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PubMed1981

Canine intestinal intussusception following renal and pancreatic transplantation.

In 138 mongrel dogs given renal transplants, 10 developed postoperative intussusceptions. The sites were jejunojejunal (seven), ileo-ileal (two) and ileocolic (one). In 30 puppies given intrasplenic autografts of dispersed pancreatic fragments after total pancreatectomy, five developed jejunojejunal intussusceptions. Presenting signs included vomiting, failure to eat, periodic attacks of pain, straining with the passage of bloodstained mucous, dehydration, weight loss, abdominal wall rigidity and an abdominal mass. The majority of dogs presented within the first seven days following transplantation, occasionally as late as the third week. Early operative intervention was essential to save the dogs and at laparotomy eight of nine intussusceptions were successfully reduced manually; one small bowel resection was performed for irreducibility. Recurrence was not observed in this series but reoperation in the puppies was invariably fatal. Factors contributing to the development of intussusception in the puppies included round worm infestation, recent dietary change following weaning, malabsorption and diarrhoea due to pancreatic insufficiency following pancreatectomy and respiratory infections suggesting an infective origin for the intussusceptions.

Animals↗

PubMed1992

Childhood intussusception: US-guided hydrostatic reduction.

Over a 30-month period, real-time ultrasound (US) was performed in 116 children with suspected intussusception. US findings were positive in all 75 cases of intussusception. Except in one case of transient small-bowel intussusception, the authors immediately attempted US-guided hydrostatic reduction in all cases. Reduction was successful in 63 cases (85%), as demonstrated with US and resolution of signs and symptoms of intussusception. Negative sonograms were confirmed with clinical follow-up. Among 11 failed cases, reduction with barium enema was attempted in six, but all attempts failed. No complications have occurred to date. The authors conclude that US is a reliable diagnostic screening modality in cases of suspected intussusception and that US-guided hydrostatic reduction is a promising technique in nonoperative treatment.

Child↗

PubMed1994

Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography.

PURPOSE: To assess the diagnostic usefulness of ultrasonography (US) in intussusception in children and determine whether color Doppler sonography (CDS) can indicate bowel viability and help in prediction of reducibility. MATERIALS AND METHODS: US was used to examine 176 children in whom the presence of intussusception was clinically suspected. CDS was performed in 64 patients with 65 cases of intussusception proved with US. RESULTS: The positive US findings were confirmed with air enema; the negative findings, with air enema in 46 patients and clinical follow-up in 66 patients (100% specificity and sensitivity). CDS indicated blood flow in 62 of 65 cases of intussusception; pneumatic reduction was achieved in 58 (94%) of these 62 cases. Four patients (6%) underwent manual reduction of viable bowel; three patients (5%) who had no color Doppler signal underwent segmental resection. The difference in reduction rates based on blood flow was statistically significant (P = .0008). CONCLUSION: US is sensitive and specific in the diagnosis of intussusception, and CDS is a promising predictor of bowel viability.

Air Pressure↗

PubMed1996

Intussusception: trapped peritoneal fluid detected with US--relationship to reducibility and ischemia.

PURPOSE: To determine the frequency and meaning of fluid inside the intussusception at ultrasound (US) and its relationship to irreducibility and ischemia. MATERIALS AND METHODS: US enabled the diagnosis of intussusception in 145 cases. Shape and axial diameters of the area of fluid were determined. US-guided hydrostatic reduction was attempted in 144 cases. RESULTS: Fluid was present in the intussusception in 20 cases (14%) and appeared on axial images as an anechoic crescent between both serosal layers of the enfolded and everted intussusceptum. No cystic structural anomaly was detected at surgery. Rates of reduction were 89% (111 of 125) in cases without fluid and 26% (five of 19) in cases with fluid (P < .001). At surgery, ischemia was absent in all 14 cases without fluid and present in 10 of 20 cases with fluid; necrosis was present in two cases with fluid. Areas of fluid greater than 14 x 5 mm, especially if associated with fluid in the dilated apex of the intussusception, were strongly related to irreducibility and ischemia (odds-likelihood ratio, 67.5). CONCLUSION: Fluid seen inside the intussusception represented trapped peritoneal fluid. Substantial amounts of fluid were associated with irreducibility and ischemia.

