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1.
BMC Gastroenterol ; 24(1): 180, 2024 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-38778288

RESUMEN

BACKGROUND: Intussusception presents a significant emergency that often necessitates bowel resection, leading to severe complications and management challenges. This study aims to investigate and establish a scoring system to enhance the prediction of bowel resection necessity in pediatric intussusception patients. METHODS: This retrospective study analyzed 660 hospitalized patients with intussusception who underwent surgical management at a pediatric hospital in Southwest China from April 2008 to December 2020. The necessity of bowel resection was assessed and categorized in this cohort. Variables associated with bowel resection were examined using univariate and multivariate logistic regression analyses. Based on these analyses, a scoring system was developed, grounded on the summation of the coefficients (ß). RESULTS: Among the 660 patients meeting the inclusion criteria, 218 required bowel resection during surgery. Bowel resection occurrence was linked to an extended duration of symptoms (Odds Ratio [OR] = 2.14; 95% Confidence Interval [CI], 1.03-5.23; P = 0.0015), the presence of gross bloody stool (OR = 8.98; 95% CI, 1.76-48.75, P < 0.001), elevated C-reactive protein levels (OR = 4.79; 95% CI, 1.12-28.31, P = 0.0072), lactate clearance rate (LCR) (OR = 17.25; 95% CI, 2.36-80.35; P < 0.001), and the intussusception location (OR = 12.65; 95% CI, 1.46-62.67, P < 0.001), as determined by multivariate logistic regression analysis. A scoring system (totaling 14.02 points) was developed from the cumulative ß coefficients, with a threshold of 5.22 effectively differentiating infants requiring surgical intervention from others with necrotizing enterocolitis (NEC), exhibiting a sensitivity of 78.3% and a specificity of 71.9%. CONCLUSIONS: This study successfully identified multiple risk factors for bowel resection and effectively used a scoring system to identify patients for optimal clinical management.


Asunto(s)
Intususcepción , Humanos , Intususcepción/cirugía , Intususcepción/diagnóstico , Estudios Retrospectivos , Masculino , Femenino , Lactante , Preescolar , China , Proteína C-Reactiva/análisis , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Modelos Logísticos , Niño , Factores de Riesgo
2.
BMC Pediatr ; 24(1): 227, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38561715

RESUMEN

BACKGROUND: Summarizing the clinical features of children with intussusception secondary to small bowel tumours and enhancing awareness of the disease. METHODS: Retrospective summary of children with intussusception admitted to our emergency department from January 2016 to January 2022, who underwent surgery and were diagnosed with small bowel tumours. Summarize the types of tumours, clinical presentation, treatment, and prognosis. RESULTS: Thirty-one patients were included in our study, 24 males and 7 females, with an age of onset ranging from 1 m to 11y 5 m. Post-operative pathology revealed 4 types of small intestinal tumour, 17 lymphomas, 10 adenomas, 4 inflammatory myofibroblastomas and 1 lipoma. The majority of tumours in the small bowel occur in the ileum (83.9%, 26/31). Abdominal pain, vomiting and bloody stools were the most common clinical signs. Operative findings indicated that the small bowel (54.8%, 17/31) and ileocolic gut were the main sites of intussusception. Two types of procedure were applied: segmental bowel resection (28 cases) and wedge resection of mass in bowel wall (3 cases). All patients recovered well postoperatively, with no surgical complications observed. However, the primary diseases leading to intussusception showed slight differences in long-term prognosis due to variations in tumor types. CONCLUSIONS: Lymphoma is the most common cause of intussusception in pediatric patients with small bowel tumours, followed by adenoma. Small bowel tumours in children tend to occur in the ileum. Therefore, the treatment of SBT patients not only requires surgeons to address symptoms through surgery and obtain tissue samples but also relies heavily on the expertise of pathologists for accurate diagnosis. This has a significant impact on the overall prognosis of these patients.


