RESUMEN
Intestinal mantle cell lymphoma complicated with intussusception is rare in clinical practice,lacking specific clinical manifestations.CT and colonoscopy are helpful for the diagnosis of this disease,which need to be distinguished from colorectal cancer,Crohn's disease,and other pathological subtypes of lymphoma.The diagnosis still needs to be confirmed by pathological examination.This paper reports a case of intestinal mantle cell lymphoma complicated with ileocecal intussusception in an adult,aiming to improve the clinical and imaging doctors' understanding of this disease.
Asunto(s)
Enfermedades del Íleon , Intususcepción , Linfoma de Células del Manto , Humanos , Linfoma de Células del Manto/complicaciones , Intususcepción/etiología , Intususcepción/diagnóstico por imagen , Intususcepción/complicaciones , Masculino , Enfermedades del Íleon/etiología , Enfermedades del Íleon/complicaciones , Enfermedades del Íleon/diagnóstico por imagen , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/patología , Neoplasias Intestinales/diagnóstico por imagen , Persona de Mediana Edad , Válvula Ileocecal/diagnóstico por imagen , Válvula Ileocecal/patologíaRESUMEN
BACKGROUND: Image-guided reduction of intussusception is considered a radiologic urgency requiring 24-h radiologist and technologist availability. OBJECTIVE: To assess whether a delay of 6-12 h between US diagnosis and fluoroscopic reduction of ileocolic intussusception affects the success frequency of fluoroscopic reduction. MATERIALS AND METHODS: Retrospective review of 0-5-year-olds undergoing fluoroscopic reduction for ileocolic intussusception from 2013 to 2023. Exclusions were small bowel intussusception, self-reduced intussusception, first fluoroscopic reduction attempt>12 h after US, prior bowel surgery, inpatient status, and patient transferred for recurrent intussusception. Data collected included demographics, symptoms, air/contrast enema selection, radiation dose, reduction failure, 48-h recurrence, surgery, length of stay, and complications. Comparisons between<6-h and 6-12-h delays after ultrasound diagnosis were made using chi-square, Fisher's exact test, and Mann-Whitney U tests (P< 0.05 considered significant). RESULTS: Of 438 included patients, 387 (88.4%) were reduced in <6 h (median age 1.4 years) and 51 (11.7%) were reduced between 6 and 12 h (median age 2.05 years), with median reduction times of 1:42 and 7:07 h, respectively. There were no significant differences between the groups for reduction success (<6 h 87.3% vs. 6-12 h 94.1%; P-value = 0.16), need for surgery (<6 h 11.1% vs. 6-12 h 3.9%; P-value=0.112), recurrence of intussusception within 48 h after reduction (<6 h 9.3% vs. 6-12 h 15.7%; P-value=0.154), or length of hospitalization (<6 h 21:07 h vs. 6-12 h 20:03 h; P-value=0.662). CONCLUSION: A delay of 6-12 h between diagnosis and fluoroscopic reduction of ileocolic intussusception is not associated with reduced fluoroscopic reduction success, need for surgical intervention after attempted reduction, recurrence of intussusception following successful reduction, or hospitalization duration after reduction.
