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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↗

PubMed1990

Simple device for air reduction of intussusception.

A new device has been developed for pneumatic reduction of childhood intussusception. The device consists of a reusable, hand-held pressure gauge and insufflator connected to a disposable enema tip and tubing system. The assembled device permits one-handed operation which maximizes operator control of the air reduction procedure. The system has been used to evaluate 50 cases of suspected intussusception. Reduction was successful in 19 of 22 confirmed intussusceptions. This device provides a practical, simple and safe method for diagnosis and treatment of intussusception.

Air Pressure↗

PubMed1976

Intussusception in the older child- suspect lymphosarcoma.

Examination of the records of 378 children with intussusception at our institution revealed that 29 cases were caused by an identifiable intestinal lesion. A Meckel's diverticulum was the causative agent in 21 children, all of whom were under 2 yr of age. A previously undiagnosed ileal lymphosarcoma produced the intussusception in six other children, all between 6 1/2 and 9 yr of age. Our experience indicates that any child over 6 yr of age with the clinical findings of colicky abdominal pain, bloody stools, and a palpable mass plus the radiographic evidence of intussusception must be considered to have ileal lymphosarcoma until proven otherwise. Hydrostatic reduction of the intussusception must be accompanied by extensive small bowel reflux of barium in order to effectively rule out a small intestinal lesion. If this is not accomplished, surgery should be planned with the suspicion that a malignancy may be present. If this suspicion is confirmed by frozen section, the operation procedure should include wide surgical excision of the lesion along with the regional lymph nodes.

Child↗

PubMed1977

Nonischemic intussusception.

Nonischemic intussusception is defined as a variant of acute intussusception exhibiting less acute symptoms of abdominal pain, vomiting, and diarrhea in the older child, longer duration of symptoms (usually 4-14 days), signs of imcomplete bowel obstruction, and absence of intestinal ischemia. Over a 10 yr period (1964-1973) 20 children with this disease were treated without mortality or recurrence at three children's hospitals in Chicago, Illinois. The higher incidence of diarrhea, the lower incidence of a palpable abdominal mass, and the lower incidence of blood per rectum in nonischemic intussusception predispose to diagnostic errors and delays in treatment. Despite the longer duration of symptoms, this variant of intussusception can be treated initially with a careful attempt at barium hydrostatic reduction. If this fails, easy operative manual reduction is the rule.

Acute Disease↗

PubMed1990

Progression of intussusception.

The position of the apex in intussusception indirectly reflects the length of the intussusceptum in the majority of cases in which the intussusception begins in the region of the terminal ileum. The relationship of the apex to the duration of symptoms and the ease of enema reduction suggests that progression of intussusception occurs rapidly after the onset of symptoms and is normally complete by the time the patient presents to hospital. Further increase in length of the intussusception is probably limited by progressive edema of the intussusceptum and by the length of small bowel mesentery available to it. The position of the apex per se is not a contraindication to attempted enema reduction, although once the apex has reached the rectosigmoid region successful enema reduction is less likely.

Barium Sulfate↗

PubMed1979

Glucagon in experimental intussusception.

A standard type of ileocolic intussusception was produced in 69 puppies and the effect of glucagon on the hydrostatic reduction of the intussusceptions evaluated in a prospective, double-blind study. The reductions were attempted at intervals varying from 18 to 60 hr following the production of the intussusceptions. The overall reduction rate was 70% and there was no statistical difference in this rate between the animals receiving glucagon and those receiving placebos. None of the gangrenous intussusceptions were reducible with the hydrostatic pressure technique, irrespective of whether glucagon was used or not. A further evaluation was made of those animals in whom successful reductions were accomplished by the hydrostatic pressure method. Glucagon did result in significantly easier reductions, and an earlier return of normal vascular supply as measured by color and by arterial pulsations as compared to the control group.

Animals↗

PubMed1990

Intussusception complicated by bowel perforation during hydrostatic reduction.

Most perforations of the bowel during attempt at hydrostatic reduction of intussusception occur in an area of localised infarction in the normal transverse or left colon. An animal model of intussusception was used to find indications for the cause of this phenomenon. We submitted the intussuscipiens of 10 strangulated intussusceptions in 6 dogs to a histological examination. In 6 of 10 intussusceptions we found ischaemic changes in the mucosa of the intussuscipiens. In 3 cases these lesions were multiple. All lesions were found in locations where there was a close contact between the intussusceptum and the intussuscipiens. We did not find signs of impaired circulation of the whole intussuscipiens. We conclude that our findings give an indication that perforation of the intussuscipiens during attempt at hydrostatic reduction occurs through areas of localised ischaemic infarction on the basis of direct pressure by the intussusceptum.