Ascitic Fluid↗

PubMed2002

Two unusual cases of adult intussusception.

Adult intussusception is very rare. We report 2 unusual cases, a 58-year-old man with a transverse colo-colonic intussusception caused by a malignant sessile polyp that also had an asymptomatic synchronous neoplasm of the kidney, and an 18-year-old female with an ileocecolic intussusception caused by acute appendicitis. This report stresses the point that intussusception in adults may represent an underlying malignancy. The age of the patient and the anatomic location of the intussusception provide significant input as to the etiology and hence the most appropriate surgical procedure.

Acute Disease↗

PubMed1990

The computed tomographic appearances and clinical significance of intussusception in adults with malignant neoplasms.

The computed tomography (CT) appearances of intussusception in 14 patients and the clinical follow-up of this condition in 17 adults with known primary malignant neoplasms were retrospectively reviewed. The ages of the 11 men and six women ranged from 25 to 83 years. Nine patients had been treated for malignant melanoma and the others for various primary neoplasms. Intussusception on CT was characterized by thickening of the affected bowel segment in all 14 patients and by the presence of intraluminal fat density material in 13, a concentric ring or "target" lesion in four, and an intra-luminal soft-tissue mass in nine. Five patients had intussusception, without other evidence of disease, caused by metastases in three patients, lipoma in one and idiopathic in one. Eleven of the other 12 patients had extensive disease, and one had small bowel cytomegalovirus infection. Five of these patients had more than one site of bowel involvement. Ten of the 12 patients had progression of disease on follow-up CT examinations and six died between 26 days and 7 months after diagnosis of intussusception. Intussusception may occur as the first indication of tumour recurrence or metastasis, but is more commonly a manifestation of widespread disease. However, even in patients with malignant neoplasms, it may be idiopathic or a result of benign neoplasm.

Adult↗

PubMed2001

Intussusception: hospital size and risk of surgery.

OBJECTIVE: To determine whether the risk of operative management of children with intussusception varies by hospital pediatric caseload. DESIGN: A cohort of all children with intussusception in Washington State from 1987 through 1996. SETTING: All hospitals in Washington State. METHODS: Five hundred seventy children with a hospital discharge diagnosis of intussusception were identified. Sixty-two were excluded because of missing data. Procedure codes for operative management and radiologic management were also identified. RESULTS: Fifty-three percent of the children had operative reduction and 20% had resection of bowel. Children with operative reduction did not differ from those with nonoperative care by median age or gender; however, children with operative care were significantly more likely to receive care in hospitals with smaller pediatric caseloads and to have a coexisting condition associated with intussusception. Sixty-four percent of children who received care in a large children's hospital had nonoperative reduction, compared with 36% of children who received care in hospitals with 0 to 3000 annual pediatric admissions and 24% of children who had care in hospitals with 3000 to 10 000 annual pediatric admissions. Median length of stay and charges were significantly less in the large children's hospital, compared with other centers. CONCLUSIONS: Children who received care for intussusception in a large children's hospital had decreased risk of operative care, shorter length of stay, and lower hospital charges compared with children who received care in hospitals with smaller pediatric caseloads.

Child, Preschool↗

PubMed2001

Intussusception, infection, and immunization: summary of a workshop on rotavirus.