Asunto(s)
Enfermedades del Íleon , Intususcepción , Humanos , Fluoroscopía , Intususcepción/diagnóstico por imagen , Intususcepción/terapia , Femenino , Masculino , Estudios Retrospectivos , Preescolar , Enfermedades del Íleon/diagnóstico por imagen , Lactante , Resultado del Tratamiento , Recién Nacido , Tiempo de Tratamiento , Ultrasonografía/métodos , Factores de TiempoAsunto(s)
Enfermedades del Íleon , Intususcepción , Humanos , Masculino , Enfermedades del Íleon/complicaciones , Enfermedades del Íleon/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Intususcepción/complicaciones , Intususcepción/diagnóstico por imagen , Preescolar , Recien Nacido Prematuro , Ultrasonografía , Remisión Espontánea , Dolor Abdominal/etiología , Náusea/etiología , Vómitos/etiologíaAsunto(s)
Neoplasias del Íleon , Intususcepción , Humanos , Intususcepción/cirugía , Intususcepción/etiología , Intususcepción/diagnóstico por imagen , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Enfermedades del Íleon/cirugía , Enfermedades del Íleon/etiología , Enfermedades del Íleon/diagnóstico por imagen , Femenino , MasculinoRESUMEN
A 47-year-old woman was referred to our hospital with recurring lower abdominal pain persisting for more than 2 weeks. Imaging modalities showed small bowel obstruction caused by a mass lesion in the terminal ileum. Despite undergoing fasting, rehydration, and decompression through an ileus tube, her symptoms persisted. Furthermore, the condition deteriorated on day 4, with the onset of her menstrual period. An emergency surgery was conducted on the 7th day after hospitalization. Surgical observations indicated severe stenosis around the ileocecal valve and ileal perforation approximately 40cm from the oral stricture. As a result, ileocecal resection was performed. Pathological examination revealed endometrial tissue infiltration through the mucosal lamina propria to the ileal subserosa. Thus, the patient was identified with intestinal endometriosis of the ileocecum. Endometriosis of the small bowel is an uncommon condition that eventually causes intractable bowel obstruction. Although preoperative diagnosis is considered challenging, intestinal endometriosis should be included in the differential diagnosis in cases of bowel obstruction in women of childbearing age.
Asunto(s)
Endometriosis , Enfermedades del Íleon , Obstrucción Intestinal , Perforación Intestinal , Humanos , Femenino , Endometriosis/complicaciones , Persona de Mediana Edad , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Perforación Intestinal/etiología , Perforación Intestinal/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Enfermedades del Íleon/diagnóstico por imagenAsunto(s)
Divertículo , Enfermedades del Íleon , Intususcepción , Divertículo Ileal , Adulto , Humanos , Intususcepción/etiología , Intususcepción/cirugía , Divertículo Ileal/complicaciones , Divertículo Ileal/diagnóstico por imagen , Divertículo Ileal/cirugía , Divertículo/complicaciones , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugíaRESUMEN
BACKGROUND: In children with ileocolic intussusception, sedatives such as midazolam, ketamine and propofol may facilitate radiologic enema reduction, but studies on their separate and joint effects remain controversial. OBJECTIVES: We aimed to systematically analyze studies for the effects of sedatives on the radiologic reduction of ileocolic intussusception in children. METHODS: We searched PubMed, EMBASE, CINAHL, Scopus and Web of Science from database inception through March 2023 for articles that enrolled children with ileocolic intussusception who underwent non-operative pneumatic or hydrostatic enema reduction under ultrasound or fluoroscopic guidance with or without the use of sedatives. The primary and secondary outcomes were success rate in radiologic reduction of ileocolic intussusception and risk of perforation, respectively. Effect estimates from the individual studies were extracted and combined using the Hartung-Knapp-Sidik-Jonkman log-odds random-effects model. Heterogeneity between studies was checked using Cochran's Q test and the I2 statistic. RESULTS: A total of 17 studies with 2094 participants were included in the final review, of which 15 were included in the meta-analysis. Nine studies reported on the success rate of radiologic reduction performed under sedation in all participants, while six studies compared the success rate in two patient groups undergoing the procedure with or without sedation. The pooled success rate of non-operative reduction under sedation was 87 % (95 % CI: 80-95 %), P = 0.000 with considerable heterogeneity (I2 = 85 %). A higher success rate of 94 % (95 % CI: 88-99 %) and homogeneity (I2 = 12 %) were found in studies with pneumatic enema reduction. Among comparative studies, the odds of success of non-operative reduction were increased when the procedure was performed under sedation, with a pooled odds ratio of 2.41 (95 % CI: 1.27-4.57), P = 0.010 and moderate heterogeneity (I2 = 60 %). In a sensitivity analysis, homogeneity was found between analyzed studies when two outliers were excluded (I2 = 0.73 %). The risk of perforation was not significantly different (OR 1.52, 95 % CI: 0.09-23.34), P = 0.764 indicating small study effects. No publication, bias was detected on visual inspection of the funnel plots or the Begg's and Egger's bias tests. Most studies were categorized as having a low risk of bias using Joanna Briggs Institute checklists. CONCLUSIONS: In selected patient groups, sedation can increase the success rate of radiologic enema reduction in children with ileocolic intussusception without evidence of increased risk of perforation. Systematic review protocol registration: PROSPERO CRD42023404887.