Asunto(s)
Neoplasias Intestinales , Intususcepción , Masculino , Femenino , Humanos , Niño , Intususcepción/etiología , Intususcepción/cirugía , Estudios Retrospectivos , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/cirugía , Dolor Abdominal/complicaciones , Intestino Delgado/cirugía
3.
J Paediatr Child Health ; 60(1): 5-11, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37942803

RESUMEN

AIM: Intussusception is the most common surgical complication of IgA vasculitis (IgAV), and intestinal perforation is usually associated with intussusception. If they are not recognised and treated in a timely manner, serious consequences may occur. The objective is to summarise the clinical features of IgAV complicated by intussusception and intestinal perforation and explore its risk factors. METHODS: The clinical data of 32 patients with IgAV complicated by surgical complications (25 cases of intussusception and 7 cases of intestinal perforation) were retrospectively analysed. A total of 160 IgAV children with gastrointestinal (GI) involvement but without surgical complications were randomly selected as a control group. Binary logistic regression analysis was performed to explore the risk factors for IgAV with intussusception and intestinal perforation. RESULTS: Compared with the intussusception group, the intestinal perforation group had a significantly higher number of patients with GI symptoms prior to skin purpura and GI bleeding, a significantly higher number of days of abdominal pain, a significantly higher Wong-Baker score, and a significantly higher white blood cell count. Multivariate logistic regression analysis indicated that age ≤7 years, GI symptoms prior to skin purpura, abdominal pain intensity (Wong-Baker scale) and timing of glucocorticoid treatment were independent risk factors of IgAV with intussusception and intestinal perforation. CONCLUSION: Age less than 7 years, severe abdominal pain, and GI symptoms prior to skin purpura were risk factors for IgAV with intussusception and intestinal perforation. Early use of glucocorticoids may prevent intussusception and intestinal perforation.


Asunto(s)
Vasculitis por IgA , Perforación Intestinal , Intususcepción , Niño , Humanos , Vasculitis por IgA/complicaciones , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Intususcepción/etiología , Intususcepción/cirugía , Estudios Retrospectivos , Inmunoglobulina A , Dolor Abdominal
4.
Pediatr Surg Int ; 40(1): 148, 2024 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-38825635

RESUMEN

BACKGROUND: Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous gastrointestinal polyps along with the characteristic mucocutaneous freckling. Multiple surgeries for recurrent intussusception in these children may lead to short bowel syndrome. Here we present our experience of management in such patients. METHODS: From January 2015 to December 2023, we reviewed children of PJS, presented with recurrent intussusceptions. Data were collected regarding presentation, management, and follow-up with attention on management dilemma. Diagnosis of PJS was based on criteria laid by World Health Organization (WHO). RESULTS: A total of nine patients were presented with age ranging from 4 to 17 years (median 9 years). A total of eighteen laparotomies were performed (7 outside, 11 at our centre). Among 11 laparotomies done at our centre, resection and anastomosis of bowel was done 3 times while 8 times enterotomy and polypectomy was done after reduction of intussusception. Upper and lower gastrointestinal endoscopy (UGIE & LGIE) was done in all cases while intraoperative enteroscopy (IOE) performed when required. Follow-up ranged from 2 months to 7 years. CONCLUSION: Children with PJS have a high risk of multiple laparotomies due to polyps' complications. Considering the diffuse involvement of the gut, early decision of surgery and extensive bowel resection should not be done. Conservative treatment must be tried under close observation whenever there is surgical dilemma. The treatment should be directed in the form of limited resection or polypectomy after reduction of intussusception.


Asunto(s)
Intususcepción , Síndrome de Peutz-Jeghers , Recurrencia , Humanos , Síndrome de Peutz-Jeghers/complicaciones , Síndrome de Peutz-Jeghers/cirugía , Intususcepción/cirugía , Intususcepción/terapia , Niño , Preescolar , Adolescente , Femenino , Masculino , Estudios Retrospectivos , Laparotomía/métodos , Estudios de Seguimiento
5.
Can Vet J ; 65(1): 25-28, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38164375

RESUMEN

An 8-year-old spayed female British bulldog was presented with vomiting, hyporexia, and large-bowel diarrhea. Abdominal ultrasound revealed a focal colonic mass with an intussusception located immediately oral to the mass. The intussusception encompassed the ascending and transverse colon and was non-reducible. Colonic resection and anastomosis were completed to include the intussusception and colonic mass. Histopathological examination of the mass demonstrated a spindle cell neoplasm arising within the muscular wall of the intussuscepted segment that obliterated normal architecture. Mild-to-moderate cytoplasmic immunoreactivity of the tumor cell population for CD117 and smooth muscle actin was consistent with a diagnosis of a gastrointestinal stromal tumor. The dog described herein remains alive and free of progressive disease at the time of writing. Key clinical message: The entire gastrointestinal tract should be evaluated in any animal with gastrointestinal symptoms. A gastrointestinal stromal tumor remains a plausible differential diagnosis, regardless of the intestinal segment affected, and tumorassociated intussusception is a rare but urgent clinical finding.


