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INTRODUCTION: Acute intestinal intussusception (AII) in adults, unlike in children, is a rare manifestation that is frequently secondary to malignant or benign tumors and intestinal intussusception on a lipoma is more exceptional. CASE PRESENTATION: We present a rare case of AII caused by a lipoma in a previously healthy 44-year-old man. He experienced severe right lower quadrant pain and constipation. An abdominal CT scan revealed ileocecal intussusception, displaying the classic "sandwich" and "cocarde" images. Additionally, a Caecal lipoma was identified. The patient underwent midline laparotomy, revealing significant small bowel distention upstream of the ileocolic intussusception. Subsequently, a right hemicolectomy with ileocolostomy was performed. Pathological examination confirmed colonic ischemic necrosis attributed to AII originating from a submucosal caecal lipoma. CLINICAL DISCUSSION: AII is a rare cause of abdominal pain and accounts for 1 to 5 % of adult intestinal obstructions. In adults, an organic cause is found in 70 to 90 % of cases, often secondary to an endoluminal lesion of malignant nature. Pure colonic intussusception on a lipoma is exceptional. CT scan, can show characteristic images and confirms the fatty nature of the lipoma. Surgical intervention is necessary as treatment for intussusception and anatomopathological examination is required for diagnostic confirmation. CONCLUSION: Intestinal intussusception caused by an intestinal lipoma is rare. Imaging, mainly ultrasound and CT scan, plays a crucial role in providing a positive and etiological diagnosis of the condition by showing characteristic images. Treatment is always surgical, and there is no place for reduction under radiological control.
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INTRODUCTION: Acute intestinal intussusception (AI) in adults secondary to jejunostomy is a rare complication and a surgical emergency requiring early diagnosis and treatment. PRESENTATION OF CASE: We report the case of a 44-year-old patient, without medical history, who presented dysphagia after caustic ingestion. The patient underwent a Witzel feeding jejunostomy. The evolution was marked by the installation of abdominal distension with vomiting and alteration of the general state, the diagnosis of an intussusception in the jejunostomy tube was made in the abdominal CT scan, which required a surgical intervention, and reduction of intussusception, with simple after effects. DISCUSSION: Acute intestinal intussusception (IIA) secondary to jejunostomy tube placement is a rare abdominal emergency. It manifests with signs of upper gastrointestinal obstruction. Diagnosis is based on abdominal imaging by ultrasound or CT scan. Treatment is most often surgical (Chavrier et al., 1992) [1]. CONCLUSION: We present a very rare example of acute intestinal intussusception in adults, complicating jejunostomy, with non-specific clinical signs, which needed an early radiological diagnosis for adequate management.
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OBJECTIVE: The objective of this work was to study the place of ultrasound in the positive diagnosis, etiology and choice of the therapeutic modality of acute intestinal intussusception. MATERIAL AND METHODS: This was a retrospective, descriptive, cross-sectional, multicenterstudy, carried out over a period of 18 months (January 1, 2016 to June 30, 2017) on 45 patient files collected in the radiologydepartments (Aristide Le Dantec and Albert Royer). Were included all patients aged less than 14 years, admitted with acute abdominal pain, whose diagnosis of IIA was retained on ultrasound. Pneumatic disinvagination was performed in patients without signs of severity. We studied the time of management, the ultrasound aspects of the invagination puddles, the therapeutic choice but also the radiosurgical concordance and the factors of failure of the pneumatic enema. Statistical analysis was done by SPSS version 21.0 software. RESULTS: Ultrasound was used to make the diagnosis of IIA in 43 cases (95.5%). The sonographic characteristics were as follows: 27.9% of the IIA were located in the right hypochondrium, 19 cases were ileo-caecal, 10 (22.2%) ileo-caeco-colic, 9 (20%) ileo-colic, 4 (8.9%) colo-colic and one (2.2%) gregelic; 44 cases were idiopathic and one case was a Meckel's diverticulum The management time was less than 48 hours in 34% of cases and 66% more than 48 hours. Pneumatic reduction was performed in 18 cases (40%), with success in 14 cases (77.8%) and one case of pneumoperitoneum complication. Surgery was performed in 31 cases (68.8%). The sensitivity and specificity of ultrasound in the diagnosis of signs of severity were 77.7% and 78.9%. Good agreement was observed between the results of the Doppler ultrasound and the intraoperative findings. Ultrasound parameters associated with failed pneumatic deinvagination were: outer cylinder thickness ≥10 mm, adenopathy at the level of the small-axis bladder ≥10 mm, effusion in the bladder, and hypovascularization of the bladder head. Hypovascularization of the boudin head was the only factor independently associated with failure of pneumatic disinvagination. CONCLUSION: Ultrasound is a powerful imaging modality in the positive diagnosis, etiology, severity and therapeutic choice of IIA.