This article summarizes the proceedings of a workshop sponsored by the National Institutes of Health and the National Vaccine Program Office, and held in Bethesda, Maryland, on January 21, 2000. The objective of the meeting was to focus research toward an understanding of the basis for the possible association between intussusception and the reassortant rhesus-human rotavirus vaccine tetravalent (RRV-TV). After numerous reports of intussusception after administration of RRV-TV, the manufacturers of this vaccine voluntarily withdrew it from the United States market. The American Academy of Pediatrics, the Advisory Committee on Immunization Practices, and the American Academy of Family Physicians also withdrew their original recommendations for administration of RRV-TV to children at 2, 4, and 6 months of age. These actions will have global implications for the prevention of morbidity and mortality attributable to rotavirus infection. Benefit-cost ratios for the use of RRV-TV will be substantially different in developing countries compared with developed countries. Therefore, extensive research is needed in both of these settings, to further our understanding of the epidemiology, pathogenesis, and pathology of both rotavirus disease and intussusception to enable optimal prevention. The workshop reviewed the current understanding of the possible association between RRV-TV and intussusception, as well as the possible association between a variety of viral infections and intussusception. The workshop also identified critical areas of research regarding this possible association. This research will be essential not only for the development of safe and effective rotavirus vaccines, but for the development of other oral vaccines as well.

Child, Preschool↗

PubMed2003

Postreduction management of intussusception in a children's hospital emergency department.

OBJECTIVE: To evaluate the current management of patients with intussusception who have undergone successful reduction by contrast enema in a tertiary care children's hospital. To compare differences in the incidence of recurrence and adverse events between those patients who were hospitalized after enema reduction and those who were observed in the emergency department (ED). METHODS: This was a retrospective cohort study of children 0 to 18 years of age who underwent uncomplicated enema reduction for intussusception. Hospitalization versus ED observation management were compared for length of stay, incidence of recurrence, and adverse events. RESULTS: One hundred twenty-three children were identified with an International Classification of Diseases, Ninth Revision code for intussusception. Of those, 106 patients (86%) had an enema reduction attempted. Three had a normal enema and were given the diagnosis of "resolved intussusception." Eighty-three (80%) of the patients had a successful reduction. Seventy-eight (94%) of those patients had no preexisting condition and had complete medical records. Of those 78 patients, 27 (35%) were hospitalized and 51 (65%) were observed in the ED. The mean length of hospitalization was 22.7 hours (range: 10-50 hours), and the mean length of ED observation was 7.2 hours (range: 0-21 hours). Eleven recurrences were observed in 8 of these 78 patients (10% recurrence rate). Four patients in the hospitalized group and 4 patients in the ED observation group had recurrences (5 hours-10.9 months). Four of the 8 patients had a recurrence within the first 48 hours. All first recurrences occurred after the patient had been discharged from the hospital or ED observation unit. No adverse events occurred in any of the patients who had a successful initial reduction (95% confidence interval [0%-4.6%]). CONCLUSIONS: The postreduction management of intussusception is variable at our institution. Previously healthy patients who have undergone successful enema reductions are unlikely to have adverse outcomes. Postreduction observation in the ED or the hospital does not seem to affect outcomes in this clinical setting.

Adolescent↗

PubMed1975

Barium findings in retrograde intussusception.

Four instances of antiperistaltic intussusception are presented. These serve to depict the varied roentgen appearances in both types of intussusception on barium study and emphasize two simple interpretational principles: (1) when contrast material is administered orad to an antegrade or caudad to a retrograde intussusception, it must first enter the intussusceptum; and (2) when barium is administered orad to a retrograde or caudad to an antegrade intussusception, it must first enter the intussuscipiens. Attention is also directed to tube related intussusceptions and to potential difficulty in their identification.

Aged↗

PubMed1982

Intussusception on small bowel examinations in children.

Six children in whom an intussusception was diagnosed on a small bowel follow-through examination are presented. The radiographic signs of intussusception on such a study include: (1) a narrow channel of barium representing the compressed lumen of the intussusceptum, (2) a soft-tissue mass on either side of this channel due to hypertrophy and edema of the walls of the intussuceptum and intussuscipiens, (3) a coil spring appearance around the narrow channel, and (4) a mass lesion at the distal end of the narrow channel. Not all of these signs are present in each case. Intussusception is a dynamic process and the value of delayed films and frequent fluoroscopy during small bowel follow-through studies in these cases is stressed. All six cases had a demonstrable lesion as a lead point. Jejunal intussusceptions are usually caused by bening lesions--malignancy being found almost exclusively in distal intussusceptions.