Tumeur stromale gastro-intestinale du côlon (GIST) présentant une invagination colocolique : un rapport de cas rare. Une femelle bouledogue anglais stérilisée de 8 ans a présenté des vomissements, une hyporexie et une diarrhée d'origine du gros intestin. L'échographie abdominale a révélé une masse colique focale avec une invagination située immédiatement oralement à la masse. L'intussusception englobait le côlon ascendant et transverse et était non réductible. La résection colique et l'anastomose ont été réalisées pour inclure l'intussusception et la masse colique. L'examen histopathologique de la masse a révélé un néoplasme à cellules fusiformes apparaissant dans la paroi musculaire du segment invaginé qui a oblitéré l'architecture normale. L'immunoréactivité cytoplasmique légère à modérée de la population de cellules tumorales pour le CD117 et l'actine des muscles lisses étaient compatibles avec un diagnostic de tumeur stromale gastro-intestinale. Le chien décrit ici est toujours vivant et exempt de maladie évolutive au moment de la rédaction.Message clinique clé :L'ensemble du tractus gastro-intestinal doit être évalué chez tout animal présentant des symptômes gastrointestinaux. Une tumeur stromale gastro-intestinale reste un diagnostic différentiel plausible, quel que soit le segment intestinal atteint, et l'intussusception associée à la tumeur est une constatation clinique rare mais urgente.(Traduit par Dr Serge Messier).


Asunto(s)
Neoplasias del Colon , Enfermedades de los Perros , Tumores del Estroma Gastrointestinal , Intususcepción , Femenino , Animales , Perros , Intususcepción/diagnóstico , Intususcepción/cirugía , Intususcepción/veterinaria , Tumores del Estroma Gastrointestinal/complicaciones , Tumores del Estroma Gastrointestinal/diagnóstico , Tumores del Estroma Gastrointestinal/cirugía , Tumores del Estroma Gastrointestinal/veterinaria , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/cirugía , Neoplasias del Colon/veterinaria , Diagnóstico Diferencial , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/cirugía
6.
J Pediatr Gastroenterol Nutr ; 76(3): 379-384, 2023 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-36728771

RESUMEN

OBJECTIVES: One potential treatment for gastrojejunostomy (GJ) tube-related intussusception is bowel rest, whereby the GJ tube is replaced with a gastrostomy tube. The aim of this study was to determine whether bowel rest length was associated with decreased risk of re-intussusception. METHODS: Pediatric patients with GJ tube-related intussusceptions were identified during the study period of January 1, 2010 and August 1, 2021. Records were reviewed for demographics, symptoms, need for central access to initiate parenteral nutrition, and length of stay. Comparison was made between patients with intussusception recurrence within 30 days and those without. Those undergoing earlier replacement, defined as the first quartile of rest time, or 72 hours, were then compared to longer periods of bowel rest. RESULTS: Forty-six intussusceptions were included, with a median age of 2.8 years (interquartile range, IQR: 1.4-4.1) and weight of 12 kg (IQR: 8.9-15.4). All patients diagnosed as outpatient (54.3%) required hospital admission and 9 of 46 (19.6%) required central access. There were 7 recurrences (15.2%). There was no difference in recurrence based on time of bowel rest (5 days in those without vs 6 days in those with, P = 0.30) nor a difference in recurrence with <72 hours of bowel rest compared to >72 hours (1/15, 6.7% vs 6/31, 19.3%). Patients undergoing earlier exchange had a shorter median length of hospital stay (3 vs 8.5 days, P = 0.003). CONCLUSION: Length of bowel rest was not associated with recurrent GJ tube-related intussusceptions. If bowel rest is utilized, <72 hours may be sufficient to decrease length of hospital stay.


