestinal secundaria a divertículo de Meckel complicado, intervenido de urgencia con el diagnóstico intraoperatorio. DISCUSIÓN: La invaginación íleo-ileal por un divertículo de Meckel también invaginado es algo muy poco común a la edad del paciente.

INTRODUCTION: Intestinal intussusception occurs when a segment of bowel and mesentery invaginate in the light of an adjacent intestinal segment. Intussusception accounts for 1 percent of all cases of intestinal obstruction in adults. Most intussusceptions occurs in children, occurring only 5 percent in the adult. Meckel’s diverticulum is considered the most common congenital anomalies of the intestinal tract affecting 2 percent to 3 percent of the general population to be even rarer intussusception resulting from it. CASE REPORT: We report a case of an 8 years old children with a bowel obstruction secondary to complicated Meckel’s diverticulum, surgical repair with preoperative diagnosis. DISCUSSION: The ileo-ileal intussusception by an invaginated Meckel’s diverticulum is also something very uncommon for the patient’s age”.

Sigmoidoanal intussusception with exteriorization of sigmoid adenocarcinoma

The intestinal intussusception is a rare disease in adults, and is mostly caused by malignant neoplasm. Symptoms are usually nonspecific and chronic, and in most cases suggesting intestinal obstruction. Treatment consists of removing the malignant tumor. This article reports the case of a patient with hematochezia and apparent mass in the anus who underwent anterior rectosigmoidectomy and had the diagnosis of adenocarcinoma of the sigmoid confirmed. (AU)

A intussuscepção intestinal é uma doença rara em adultos, sendo na maior parte dos casos causada por neoplasia maligna. Os sintomas são geralmente inespecíficos e crônicos, na maioria das vezes sugerindo obstrução intestinal. O tratamento consiste na remoção oncológica do tumor. Este artigo relata o caso de uma paciente com quadro de hematoquezia e exteriorização de massa através do ânus que foi submetido à retossigmoidectomia anterior alta em bloco e confirmado o diagnóstico de adenocarcinoma de sigmoide. (AU)

Intussuscepção intestinal secundária a tumor do estroma gatrointestinal (GIST) / Intussusception due to a gastrointestinal stromal tumor (GIST)

O presente artigo relata o caso de um paciente idoso com sinais e sintomas de obstrução intestinal. Após realização de exames de imagem e intervenção cirúrgica, o diagnóstico final foi compatível com intussuscepção intestinal decorrente de tumor estromal gastrintestinal. O presente artigo relata o caso de um paciente idoso com sinais e sintomas de obstrução intestinal. Após realização de exames de imagem e intervenção cirúrgica, o diagnóstico final foi compatível com intussuscepção intestinal decorrente de tumor estromal gastrintestinal.

We report a case of an elderly patient with signs and symptoms of intestinal obstruction. The final diagnosis was intestinal intussusception secondary to a gastrointestinal stromal tumor.We report a case of an elderly patient with signs and symptoms of intestinal obstruction. The final diagnosis was intestinal intussusception secondary to a gastrointestinal stromal tumor.