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PubMed1992

The changing pattern of infantile intussusception in northern Nigeria: a report of 47 cases.

Infantile intussusception is not rare in Africa, but was reported to be relatively uncommon. This retrospective review of 47 infants with the diagnosis of intussusception included 38 boys and nine girls. Surprisingly, the clinical presentation is at variance with previous reports and beliefs about intussusception in tropical Africa, but is similar to those from Europe and North America. Contrary to expectation, about 70% of infants presented with the classical clinical picture of intussusception with the complete features of vomiting, 'colicky abdominal pain', blood mucoid stools and palpable abdominal mass. The other 30% presented with various combinations of the components of the tetrad. The small bowel was the leading point in 30 infants and the colon in 17. Of the small bowel variety, the two main types were the ileo-ileal and the ileocolic, while the ileocaecal and the various types of colo-colic intussusception were of large bowel origin. Morbidity was minimal. There were four deaths. Intussusception in this series differs in many respects from previous experience in Zaria.

Colonic Diseases↗

PubMed1992

Ileal intussusception in 16 young thoroughbreds.

The paper describes the outcome of 16 cases of short-ileal-ileal intussusception in young Thoroughbred horses. The intussusception was often associated with chronic or intermittent low grade abdominal pain. At laparotomy, only the intussusception was reduced in one horse; in another, a myotomy of the thickened stenosed intussusception was carried out after reduction. In 11 cases as ileocaecal bypass anastomosis was performed proximal to the intussusception after its reduction. One horse was subjected to euthanasia during operation because of irreversible intestinal wall damage and another because of intestinal rupture. One foal had a cardiac arrest following reduction of the intussusception. One horse was subjected to euthanasia 4 months post-operatively because of intractable abdominal pain caused by intestinal adhesions. Although several horses suffered episodes of post-operative abdominal pain, and 2 were subjected to a second laparotomy, 12 horses made an eventual complete recovery.

Abdominal Pain↗

PubMed1991

Ultrasonography to diagnose and exclude intussusception in Henoch-Schönlein purpura.

Abdominal pain is a frequent symptom in the child with Henoch-Schönlein purpura and raises the suspicion of intussusception or perforation. One hundred and fifty two children with a diagnosis of Henoch-Schönlein purpura over 11 years were reviewed. Of these 60 had abdominal pain, 19 gastrointestinal bleeding, and nine were suspected intussusception. Intussusception was confirmed in two of these cases with ultrasonography. Ultrasound is an important tool in the early diagnosis of intussusception complicating Henoch-Schönlein purpura. Where the intussusception appears loose an expectant policy, with careful monitoring, may allow spontaneous reduction. It may also be used in monitoring patients for postoperative recurrence of intussusception, mural haematoma, and uncomplicated intestinal vasculitis with oedema.

Child↗

PubMed1976

Intussusception of the appendix in children.

Intussusception of the appendix is uncommon and an unusual cause of ileocolic intussusception. The pediatric age group is most often affected. Appendiceal intussusception may present as primary appendiceal invagination but more commonly leads to secondary intussusception. Two cases of partial appendiceal intussusception leading to secondary intussusception are presented. Classification, symptomatology, radiographic appearance, and differential diagnosis are discussed.

Appendix↗

PubMed1992

[Reevaluation of US and CT findings in adult intussusception].

Computed tomographic (CT) and ultrasonographic (US) findings of 10 adult patients with 11 intussusceptions were retrospectively analyzed. Through close scrutiny of wall structures of intussusceptums and mesenteric fat, new features of adult intussusceptions were found: 1. The returning walls were thicker than the entering walls in 10 of 11 intussusceptums. 2. The neck of the returning wall was thicker than its head in eight of nine intussusceptums. 3. Longitudinal compression of the wall and venous congestion resulting from an inside out turning of the wall structure were thought to be the cause of thickening of the returning wall. 4. Invaginated mesenteric fat tended to be located at the head (apex) in two of seven intussusceptions, making differentiation from intussusception caused by lipoma difficult. 5. The leading masses were detectable as apical soft tissue density masses in eight of 10 intussusceptions. These findings contradict those of previous reports on adult intussusceptions.

Adult↗

PubMed1991

Antiperistaltic and isoperistaltic intussusception associated with abnormal motility after Roux-en-Y gastric bypass: a case report.