Asunto(s)
Derivación Gástrica , Intususcepción , Humanos , Niño , Lactante , Preescolar , Nutrición Enteral , Intususcepción/etiología , Intususcepción/cirugía , Derivación Gástrica/efectos adversos , Estudios Retrospectivos , Intubación Gastrointestinal , Recurrencia
7.
Eur Surg Res ; 64(2): 246-251, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36574758

RESUMEN

INTRODUCTION: We have developed a modified vasoepididymostomy procedure, namely "fenestrated" transversal two-suture microsurgical intussusception vasoepididymostomy. This study aimed to investigate the therapeutic efficacy and outcome of this fenestrated vasoepididymostomy for epididymal obstructive azoospermia (OA). METHODS: Microsurgical two-suture transversal intussusception vasoepididymostomy was performed using our modified fenestration technique in 64 OA patients due to epididymal obstruction at our hospital. Fenestration means making an opening on the epididymal tubule wall. The edges of the epididymal tubule "window" were stitched transversally (two stitches) using the two double-armed 9-0 atraumatic sutures. The epididymal tubule was anastomosed to the lumen of the vas deferens. The patency rate and pregnancy rate were assessed. RESULTS: Of the 64 OA patients, 45 received bilateral microsurgical two-suture transversal intussusception vasoepididymostomy, while 19 underwent unilateral microsurgical two-suture transversal intussusception vasoepididymostomy. All of the patients were followed up after the operation. The follow-up period ranged from 4 to 54 months. Among 45 cases of bilateral surgery, the patency rate was 88.89% (40/45), and the natural pregnancy rate was 28.89% (13/45). After the patency was confirmed postoperatively, 3 cases had recurrent OA, of which 2 cases had return of sperm to the ejaculate by oral antibiotics and scrotal self-massage. As for the 19 cases of unilateral microsurgery, the patency rate was 68.42% (13/19), and the natural pregnancy rate was 21.05% (4/19). CONCLUSION: The fenestrated transversal two-suture microsurgical intussusception vasoepididymostomy can achieve a good patency rate in OA patients and did not increase the difficulty and duration of the procedure.


Asunto(s)
Azoospermia , Intususcepción , Embarazo , Femenino , Humanos , Masculino , Azoospermia/cirugía , Intususcepción/cirugía , Semen , Epidídimo/cirugía , Suturas , Microcirugia/métodos
8.
Pediatr Int ; 65(1): e15495, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36749147

RESUMEN

BACKGROUND: The objective of this study was to present the results of a comprehensive single-center study of the management and outcome of intussusception over a 10-year period and to review the recent literature. METHODS: A retrospective analysis was carried out of all children less than 16 years old, admitted with intussusception to our tertiary center between January 2007 and December 2016. Air enema was attempted routinely, with primary surgery reserved for selected cases. If air enema failed, open surgery was performed. The data collected included age, enema reduction rate, need for laparotomy, detail of bowel resection, hospital stay, and complications noted. RESULTS: One hundred and ninety-one children presented with intussusception, totaling 200 admissions. One hundred and seventy-four patients (87%) underwent air enema. There was a complete reduction in 66% of these cases and a perforation rate of 1.1%. Twenty-six patients (13%) underwent primary surgery. Of the 59 patients with incomplete enema reduction, 50.8% required bowel resection while 49.2% required only manual reduction. Bowel resection was necessitated in 26% of total admissions and 61.2% of those requiring surgery. Hospital stays ranged from 3-97 days (median 7 days). There were four complications (2%). CONCLUSION: This comprehensive study reveals a higher rate of surgical intervention and bowel resection than was anticipated from selective series in published literature. Institutional variation in outcome is likely multifactorial but incomplete data make comparisons difficult.


Asunto(s)
Intususcepción , Niño , Humanos , Lactante , Adolescente , Estudios Retrospectivos , Intususcepción/diagnóstico , Intususcepción/epidemiología , Intususcepción/cirugía , Tiempo de Internación , Enema/métodos , Laparotomía , Resultado del Tratamiento
9.
J Arthroplasty ; 38(9): 1827-1838, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-36940757

