La profesora Raquel Pérez González y el signo de la muela de cangrejo / Professor Raquel Pérez González and crab claw sign

La Dra. Raquel Pérez González, más conocida entre colegas, alumnos y compañeros de trabajo por "la profe Raquel", obtuvo el título de Medicina en el año 1976. Comenzó por vía directa la residencia de Radiología y obtuvo el título de especialista de primer grado en 1979. Se convirtió así, el Hospital Militar Central "Dr. Carlos J. Finlay", en la cuna de su formación profesional y en años posteriores, en la casa que la vio crecer, especialmente como maestra de numerosas generaciones de radiólogos e imagenólogos. Hoy reposan en el jardín del Departamento de Imagenología, parte de sus cenizas, custodiadas por el amor que fue capaz de cultivar. En el 2016, una paciente femenina de 60 años de edad, acudió a la consulta de gastroenterología, con dolor abdominal difuso. La radiografía de abdomen simple, anteroposterior, en posición acostado mostró, una imagen en "muela de cangrejo", visible al tomar el aire dentro del hemicolon transverso izquierdo, como contraste, el cual bordea por ese lado parcialmente, una opacidad de partes blandas, que se extiende desde el mesogastrio, hasta la fosa ilíaca derecha, donde se observa el signo del menisco. Los estudios de imágenes realizados, evidenciaron signos radiológicos típicos de invaginación por causa tumoral maligna. En varias ocasiones, la profesora Raquel utilizó la imagen de este caso, como pregunta en exámenes de promoción de residentes. La publicación de este caso constituye un homenaje a quien será siempre un paradigma de docente.

Dr. Raquel Pérez González, better known among colleagues, students and co-workers as "professor Raquel", obtained her degree in Medicine in 1976. She began her Radiology residency directly and obtained the title of first-class specialist degree in 1979. Thus, the Central Military Hospital "Dr. Carlos J. Finlay" is the cradle of her professional training and in later years, in her home where she saw her grow up, especially as a teacher to numerous generations of radiologists and imaging scientists. Today, part of her ashes rest in the garden of the Imaging Department, guarded by the love that she was able to cultivate. In 2016, a 60-year-old female patient attended the gastroenterology clinic with diffuse abdominal pain. The simple, anteroposterior abdominal x-ray, in the lying position, showed a "crab claw" image, visible when breathing into the left transverse hemicolon, as contrast, which partially borders on that side, a soft tissue opacity, which extends from the mesogastrium to the right iliac fossa, where the meniscus sign is observed. The imaging studies performed showed typical radiological signs of invagination due to malignant tumor. On several occasions, Professor Raquel used the image of this case as a question in resident promotion exams. The publication of this case constitutes a tribute to someone who will always be a paradigm of a teacher.

Risk factors for recurrent intussusception in children after ultrasound-guided saline enema reduction / 中华普通外科杂志

Objective:To explore the risk factors for recurrence of intussusception in children after successful ultrasound-guided saline enema reduction.Methods:The clinical and follow up data of 355 hospitalized children with intussusception at the First Affiliated Hospital of Zhengzhou University from Feb 2018 to Feb 2023 were reviewed.Patients were divided into two groups by recurrence develped and the differences were compared, Data with significant differences were incorporated into multi-factor logistic analysis.Results:The overall recurrence rate was 15.8% (56/355). By univariate variable analysis model, there were statistically significant differences between the two groups in age, previous intussusception history, vomiting, maximum diameter of concentric circles shown by ultrasound, and concurrent bowel organic diseases (lead points) (all P<0.05). In multivariate Logistic regression model, age, previous intussusception history, maximum diameter of concentric circles, and lead points were independent risk factors for recurrent intussusception after saline enema.The optimal cut-off values for age and maximum diameter of concentric circles were 2 years and 33.5 mm, respectively, according to ROC curve analysis. Conclusion:Age older than 2 years, previous intussusception history, maximum diameter of concentric circles longer than 33.5 mm, and lead points are independent risk factors for recurrence after saline enema.

