Risk factors for delayed bleeding after intestinal polypectomy in children / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical characteristics and risk factors of delayed bleeding after intestinal polypectomy in children, and to provide a theoretical basis for clinical surgical intervention of intestinal polyps.@*METHODS@#A retrospective analysis was conducted on the clinical data of 2 456 children with intestinal polyps who underwent endoscopic high-frequency electrocoagulation loop resection in the Endoscopy Center of Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. According to the presence or absence of delayed bleeding after surgery, they were divided into bleeding group with 79 children and non-bleeding group with 2 377 children. A multivariate logistic regression analysis was used to investigate the risk factors for delayed bleeding. The receiver operating characteristic (ROC) curve was used to investigate the value of various indicators in predicting delayed bleeding.@*RESULTS@#Of all 2 456 children, 79 (3.22%) experienced delayed bleeding, among whom 5 children with severe delayed bleeding underwent emergency colonoscopy for hemostasis and 74 received conservative treatment, and successful hemostasis was achieved for all children. There were significant differences between the bleeding and non-bleeding groups in age, body mass index, constipation rate, location of lesion, time of endoscopic procedure, resection method (P<0.05). Children with a diameter of polyps of 6-10 mm and >20 mm were more likely to develop delayed bleeding after resection (P<0.05). The multivariate logistic regression analysis showed that endoscopic operation time, polyp diameter, and resection method were significantly associated with delayed bleeding (P<0.05). The ROC curve analysis showed that the endoscopic operation time, polyp diameter, and resection method had a good value in predicting delayed bleeding after intestinal polypectomy, with an area under the ROC curve of 0.706, 0.688, and 0.627, respectively.@*CONCLUSIONS@#Endoscopic high-frequency electrocoagulation loop resection has a lower incidence of delayed bleeding in children with intestinal polyps, and the endoscopic operation time, polyp diameter, and resection method are closely associated with the occurrence of postoperative delayed bleeding.

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.

Clinical features of intestinal polyps and risk factors for secondary intussusception in children: an analysis of 2 669 cases / 中国当代儿科杂志

OBJECTIVES@#To study the clinical features of intestinal polyps and the risk factors for secondary intussusception in children.@*METHODS@#A retrospective analysis was performed for the medical data of 2 669 children with intestinal polyps. According to the presence or absence of secondary intussusception, they were divided into two groups: intussusception (n=346) and non-intussusception (n=2 323). Related medical data were compared between the two groups. The multivariate logistic regression analysis was used to identify the risk factors for secondary intussusception.@*RESULTS@#Among the children with intestinal polyps, 62.42% were preschool children, and the male/female ratio was 2.08∶1; 92.66% had hematochezia as disease onset, and 94.34% had left colonic polyps and rectal polyps. There were 346 cases of secondary intussusception, with an incidence rate of 12.96% (346/2 669). Large polyps (OR=1.644, P<0.001), multiple polyps (≥2) (OR=6.034, P<0.001), and lobulated polyps (OR=93.801, P<0.001) were the risk factors for secondary intussusception.@*CONCLUSIONS@#Intestinal polyps in children often occur in preschool age, mostly in boys, and most of the children have hematochezia as disease onset, with the predilection sites of the left colon and the rectum. Larger polyps, multiple polyps, and lobulated polyps may increase the risk of secondary intussusception, and endoscopic intervention is needed as early as possible to improve prognosis.

Clinical value of JNET classification for non-real-time diagnosis of colorectal lesions / 中华消化内镜杂志

Objective To study the diagnostic value of Japan narrow band imaging expert team ( JNET) classification for differentiating pathological type of colorectal lesions. Methods A total of 418 colorectal lesions were retrospectively diagnosed by magnifying endoscopy with narrow band imaging ( ME-NBI) using JNET classification by two inexperienced doctors after a short time of training in JNET classification. Then lesions were diagnosed with Sano classification by the two doctors. Diagnostic results were compared with histologic findings as a golden standard. Results The sensitivity, specificity, and accuracy of JNET classification and Sano classification for neoplastic lesion differentiation were 98. 2％ VS 98. 5％, 77. 8％ VS 66. 7％, and 96. 9％ VS 96. 4％, respectively ( all P>0. 05 ) . These indicators for diagnosing cancerous lesions, including high grade intraepithelial neoplasia, intramucosal carcinoma and submucosal carcinoma, were 66. 7％ VS 80. 2％ ( P=0. 023) , 87. 6％ VS 79. 5％ ( P=0. 006) , and 82. 1％ VS 79. 7％( P=0. 379 ) , respectively, and those for predicting submucosal deep invasive cancers were 34. 8％ VS 39. 1％, 100. 0％ VS 99. 0％, and 96. 4％ VS 96. 3％, respectively ( all P>0. 05) . The diagnostic accuracy of JNET classification for differentiating neoplastic lesions were 95. 2％ in those with diameter <10 mm, 97. 0％ in 10～<20 mm, and 97. 8％ in ≥20 mm (P=0. 483), this finding were 95. 2％, 85. 1％ and 72. 1％ for cancer, respectively ( P<0. 0001 ) , and 100％, 96. 3％, and 94. 4％ for submucosal deep invasive cancer, respectively (P=0. 026). Shape and location of colorectal lesions showed no significant effect on the diagnostic efficacy of JNET classification. Conclusion JNET classification is valuable for doctors without experience of ME-NBI in diagnosing colorectal lesions and the efficiency is slightly superior to Sano classification. However, the accuracy of diagnosis for cancer with diameter ≥20 mm need to be improved.