RESUMEN

BACKGROUND: Allograft prosthetic composites (APCs) have been used to perform revision total hip arthroplasty (THA) for massive femoral bone loss or deformity. Intussusception, or "telescoping", APC techniques have been proposed to enhance the contact area of this interface and provide superior mechanical fixation over conventional methods. The purpose of this study is to present to our knowledge, the largest series of telescoping APC THAs, along with surgical technique details and midterm (average 5-10 years) clinical results. METHODS: Between 1994 and 2015, 46 revision THAs performed with proximal femoral telescoping APCs were retrospectively reviewed at a single institution. Overall survival, reoperation-free survival, and construct survival rates were calculated via Kaplan-Meier methods. In addition, radiographic analyses were performed to evaluate for component loosening, union at the APC-host interface, and resorption of the allograft. RESULTS: At 10 years, the overall patient survival was 58%, reoperation-free survival was 76%, and construct survival was 95%. Reoperation was performed in 20% (n = 9) and only 2 constructs required resection. Radiographic analyses performed at latest follow-up revealed no instances of radiographic femoral stem loosening, an 86% union rate at the APC-host site, 23% with signs of some allograft resorption, and a 54% trochanteric union. The mean postoperative Harris hip score was 71 points (range, 46-100). CONCLUSION: Telescoping APCs are technically demanding, but provide reliable mechanical fixation for the reconstructing of large proximal femoral bone deficits in revision THA with excellent construct survivorship, acceptable reoperation rates, and good clinical outcomes. LEVEL OF EVIDENCE: IV.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Intususcepción , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera/efectos adversos , Estudios Retrospectivos , Intususcepción/cirugía , Fémur/cirugía , Diseño de Prótesis , Aloinjertos , Estudios de Seguimiento , Falla de Prótesis , Resultado del Tratamiento
10.
Pediatr Emerg Care ; 39(11): 841-847, 2023 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-37783201

RESUMEN

OBJECTIVES: Intussusception is one of the most common surgical emergencies in children. We aimed to analyze the current clinical characteristics of intussusception. METHODS: We retrospectively reviewed 209 children diagnosed with intussusception, who were admitted to our hospital between January 2009 and August 2022. We grouped the patients according to symptom duration (before and after 12 hours and before and after 24 hours) and age (younger and older than 1 year, and younger and older than 2 years). RESULTS: The median age at admission was 31 months (2-204 months). The median symptom duration was 12 hours (1-420 hours). Most patients (91.4%) were admitted due to abdominal pain, irritability, and/or vomiting. The most common symptoms were vomiting (70.8%) and abdominal pain (60.6%). The classical triad of symptoms was seen in 9 cases (4.3%). In patients aged younger than 1 year, bloody stool, abnormal abdominal radiography findings, and a longer intussusceptum segment were more frequent. In patients aged younger than 2 years, abdominal pain, fever, and defense on physical examination were less frequent, and irritability, bloody stool, and recurrence were more frequent. Patients aged younger than 2 years had a longer intussusceptum segment and less lymphadenopathy based on ultrasonography (USG). The patients admitted more than 12 hours after symptom onset had more diarrhea, fever, abnormal x-ray, peritoneal fluid on USG, and recurrences, and less vomiting. After the symptoms had lasted for 24 hours, fever, mass palpation, and abnormal abdominal radiography findings were more frequent. CONCLUSIONS: We recommend performing abdominal USG, especially in young children admitted to the emergency department with complaints of abdominal pain and/or vomiting, to rule out intussusception. In countries that have reported a high mortality rate from intussusception, we advise precautions such as increasing the availability of USG in emergency departments and educating the population to seek early medical assistance.


Asunto(s)
Intususcepción , Niño , Humanos , Lactante , Preescolar , Anciano , Intususcepción/diagnóstico , Intususcepción/epidemiología , Intususcepción/cirugía , Estudios Retrospectivos , Abdomen , Dolor Abdominal/etiología , Vómitos/etiología , Hemorragia Gastrointestinal
11.
Pediatr Emerg Care ; 39(2): 108-111, 2023 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-36252058

RESUMEN

ABSTRACT: Appendicitis and intussusception are 2 of the most common abdominal emergencies in children and have high rates of morbidity if not treated promptly. However, only rarely do they occur together. We present a case in which clinical suspicion for intussusception was not high. Point-of-care ultrasound (POCUS) was performed in the pediatric emergency department, revealing both ileocolic intussusception and appendicitis. This case reinforces the importance of maintaining a broad differential diagnosis in unclear clinical scenarios and of the potential utility of POCUS. In our case, identification of intussusception on POCUS facilitated expeditious treatment, identification of the lead point, and allowed the treating physicians to prepare for the possibility of surgical management.


