Postoperative intussusception in children operated for primary intussusception - A very rare entity.

Postoperative intussusception (POI) after abdominal and non-abdominal operations is a rare but recognized condition discussed several times in literature. There are scarce reports regarding POI in children operated primarily for intussusception. We discuss three such cases that were seen in our institution in the last two years. The patients showed symptoms of atypical ileus that failed to resolve two to eight days following primary surgery. Ultrasound reported intussusception and surgical intervention was sought. All patients had ileoileal intussusception. Manual reduction was successful in two cases. One had intestinal necrosis and underwent resection and anastomosis. Recovery was satisfactory without recurrence. POI should be suspected in patients who show signs of intestinal obstruction in early postoperative period. A second POI should be kept in mind after surgical reduction of the first intussusception. Ultrasound should be performed to aid diagnosis followed by urgent surgical intervention.

Small Bowel Intussusception due to Solitary Peutz-Jeghers Jejunal Polyp: A Rare Entity.

Peutz-Jeghers syndrome (PJS) is characterized by mucocutaneous pigmentation with multiple hamartomatous polyps of the gastrointestinal tract and/or a familial history with autosomal dominant inheritance pattern having incomplete penetrance, with some cases arising from spontaneous mutations. We present this case of a 12-year-old female who presented with jejunojejunal intussusception and on exploration revealed a polypoidal mass around 50 cm from duodenojejunal flexure acting as a lead point. A segmental jejunal resection with anastomosis was performed and histopathology confirmed a solitary Peutz-Jeghers (PJ) hamartomatous polyp. She neither had mucocutaneous pigmentation nor family history of PJS or any other polyps anywhere in the gut on further evaluation by endoscopies. A solitary PJ polyp in the jejunum is a rare entity, and to the best of our knowledge, only around 13 cases have been reported in world literature so far. Regular follow-up is essential in young children, so that future manifestations of the PJS are not missed.

Point-of-Care Ultrasound For Differentiating Ileocolic From Small Bowel-Small Bowel Intussusception.

BACKGROUND: Intussusception is a common pediatric emergency. The two types of intussusception are ileocolic intussusception (ICI) and small bowel-small bowel intussusception (SB-SBI), and neither are easily distinguished clinically. ICI requires radiology personnel and potentially surgical assistance for its reduction. SB-SBI is managed expectantly, as many resolve spontaneously. Differentiating between ICI and SB-SBI through point-of-care ultrasound (POCUS) requires an understanding of their salient features. Identification of the correct type of intussusception immediately assists decision making and patient disposition. OBJECTIVE OF THE REVIEW: Our objective was to provide guidance on POCUS technique for intussusception identification, and to review the ultrasound literature differentiating ICI from SB-SBI. METHODS: We systematically searched 3 separate databases and gray literature to identify articles that met our criteria and assessed them for final review. The final articles were graded for quality using The National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. RESULTS: A total of 858 articles were identified. Six articles were included in the final review. All studies were conducted in pediatric patients in different countries. Most were found to have a fair quality of evidence. The linear transducer is used when evaluating intussusception. Both ICI and SB-SBI are identified easily on POCUS, but they differ sonographically with respect to region within the abdomen, intussusception parameters, lymph nodes, and other salient features seen on real-time video. CONCLUSIONS: ICI and SB-SBI can be identified and differentiated using several sonographic features. POCUS is capable of expeditiously aiding the emergency physician's decision making and disposition when managing intussusception.

Bleeding Edge Therapy: Ileocolic Intussusception Due to Ileocecal Valve Adenocarcinoma and Its Management in an Adult Patient-Case Report and Literature Review.

Adenocarcinoma as the primary cause of bowel intussusception is uncommon. We describe the case of a 86-year-old patient admitted for ileocecal intussusception due to the presence of adenocarcinoma, located in the ileocecal valve and right colon. The etiologies of intussusception, its diagnosis, and conservative or surgical treatments are discussed, with attention placed on the indications for reduction of the invagination prior to surgical resection.

Concomitant Heterotopic Pancreas and Endometriosis as a Rare Cause of Ileo-Ileal Intussusception in a Young Woman with Spina Bifida: Case Report and Literature Review.

INTRODUCTION: Isolated heterotopic pancreas (HP) as the primary cause of bowel intussusception is extremely rare. We report a case of a 33-year-old female patient with spina bifida admitted to the Emergency Surgical Department for ileal intussusception due to the presence of heterotopic pancreas associated with endometriosis. AREAS COVERED: Symptomatic ileal intussusception for ectopic pancreas is usually associated with overt gastrointestinal blood loss (predominantly melena), abdominal pain, vomiting, and weight loss. Treatment is universally surgical. EXPERT COMMENTARY: Isolated heterotopic pancreas is a rare condition; it should be considered in the differential diagnosis of bowel intussusception.