Asunto(s)
Enfermedades del Íleon , Intususcepción , Propofol , Niño , Humanos , Lactante , Enema/métodos , Hipnóticos y Sedantes/uso terapéutico , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/terapia , Enfermedades del Íleon/etiología , Intususcepción/diagnóstico por imagen , Intususcepción/terapia , Intususcepción/etiología , Estudios RetrospectivosAsunto(s)
Enfermedades del Íleon , Intususcepción , Niño , Humanos , Lactante , Intususcepción/diagnóstico por imagen , Intususcepción/cirugía , Factores de Riesgo , Resultado del Tratamiento , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/cirugía , Estudios Retrospectivos , Recurrencia , EnemaRESUMEN
BACKGROUND: International practice regarding the method used to nonoperatively reduce pediatric intussusception is variable. OBJECTIVE: To provide an overview of ultrasound-guided pneumatic intussusception reduction and assess its safety and effectiveness. MATERIALS AND METHODS: A single-center prospective study was conducted in a tertiary referral pediatric hospital during the 15-year period between January 2008 and February 2023. All patients with ileocolic intussusception underwent abdominal sonographic examination for diagnosis. An ultrasound-guided pneumatic reduction of intussusception was then attempted. Children who were hemodynamically unstable, with signs of peritonitis or bowel perforation and those with sonographically detected pathologic lead points were excluded. RESULTS: A total of 131 children (age range 2 months to 6 years) were enrolled in this study. Pneumatic intussusception reduction was successful in 128 patients (overall success rate 97.7%). In 117 patients, the intussusception was reduced on the first attempt and in the remaining on the second. In three cases, after three consecutive attempts, the intussusception was only partially reduced. As subsequently surgically proven, two of them were idiopathic and the third was secondary to an ileal polyp. No bowel perforation occurred during the reduction attempts. There was recurrence of intussusception in three patients within 24 h after initial reduction which were again reduced by the same method. CONCLUSION: Ultrasound-guided pneumatic intussusception reduction is a well-tolerated, simple, safe and effective technique with a high success rate, no complications and no ionizing radiation exposure. It may be adopted as the first-line nonsurgical treatment of pediatric intussusception.
Asunto(s)
Enfermedades del Íleon , Perforación Intestinal , Intususcepción , Niño , Preescolar , Humanos , Lactante , Enema/métodos , Hospitales , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/terapia , Intususcepción/diagnóstico por imagen , Intususcepción/terapia , Estudios Prospectivos , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
Ileocolic intussusception is the most common cause of intestinal obstruction in children under two years of age. Treatment in most cases is radiologically guided reduction. In Slovenia, ultrasound (US)-guided hydrostatic reduction is currently the standard of care. The purpose of this study was to compare the success rate of US-guided hydrostatic reduction when performed by subspecialty-trained pediatric radiologists, non-pediatric radiologists, or radiology residents. We retrospectively analyzed medical records of patients with ileocolic intussusception who underwent US-guided hydrostatic intussusception reduction at University Medical Centre Ljubljana between January 2012 and December 2022 (n = 101). During regular daily working hours, the reduction was performed by pediatric radiologists. After hours (evenings and overnight), pediatric radiologists, non-pediatric radiologists, or radiology residents performed the reduction procedure. Patients were divided into three groups based on the operator performing the procedure. Data was analyzed using the chi-square test. Pediatric radiologists had thirty-seven (75.5%) successful first attempts, non-pediatric radiologists had nineteen (76.0%), and radiology residents had twenty (74.1%). There was no statistically significant difference in the success rate of ileocolic intussusception reduction depending on the operator who performed the procedure (p = 0.98). No perforation was observed in either group during the reduction attempts. Conclusion: Our results demonstrate that US-guided hydrostatic reduction is a reliable and safe procedure that achieves good results even in the hands of less experienced, however appropriately trained, radiologists. The results should encourage more medical centers to consider the implementation of US-guided hydrostatic reduction of ileocolic intussusception. What is Known: ⢠US-guided hydrostatic reduction is a well-established method of treatment for ileocolic intussusception in children. ⢠The results regarding the influence of operator's experience with the procedure on its success rate are scarce and contradictory. What is New: ⢠US-guided hydrostatic intussusception reduction is a reliable and safe technique that achieves similar success rates when performed by experienced subspecialized pediatric radiologists or less experienced but trained operators such as non-pediatric radiologists and radiology residents. ⢠The implementation of US-guided hydrostatic reduction in general hospitals without subspecialized pediatric radiologists could improve patient care by increasing access to radiologically guided reduction and simultaneously decreasing the time to reduction attempts.