Asunto(s)
Apendicitis , Intususcepción , Niño , Humanos , Sistemas de Atención de Punto , Apendicitis/complicaciones , Apendicitis/diagnóstico por imagen , Apendicitis/cirugía , Ultrasonografía , Pruebas en el Punto de Atención , Intususcepción/diagnóstico por imagen , Intususcepción/cirugía
12.
Rev Esp Enferm Dig ; 115(2): 101-102, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-35815774

RESUMEN

A 49-year-old woman presented with a 1-month history of abdominal pain. The symptom became aggravated in the past day. Abdominal contrast enhanced CT showed classic "Bulls eye" appearance with concentric rings on axial image. Coronal and sagittal reconstruction revealed intussusception, with the proximal intussusceptum invaginating into the adjacent distal intussuscepiens. A fat density tumor of about 5.0 cm in diamater was also detected in the hepatic flexure. Colonoscopy showed a cauliflower-like tumor with a rough surface in the hepatic flexure, measuring 5.0 cm in diameter. Laparoscopic findings confirmed ascending colonic tumor accompanied by intussusception and an radical right hemicolectomy was performed. Histopathology confirmed a 4.0 × 4.0 × 4.5 cm submucosal lipoma in the ascending colon.


Asunto(s)
Neoplasias del Colon , Intususcepción , Lipoma , Femenino , Humanos , Persona de Mediana Edad , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugía , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/cirugía , Colonoscopía , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Dolor Abdominal
13.
Medicina (Kaunas) ; 59(7)2023 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-37512039

RESUMEN

Phytobezoars constitute conglomerates of indigested plant fibers and are a rare cause of acute mechanical ileus. They exhibit an increased prevalence in the elderly population and people with specific predisposing conditions. Radiological imaging can often set a definitive diagnosis and dictate the optimal therapeutic approach, combined with the patient's clinical status. An 81-year-old male presented with deteriorating clinical symptoms of intestinal obstruction, and an exploratory laparotomy was performed following inconclusive radiological findings; multiple phytobezoars and incipient intussusception were revealed intraoperatively. A patient's medical history can often raise clinical suspicion of phytobezoars. However, a careful etiological investigation is imperative in all cases of mechanical ileus in advanced ages; early detection and dissolution of phytobezoars, when applicable, can reduce the need for surgical interventions.


Asunto(s)
Bezoares , Dispepsia , Ileus , Obstrucción Intestinal , Intususcepción , Anciano , Humanos , Anciano de 80 o más Años , Intususcepción/cirugía , Intususcepción/complicaciones , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Bezoares/complicaciones , Bezoares/cirugía , Bezoares/diagnóstico , Ileus/etiología
14.
Gan To Kagaku Ryoho ; 50(13): 1420-1422, 2023 Dec.
Artículo en Japonés | MEDLINE | ID: mdl-38303294

RESUMEN

A 52-year-old woman patient, who presented with lower abdominal pain, was suspected of having colonic intussusception. An enhanced CT examination indicated that the end of the small intestine or appendix tumor had invaginated into the transverse colon. The CT revealed no evidence of intestinal ischemia, the emergency operation was performed on the following day. After relieving a colonic intussusception, a mass of the appendix was found and we performed laparoscope-assisted ileocolic resection and D3 dissection because of a strong possibility of carcinoma. The patient was discharged 8 days after the surgery and showed no evidence of recurrence for 6 months after the surgery. In postoperative histopathological examination, appendix tumor was diagnosed as a low-grade appendiceal mucinous neoplasm(LAMN). Adult intussusception is a rare disease and most of the cases are caused by malignant lesions, and a treatment strategy for LAMN has not yet been established. We report this case , as there are very few reported cases of adult intussusception caused by LAMN, with a review of the relevant literature.