Ileoileal intussusception secondary to angiofibrolipoma

Intussusception is an uncommon cause of intestinal occlusion in adults, accounting for 1-5% of the causes. In this group it is important to rule out malignant tumors as the primary cause of intussusception. This pathology is explained by the invagination of a segment of the intestine onto itself. The clinical manifestations are those typical of intestinal occlusion. Within the study protocol, the CT scan shows the target sign or sausage image depending on the slice. Surgical management will be necessary in order to re-establish intestinal transit and remove tumors. We present the case of a 45-year-old woman with upper intestinal occlusion secondary to ileoileal intussusception due to submucosal angiofibrolipoma.

Intestinal resection and primary anastomosis as treatment of intussusception due to ileum lipoma: case report and review

Intussusception is an unusual cause of intestinal occlusion in adults, accounting for 5% of cases, and is the result of an underlying pathology in 90% of cases, 60% of which are tumors. The pathogenesis describes the invagination of an intestinal segment into the lumen of an adjacent segment with subsequent alterations in irrigation, risk of necrosis and perforation. Surgical management is indicated in adult patients to restore intestinal transit and to exclude malignancy as the axis of the intussusception. We present the case of a 58-year-old female patient with enteric intussusception at ileum due to lipoma, who underwent bowel resection and manual end-to-end intestinal anastomosis in two planes.

Intususcepción por complicación de gastrostomía / Intussusception due to gastrostomy complication

Introducción: La oclusión intestinal constituye la segunda causa de abdomen agudo quirúrgico y el 20 por ciento de los ingresos en los servicios de urgencia; algunas revisiones muestran que se producen cada año más de 9000 muertes por esta causa. Objetivo: Presentar un paciente oncológico al cual se le realizó una gastrostomía y posteriormente se complicó con una intususcepción. Caso clínico: Paciente de 59 años de edad, al cual se le realizó una gastrostomía alimentaria al presentar disfagia. Días más tarde el paciente se complicó con una oclusión intestinal y falleció en un corto periodo. Conclusiones: La intususcepción es una enfermedad infrecuente en adultos, con una presentación clínica poco específica. Los síntomas cardinales son el dolor de tipo cólico, vómitos, distención abdominal y detención del tránsito intestinal(AU)

Introduction: Intestinal occlusion is the second leading cause of surgical acute abdomen and 20 percent of admissions to emergency services; some reviews show that they produce more than 9000 deaths each year from this cause. Objective: Report a case of an oncological patient who underwent a gastrostomy and subsequently becomes complicated by intussusception. Case presentation: A 59-year-old patient, who underwent an alimentary gastrostomy due to dysphagia. A few days later, the patient developed complications with intestinal occlusion and died within short time. Conclusions: Intussusception is an uncommon disease in adults, with a non-specific clinical presentation. The cardinal symptoms are cramping pain, vomiting, abdominal distension and intestinal transit arrest(AU)

Small bowel obstruction secondary to intussusception due to double Meckel's diverticulum in an adult: a case report

Meckel's diverticulum (MD) is a normal variant in 2% of the population, it contains all the layers of the small intestine and is considered a true diverticulum. One of the most frequent complications in adults is obstruction secondary to intussusception of MD towards the ileum. We present the case of a 52-year-old man with severe abdominal pain, nausea, and vomiting, which did not respond to conservative management. Imaging studies compatible with small bowel obstruction, identifying the transition zone at the ileum level. An exploratory laparotomy was performed ruling an intussusception due to a diverticulum, an intestinal resection was performed. The histopathological study revealed a double MD. In adults with symptomatic MD, this represents a challenge in early diagnosis and immediate surgical treatment. Intestinal intussusception in adults secondary to MD is rare and should be considered in the differential diagnosis of those with abdominal pain and small bowel obstruction.

Intususcepción en adulto como complicación de un lipoma parietal intestinal Reporte de caso / Intussusception in an adult as a complication of an intestinal parietal lipoma. case report

Resumen La intususcepción en el adulto es una entidad clínica quirúrgica extremadamente rara, su etiología principal en esta población se atribuye generalmente a origen maligno, la patología benigna es de menor frecuencia y presenta un reto para el diagnóstico prequirúrgico, puesto que su presentación es inespecífica y variable. A continuación, se presenta un caso clínico que debuta con un cuadro clínico de dolor en hipocondrio derecho intermitente, manifestando agudización y resultados de estudios de laboratorio inespecíficos, por lo que inicialmente se pensó que la razón del dolor era una patología de origen biliar y, por ende, se realizó una ecografía de hígado y vías biliares, con lo que observaron signos sugestivos de intususcepción secundaria a un lipoma, por lo que se realizó una tomografía de abdomen simple que corroboró el diagnóstico.

