Developing a nomogram to predict recurrent intussusception after pneumatic reduction of primary intussusception in children.

BACKGROUD: Intussusception is a common acute abdominal disease in children, often leading to acute ileus in infants and young children. OBJECTIVE: This study aimed to develop and validate a nomogram for predicting recurrent intussusception in children within 48 h after pneumatic reduction of primary intussusception. METHODS: Clinical data of children with acute intussusception admitted to multiple hospitals from March 2019 to March 2021 were retrospectively analyzed. The children were divided into a successful reductioncontrol group (control group) and a recurrent intussusception group (RI group) according to the results of pneumatic reduction. RESULTS: A total of 2406 cases were included in this study, including 2198 control group and 208 RI group. In the total sample, 1684 cases were trained and 722 cases were verified. A logistic regression analysis was conducted to establish a predictive model based on age, abdominal pain time, white blood cells count, and hypersensitive C-reactive protein levels as independent predictors of intussusception recurrence. The nomogram successfully predicted recurrent intussusception after pneumatic reduction. CONCLUSION: In this study, a nomogram was developed based on clinical risk factors to predict recurrent intussusception following pneumatic reduction in children. Age, abdominal pain time, white blood cell counts, and hypersensitive C-reactive protein levels were identified as predictors and incorporated into the nomogram. Internal validation demonstrated that this nomogram can offer a clear and convenient tool for identifying risk factors for recurrence of intussusception in children undergoing pneumatic reduction.

Duodeno-duodenal intussusception due to gastrointestinal stromal tumor: A case report.

Gastrointestinal stromal tumors, previously referred to as leiomyomas and leiomyosarcomas, are one of the most common mesenchymal tumors of the gastrointestinal tract, predominantly located in the stomach (60%-70%), followed by the small intestine (20%-30%). They manifest at any age but more commonly in patients older than 50 years. Patients with gastrointestinal stromal tumors usually have vague and nonspecific symptoms. The diagnosis is sometimes challenging requiring multiple imaging modalities, including computed tomography and magnetic resonance imaging, used for diagnosis, staging, and surveillance. Treatment involves surgery and targeted therapy. Serious complications have been reported such as intussusception which is exceptionally rare due to the extraluminal growth pattern tendency of gastrointestinal stromal tumors. We present the case of a 77-year-old female with duodeno-duodenal intussusception secondary to a gastrointestinal stromal tumor. This case report contributes valuable insight into the diverse presentation and complications of gastrointestinal stromal tumors.

Anal sphincter function in rectal intussusception and high and low "take-off" external rectal prolapse-A prospective observational study.

AIM: Rectal intussusception (RI) and external rectal prolapse (ERP) are associated with anal sphincter dysfunction. The aim of this study was to examine sphincter function with anal acoustic reflectometry (AAR) in RI and two distinct phenotypes of ERP termed high and low "take-off". METHODS: A prospective study of patients with RI and ERP attending a tertiary pelvic floor unit. Clinical data, AAR, and conventional anal manometry were analysed according to the Oxford prolapse grade. RESULTS: A total of 108 (102 [94%] female, median age 62 years [range: 26-95]) patients were recruited into three groups according to prolapse grade: Oxford grades I and II (intrarectal RI, n = 34), Oxford grades III and IV (intra-anal RI, n = 35) and Oxford grade V (ERP, n = 39). As the grade of prolapse increased, resting AAR measurements of opening pressure, opening elastance, closing pressure, and closing elastance decreased (p < 0.001). Maximum resting pressure with manometry was reduced in ERP and intra-anal RI compared to intrarectal RI (p < 0.001). However, incremental squeeze function was not different between the three groups with either AAR or manometry (p > 0.05). There were no differences in AAR or manometry variables between grade IV RI (n = 18) and high take-off ERP (n = 20) (p > 0.05). By contrast, opening pressure (p = 0.010), closing pressure (p = 0.019) and elastance (p = 0.022) were reduced in low take-off ERP (n = 19). CONCLUSION: Increasing rectal prolapse grade is associated with reduced anal sphincter function at rest indicating internal anal sphincter dysfunction. Physiological differences exist between high and low take-off ERP with sphincter function in the former similar to that seen in grade IV RI.