Animals↗

PubMed1989

Idiopathic postoperative intussusception.

During the last 11 years idiopathic postoperative intussusception developed in ten children. The incidence was 5.5% of all the intussusceptions. The age ranged from three months to ten years and the interval between two surgical procedures differed from three to eight days. Only one of the patients presented the classical signs of intussusception. In nine of them, the obstructions were in the small bowel. Nine of the ten intussusceptions needed simple manual reduction. Postoperative recovery was uneventful.

Child↗

PubMed1987

Intussusception in a premature infant simulating necrotising enterocolitis.

Intussusception in older infants is manifested by bloody stools, colicky abdominal pain and a palpable abdominal mass. In neonates the symptoms are often restricted to vomiting, guaiac positive stools and abdominal distension. These symptoms closely mimic necrotising enterocolitis. Surgical treatment of necrotising enterocolitis should be postponed until perforation of the gastrointestinal tract has occurred, whereas, prompt surgical treatment is recommended for intussusception. We report a case of intussusception that simulated necrotising enterocolitis in a 740 grammes premature infant in the second week of life. The clinical and radiographic features are described and the difficulty in distinction between the two conditions is emphasised. Neonatologists and paediatric surgeons should always include intussusception in the differential diagnosis of abdominal distension and guaiac positive stools in small premature infants.

Diagnosis, Differential↗

PubMed1990

Intussusception in the Syrian golden hamster.

Of a series of ninety-six young male Syrian Golden hamsters, 13% developed lethargy, anorexia, diarrhoea and colocolic intussusception when their diet was changed from a basal laboratory-grade rodent chow to a nutritionally complete semi-purified diet. Histologically, the colon of the hamsters with intussusception had markedly reduced mucus production. Plasma levels of gastric inhibitory polypeptide (GIP) were reduced 80% (P less than 0.01) but peptide tyrosine/tyrosine and enteroglucagon in plasma were increased 290 and 526% respectively in hamsters with intussusception. Variations in dietary fatty acid composition had no effect but intussusception was not observed after changing the dietary carbohydrate from sucrose to starch.

Animals↗

PubMed1988

Intussusception. A case that suggests a new cardinal symptom--lethargy.

Intussusception is an uncommon condition, but it is the most frequent cause of bowel obstruction in infants and children aged 3 months to 5 years. If undiagnosed, it can result in bowel necrosis, perforation, and even death. Four cardinal signs and symptoms (abdominal pain, rectal bleeding, vomiting, and abdominal mass) are described in patients with intussusception, but these manifestations are not always present and their absence may lead to misdiagnosis. Lethargy might be considered a fifth cardinal symptom. As demonstrated in this case, lethargy may be a significant presenting feature in an infant with no history of abdominal pain, and in association with the other cardinal symptoms, it may be an early indication of a significant illness such as intussusception. Awareness of this association may result in an earlier diagnosis and an improved outcome in patients with intussusception.

Female↗

PubMed1987

Intussusception in infants and older children: a comparison.

The clinical features and operative findings in 37 infants and 29 older children with intussusception seen over a 10-year period were compared and contrasted. While most of the children presented acutely, 28% of older children had chronic intussusception compared with 5% in infants. Only about a third of all children had the four classical features of abdominal pain, vomiting, abdominal mass and bloody stool; the rest had two or three of the above features. Pain and palpable abdominal mass were more common features in older children while abdominal distension, constipation and diarrhoea were more prominent in infants. Fifty-four per cent of intussusceptions in infants were entero-colic while in older children 69% were colonic. All the intussusceptions in infants were idiopathic while in 14% of older children there were predisposing causes. Resection for gangrene/perforation was required in 30% of infants compared with 7% of older children.

Adolescent↗

PubMed1991

Duodenojejunal intussusception secondary to hamartomatous polyp of Brunner's glands.

A case of duodenojejunal intussusception secondary to a large hamartomatous polyp of Brunner's glands was reported in a 15-year-old girl. Despite a great preponderance of ileocolic intussusception in childhood, this is the first reported case of duodenojejunal intussusception occurring in that age group. The diagnosis was not made by clinical examination; complete duodenal obstruction was shown in upper gastrointestinal series and by endoscopy. The intussusception was reduced manually at laparotomy, and the polyp was excised. Pathological examination revealed a preponderance of normal-appearing Brunner's glands in the tumor, consistent with the diagnosis of Brunner's gland hamartoma.

Adolescent↗

PubMed1992

The role of abdominal x-rays in the diagnosis and management of intussusception.