Abstract Intussusception in adults is an extremely rare surgical clinical entity, its main etiology in this population is generally attributed to malignant origin, benign pathology is less frequent and presents a challenge for pre-surgical diagnosis, since its presentation is non-specific and variable. Below is a clinical case that debuted with a clinical picture of intermittent pain in the right upper quadrant, manifesting exacerbation and non-specific laboratory tests, for which initially pathology of biliary origin was thought to be the reason for the pain, and therefore, an ultrasound of the liver and bile ducts was performed, observing signs suggestive of intussusception secondary to a lipoma, for which a simple abdominal tomography was performed to corroborate the diagnosis.

Apendicitis aguda por intususcepción secundaria a endometriosis. Reporte de caso / Acute appendicitis due to intussusception secondary to endometriosis. Case report

Introducción. La intususcepción del apéndice corresponde a su invaginación en el ciego. Existen varias causas, pero la endometriosis ha sido informada pocas veces. Aunque el diagnóstico se debe sospechar clínicamente, por lo general su causa solo se determina en el intraoperatorio, donde se deben tener en cuenta causas oncológicas que requieran una resección amplia. Caso clínico. Mujer de 21 años que consultó por dolor abdominal agudo generalizado. Se practicó una tomografía computarizada de abdomen, observando una intususcepción del apéndice en el ciego, estriación de la grasa pericecal y adenomegalias. Se realizó laparoscopia diagnóstica encontrando intususcepción casi completa del apéndice cecal, de aspecto neoplásico. Se convirtió a laparotomía para proceder a hemicolectomía derecha, con vaciamiento ganglionar y anastomosis del íleon al colon transverso. Discusión. La sospecha clínica de intususcepción debe corroborarse mediante ecografía, tomografía o estudios baritados. El tratamiento siempre es quirúrgico, como en el caso de nuestra paciente, quien evolucionó de forma adecuada y continuó asintomática después de un año de seguimiento. Conclusión. El diagnóstico temprano de la intususcepción permite realizar tratamientos quirúrgicos menos agresivos y disminuye el riesgo de filtración de la anastomosis. Se debe tener en cuenta el diagnóstico de endometriosis como posible causa. Se debe realizar el manejo complementario por parte de ginecología.

Introduction. The intussusception of the appendix corresponds to its invagination in the cecum. There are several causes, endometriosis being rarely reported. Although the diagnosis must be suspected clinically, its cause is generally only determined intraoperatively, where oncological causes that require extensive resection must be taken into account. Clinical case. A 21-year-old woman who consulted due to acute generalized abdominal pain, an abdominal tomography was performed, finding an intussusception of the appendix in the cecum, striation of pericecal fat, and lymph nodes. A diagnostic laparoscopy was performed, finding almost complete intussusception of the appendix, with a neoplastic appearance. She was converted to laparotomy to perform a right hemicolectomy, with lymph node dissection and ileal to transverse anastomosis. Discussion. Clinical suspicion of intussusception should be confirmed by ultrasound, abdominal tomography, or barium studies. Treatment is always surgical, as in the case of our patient, who evolved adequately and remained asymptomatic after one year of follow-up. Conclusion. Early diagnosis of intussusception allows for less aggressive surgical treatment and decreases the risk of anastomosis leakage. The diagnosis of endometriosis should be taken into account as a possible cause. Complementary management by gynecologists should be performed.

Ileocolic intussusception-a rare cause of acute intestinal obstruction in adults

The primary report of intussusception was made in 1674 by Barbette of Amsterdam. It increases the patient's risk of intestinal obstruction, parietal ischemia, perforation, and peritonitis. Small intestinal submucosal lipomas are an uncommon kind of gastrointestinal tumour. It is a silent disease that occasionally causes gastrointestinal haemorrhage, intussusception, and bowel obstruction. Surgery is frequently required to confirm the diagnosis and rule out an underlying malignancy. We present a case of submucosal lipoma causing enteric obstruction in a young female.