Ileal intussusception due to heterotopic pancreas in the ileum: a case report.

Heterotopic pancreas (HP) is a rare condition where pancreatic tissue is found outside its usual location, usually within the gastrointestinal tract. While typically asymptomatic, HP can cause complications like gastrointestinal bleeding and intussusception, especially in adults, posing diagnostic and therapeutic challenges. A 31-year-old male presented with severe abdominal pain, nausea, and vomiting. Initial imaging revealed significant ileal and cecal wall thickening. Despite antibiotic therapy, his condition worsened, necessitating exploratory laparotomy. Intraoperative findings showed ileal intussusception near the cecum, leading to ileocecal resection and ileo-colic anastomosis. Pathological examination confirmed HP as the cause of intussusception. This case underscores the importance of considering HP in adult intussusception. Timely surgical intervention is critical to prevent severe complications. At a two-year follow-up, he remained symptom-free, highlighting the necessity for prompt diagnosis and management.

The Importance of Abdominal Pain in the Elderly: An Unlikely Diagnosis of 17 cm Colo-Colonic Intussusception.

We report an interesting case of a 17 cm colo-colonic intussusception involving the transverse colon, caecum, and distal small bowel in a previously healthy 79-year-old man. The patient presented to the emergency department with a two-day history of mild, left to right iliac fossa abdominal pain, with no other concerning symptoms. He had a CT of the abdomen and pelvis with contrast for suspected subacute bowel obstruction secondary to recurrent bowel cancer. This was reported as colo-colonic intussusception. Following a surgical review, he was transferred from the local district general hospital for an exploratory laparotomy and underwent a right hemicolectomy with primary ileocolonic anastomosis the same evening. The patient was discharged seven days later following an unremarkable post-operative recovery. Final histology confirmed a mucinous adenocarcinoma of the caecum with postoperative cancer staging as T2N0M0. Following discussion at the colorectal multidisciplinary meeting, no adjuvant therapy was advised, and he was placed on the standard colorectal cancer surveillance program for the next five years.

Entangled: Rapunzel syndrome with postoperative intussusception.

We present a case of a 7-year-old girl with Rapunzel syndrome, a rare complication of trichobezoar, initially presenting with nonspecific symptoms. Diagnostic challenges led to delayed intervention. Surgical removal of the trichobezoar was successful, but postoperative complications included jejunojejunal intussusception, highlighting the necessity for vigilant follow-up and comprehensive psychiatric evaluation. The emergence of intussusception emphasizes the profound impact of underlying psychiatric disorders, such as trichotillomania and trichophagia, which contribute to trichobezoar formation. These conditions necessitate ongoing psychiatric management to address behavioral factors that predispose to recurrent bezoar formation and associated gastrointestinal complications. Effective follow-up strategies should encompass immediate postoperative care and long-term psychiatric support to optimize patient outcomes and minimize the risk of recurrent intussusception.

When the vermiform appendix resembles a polyp: Be cautious of an intussuscepted appendix polypectomy.

This article discusses a recently published case report on a rare instance of type IV appendiceal intussusception with a concurrent mucinous adenocarcinoma of the cecum in a young individual. The report highlights challenges in diagnosing appendiceal intussusception, emphasizing the importance of endoscopic expertise in preventing impulsive decisions such as inappropriate polypectomies. The rarity of the concurrent intussuscepted appendix and mucinous cecal cancer is underscored, prompting consideration of malignancy in appendiceal intussusception cases. Additionally, the report addresses the increasing incidence of early-onset colorectal cancer and the need for a revaluation of diagnostic paradigms in the context of evolving epidemiological trends. The awareness of potential misinterpretations and the imperative for further investigation into this rare condition are emphasized.

Case Report: Ileocecal Intussusception Secondary to a Metastatic Malignant Melanoma From the Scalp.