OBJECTIF: L'objectif de ce travail était d'étudier la place de l'échographie dans le diagnostic positif, étiologique et le choix de la modalité thérapeutique des invaginations intestinales aigues. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude rétrospective, descriptive, transversale, multicentrique, réalisée sur une période de 18 mois (01 Janvier 2016 au 30 Juin 2017) portant sur 45 dossiers de patients colligés dans les services de radiologie (Aristide Le Dantec et Albert Royer). Ont été inclus tous les patients âgés de moins de 14 ans, admis dans un tableau de douleur abdominale aigue, dont le diagnostic d'IIA était retenu à l'échographie. Une désinvagination pneumatique a été réalisée chez les patients sans signe de gravité.Nous avons étudié le délai de prise en charge, les aspects échographiques des boudins d'invagination, le choix thérapeutique mais aussi la concordance radio-chirurgicale et les facteurs d'échec du Lavement pneumatique. L'analyse statistique a été faite par le logiciel SPSS version 21.0. RÉSULTATS: L'échographie a permis de faire le diagnostic d'IIA dans 43 cas (95,5%). Les caractéristiques échographiques étaient les suivantes : 27,9% des IIA siégeaient au niveau de l'hypochondre droit, 19 cas de forme iléo-caecales, 10(22,2%) cas iléo-caeco-colique, 9(20%) casiléo-colique, 4(8,9%)cascolo-colique et un cas (2,2%) grélo-grélique; 44 cas idiopathiques et un cas de diverticule de Meckel. Le delais de prise en charge était inférieur à 48heures dans 34 % des cas et 66% supérieur à 48heures. Une réduction pneumatique a été réalisée dans 18 cas (40%), avec succès dans 14 cas (77,8%) et un cas de complication à type de pneumopéritoine. Une chirurgie était réalisée dans 31 cas (68,8%). La sensibilité et la spécificité de l'échographie dans le diagnostic des signes de gravité étaient de 77,7% et 78,9%. Une bonne concordance étaitobservée entre les résultats de l'écho-Doppler et les constatations peropératoires. Les paramètreséchographiquesassociés à un échec de la désinvagination pneumatique étaient : une épaisseur du cylindre externe ≥10 mm, des adénopathies au niveau du boudin de petit axe ≥10 mm, un épanchement dans le boudin et une hypovascularisation de la tête du boudin. L'hypovascularisation de la tête du boudin était le seul facteur indépendamment associe à l'échec de la désinvagination pneumatique. CONCLUSION: L'échographie est une modalité performante d'imagerie dans le diagnostic positif, étiologique, de gravité et dans le choix thérapeutique des IIA.
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Acute intestinal intussusception remains a surgical emergency in infants and young children aged 3 months to 3 years. It results from the incarceration of the upstream intestinal segment in the downstream segment. In the majority of cases it is idiopathic, but can be secondary to certain pathologies notably Meckel's diverticulum. The site is most often ileo cecal. The symptomatological triad is made up of pain, vomiting, and rectal bleeding. The diagnosis is confirmed by imaging, dominated by ultrasound which remains the reference imaging. We report the case of a 3 year-old boy, followed for a malformation who presented with abdominal distension, abdominal pain, and rectal bleeding. The diagnosis of acute ileo-ileal intussusception was made. After an attempt at hydrostatic reduction under ultrasound guidance, he underwent surgical management. The postoperative period was simple and uncomplicated. Intestinal intussusception remains a pathology with a low morbidity and mortality rate of 0% to 1% due to delayed diagnosis and delayed therapeutic management.
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Acute intestinal intussusception occurs primarily in infants and young children. It uncommonly occurs in adults. It can have various causes. In the vast majority of cases, it is secondary to a benign or malignant tumor. Intestinal T-cell lymphoma revealed by intestinal intussusception is very rare. We report the case of a 43-year old patient admitted with intestinal occlusion to the Emergency Department at the University Hospital Hassan II, Fes, Morocco. Abdominal CT scan showed acute intestinal intussusception associated with incarcerated bowel loop with bowel wall thickening. Treatment was based on open carcinological resection. Anatomopathological and immunohistochemical examination of the surgical specimen showed large T-cell anaplastic lymphoma. After surgery, chemotherapy was indicated to improve prognosis and to avoid a potential relapse. Intestinal intussusception rarely occurs in adults. It most often leads to the detection of an organic cause such as a tumor. This study and literature review aim to highlight the clinical and diagnostic features as well as the therapeutic approaches for this rare disease.