Asunto(s)
Enfermedades del Íleon , Intususcepción , Radiología , Niño , Humanos , Lactante , Intususcepción/diagnóstico por imagen , Intususcepción/terapia , Estudios Retrospectivos , Resultado del Tratamiento , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/terapia , Enema , Presión Hidrostática , Radiólogos , Ultrasonografía IntervencionalRESUMEN
We present the case of a 63-year-old woman in whom the clinical and ultrasound imaging initially suspected the existence of colon neoplasia, which finally turned out to be an ileocolic invagination, with the prognostic change that this entails. The contribution of this article is to bring readers closer to clinical cases that, although infrequent, should be taken into account. In this way, it allows the reader to suspect it in clinical practice in patients who meet the clinical characteristics mentioned.
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Neoplasias del Colon , Enfermedades del Íleon , Intususcepción , Femenino , Humanos , Adulto , Persona de Mediana Edad , Intususcepción/diagnóstico por imagen , Enfermedades del Íleon/complicaciones , Enfermedades del Íleon/diagnóstico por imagen , Ultrasonografía , Endoscopía , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico por imagenAsunto(s)
Neoplasias Colorrectales Hereditarias sin Poliposis , Enfermedades del Íleon , Intususcepción , Embarazo , Femenino , Humanos , Tercer Trimestre del Embarazo , Neoplasias Colorrectales Hereditarias sin Poliposis/complicaciones , Neoplasias Colorrectales Hereditarias sin Poliposis/diagnóstico , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiologíaRESUMEN
Intussusception is the most common cause of bowel obstruction in infants four to ten months old and is commonly idiopathic or attributed to lymphoid hyperplasia. Our patient was a 7-month-old male who presented with two weeks of intermittent abdominal pain associated with crying, fist clenching and grimacing. Ultrasound demonstrated an ileocolic intussusception in the right abdomen. Symptoms resolved after contrast enemas, and he was discharged home. He re-presented similarly the next day and was found to be COVID-19 positive. Computed tomography scan demonstrated a left upper quadrant ileal-ileal intussusception. His symptoms spontaneously resolved, and he was discharged home. This suggests that COVID-19 may be a cause of intussusception in infants, and infants presenting with intussusception should be screened for this virus. Additionally, recurrence may happen days later at different intestinal locations. Caregiver education upon discharge is key to monitor for recurrence and need to return.
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COVID-19 , Enfermedades del Íleon , Obstrucción Intestinal , Intususcepción , Humanos , Masculino , Lactante , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugía , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , COVID-19/complicaciones , UltrasonografíaRESUMEN
BACKGROUND: Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays (> 24 h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays. OBJECTIVE: This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema. MATERIALS AND METHODS: A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation. RESULTS: There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1 h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6 h; and 81.2% (9/11) with greater than 6 h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07). CONCLUSIONS: There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8 h.
Asunto(s)
Enfermedades del Íleon , Obstrucción Intestinal , Intususcepción , Niño , Humanos , Lactante , Intususcepción/diagnóstico por imagen , Intususcepción/terapia , Estudios Retrospectivos , Resultado del Tratamiento , Enema/métodos , Obstrucción Intestinal/etiología , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/terapiaRESUMEN
INTRODUCTION: Ileocolic intussusception is a common cause of pediatric bowel obstruction. Contrast enema is successful in treating the majority of patients, and if initially unsuccessful, approximately one-third may be reduced with repeat enemas. We sought to study protocol implementation for delayed repeat enema in pediatric patients not reduced completely by an initial contrast enema. Our aims were to assess repeat enema success rates and outcome differences in preprotocol and postprotocol patients with respect to (1) intussusception recurrence, (2) surgical intervention and complication rates, and (3) length of stay. MATERIALS AND METHODS: We performed a retrospective review of treatment and clinical outcomes prior to and following protocol implementation for repeat enema for intussusception at two tertiary pediatric referral hospitals. The preprotocol period was defined from 2/2013 to 2/2016, and the postprotocol period was from 8/2016 to 11/2019. RESULTS: There were 112 patients in the preprotocol group, with 74 (66%) having successful reduction following the first enema. Of the 38 patients without successful reduction, 16 (42%) patients underwent repeat enema, and five were successful (31%). The postprotocol group included 122 patients, with 84 (69%) having successful first reduction. Of the 38 patients that failed, 25 patients (66%) underwent repeat enema, of which 13 (52%) were successful. Compared to preprotocol patients, postprotocol patients had significantly more enemas repeated and a trend toward fewer surgical interventions. CONCLUSIONS: Protocol implementation of repeat delayed enemas was significantly associated with an increased rate of repeat enemas at our institutions and reduced need for operative intervention during the index stay.