Adult intussusception is an unusual condition that is infrequently associated with malignancy. We experienced a rare occurrence of ileocecal intussusception in a 31-year-old male, secondary to metastatic melanoma. The patient, with a medical history of scalp malignant melanoma treated surgically and with chemotherapy, presented with persistent lower abdominal pain. Diagnostic modalities, including computed tomography (CT) and colonoscopy, revealed ileocecal intussusception. Subsequent laparoscopic surgery and pathological examination identified metastatic melanoma as the etiological factor for the intussusception, leading to the surgical resection of the involved bowel segment. The postoperative period was marked by a smooth recovery with no complications. This case shows the importance of considering malignancy in the differential diagnosis of adult intussusception and underscores the urgency of surgical intervention in the management of such cases.

Ileocolic Intussusception Due to Low-Grade Appendiceal Mucinous Neoplasm.

We report a rare case of low-grade appendiceal mucinous neoplasm (LAMN) causing ileocolic intussusception. The case underscores the importance of considering ileocolic intussusception in differential diagnoses for nonspecific gastrointestinal symptoms. Early diagnosis via contrast-enhanced CT and scrupulous surgical intervention are crucial for favorable outcomes.

Pedunculated colonic lipoma causing adult colo-colic intussusception: A case report and literature review.

INTRODUCTION: Colo-colonic intussusception (CI) in adults is rare, usually caused by malignant conditions. Nonmalignant tumors, like colonic lipomas (CLs), can also be an underlying cause. CASE REPORT: We report an unusual case of a 62-year-old man admitted to the emergency department with acute abdominal symptoms. The CT scan confirmed the colonic obstruction, causing significant distention in the transverse and right colon. It also revealed an intraluminal pedunculated colonic mass with fatty density. Peroperatively, a descending colon intussusception was noted. We performed a left colon resection with a double colostomy on the left flank. The postoperative follow-up was uneventful. Pathologic examination of the surgical specimen revealed two lipomas. One of them was pedunculated and protruded into the colonic lumen causing the intussusception. DISCUSSION: We conducted a literature review of adult CLs complicated by CI, covering the period from January 1900 to June 2024, including 203 cases. We excluded lipomas exclusive to the small intestine and ileocecal valvula. Our analysis focused on the clinical and pathological characteristics of these cases, as well as the available management options. CONCLUSION: Colonic intussusception due to lipomas are uncommon with a challenging preoperative diagnosis despite the evolution of imaging procedures. We aimed by our case to highlight such pathology and to study its features and the possibilities of its management.

Postoperative intussusception following surgical repair of third-grade spleen rupture in a child: A unique case report.

INTRODUCTION AND IMPORTANCE: Postoperative intussusception (POI) is a remarkably rare complication that may follow different types of operations. POI is responsible for 5-10 % of postoperative bowel obstruction. The main challenge in diagnosing this condition due to its nonspecific symptoms, which mimic post-op ileus. CASE PRESENTATION: An 8-year-old Syrian female was presented to the emergency department with multiple traumas. Laboratory tests were normal except for leukocytosis. Abdominal and pelvic ultrasound revealed a moderate amount of free fluid in Morison's pouch and splenorenal recess. Investigative laparotomy revealed third-degree splenic rupture, leading to splenorrhaphy. After a week, she suffered from sudden nausea and bilious vomiting. The patient's condition deteriorated, so a second investigative laparotomy was performed and revealed the presence of jejune-jejunal intussusception (1 m distally from the ligament of Treitz) without any predisposing lead point. The intussusception was manually solved, the patient was discharged after five days. She has been seen in follow-up with complete recovery. CLINICAL DISCUSSION: POI is one of the rare complications that may happen after various surgeries especially abdominal operations. POI is associated with some specific surgeries. The most prominent symptoms of POI are restlessness, bilious vomiting, abdominal distension, and abdominal pain, consequently, they are less specific. CONCLUSION: POI is a rare complication after surgery but it should be considered in case of the presence of bowel obstruction symptoms in the first two weeks after operation. Our case highlights this unexpected complication emphasizes the need for further studies to demonstrate the mechanism of postoperative intussusception.

