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PubMed1989

Gas reduction of intussusception.

Efforts to improve the non-surgical management of childhood intussusception centre around (a) reassessment of selection criteria used to ensure as many children as possible have the advantage of hydrostatic reduction, and (b) improvements and modifications of enema technique to ensure successful and safe reductions without increased morbidity. Reports that pneumatic reduction was highly successful in treating childhood intussusception prompted the authors to evaluate this technique over an 18 month period using our previously reported technique of oxygen at 2 litres/minute and a pressure of 80 mm Hg. Pneumatic reduction was attempted in 114 of 129 consecutive cases of intussusception, and was successful in 85 (75%). Fifteen patients (8.6%) were considered unacceptable risks for gas reduction using our current selection criteria and had primary surgery. The overall success rate considering all cases of intussusception managed at our institution over this period was 66% (85/129). As with any form of hydrostatic reduction, pneumatic reduction of intussusception requires careful selection of patients, meticulous technique, and awareness of complications and their appropriate management. Because of its simplicity and improved success rate, pneumatic reduction has replaced traditional barium reduction at our institution. It may be that with further evaluation of selection criteria, higher pressures, and prolonged attempts that results will improve further.

Barium Sulfate↗

PubMed1986

Intussusception due to lymphoma.

Over 1,200 infants and children with an intussusception were treated at our hospital over the last 40 years and from this group, only 11 were found to have a lymphoma as a leading point for the intussusception. This number represents 17% of the 65 pathologic lesions that have caused an intussusception. Three children were under 41/2 years of age. All the children except two were chronically ill with pain for at least 1 week and usually for several months; weight loss and an abdominal mass in many instances provided the suspicion of a possible malignancy. When barium studies were done, there was almost always an ileocolic intussusception present with some obstruction. Reduction of the intussusception was accomplished with hydrostatic barium enema in 10 of the 11 patients; the one reduction, however, had a residual filling defect. Surgery confirmed the above findings and a resection of the leading point lymphoma was carried out in all of the children. In spite of all forms of treatment, death followed in all but three, usually within several months. One of these three survivors was treated with radiotherapy and steroids (after surgical excision) and is alive after 30 years; the second was also given chemotherapy and is alive and well after 6 years, and the third has not had radiotherapy and is alive after 10 months.

Child↗

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↗

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↗

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↗

PubMed1989

Prevention of postoperative intestinal intussusception by prophylactic morphine administration in dogs used for organ transplantation research.

In this report 149 kidney transplants were performed as part of experiments on renal perfusion preservation, and the effect of morphine treatment on the incidence of postoperative intussusception was concurrently evaluated. Intestinal intussusception developed in 17% (14 of 83 dogs transplanted) of untreated dogs after transplantation. Intraoperative intravenous administration of morphine (0.5 mg/kg) resulted in a reduction in the rate of intussusception to 3.3% (2 of 61 dogs transplanted). Postoperative administration of morphine was ineffective in reducing the incidence of intussusception. The results indicate that intraoperative administration of morphine is effective in preventing postoperative intussusception in dogs used for experimental transplantation and may reduce animal losses and research costs in experimental surgical laboratories.

Animals↗

PubMed1989

Intussusception revisited: clinicopathologic analysis of 261 cases, with emphasis on pathogenesis.

In the ten-year period from 1978 through 1987, 261 patients with intussusception were admitted to Chang Gung Memorial Hospital. The diagnosis was established by barium enema or at laparotomy. The patients were divided into two groups; there were 228 children ranging in age from 1 month to 14 years, and 33 adults. Among the children, 134 (59%) were male and 94 (41%) were female, a ratio of 1.4:1. There was no clear seasonal incidence. The age group most commonly affected was between 3 and 11 months of age (72.4%). The classic triad of abdominal pain, vomiting, and rectal bleeding was encountered in 187 cases (82%). Two hundred one cases (88%) were idiopathic, without any definite leading point. In these cases, the ileocecal area was the site most commonly involved (82%), hypertrophic Peyer's patches of the terminal ileum being responsible for 39% of the idiopathic intussusceptions in the ileocolic area. Enlargement of the mesenteric lymph nodes occurred in 67 of the idiopathic cases (33%). Local pathology or the leading point precipitating intussusception was found in 27 cases (12%); there were eight benign tumors, six malignant tumors, and 13 tumor-like lesions. In 32 of the 33 cases in adults, there was a definite contributing pathologic entity, including 18 benign tumors, 11 malignant tumors, and three tumor-like lesions. In infants and young children, there is usually no apparent predisposing disease, and a contributing or causative local pathologic lesion is seldom found. In contrast, intussusception in adults is almost invariably caused by some preexisting lesion involving the bowel wall. Furthermore, trauma, lymphoid hyperplasia, pregnancy, and viral infection may be possible predisposing factors in the production of intussusception.

Adolescent↗

PubMed1988

[Usefulness of echography in the diagnosis of intestinal intussusception].

The usefulness of echography in the diagnosis and tracing down of an intestinal intussusception is discussed. An abdominal ecograph was done in 29 children with suspected intestinal intussusception. In 31 cases (63%) the diagnosis was confirmed by the typical "target" image. In 17 cases (34%) the picture of intussusception was not detected, all children evolved favourably except for one case which, upon revision of the ecograph, showed the "target" picture not properly interpreted in the first place. We find the abdominal ecograph a useful means for diagnosis of intestinal intussusception. We present the diagnostic-therapeutic routine in our centre in cases of possible intestinal intussusception.

Child↗

PubMed1985

Small bowel tumours causing intussusception in childhood.

In a series of 292 children with intussusception ten (3.5 per cent) were caused by small bowel tumours. The average age of these patients was greater than in idiopathic cases; seven of the ten being older than 2 years. Intussusception due to Peutz-Jeghers hamartomas was jejunojejunal whereas other small bowel tumours causing intussusception were in the terminal ileum. The majority of these intussusceptions were either irreducible or gangrenous and all required resection of bowel. There was only one death in the entire series of 292 patients, and this was a child with lymphosarcoma.

Child↗

PubMed1989

Chronic intussusception in children.

Nine children presented with intussusception lasting for 14 days or more. Their mean age was 8.5 years. Diagnosis of intussusception was delayed considerably, probably due to an unusual presentation. Compared with acute intussusception, symptoms consist of infrequent attacks of abdominal pain, sporadic vomiting and no, or small, changes in defecation. Marked weight loss and an abdominal mass assume diagnostic significance, in contradiction to bloody stools. Ultrasonography can be of diagnostic value. An attempt at hydrostatic reduction is often unsuccessful. A high frequency of organic lesions precipitating intussusception warrants early surgical intervention.

Adolescent↗

PubMed1986

Proximal jejunal intussusception associated with a long tube.

An intussusception of the small intestine in association with a long tube usually occurs in the vicinity of the mercury-filled bag and can be visualized radiographically by instilling barium directly into the tube. On rare occasions, an intussusception develops in the proximal jejunum and is difficult to recognize. We report the fifth and sixth cases of a proximal jejunal intussusception with a long tube in situ and outline a clinical approach that facilitates a prompt, accurate diagnosis. A proximal jejunal intussusception should be suspected if copious bilious vomiting and abdominal pain occur following intubation of the small intestine with a long tube.

Female↗

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↗