Metastatic clear-cell renal carcinoma: an exceptional cause of ileocolonic intussusception in adults

Introduction: Intussusceptions in adults are rare, representing 1% to 5% of intestinal obstructions in this age group. This condition can be caused by benign and malignant lesions acting as lead points, the latter being the most frequent. Furthermore, the diagnosis is challenging due to the non-specific symptoms with variable duration. Case Presentation: A 43-year-old man, with a history of localized clear-cell renal carcinoma (ccRCC) treated 9 years earlier with a right radical nephrectomy, presented with bowel obstruction symptoms. An abdominal computed tomography scan showed an ileocolonic intussusception. Hence, the patient required a right hemicolectomy with ileotransverse anastomosis. The histopathological analysis showed a metastatic ccRC to the terminal ileum causing the intussusception. Discussion: Adult intussusceptions are rare. However, they should be considered in the differential diagnosis of patients with abdominal pain and symptoms of bowel obstruction. Metastases of renal cancer to the small bowel are uncommon and even more so in the form of intussusception. Definitive treatment must be tailored to the patient's condition and underlying cause. (AU)

Intussusception as an unusual etiology of intestinal obstruction in adults: case report and review

Intussusception is a rare entity in adults, representing 1 to 5 percent of cases of intestinal obstruction. The clinical manifestations are non-specific, a structural lesion is identified by imaging, in more than 70% of the cases. Most cases require surgical treatment. We report the case of a 65-year-old female patient, with a history of intermittent colicky abdominal pain of two months of evolution, associated with nausea, vomiting, melena, and weight loss. Assessed in the emergency department due to worsening abdominal pain and lack of defecation. Her laboratory data reported anemia and leukocytosis. Abdominopelvic CT scan reported an image compatible with intussusception. We performed an emergency exploratory laparotomy, finding the terminal ileum invaginated into the colonic lumen., caused by a gastrointestinal stromal tumor. Intussusception in adults is uncommon but it should be considered as a diagnostic possibility in patients with intestinal obstruction, intestinal bleeding, and a palpable abdominal mass. Although these are non-specific manifestations, complementing the study with chemical and imaging analyzes significantly increases the diagnostic probability. The set of data obtained should be used to select the most appropriate treatment.

Intussusception as an unusual etiology of intestinal obstruction in adults: case report and review

Intussusception is a rare entity in adults, representing 1 to 5 percent of cases of intestinal obstruction. The clinical manifestations are non-specific, a structural lesion is identified by imaging, in more than 70% of the cases. Most cases require surgical treatment. We report the case of a 65-year-old female patient, with a history of intermittent colicky abdominal pain of two months of evolution, associated with nausea, vomiting, melena, and weight loss. Assessed in the emergency department due to worsening abdominal pain and lack of defecation. Her laboratory data reported anemia and leukocytosis. Abdominopelvic CT scan reported an image compatible with intussusception. We performed an emergency exploratory laparotomy, finding the terminal ileum invaginated into the colonic lumen., caused by a gastrointestinal stromal tumor. Intussusception in adults is uncommon but it should be considered as a diagnostic possibility in patients with intestinal obstruction, intestinal bleeding, and a palpable abdominal mass. Although these are non-specific manifestations, complementing the study with chemical and imaging analyzes significantly increases the diagnostic probability. The set of data obtained should be used to select the most appropriate treatment.

Intestinal intussusception due to “Rapunzel syndrome” in an adult

The bezoars are collections of foreign bodies or ingested material that accumulate over time and are often located in the stomach or small intestine,but can be found throughout the digestive tract. Most bezoars are of indigestible organic matter such as trichobezoars (hair); or vegetable and fruit- phytobezoars; or a combination of both but other rare substances have also been described in literature. In some cases, the trichobezoar extends through the pylorus into duodenum, jejunum or even into the colon. Rapunzel syndrome is a rare manifestation of a trichobezoar, which occurs when strands of swallowed hair extend beyond the pylorus of the stomach, into the intestine as a tail. It was first described by Vaughan et al in 1968. Trichobezoars can block the intestinal tract and, if left untreated, can be a life-threatening emergency requiring surgery. Patients are often women, under the age of 20 and have insidious non-specific abdominal symptoms and staggered presentations over months to years. The diagnosis of this type of pathology is usually a challenge for the attending physician, so we present a case report of a 38-year-old female with gastric-intestinal occlusion secondary to trichobezoar.