A Case of Colonic Intussusception with Post-polypectomy Electrocoagulation Syndrome and Review of Literature: How to Manage Intussusception Following Colonoscopy?

Colonic intussusception is often reported to be related to malignancy in adults. Colonoscopy itself with or without polypectomy is known to be a rare cause of colonic intussusception. We encountered a case in which an individual was diagnosed with intussusception following colonoscopy. The patient was a 44-year-old female who, on the same day, had undergone a colonoscopy including endoscopic mucosal resection for a polyp in the ascending colon. She visited the emergency room with complaints of right-sided abdominal pain. Abdominal examination revealed peritoneal irritation in the right upper quadrant. Abdominal CT revealed colocolic intussusception near the hepatic flexure. This was suspected to have been induced by post-polypectomy electrocoagulation syndrome. A laparoscopic right hemicolectomy was performed because conducting a reduction trial through colonoscopy involves a high risk of peritonitis, in addition to a low likelihood of spontaneous reduction of intussusception due to the additional edema and ischemia resulting from the polypectomy. The patient was discharged without complications six days after the surgery. Though some cases have been reported, there is no treatment strategy for intussusception following colonoscopy. Therefore, we report this case of colonic intussusception following colonoscopy, which was found to be caused by Post-polypectomy Electrocoagulation Syndrome, with a literature review.

Jejuno-jejunal intussusception following feeding jejunostomy: A case report and literature review.

INTRODUCTION: Feeding jejunostomy is a rare cause of jejuno-jejunal intussusception, with presentations ranging from mild bowel obstruction to severe ischemia or perforation. CASE PRESENTATION: A 21-year-old male with a recent history of feeding jejunostomy placement presented with acute upper abdominal pain, bilious vomiting, and inability to pass stool or flatus. Ultrasonography confirmed jejuno-jejunal intussusception, necessitating resection of the affected segment and jejuno-jejunal anastomosis. One year postoperatively, the patient remains asymptomatic with no recurrence. DISCUSSION: Review of 17 cases of jejuno-jejunal intussusception post-jejunostomy revealed abdominal pain, vomiting, and abdominal distension as common symptoms. Diagnosis relied on imaging modalities like ultrasound or CT, and surgery was the primary treatment. CONCLUSION: This case underscores the importance of suspicion and timely intervention to prevent complications in patients with feeding jejunostomy presenting with obstructive symptoms.

Relationship between postoperative rehabilitation style, gastrointestinal function, and inflammatory factor levels in children with intussusception.

BACKGROUND: Intussusception occurs in children and progresses rapidly. If not treated in time, it may lead to secondary complications such as intestinal perforation, which affect the quality of life and health of children. Surgery is the most common clinical treatment and has a good effect. However, the postoperative prognosis of children with intussusception has a correlation with the postoperative rehabilitation method. Therefore, in this study, we explored the relationship between postoperative rehabilitation, gastrointestinal function, and the expression of inflammatory factors in children with intussusception. AIM: To explore the relationship between postoperative rehabilitation, gastrointestinal function, and inflammatory factor levels in children with intussusception. METHODS: The medical records of 18 children who were admitted to our hospital for intussusception surgery between October 2022 and May 2024 were retrospectively reviewed. The patients were divided into the routine nursing group (n = 6) and rehabilitation training group (n = 12) according to the postoperative rehabilitation method. The general data, gastrointestinal function, and inflammatory factor levels of the two groups were statistically analyzed. Pearson correlation analysis of gastrointestinal function, inflammatory factors, and postoperative rehabilitation was performed. RESULTS: We found no significant intergroup differences in sex, age, or disease course (P > 0.05). The times to first defecation, bowel sound recovery, and anal exhaust were shorter and inflammatory factor levels were lower in the rehabilitation training group than in the routine nursing group (P < 0.05). Pearson correlation analysis showed that gastrin and motilin levels were positively correlated with postoperative rehabilitation (P < 0.05). Interleukin (IL)-2, IL-4, IL-6, IL-10, high-sensitivity C-reactive protein, and tumor necrosis factor-α levels were negatively correlated with postoperative rehabilitation (P < 0.05). Gastrointestinal function was positively correlated (P < 0.05), and levels of inflammatory factors were negatively correlated with postoperative recovery time (P < 0.05). CONCLUSION: We found a positive correlation between gastrointestinal function and postoperative rehabilitation training, and a negative correlation between inflammatory factor levels and rehabilitation training in children with intussusception.