Adolescent↗

PubMed1988

John Caffey Award. Intussusception reduction in children by rectal insufflation of air.

Air was used as the contrast medium for colonic studies in 282 patients with suspected intussusception. Intussusception was documented in 118 of these patients (42%), and reduction was achieved in 89 (75%) of those 118. Twenty-nine patients, in whom the intussusception could not be reduced with air, underwent surgery. Seven of these patients required surgical resection of devitalized bowel. In seven others, the intussusception was reduced by the surgeon with difficulty; in 12, surgical reduction was achieved easily. Three perforations occurred with the use of air. These patients were treated surgically without sequelae. This pilot study of 282 patients suggests that air is a safe substitute for hydrostatic reduction of intussusception.

Administration, Rectal↗

PubMed1996

Distal ileocolic intussusception: another cause of inversion of superior mesenteric vessels in infants.

OBJECTIVE: Inversion of the superior mesenteric vessels is associated with various conditions. The purpose of this study was to prospectively evaluate the position of these vessels in infants with idiopathic ileocolic intussusception. SUBJECTS AND METHODS: Abdominal sonography was performed before and after reduction of ileocolic intussusception in 16 infants. RESULTS: In 14 infants with ileocolic intussusception proximal to the splenic flexure, the relationship of the superior mesenteric vessels was normal (superior mesenteric vein to the right ventral side of superior mesenteric artery). Inversion of the superior mesenteric vessels (superior mesenteric vein to the left of the superior mesenteric artery) was found in two patients with distal ileocolic intussusception (head of the intussusceptum at the sigmoid colon or rectum). After reduction, the relationship of these vessels was normal in all 16 infants. CONCLUSION: Inversion of the superior mesenteric vessels is sometimes caused by distal ileocolic intussusception in infants.

Colon, Sigmoid↗

PubMed2001

Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects.

OBJECTIVE: The aim of this study was to provide measurements for the defecographic diagnosis of rectal intussusception and rectal prolapse. MATERIALS AND METHODS: Four hundred thirty-seven consecutive patients with defecation and micturition disorders and gynecologic complaints were studied by means of defecography (120 patients), colpodefecography (17 patients), or cystocolpodefecography (300 patients). As a control group, 43 asymptomatic subjects underwent defecographic examination. RESULTS: Thirty-five patients were found to have rectal intussusception and 18, to have rectal prolapse. Anterior and posterior rectal wall folding thickness, intussuscipiens diameter, intussusceptum lumen diameter, and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were measured in all patients. The findings were compared with those obtained in 13 of 43 asymptomatic subjects with rectal outline changes mimicking intussusception. Rectal folding thickness and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were significantly greater in subjects with rectal intussusception and rectal prolapse than in asymptomatic subjects with rectal mucosa folding. CONCLUSION: Our findings suggest that dynamic evacuation radiology contributes to making a differential diagnosis between rectal intussusception and mucosal folds in the rectum.

Case-Control Studies↗

PubMed2001

Intussusception during enteral nutrition: a case report.

We report a case of intussusception during enteral nutrition after esophagectomy. The case was a 60-year-old patient who underwent subtotal esophagectomy via the right thoraco-abdominal approach, reconstructed with esophagogastrostomy. He underwent tube feeding through gastrostomy after surgery. The tip of the feeding tube was emplaced in the jejunum. He complained of intermittent abdominal pain and the drainage volume through the gastric decompression tube was increased on the 2nd week from surgery. There was no abnormal finding on abdominal CT or or radiography of the digestive tract, and so a diagnosis of intussusception was made and laparotomy was performed. There was descending intussusception with the jejunum where the feeding tube was emplaced. Enterectomy was not necessary in this case. Adult intussusception is rare. The surgery is sometimes the cause for intussusception. Another cause is use of a long intestinal tube. Since enteral nutrition has priority for nutritional support after esophagectomy, it is important to make an early decision whether surgical intervention is required or not, using abdominal examination by CT, ultrasound and contrast radiography, when bowel obstruction occurs during enteral nutrition through a feeding tube.