Intususcepción intestinal debido a un pólipo fibroide inflamatorio (tumor de vanek) / Intestinal intussusception due to an inflammatory fibroid polyp (vanek tumor)

La intususcepción en un adulto debe hacer sospechar un tumor (benigno o potencialmente riesgoso); el diagnóstico certero es crucial para el tratamiento adecuado del paciente1. Alrededor del 90% de estos casos se dan en el intestino delgado y colon, el 10% restante se originan en el estómago y en estomas creados quirúrgicamente2. En los adultos, aproximadamente 90% de los casos de intususcepción son secundarios a una lesión definible3. El tumor de Vanek o pólipo fibroide inflamatorio, se conoce como una lesión benigna, rara, de localización submucosa, no encapsulada, cuya ubicación puede darse a lo largo del tracto digestivo, siendo más común en el antro gástrico (80 %), aunque también se ha descrito en la unión gastroesofágica, duodeno, yeyuno, íleon y colon4.

Intussusception in an adult must make us suspect the presence of a tumor (benign or potentially dangerous) as the most frequent cause. Accurate diagnosis is of great importance in order to provide appropriate treatment and improve patient prognosis1. About 90% of these cases occur in the small intestine and colon, and the remaining 10% originate in the stomach and surgically created ostomas2. In adults, approximately 90% of cases of intussusception are secondary to a definable lesión3. The Vanek's tumor or inflammatory fibroid polyp (IFP) is a rare benign lesion of submucosal location, not encapsulated, that may be located throughout the digestive tract, being more common in the gastric antrum (80%), although it has also been described in the gastroesophageal junction, duodenum, jejunum, ileum and colon4.

Inflammatory Fibroid Polyp in the Jejunum Causing Small Bowel Intussusception

Intussusceptions are defined as the telescoping of one segment of the gastrointestinal tract into an adjacent distal segment. In the small bowel, intussusceptions are typically caused by benign processes, but can occasionally be caused by inflammatory fibroid polyps, which often present as intussusception and bowel obstruction. These polyps are rare, benign, tumorous lesions in the gastrointestinal tract and are typically observed in the stomach, but can occur anywhere in the gastrointestinal tract. Any case of a jejunojejunal intussusception caused by inflammatory fibroid polyps is considered rare, and we report the case of a 51-year-old woman with an inflammatory fibroid polyp of the jejunum presenting as an intussusception who was successfully treated with a resection.

Giant Solitary Ileal Polyp Presenting as an Intussusception in a 10-year-old Boy

This is a case report of a 10-year-old boy who presented with features of acute intestinal obstruction. Clinical examination revealed distended abdomen, visible bowel loops, and a lump in the right upper quadrant of the abdomen. Clinically, the diagnosis of intussusception was suspected and confirmed on sonography examination. Exploration of the abdomen revealed ileo-colic intussusception. Manual reduction of intussusception was possible except the last part that had an intraluminal solitary polyp (3 × 4 cm) occupying the 3/4th of the lumen of the terminal ileum. Segmental resection of the ileum containing polyp was done, and the ileal continuity was restored with ileo-ileal anastomosis. His post-operative recovery was uneventful. Histologically, it was consistent with the inflammatory intestinal polyp without any evidence of malignancy.

Bone in intestinal polyp-a curious observation.

We report rare phenomena of ossification in benign colon polyp. An adult woman presented with occasional bleeding per rectum for which she was investigated. A polypoid rectal swelling was detected and histolopathology revealed an inflammatory polyp with osteoid formation. The case is presented for its rarity and available literature is reviewed.

Minimal incision laparotomy assisted endoscopic resection for polyps in small intestine in patients with Peutz-Jeghers syndrome / 中华消化内镜杂志

Objective To evaluate the effectiveness and safety of minimal incision laparotomy assisted endoscopic resection for polyps in small intestine in patients with Peutz-Jeghers syndrome. Methods The clinical data of patients with Peutz-Jeghers syndrome, who underwent minimal incision laparotomy assisted endoscopic resection for polyps in small intestine, were retrospectively studied. The size and number of the endoscopically rosected polyps, and the procedure related complications were documented. Results A total of 812 polyps in small-bowel were resected in 8 patients, in which 384 were smaller than 10mm, 356 with diameter ranging from 11 mm to 30mm, and 72 were larger than 30mm in diameter. Procedure related complications included intestinal dysfunction in 1 patient and abdominal pain in another. No bleeding with a fall in Hb or other severe complications were observed. Conclusion Minimal incision laparotomy assisted endoscopic resectio is a safe and reliable procedure for the treatment of mid-small bowel polyps in patients with Peutz-Jeghers syndrome. It revolutionizes the therapeutic options for polyps in the region of the mid-small bowel and limits the indications for primary surgical management.