Colocolonic intussusception in an adult secondary to an inflammatory polyp of the transverse colon - clinical case

There are multiple causes of colocolonic intussusception in adults, such as tumors, autoimmune pathologies, previous abdominal surgeries, and gynecological conditions. Associated complications are small bowel obstruction, ischemia, necrosis, perforation with peritonitis, and sepsis that require urgent attention. A 78-year-old woman who started with colic in the mesogastrium of 5 months of evolution and changes in bowel habits. She went to the emergency room due to intense pain in the mesogastrium. On physical examination, she presented dehydration of the mucous membranes and pale integuments, pain on superficial and deep palpation in the mesogastrium. Admission laboratories: leukocytosis 17,110/ul, neutrophilia 67.9%, hydroelectrolyte imbalance: mild hyponatremia, mild hypochloremia, slightly prolonged coagulation times, normal blood chemistry. Abdominal ultrasound with "pseudokidney" image. Computed tomography reports an image of the introduction of a segment of the transverse colon into a contiguous segment of the same, with data of associated intestinal pneumatosis. Due to the previous findings, an emergency exploratory laparotomy was performed. Invagination of the transverse colon is located, accompanied by dilation of the vessels of the greater omentum; it is reduced manually, an enterotomy is performed and a tumor dependent on the wall is located, for which a 25 cm transverse colon resection, end colostomy and mucous fistula are decided. Pathology report reports inflammatory polyp. In the postoperative period, the patient improved and was discharged. Abdominal pain is the common presentation of intussusception; however, given its rarity in adults, the possibility of missing the finding on abdominal imaging leads to misdiagnosis.

Reducción de intususcepción ileocólica con enema hidrostático bajo guía ecográfica en pacientes pediátricos: Reporte de casos

La intususcepción ileocólica es una emergencia pediátrica con tratamiento inicial no quirúrgico a nivel mundial. La reducción hidrostática bajo guía ecográfica en pacientes pediátricos es un método de tratamiento inicial ampliamente utilizado en el mundo; sin embargo, en nuestro medio no se encuentra difundido su uso. Presentamos 4 casos de pacientes con intususcepción ileocólica tratados mediante enema hidrostático bajo guía ecográfica en el Instituto Nacional de Salud del Niño - San Borja (INSNSB), con reducción terapéutica y sin complicaciones.

Ileocolic intussusception is a pediatric emergency with initial non-surgical treatment. Ultrasound-guided hydrostatic reduction in pediatric patients is a widely used initial treatment method in the world; however, its use is not widespread in our environment. We present 4 cases of patients with ileocolic intussusception treated by ultrasound-guided hydrostatic reduction in the Instituto Nacional de Salud del Niño - San Borja (INSNSB), with therapeutic reduction and without complications.

Invaginación Apendicular en preescolar: Reporte de un caso y revisión de la literatura / Appendicular invagination in a pre-school child; a case-report and literature review

La invaginación intestinal sucede cuando un segmento del intestino se introduce en otro. La presentación apendicular es menos común, afectando principalmente a lactantes. Frecuentemente, se comprueba durante el intraoperatorio. El tratamiento es la desinvaginación, seguido de la exéresis del apéndice. De no lograrse, se prefiere la resección amplia o una hemicolectomía derecha. Se presenta en caso de una niña de 4 años que acudió por dolor abdominal, hiporexia, vómitos y sensación de alza térmica; la ecografía mostró conglomeración de asas intestinales e imagen redondeada. En cirugía se encontró invaginación apendicular que compromete el ciego, se resecó la masa hasta el inicio del colon ascendente. Se realizó una ileostomía sin fístula mucosa; el estudio anatomo-patológico informó necrosis del apéndice cecal. Tres meses después se restituyó el tránsito intestinal. La Intususcepción apendicular tiene síntomas inespecíficos. En Perú, puede llegar a ser mortal. Una historia clínica detallada con evaluación minuciosa ofrece un acertado diagnóstico y un tratamiento oportuno.

