Primary Malignant Lymphoma of the Terminal Ileum Causing Intussusception in Adults

Most intussusceptions occur in children and no etiologic factor can be determined in most cases. In contrast, adult intussusception is rare and many cases in adults are generally related to neoplasm such as lymphoma, carcinoid tumor, malignant tumor, sarcoma, benign tumor and congenital abnormalities. Intussusception in adults that's due to primary malignant lymphoma of the terminal ileum is a rare clinical condition. We describe here two cases of ileo- colonic-type intussusception that were due to primary malignant lymphoma of the terminal ileum. The clinical, radiographic and pathologic finding are described along with a brief review of the literature.

Clinical Consideration of Choledocholithiasis Treatment: Analysis of Primary Closure versus T-tube Drainage after Choledochotomy

PURPOSE: The placement of a drainage tube in the common bile duct, following a choledochotomy, has become accepted as routine procedure since it was first reported, by Abbe, in 1892. However, many complications are associated with T-tube drainage, such as bile peritonitis after its removal, accidental dislodgement, bile leakage from the T-tube track and a high incidence of postoperative bacteremia, have been reported. This study was designed to evaluate the primary closure as a suitable surgical technique in placce of T-tube drainage following a choledochotomy METHODS: Between January and December 2002, primary closures were performed in 41 cases and T tube drainage in 112, following a choledochotomy. These cases were divided into 2 groups (group A: primary closure, and group B: T-tube drainage). The medical records of the patients were reviewed, and the following data analysed -age, sex, preoperative laboratory value, intraoperative finding, postoperative laboratory value, complication, and days of postoperative hospital stay. RESULTS: There were no significant differences observed in the data of the investigated parameters, with the exception of the mean post-operative hospital stay. The mean post- operative hospital stays were 11.82 and 18.08 days in groups A and B (P=0.0034), respectively. The complication rates of each group showed no statistical difference. However bile peritonitis or bile leakage after T-tube removal developed 5 cases from group B. There were 2 and 5 deaths due to MODS & ARDS, respectively. CONCLUSION: A primary closure, following a choledochotomy, may be a suitable alternative technique to T-tube drainage under reasonable conditions.