Point-of-care ultrasound diagnosis of small bowel-small bowel vs ileocolic intussusception.

BACKGROUND: Identification of intussusception is feasible with emergency department (ED) point-of-care ultrasound (PoCUS) due to its ease-of-use and high accuracy. Little is known about the clinical characteristics and outcomes of small bowel-small bowel intussusception (SB-SBI) relative to ileocolic intussusception (ICI) identified by PoCUS. METHODS: We conducted a retrospective cohort study at a single, tertiary care, urban pediatric ED of intussusception identified by PoCUS. Demographic information, clinical data, and outcomes, including clinical course, intussusception characteristics, recurrence rates, and interobserver agreement (Cohen's kappa), were evaluated. RESULTS: ED PoCUS identified thirty-seven patients with intussusception over a 4-year period. Twenty-one patients (57%) identified were SB-SBI. The median age was 54 months (IQR 35-76 months) for SB-SBI and 8 months (IQR 5.8-13.5 months) for ICI. The mean diameter was 1.68 cm (SD 0.52 cm) for SB-SBI and 2.74 cm (SD 0.43 cm) for ICI (p < 0.05). Two of 21 (9.5%) SB-SBI subjects required surgical intervention, while the rest spontaneously reduced. Fourteen of 16 (88%) ICI subjects required intervention. There were two (9.5%) recurrences of SB-SBI and 1 (6.3%) recurrence of ICI confirmed on PoCUS. Cohen's kappa was 0.85 (95% CI 0.68-1.0). CONCLUSIONS: SB-SBI may be identified more frequently than previously thought when screened with ED PoCUS. Older children with SB-SBI may have underlying lead-points and may require surgical intervention. PoCUS can help differentiate between variants of intussusception that range from a surgical emergency to a transient source of abdominal pain that may be recurrent and otherwise unexplained, allowing clinicians to better manage these patients accordingly.

Evaluation and novel treatment in a case of refractory small bowel-small bowel intussusception.

Small bowel into small bowel intussusception can present with symptoms similar to those observed in patients with more common small bowel into large bowel intussusception. In most cases, intussusceptions isolated to the small bowel are self-limited and less likely to result in bowel ischemia. Nonetheless, any patient with recurrent intussusception should be evaluated to assess location and for the presence of a pathologic lead point. We report a patient with recurrent small bowel into small bowel intussusception who underwent a comprehensive evaluation that revealed lymphoid hyperplasia in the absence of a pathologic lead point. His symptoms resolved after a dose of oral dexamethasone.

Rare Idiopathic Adult Intussusception: A Case Report.

Intussusception is highly uncommon in adults, with most cases caused by a pathological lead point that requires surgical resection. This case presentation highlights a rare example of idiopathic intussusception in a young male adult. Our patient is a 23-year-old African American male who presented at the Piedmont Macon Medical Center emergency department in February 2023 with acute-onset severe periumbilical pain, nausea, vomiting, and diarrhea. Computed tomography (CT) imaging was inconclusive, and his diagnosis of an ileo-ileal intussusception in the distal ileum was made during an exploratory (diagnostic) laparoscopy. Based on a visual inspection of the bowel demonstrating no evidence of inflammation, adhesions, lesions, ischemia, or a pathological lead point, manual reduction without resection was indicated. While intussusception is rare in adults, it is an important clinical prognosis that should be carefully considered in the differential diagnosis.

Submucosal Lipoma-Induced Small Bowel Intussusception: A Case Study of Surgical Intervention and Management in an Adult Female.

We present an adult patient, a 39-year-old female, with chief complaints of pain in the umbilical region. The patient was further evaluated by radiological investigations and was diagnosed with small bowel intussusception caused by submucosal lipoma as the lead point. She had undergone ileal resection and anastomosis of the affected segment. The postoperative period was uncomplicated, and the patient continued with regular oral intake. The histopathological analysis revealed it to be adipose tissue with no features of atypia. This case shows the rare presentation of small bowel intussusception due to a submucosal lipoma. It emphasizes the significance of diagnostic imaging tools for diagnosis and the need for surgery for proper administration.

Intussusception and Gut Dysmotility: A Systematic Review Assessing Unexpected Complications of Bariatric Surgery.