Antiperistaltic and recurrent intussusceptions are extremely rare in the adult. We report a patient with both. The patient developed an antiperistaltic intussusception distal to her Roux enteroenterostomy years after a Roux-en-Y gastric bypass for morbid obesity. The diagnosis was made preoperatively with gastrointestinal contrast radiography and ultrasonography. At surgery, the intussusception was reduced, and 12 inches of nonviable bowel was resected, with a functional end-to-end anastomosis. An isoperistaltic intussusception occurred in the early postoperative period just distal to the anastomosis. Manometric evaluation of the Roux limb after the second operation showed altered gastrointestinal motility, consisting of orad-propagated and aboard-propagated migrating motor complexes, minimal phase 2 activity, and lack of conversion to the fed pattern with a liquid meal. Although manometry was not performed before the development of the intussusception, our findings are consistent with the hypothesis that altered intestinal motility may contribute to the development of intussusception.

Adult↗

PubMed1990

Intussusception: is floating caecum a causative factor? Analysis of 10 cases.

Ten consecutive cases of intussusceptions treated by the authors at the University of Port Harcourt Teaching Hospital (UPTH) in a five year period are analysed. The median age of occurrence was nine months; average 5.2 years; range: one month to 25 years. The male to female ratio was 2:3. Five patients had ileocaecal, two ileoileal, two colocolic and one ileocolic intussusceptions. Of the two patients with ileoileal intussusceptions one had antegrade with Meckel's diverticulum and the other retrograde with lipoma as lead-points. The two patients with colocolic intussusceptions had mesenteric and mesocolic lymph nodes hypertrophy. The remaining six patients had freely mobile caecum anchored to the posterior peritoneum by a long mesocaecum and such arrangement was believed to be the cause of the intussusceptions. In addition to intraoperative reduction in five cases and resection with end to end ileoileal anastomosis in one, each of these six patients had the caecum fixed to the posterior abdominal wall to prevent recurrence of the intussusception.

Adolescent↗

PubMed1978

Colonic intussusceptions in children.

There is a high incidence of primary colonic intussusceptions in infants and children in Africa. The case histories of 37 patients are reviewed. Of the varieties described, the caecocolic intussusception (16 patients) presents as an intestinal upset, often mild, with symptoms of colic and vomiting. In many of these patients there is known to be an intestinal infestation with Ascaris lumbricoides. This often leads to a delay in establishing the correct diagnosis. Colocolic intussusception (13 patients) gives rise to more acute abdominal symptoms. On clinical assessment, signs of intestinal obstruction are found and there is usually an intra-abdominal mass which can be palpated in the left colon. Further confirmatory evidence of intussusception is the finding of occult blood in stools. There is an unusually high incidence of sigmoid intussusceptions in infants (8 patients). The diagnosis of this form of intussusception is often delayed owing to inadequate clinical assessment of prolapsed bowel at the anal orifice. The length of the prolapsed bowel, the curved nature of the prolapse and the possible demonstration of a sulcus between the prolapsed bowel and the anal canal wall, aid in diagnosis.

Cecal Diseases↗

PubMedDate not supplied

Radionuclide imaging of bowel infarction complicating small bowel intussusception in dogs.

Technetium-99m (99mTc)-pyrophosphate was investigated for use as an indicator of intestinal infarction in intussuscepted bowel. Irreducible intussusceptions were created in eight adult mongrel dogs. Technetium-99m-pyrophosphate was then injected intravenously 24 and 48 hrs later for external scanning. In six of the dogs, infarction developed in the intussusception, and each demonstrated increased uptake of 99mTc-pyrophosphate on in vivo scintiscans. The two dogs without infarction showed no increase uptake of the radionuclide. Well-counting and specimen scanning confirmed increased radionuclide in the infarcted intussusceptions. These observations suggest that 99mTc-pyrophosphate is a reliable indicator of the vascular compromise that sometimes occurs with intestinal intussusception.

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↗

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↗

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↗

PubMed1992

[Primary colonic intussusception protruding from the anus in adults. Two cases].

The authors report two cases of colonic intussusception in the adult protruding from the anus--or colon-anal intussusception--, not due to a tumor. The first case was a chronic ileo-caeco-colique intussusception, the second case was an acute colo-rectal intussusception. Colo-anal intussusceptions are very rare: less than twenty cases have been described since 1925 in adults. The absence of a tumor origin in our cases represents a special feature, as only three other similar cases have been described. The surgical treatment in both cases was primary colonic resection without colostomy. The surgical treatment of the first case was subtotal colectomy with ileo-rectal anastomosis. The second case was primarily reduced by barium enema which allowed optimal secondary surgical resection of a prepared colon.

Adolescent↗

PubMed1992

[Primary colonic intussusception protruding from the anus in adults. Two cases].