Asunto(s)
Neoplasias del Apéndice , Intususcepción , Femenino , Humanos , Persona de Mediana Edad , Neoplasias del Apéndice/complicaciones , Neoplasias del Apéndice/cirugía , Apéndice/cirugía , Colectomía , Intususcepción/etiología , Intususcepción/cirugía
15.
Gan To Kagaku Ryoho ; 50(13): 1638-1640, 2023 Dec.
Artículo en Japonés | MEDLINE | ID: mdl-38303367

RESUMEN

The patient was a 33-year-old female. She was referred to our hospital from a previous clinic with abdominal pain and vomiting. Contrast-enhanced abdominal CT revealed intussusception, leading to a diagnosis of intussusception with a small intestinal tumor as an advanced part. Intestinal obstruction symptoms were observed, and emergency surgery was performed on the same day. As a technique, single port surgery was selected, and laparoscopic reduction was attempted. However, it was ineffective. The site of intussusception was induced outside the body through a small laparotomy wound, and reduction was performed using Hutchinson's procedure. As an adjacent lymph node was markedly swollen, the mesentery involving this lymph node was dissected in a fan shape, and the tumor was extirpated. The tumor measured 40 mm in long diameter, being a hemicircular, protruding lesion. Histologically, disarray of short spindle tumor cells was observed. Immunostaining showed Kit- and DOG1-negtive reactions and partially α-SMA and desmin-positive reactions, suggesting leiomyosarcoma. With the establishment of an immunostaining-test-based classification, leiomyosarcoma is currently rare. In this study, we report a patient in whom single port surgery for intussusception related to small intestinal leiomyosarcoma was successful.


Asunto(s)
Neoplasias Duodenales , Neoplasias del Íleon , Neoplasias Intestinales , Intususcepción , Leiomiosarcoma , Femenino , Humanos , Adulto , Intususcepción/etiología , Intususcepción/cirugía , Leiomiosarcoma/complicaciones , Leiomiosarcoma/cirugía , Neoplasias del Íleon/patología , Intestino Delgado/cirugía , Intestino Delgado/patología , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/cirugía , Neoplasias Intestinales/patología , Neoplasias Duodenales/patología
16.
Nihon Shokakibyo Gakkai Zasshi ; 120(10): 845-851, 2023.
Artículo en Japonés | MEDLINE | ID: mdl-37821374

RESUMEN

A 78-year-old female patient presented to our hospital with abdominal pain and melena. Abdominal ultrasonography detected a multiple concentric ring sign and retrograde invagination mass near the hepatic flexure. Colonoscopy revealed a 40-mm diameter type 1 tumor in the transverse colon near the splenic flexure, and the biopsy specimen demonstrated a well-differentiated adenocarcinoma. Retrograde intussusception due to transverse colon cancer was diagnosed, and laparoscopic transverse colon resection with lymph node dissection was performed. The resected specimen revealed a 48×40mm diameter type 1 tumor in the transverse colon and was diagnosed as pT2N0M0 pStage I. Contrast-enhanced computed tomography was unavailable, but real-time assessment of the invaginated mass and bowel blood flow was possible by abdominal ultrasonography, which was useful in determining the diagnosis and treatment strategy.


Asunto(s)
Colon Transverso , Neoplasias del Colon , Intususcepción , Femenino , Humanos , Anciano , Colon Transverso/diagnóstico por imagen , Colon Transverso/cirugía , Colon Transverso/patología , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugía , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/cirugía , Abdomen/patología , Colonoscopía
17.
Niger J Clin Pract ; 26(3): 365-367, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37056115

RESUMEN

Melanoma is a relatively rare tumour with tendency to metastasize to the gastrointestinal tract. Metastasis to the intestine constitutes a majority of the gastrointestinal tract melanoma metastases and confers a poor prognosis. While post-mortem studies detect that more than half of the melanoma patients have gastrointestinal tract metastasis, only minority are diagnosed, and even rarer present with intussusception. Intussusception, mainly a paediatric entity, is also seen among adult patients with underlying inflammatory bowel disease or tumour. In this report, we describe a patient with a melanoma in remission who presented with intestinal obstruction after months of vague abdominal complaints. Laparotomy revealed jejunal intussusception and histopathological staining confirmed the melanoma diagnosis. No other distant metastases other than the jejunum were revealed after extensive investigation.