SUMMARY Intestinal invagination occurs when an intestinal segment is introduced into another segment. The appendicular presentation is less common and affects predominantly infants. The diagnosis is corroborated during the surgical intervention which consists of de-invagination followed by surgical removal of the appendix, if the latter is not possible then a wide resection or right hemicolectomy is indicated. We present the case of a 4-year-old girl who attended with a history of abdominal pain, anorexia, vomiting and fever; an abdominal ultrasound showed intestinal agglomeration and a rounded mass. The surgical findings included appendicular invagination that affected the cecum, the lesion was resected until the ascending colon. An ileostomy was performed, the anatomopathological findings indicated necrosis of the appendix. Three months later the normal intestinal transit was restored. Appendicular intussusception has non-specific symptoms and could be mortal in Peru. A detailed clinical history may help in diagnosing and offering proper treatment.

Tumor miofibroblastico inflamatorio que causa obstrucción intestinal en adulto mayor por intususcepción intestinal: Reporte de caso

La intususcepción intestinal en pacientes adultos es una entidad infrecuente, la cual corresponde alrededor del 5% de todas las causas de obstrucción intestinal. Su diagnóstico no es fácil, dado lo poco especifico de los síntomas de los pacientes que la presentan; este se sustenta principalmente en los hallazgos de los estudios de imagen. El manejo quirúrgico es la piedra angular del tratamiento de esta patología, y su éxito va a estar determinado por el diagnóstico oportuno y la experticia del cirujano tratante. En este artículo se presenta el caso de un paciente masculino de 62 años, que consulta por cuadro de dolor abdominal inespecífico y síntomas urinarios irritativos, el cual por persistencia del dolor abdominal pese al manejo medico es llevado a cirugía, donde se diagnostica de manera intraoperatoria una invaginación intestinal a nivel de íleon distal.

Intestinal intussusception in adult patients is a rare entity, which corresponds to about 5% of all causes of intestinal obstruction, its diagnosis is not easy given the lack of specific symptoms of patients who present it. This is mainly based on the findings of imaging studies, surgical management is the cornerstone of treatment of this pathology and its success will be determined by timely diagnosis as well as by the expertise of the treating surgeon. This article presents the case of a 62-year-old male patient who consults due to nonspecific abdominal pain and irritative urinary symptoms, who due to persistence of abdominal pain despite medical management is taken to surgery where it is diagnosed intraoperatively. an intestinal intussusception at the level of the distal ileum.

Ileo-Ileal Intussusception with Meckel Diverticulum in a Filipino adolescent

@#Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. Intussusception occurs primarily in infants and toddlers.1 The peak incidence is between 4 and 36 months of age, and it is the most common cause of intestinal obstruction in this age group. 2 Approximately 1 percent of cases are in infants younger than three months, 30 percent between 3 and 12 months, 20 percent between one and two years, 25 percent between two and three years, and 10 percent between three and four years.3 Although intussusception is most common in infants and young children, it is important to consider this diagnosis in children outside this age range. Approximately 10 percent of cases are in children over five years, and 3 to 4 percent in those over 10 years.3,4 We share here images from an actual case of a 15-year-old Filipino male with an ileo-ileal intussusception that is beyond the typical age range, with an incidental finding of an intraluminal mass that was histomorphologically diagnosed as Meckel’s diverticulum (MD). The diagnosis of intussusception is relatively rare in the patient’s age and the diagnosis of MD in the presence of intussusception is sparsely reported in the Philippines. Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. Intussusception occurs primarily in infants and toddlers.1 The peak incidence is between 4 and 36 months of age, and it is the most common cause of intestinal obstruction in this age group. 2 Approximately 1 percent of cases are in infants younger than three months, 30 percent between 3 and 12 months, 20 percent between one and two years, 25 percent between two and three years, and 10 percent between three and four years.3 Although intussusception is most common in infants and young children, it is important to consider this diagnosis in children outside this age range. Approximately 10 percent of cases are in children over five years, and 3 to 4 percent in those over 10 years.3,4 We share here images from an actual case of a 15-year-old Filipino male with an ileo-ileal intussusception that is beyond the typical age range, with an incidental finding of an intraluminal mass that was histomorphologically diagnosed as Meckel’s diverticulum (MD). The diagnosis of intussusception is relatively rare in the patient’s age and the diagnosis of MD in the presence of intussusception is sparsely reported in the Philippines.