A Case Report of a Young Adult With Peutz-Jeghers Syndrome Presenting With Acute Small Bowel Obstruction: A Common Complication of an Uncommon Disease.

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous polyposis of the gastrointestinal tract, melanin pigmentation of the skin and mucous membranes, and an increased risk for cancer. Radiological imaging, contrast studies, and scopy-directed biopsies confirm the diagnosis and help in surveillance. Hamartomatous mucosal polyps, which are characterized by a central core of branching smooth muscle connected to a mucosa unique to the site of origin, are pathognomonic for PJS. We present the case of a young male with a history of pain in the abdomen and vomiting. The patient had mucocutaneous pigmentations on the buccal mucosa. CT scan revealed jejuno-jejunal intussusception with multiple small and large bowel polyps causing acute intestinal obstruction. Intraoperatively, jejunal polyps were found to be the cause of jejuno-jejunal intussusception. Histopathology revealed hamartomatous polyps of PJS. Our interest in this case is due to the uncommon case of intussusception in an adult where radiological imaging played an important role in diagnosis.

Multiple Intussusceptions with multiple polyps as identifiable lead point: A curious case report.

Intussusception is a condition in which the proximal segment of the bowel telescopes into the distal segment. 90% of the cases, especially in infants and toddlers, do not have any lead point and are due to lymphoid hypertrophy, following a viral infection. The presence of polyps in the form of lead point in children is rare. In fact, multiple polyps presenting as multiple sites intussusception are much rarer. We report a case of multiple intussusceptions in a 11-year-old female who presented with complaints of pain abdomen and blood-mixed stool. On imaging examination, she was found to having multiple polyps serving as a possible lead point, and was managed with hydroreduction. Imaging in case of multiple intussusception typically reveals concentric rings of bowel within the bowel giving a "target sign" on axial scans and a "pseudo-kidney sign" on coronal/sagittal CT scans. Our case report shows that, multiple intussusception due to multiple polyps can be a possibility for acute pain abdomen in children.

Intussusception Within a Jejunostomy With Closed Loop Obstruction: A Case Report.

Jejunojejunal intussusception is a rare yet severe complication of Roux-en-Y gastric bypass (RYGBP) surgery. We are presenting a unique case of retrograde jejunal intussusception with a closed-loop blockage and an associated abdominal herniation that occurred two years after a laparoscopic RYGBP. The patient presented with abdominal pain, nausea, and vomiting, prompting a clinical diagnosis and a biphasic contrast-enhanced computed tomography (CT) scan, which later revealed a complicated jejunal intussusception with signs of ischemia showing decreased wall enhancement and distal collapsed jejunal walls with complete closed-loop bowel obstruction. The case was successfully managed through emergent laparoscopy to repair the hernia and reduce the intussusception, after which the postoperative period was unremarkable. This article aims to raise awareness about this rare but significant postoperative complication and stress the importance of early medical attention in similar cases.

Appendiceal intussusception due to endometriosis presenting as acute right lower quadrant pain.

Appendiceal intussusception is a rare condition characterized by the telescoping or invagination of a portion or the entire appendix into the caecum or within the appendix itself. Diagnosing appendiceal intussusception can be challenging due to its rarity, non-specific symptoms, and lack of awareness among physicians. We present a case report of appendiceal intussusception caused by endometriosis presenting with recurrent abdominal pain in a young female that was initially missed on CT scan and laparoscopy and eventually diagnosed on CT enterography.