Intestinal intussusception in adults: tomographic findings and report of two cases / Intestinal intussusception in adults: tomographic findings and report of two cases.

Intestinal intussusception is infrequent in adults. Unlike what happens in kids, it shows a demonstrable etiology in most cases: polyps, lipomas, hamartomas, malignancies, etc. Among diagnostic methods, CT scan is the study that yields the best results for the diagnosis, giving forth pathognomonic signs and favoring therapeutic decision-making. Two cases of intestinal intussusception in adults secondary to benign pathology are analyzed, stressing mainly the tomographic findings and some considerations about therapeutic decision-making based on tomographic results.

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.

Terminal ileum of patients who underwent colonoscopy: endoscopic, histologic and clinical aspects / Íleo terminal de pacientes submetidos a colonoscopia: aspectos endoscópicos, histológicos e clínicos

CONTEXT: For the diagnosis of the diseases which affect the terminal ileum, the colonoscopy allows macroscopic evaluation and the performing of biopsies. Studies with criteria for the endoscopic and histological characterization of this segment are scarce and there are still some doubts about the need of biopsies in patients with normal ileoscopy. OBJECTIVE: Study the terminal ileum of patients who underwent colonoscopy considering: endoscopic and histological correlation; agreement between results of the initial histological evaluation and slides review, and the chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea to show histological alterations. METHODS: In a prospective study, 111 patients who presented smooth mucosa without enanthema in the endoscopic exam of the terminal ileum were selected. Biopsies of the ileal mucosa of such patients were performed, being the slides routinely examined and reviewed afterwards. RESULTS: The correlation between patients with normal ileoscopy and ileum with preserved histological architecture was of 99.1 percent. The agreement between initial histological evaluation and slides review calculated by the Kappa test was 0.21. In patients with abdominal pain and/or chronic diarrhea, the chance of showing histological alterations was 2.5 times higher than the others. CONCLUSIONS: The correlation between endoscopic and histological findings was high. The agreement between the initial histologic evaluation and slides review was not satisfactory. The chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea, showing histological alterations was higher in relation to the asymptomatic ones or with other symptoms, although the clinical importance of this datum was not evaluated.

CONTEXTO: Para o diagnóstico de doenças que afetam o íleo terminal, a colonoscopia permite avaliação macroscópica e realização de biopsias. Estudos com critérios para caracterização endoscópica e histológica desse segmento são escassos e ainda persistem dúvidas quanto à necessidade de biopsias em pacientes com ileoscopia normal. OBJETIVO: Estudar o íleo terminal de pacientes submetidos a colonoscopia, considerando correlação endoscópica e histológica; concordância entre resultados da avaliação histológica inicial e revisão de lâminas e chance de indivíduos com ileoscopia normal, com dor abdominal e ou diarreia crônica apresentarem alterações histológicas. MÉTODOS: Estudo prospectivo, no qual foram selecionados 111 pacientes, que apresentaram ao exame endoscópico do íleo terminal mucosa lisa e sem enantema. Foram realizadas biopsias da mucosa ileal nesses indivíduos, sendo as lâminas examinadas rotineiramente e revisadas posteriormente. RESULTADOS: A correlação entre pacientes com ileoscopia normal e íleo com arquitetura histológica preservada foi de 99,1 por cento. A concordância entre avaliação histológica inicial e revisão de lâminas calculada pelo teste de Kappa, foi 0,21. Nos pacientes com ileoscopia normal, com dor abdominal e ou diarreia crônica, a chance de apresentarem alterações histológicas foi 2,5 vezes maior em relação aos demais. CONCLUSÃO: A correlação entre achados endoscópicos e histológicos foi elevada. A concordância entre avaliação histológica inicial e revisão de lâminas não foi satisfatória. A chance de indivíduos com ileoscopia normal, com dor abdominal e ou diarreia crônica, apresentarem alterações histológicas foi maior, porém a importância clínica desse dado não foi avaliada.

Endometriosis del íleon como causa de obstrucción intestinal: Report of two cases / Ileal endometriosis as a cause of intestinal obstruction. Report of two cases

Endometriosis is a common, chronic, benign, estrogen dependent gynecological disorder associated to pelvic pain and infertility. Its main characteristic is the presence of endometrial tissue outside the uterus. The prevalence of pelvic endometriosis ranges between 6% and 10% women during their reproductive years. Clinical symptoms of pelvic endometriosis are pelvic pain, dysmenorrhea, dispareunia and infertility. Distal ileum endometriosis is an uncommon cause of intestinal obstruction with a frequency of 7% to 23% of all cases with intestinal involvement. We report two patients, 30 and 34 years old, with terminal ileum endometriosis and intestinal obstruction that required surgery and intestinal resection. Both patients are well one year after the operation.