Asunto(s)
Obstrucción Intestinal , Intususcepción , Melanoma , Adulto , Humanos , Niño , Intususcepción/diagnóstico , Intususcepción/etiología , Intususcepción/cirugía , Yeyuno , Recurrencia Local de Neoplasia , Melanoma/complicaciones , Melanoma/diagnóstico , Melanoma/cirugía , Obstrucción Intestinal/patología , Síndrome
19.
BMC Gastroenterol ; 22(1): 283, 2022 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-35659585

RESUMEN

BACKGROUND: For infants who need long-term enteral feeding but are unable to maintain sufficient oral intake, feeding gastrostomy tube placement is required. The use of a Foley catheter as a replacement catheter in a Stamm gastrostomy is indicated in the absence of dedicated gastrostomy feeding tubes; however, this approach has been associated with many morbidities. In this report, an unusual case of an infant who underwent a major operation due to coiled spring jejunal intussusception caused by Foley catheter migration is described. CASE PRESENTATION: A 6-month-old neurologically impaired premature female patient was admitted to the emergency unit with respiratory distress, nonbilious vomiting and an ineffective gastrostomy feeding tube. Her history revealed that, at the age of 2 months, she had undergone Stamm gastrostomy for enteral feeding with a Pezzer catheter. However, at the age of 5 months, the Pezzer catheter became dislodged and was replaced with a Foley catheter. The patient subsequently underwent emergent exploratory laparotomy due to intestinal obstruction. During the operation, retrograde coiled spring jejunal intussusceptions with multiple areas of local necrosis and perforations were observed. Resection of the affected jejunal segment and end-to-end anastomosis were performed. The postoperative period was long and very demanding due to the presence of several comorbidities. To our knowledge, this is the first operative demonstration of coiled spring intussusception. CONCLUSION: This case report aims to increase clinical awareness of the possibility of coiled spring intussusception following the use of Foley catheter in a gastrostomy and the difficulties encountered in the surgical course of a premature infant.


Asunto(s)
Dispositivos Anticonceptivos Femeninos , Intususcepción , Catéteres/efectos adversos , Dispositivos Anticonceptivos Femeninos/efectos adversos , Nutrición Enteral/efectos adversos , Femenino , Gastrostomía/efectos adversos , Humanos , Lactante , Intususcepción/etiología , Intususcepción/cirugía
20.
Eur J Pediatr ; 181(11): 3937-3944, 2022 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-36094665

RESUMEN

To evaluate the clinical features, surgical management, and prognosis of ileocecal duplication in children. A total of 115 patients diagnosed with ileocecal duplication at Beijing Children's Hospital between January 2010 and June 2021 were retrospectively reviewed. Ileocecal duplications were divided into ileal intraluminal (n = 41), ileal extraluminal (n = 24), ileocecal valve (n = 11), cecal intraluminal (n = 18), and cecal extraluminal (n = 3) types according to their locations. Median age at diagnosis was 9.5 (0.1-169.2) months. Intussusception was only observed preoperatively in patients with the ileal intraluminal (8/41), ileocecal valve (4/11), and cecal intraluminal (7/18) types (P = 0.004). Ileocecal resection and ileocolostomy and cyst excision without ileocecal resection were performed in 41 (35.7%) and 74 (64.3%) patients, respectively. The proportions of cyst excision without ileocecal resection performed in patients with different types were 78.0% (32/41), 91.7% (22/24), 27.3% (3/11), 27.8% (5/18), and 100.0% (3/3) (P < 0.001). Time of oral intake (P = 0.003) and hospital stay after surgery (P < 0.001) were significantly shorter in patients undergoing cyst excision without ileocecal resection. There were no significant differences in the complications, growth, and stool frequency (older than 4 years) between patients undergoing different surgical procedures. Regarding the stool consistency (older than 4 years), there was a lower proportion of dry stool in patients undergoing cyst excision (P = 0.008). CONCLUSIONS: Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. At mid-term follow-up, the children's growth and defecation patterns do not seem to be affected by ileocecal resection. WHAT IS KNOWN: • How to address ileocecal duplication has always been challenging in clinical management. • Children who have an ileocecal resection can develop some early postoperative complications. WHAT IS NEW: • Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. • Children's growth and defecation patterns do not seem to be affected by ileocecal resection.


Asunto(s)
Quistes , Válvula Ileocecal , Intususcepción , Ciego/cirugía , Niño , Humanos , Válvula Ileocecal/cirugía , Lactante , Intususcepción/diagnóstico , Intususcepción/etiología , Intususcepción/cirugía , Estudios Retrospectivos
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