The management of intussusception requires early diagnosis and reduction with either barium enema or surgical intervention. Supine and erect abdominal radiographs are often obtained prior to ordering a barium enema. In many pediatric centers, the critical, initial interpretation of these radiographs is made by nonradiologists and, in most instances, by pediatric emergency physicians. We determined the sensitivity and specificity of abdominal radiographs in diagnosing intussusception when interpreted by these physicians. Six full-time pediatric emergency physicians evaluated 126 radiographs from 42 patients with intussusception, 42 in whom the disease was clinically suspected but ruled out, and 42 in whom the final radiology report was "normal." These were presented to pediatric emergency physicians in a blinded, randomized sequence without any additional clinical information. These physicians then identified patients for whom they would proceed to barium enema. The mean sensitivity was 80.5% (range, 71-93%), and the mean specificity was 58% (range, 48-69%). This compares favorably to the sensitivity of signs and symptoms, and we conclude that plain and upright abdominal films are a useful adjunct for the clinician evaluating patients for suspected intussusception.

Barium Sulfate↗

PubMed1991

Postoperative intussusception: increasing frequency or increasing awareness?

Postoperative intussusception in children is a rare but well recognized phenomenon. The diagnosis is often delayed due to the protean manifestations of the disorder (ileus, distention, and nausea and vomiting) which, when encountered shortly after an abdominal operation, usually result in a low index of suspicion because they are common after laparotomy. Experience with two cases of postoperative intussusception within 24 hours heightened our index of suspicion. Review of our records indicated we had diagnosed and treated postoperative intussusception in 14 children during the preceding 4 years. Patient ages ranged from 4 months to 12 years (mean 39 months, median 20 months), and symptoms appeared on postoperative days 3 to 36 (mean 10 days, median 6 days). Initial operations included excision of a retroperitoneal or abdominal tumor (five cases), Nissen fundoplication and gastrostomy (three), ileal resection (two), Ladd procedure (one), Duhamel operation (one), and operative reduction of ileocolic intussusception (the two most recent cases). Eleven patients had appendectomy (five by the inversion technique), and three had placement of a transgastric small bowel feeding tube. Nine children had had either barium enema or upper gastrointestinal studies because of the postoperative suspicion of obstruction; one patient had both. Diagnostic studies were not done in four patients. Operative reduction was successful in all but one child, who required bowel resection.

Child↗

PubMed1991

Ultrasound of intussusception with lead points.

Ultrasonography of 4 cases of intussusception in children with proven lead points were reviewed retrospectively. The lead points were due to lymphosarcoma, inverted Meckel's diverticulum, jejunal polyps and an inverted appendiceal stump. The lead points form a complex mass in the centre of the intussusception in both transverse and longitudinal sections, distinct from primary intussusception. The presence of such ultrasonographic findings are suggestive of secondary intussusception with a lead point and surgical reduction rather than hydrostatic reduction should be considered.

Child↗

PubMed1976

Tropical intussusception in adults.

In contrast with the incidence in Britain and the United States, about 50% of intussusceptions in Sri Lanka occur in adults, the maximum age incidence being in the fourth decade. Seventy-six cases of intussusception in adults are analysed in this paper, 62 of which were of the caecocolic type, which though only rarely described in the West, have also been frequently reported from other tropical countries. The clinical picture was characteristic, and a mass was palpable in 90% of the patients, facilitating diagnosis without ancillary investigations. On the basis of the histological examination of resected specimens it is concluded that amoebic granulomatous formation in the dependent "diverticulum" of the caecum is the predisposing cause of the caecocolic intussusception, accounting for the chronicity of a large number of cases. Irrespective of the duration of the illness, gangrene did not occur in any of the cases if this type, although resection was occasionally required on account of irreducibility. In view of the proliferation of fibrous tissue in the wall of the caecum, complete evagination of the intussusception can only be achieved by surgical exploration and manipulation, the results of which are excellent.

Adolescent↗

PubMed1989

Jejunogastric intussusception: therapeutic options.

Acute jejunogastric intussusception is a rare complication of gastric surgery. It presents considerable difficulties in diagnosis unless the index of suspicion is high. Four cases of acute retrograde jejunogastric intussusception are reported. They were managed surgically after diagnosis had been confirmed by upper gastrointestinal contrast studies. In situ resection of the distal portion of gangrenous intussusceptum was performed in one case, while the intussusception could be reduced manually in the other three cases. The importance of early diagnosis in preventing avoidable morbidity and mortality has been stressed. In situ resection is recommended as the method of choice for the management of irreducible, gangrenous intussusception.

Adult↗