Obstruçäo do íleo terminal por mucosa gástrica heterotópica: relato de caso / Terminal ileum from obstruction owing to heterotopic gastric mucosa: case report

A mucosa gástrica ectópica localizada no intestino delgado, distal ao ligamento de Treitz é muito rara, excetuando-se a encontrada habitualmente no divertículo de Meckel e na duplicaçao intestinal. Existem formas congênita e adquirida, sendo esta última secundária à processos inflamatórios intestinais. As diferenças entre estas formas sao basicamente histológicas, determinando no entanto aspectos fisiopatológicos distintos. Apresentamos caso de mucosa gástrica ectópica em paciente de 34 anos de idade, manifestada por obstruçao do íleo terminal. Submetido a duas enterectomias e anastomoses primárias, apresentou boa evoluçao pós-operatória. O aspecto histopatológico, típico da forma adquirida com mucosa antral e intensa fibrose, foi provavelmente relacionado à quadro recente de tuberculose intestinal, porém nao confirmada histologicamente. O antecedente de tuberculose pulmonar recente na família, aliado à linfoadenomegalia mesentérica encontrada a operaçao, sustentam tal suspeita. Este é fato inédito na literatura dentre as outras 28 publicaçoes de heterotopia gástrica no jejuno e íleo.

Ileal typhoid perforation: a study of 40 cases

This is a retrospective study of 40 patients, who presented as acute abdomen and underwent emergency surgery for ileal perforations. High grade fever, abdominal pain, vomiting and constipation were common symptoms, while generalized tenderness, rigidity and obliteration of liver dullness were the main clinical findings. Sex incidence revealed male predominance, 33 male versus 7 females. The ages of the patients ranged from 12 to 75 years with a mean of 34 years. Ileal perforation due to typhoid enteritis was the diagnosis in all cases. Surgical procedures carried out included primary closure of the perforation in 27 cases and primary closure with loop ileostomy in 12 cases. In one case right hemicolectomy was performed. A mortality rate of 15% was seen in this series

Endometriosis en ileon terminal: presentación de un caso / Endometriosis of the terminal ileum: a case report

La endometriosis afecta a un 8 - 15 por ciento de mujeres durante la edad reproductiva, media y final provocando una gran variedad de síntomas (1). Compromete las zonas vecinas al útero tales como ovarios, ligamentos uterinos, tabiques rectovaginal, y el peritoneo pélvico; sin embargo, infrecuentemente puede también afectar el colon y el intestino delgado. Presentamos el caso de una paciente femenina de 27 años de edad, quien consultó a nuestra institución por presentar cuadros de pseudo obstrucción intestinal, caracterizado por dolor abdominal y vómitos de contenido biliar, debido a endometriosis de Ileon Terminal

Abscesso de ileopsoas: diagnostico por imagem / Heopsoas abscess: image diagnostic

Os autores descrevem alguns aspectos dos abscessos do ileopsoas, com enfase para o diagnostico por metodos de imagem.

Intestinal anisakiasis: first reported case in Thailand.

A case of intestinal anisakiasis is reported. The patient came with the symptoms of acute abdominal obstruction. The diagnosis was obtained by identification of the parasite in the tissue sections of the resected segment of the small intestine. This case appears to be the first reported case in Thailand.

Invaginaçäo intestinal na infância por polipose linfóide benigna: relato de 2 casos intervidos cirurgicamente e com evoluçäo favorável / Intestinal intussusception in childhood by benign polyposis lymphoid: description of 2 cases, surgically treated with favorable evolution

Säo relatados dois casos de intussuscepçäo intestinal desencadeados pela polipose linfóide benigna do íleo em infantes. Säo descritos os achado anátomo-patológicos e comentadas as condutas de diagnóstico e tratamento. A longa evoluçäo pós-cirúrgica favorável em ambos os casos ratifica os corretos diagnósticos firmados, particularmente na exclusäo de linfomas como etiología da polipose e da invaginacäo nos presentes casos

Megaíleo chagásico: descriçäo de um caso / Chagasic megaileum: report of a case

É apresentado um caso de megaíleo de natureza chagásica. O paciente, portador da Doença de Chagas, branco com 41 anos, apresentava história de 3 anos de episódios de cólicas abdominais, distensäo e diarréia, que foram se tornando mais intensas e mais freqüentes. Fora crises, apresentava-se assintomático. O diagnóstico de megaíleo foi estabelecido por meio do estudo radiológico contrastado do intestino delgado. O estudo histológico realizado em fragmento obtido à intervençäo cirúrgica mostrou diminuiçäo do número de células ganglionares dos plexos mientéricos