Asunto(s)
Enfermedades del Íleon , Intususcepción , Niño , Enema/efectos adversos , Enema/métodos , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/cirugía , Lactante , Intususcepción/diagnóstico por imagen , Intususcepción/terapia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: COVID-19 disease can manifest with intussusception in pediatric patients, but prevalence of abnormalities on ultrasounds performed for intussusception is uncertain. We aim to report our experience in children with COVID-19 presenting with suspected intussusception imaged with ultrasound. METHODS: Children under 18 years who had an ultrasound for possible intussusception underwent retrospective analysis and were tested for COVID-19 between April 1 and December 14, 2020. Patients' demographic, clinical, radiological and surgical characteristics were reviewed. RESULTS: Twenty-four COVID-19-positive patients were identified; 19 boys with mean age 3 years (range: 3 months-18 years). Ultrasound was abnormal in 11 patients (11/24, 46%). Sonographic features of enterocolitis were documented in seven children (7/24, 29%). Three boys (3/24, 13%) were found to have ileocolic intussusception on ultrasound and underwent air enema with failed reduction (3/3, 100%), precipitating surgical reductions, all with favorable outcomes. One patient (1/24, 4%) was found to have a long segment of persistent small bowel-small bowel intussusception which was surgically repaired. CONCLUSION: Given the known association between failed reduction at air enema and delayed presentation, heightened awareness for intussusception in the setting of COVID-19 should be maintained, though more often, the etiology was attributed to other GI manifestations of COVID-19.
Asunto(s)
COVID-19 , Enfermedades del Íleon , Intususcepción , Adolescente , Niño , Enema , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Lactante , Intususcepción/diagnóstico por imagen , Intususcepción/cirugía , Masculino , Estudios Retrospectivos , SARS-CoV-2 , Resultado del TratamientoRESUMEN
OBJECTIVES: Ultrasound-guided saline enema is highly successful in treating pediatric intussusception; however, early recurrence-within 48 hours-is possible. This study aimed to explore effective methods of reducing early recurrence. METHODS: This study included patients aged 0 to 14 years diagnosed with ileocolic intussusception with a symptom duration of <48 hours from January 2019 to March 2021. The patients were divided into control and intervention groups. All patients received successful treatment with ultrasound-guided saline enema; however, in patients treated before January 4, 2020 (control group), the intestinal fluid was drained immediately, and in patients treated after January 4, 2020 (intervention group), the intestinal fluid was drained after 15 minutes of intestinal pressure maintenance. Early recurrence rates of the groups were compared. RESULTS: Ileocolic intussusception was treated successfully by ultrasound-guided saline enema in 231 patients (116, control group;115, intervention group). The early recurrence rate in the intervention group (10%; 95% CI: 4.9-16.5) was numerically lower than that in the control group (19%; 95% CI: 12.3-27.3). No significant difference was observed in the number of recurrences per person between the groups (P = .448). Patients without early recurrence were older (P = .004) and received enemas of a shorter duration (P < .001) and lower pressure (P < .001) than patients without early recurrence. CONCLUSIONS: Maintaining reduction pressure for 15 minutes after a successful ultrasound-guided saline enema may reduce the early recurrence of intussusception. A randomized controlled trial is needed because the intervention and control cohorts were most probably incomparable (due to the COVID-19 pandemic).