The authors report two cases of colonic intussusception in the adult protruding from the anus--or colo-anal intussusception--, not due to a tumor. The first case was a chronic ileo-caeco-colique intussusception, the second case was an acute colo-rectal intussusception. Colo-anal intussusceptions are very rare: less than twenty cases have been described since 1925 in adults. The absence of a tumor origin in our cases represents a special feature, as only three other similar cases have been described. The surgical treatment in both cases was primary colonic resection without colostomy. The surgical treatment of the first case was subtotal colectomy with ileo-rectal anastomosis. The second case was primarily reduced by barium enema which allowed optimal secondary surgical resection of a prepared colon.

Acute Disease↗

PubMed1990

Colocolic intussusception in a three-year-old child caused by a colonic polyp.

Colocolic intussusception is an uncommon cause of pediatric intestinal obstruction in North America; 95% of cases are ileocolic in location, with an equal percentage in which no pathologic lead point is evident on barium enema or laparotomy. In the last 20 years less than 3% of approximately 32,500 reported cases of intussusception originated in the colon. In a significant number of these cases juvenile polyps were identified as leading points. The majority of juvenile polyps occur in the rectosigmoid colon within the reach of a standard pediatric sigmoidoscope. These tumors most often cause painless hematochezia. Occasionally, juvenile polyps may grow large and serve as lead points for colocolic intussusception when located in the proximal colon. Pediatric patients presenting with documented colocolic intussusception should suggest the possibility of a colonic polyp or other mass lesion. Careful physical examination and barium studies should provide important diagnostic clues. Treatment is aimed at removing the lead point in patients presenting with intestinal obstruction. Colonoscopic polypectomy performed by an experienced endoscopist may serve as an alternative to surgical removal of the polyp. We report a case in a three-old-child of colocolic intussusception caused by a colonic polyp, and review some of the salient features of this clinical entity.

Child, Preschool↗

PubMed1990

[Ileocolic intussusception in a recurrent non-Hodgkin's lymphoma; report of a case].

The adult intussusception is rare. Here, we describe a case of an adult patient with ileocolic intussusception secondary to a recurrent lymphoma of the terminal ileum. The patient was a 42-year-old female, who had a history of the subtotal gastrectomy because of the primary gastric lymphoma. Eight months after the operation, she had a relapse in the abdomen and received the combination chemotherapy. She acquired the complete remission, but six months after the completion of the chemotherapy, she suffered from the right lower abdominal pain and diarrhea. Physical examination revealed a soft mass with tenderness in the right iliac fossa. Barium studies and abdominal computed tomography showed an ileocolic intussusception. At laparotomy, a 4.5 cm polypoid tumor was found in the terminal ileum and it passed through the ileocaecal valve to form an intussusception. Histologic examination disclosed the follicular lymphoma of medium-sized cell type. So far as we are aware, this is the first report of an adult patient with intussusception secondary to a lymphoma in Japan.

Adult↗

PubMed1991

Are hydrostatic and pneumatic methods of intussusception reduction comparable?

The hydrostatic pressures and flow rates of barium sulphate and water soluble contrast in concentrations representative of those used for intussusception reduction were measured. The change of height with discharge of fluid from the filled kit was also assessed. A group of experienced paediatric radiologists and radiographers significantly underestimated the height to which contrast should be placed for intussusception reduction. The results indicate that baseline hydrostatic reduction pressures tend to be less and maximum pressures significantly less than those presently advocated for pneumatic reduction. This disparity may account for the apparent improvement in intussusception reduction rates reported for air enema when compared with barium enema. Intraluminal pressure monitoring during contrast enema would aid control of intussusception reduction but hydrostatic reduction would still be at a disadvantage because of lower flow rates. Where hydrostatic reduction is performed, the contrast density and height used should be set to give known pressure, according to local guidelines.

Barium Sulfate↗

PubMed1990

Documentation of spontaneous reduction of childhood intussusception by ultrasound.

Spontaneous reduction of a presumed ileo-colonic intussusception was demonstrated by ultrasound examination followed by a barium enema. No premedication or anesthetic had been given to the child. This case illustrates the possible natural history of intussusception rarely confirmed by imaging studies. Intussusception is the most common abdominal emergency of early childhood. Diagnosis and therapy is usually performed with a contrast enema. If unsuccessful, surgical reduction is indicated. We wish to report a case of spontaneous reduction of a presumed ileocolonic intussusception. This was initially diagnosed by ultrasound examination, but had spontaneously reduced by the time a barium enema was performed.

Humans↗