Enteral Nutrition↗

PubMed2005

Colonoscopic diagnosis of appendiceal intussusception: a case report.

Intussusception of the appendix is an uncommon condition and the diagnosis is rarely made preoperatively. Intussusception of the appendix may mimic a neoplastic lesion. Colonoscopy is a valuable tool for diagnosis of the appendiceal intussusception. A 17-yr-old female admitted with repeated abdominal pain, nausea, vomiting and febrile sensation. We diagnosed as appendiceal intussusception by colonoscopy, which showed a polypoid tumor (about 1.5 cm) in the cecum. This sessile polypoid mass looks like foreskin or glans. We present colonoscopic finding of appendiceal intussusception and review the literature.

Adolescent↗

PubMed2004

Intussusception in children seen at Muhimbili National Hospital, Dar es Salaam.

OBJECTIVE: To review infants and children with intussusception and assess its magnitude of concern and any seasonal variation in our environment. DESIGN: A retrospective study. SETTING: Muhimbili National Hospital general paediatric and surgical wards from January 2000 to February 2004. METHODOLOGY: The charts of all infants and children up to the age of 10 years diagnosed to have intussusception were reviewed. Demographic factors evaluated included age, incidence in up to one-year olds, sex, month of presentation to assess seasonal variation, clinical features, methods of diagnosis and management, aetiology and any recurrence. RESULTS: Twenty eight children were diagnosed to have intussusception. Sixteen were males and 12 females (M:F=l .3:1). Of these, 21(75%) were infants (up to the age of one year), nine were boys and 12 were girls( M.F=l:1.3). Incidence rate in this age group was approximately 1: 7557. Most cases presented in January-March(39.3%) and July to September(39.3%). No case was seen in the month of April during the 4-year period. Except in 2002, there has been a male preponderance. The aetiology was mainly idiopathic (85.7%), there were three cases suspected to be due to mesenteric adenitis and one case of intraluminal haemangioma. There were two recurrent cases, one was within a week with no known aetiology. All patients presented with vomiting and abdominal pain/distension. Preceding gastro-enteritis was common. The majority of the cases, 17(60.7%) presented with the classic triad of vomiting, rectal bleeding and abdominal pain/distension. Abdominal mass was often difficult to palpate due to gross or tense abdomen and was only palpated in four cases(14.3%). Air or barium reduction is not done at our institution due to apart from lack of facilities, majority of the children present late, >48 hours from the onset of symptoms and diagnosis was mainly based on clinical symptoms and signs of intestinal obstruction and confirmed with presence of multiple fluid levels on a plain erect abdominal X-ray. All children were then managed by surgery, 11(39.3%) underwent bowel resection. Histopathology reports of those available did not show cause of intussusception. Seven patients died postoperatively, hospital mortality of 25%. CONCLUSION: The approximate incidence of intussusception in less than one-year olds is 1:7557 in Dar es Salaam. It is a concern in our environment causing considerable morbidity and mortality due to late presentation and efforts should be made to improve sanitation and hygiene, referring health facilities, socio-economic factors and probably look into ways of preventing the problem occurring. Seasonal variation was seen, most cases(78.6%) presenting in the dry season when there is shortage of water in the city.

Child↗

PubMedDate not supplied

The "Ibadan intussusception"; now a myth? A 10 year review of adult intestinal obstruction in Ibadan, Nigeria.

Caecocolic intussusception was a significant cause of adult intestinal obstruction in Ibadan where it earned itself the appellation "Ibadan Intussusception". Recently, it has been noticed that there is a significant drop in the cases of adult intussusception. A retrospective review of the intra-operative diagnoses of adult patients who presented to the University College Hospital, Ibadan with intestinal obstruction between June 1990 and June 2000 was carried out. The most common cause of adult intestinal obstruction was obstructed groin hernias followed by adhesions. There was a significant paucity of cases of intussusception, hence the paper queries the veracity of the appellation "Ibadan intussusception" in the present day.

Adolescent↗