Bariatric surgery, although effective in treating obesity-related comorbidities, rarely results in intussusception, which is a severe complication. This study aimed to enhance clinical practice and establish early diagnosis by elucidating risk factors and management strategies associated with intussusception. We conducted this systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 criteria. We looked through PubMed, PubMed Central, ScienceDirect, ScienceOpen, MyScienceWork, Hyper Articles en Ligne (HAL), Google Scholar, and the Medical Literature Analysis and Retrieval System Online for relevant studies and research. Articles were screened according to inclusion and exclusion criteria, and relevance. We employed pertinent quality appraisal instruments to look for bias. Initially, we discovered 2,833 items. We eliminated redundant and unnecessary publications. After reviewing all the articles, we selected 30 studies based on their titles and abstracts. Out of the 30 studies reviewed, 12 papers were included in this review, with the remaining 18 being eliminated due to low quality. Medical practitioners and surgeons have a responsibility to meticulously monitor and provide postoperative surveillance, with a particular emphasis placed on individuals exhibiting symptoms of abdominal pain and vomiting, as there is a clinical imperative to consider the possibility of intussusception. The management approach, whether conservative or surgical, remains contingent upon the clinical context.

Case Report: A Closed Loop Obstruction Secondary to Idiopathic Small Bowel Intussusception in an Elderly Woman.

Intussusception is primarily a disease of children and is the primary cause of intestinal obstruction in the pediatric age group. It accounts for around 5-16% of cases of intestinal obstruction in adults of the western population. Most cases of adult intussusception (up to 90%) are secondary to an identified structural lesion or a lead point contrary to pediatric intussusception. Adults with intussusception present with subacute or chronic symptoms of partial obstruction. CT is the best imaging to make a preoperative diagnosis of adult intussusception. The standard treatment for adult intussusception is surgery, and non-operative reduction should not be attempted. Here, we present a rare case of idiopathic small bowel intussusception in a 50-year-old woman. She presented with crampy abdominal pain for one-week duration. It was associated with frequent vomiting of bilious matter. She claimed to have had similar symptoms for the past 2 months and had repeatedly visited nearby health facilities. She had an abdominal CT, which suggested a complicated small bowel intussusception. Exploratory laparotomy was done, and there was a small bowel intussusception and an inflammatory stricture at the end of the intussusceptum, which is believed to form a closed-loop like obstruction. The intussusceptum was resected en-bloc then end-to-end jejuno-jejunal anastomosis was performed. This case report makes physicians aware of this rare condition in adults. So that they have a high index of suspicion when a patient presents with symptoms of subacute or chronic intestinal obstruction and inform that abdominal CT should be done in these circumstances and surgery is the mainstay of treatment. Our case is unique, and there is no report in the literature similar to ours.

Idiopathic Small Bowel Intussusception in Adults: Conservative Versus Surgical Management.

Intussusception is a rare diagnosis in adults and generally has a pathological cause. In this case report, we highlight an adult, male patient who presented with typical signs and symptoms of intussusception, and a diagnosis was subsequently confirmed with imaging. After 24 hours of no clinical improvement, the intussusception was resolved through a laparoscopic approach. No lead point or other pathological cause was identified that may have contributed to the development of intussusception. The idiopathic presentation of intussusception in adults is scarcely represented in the scientific literature, making its best management practices vague and leaving room for studies regarding best surgical management. We conducted a brief literature review of adult idiopathic intussusception cases and found fewer than 25 cases documented since 2010. Our analysis revealed that the majority of cases were resolved through a laparoscopic method and only about a quarter were conservatively managed with supportive measures. More research is needed in this subject matter to more accurately determine the need for surgical management in cases of adult idiopathic intussusception.

Small bowel intussusception in an adult secondary to gastrointestinal stromal tumor: a rare case report.

Intussusception is a rare surgical condition in adults less commonly confined to small bowel. Adult intussusception is an indication of surgical resection due to possibility of ischemia and malignant pathological cause like gastrointestinal stromal tumor (GIST) as in this case. Case presentation: A 32-year-old male presented with abdominal pain and vomiting for 3 days. Vitals parameters and abdominal examinations were normal. Abdominal ultrasonography revealed target sign suggesting ileoileal intussusception in right lower quadrant. Abdominal contrast-enhanced computed tomography of abdomen showed features suggestive of ileoileal intussusception. Diagnostic laparoscopy was done which was later turned to laparotomy for segmental resection and anastomosis of ileum for ileoileal intussusception. Polypoidal growth noted in the resected section of ileum was found to be GIST (CD117 and DOG-1 positive) which was considered to be the lead point. Patient recovered well during postoperative period and later referred to oncology clinic for chemotherapy. Clinical discussion: Intussusception and subsequent obstruction are very uncommon presentation in a patient with GIST because of their tendency to grow in an extraluminal fashion. As intussusception is rare in adult, high level of suspicion and proper imaging technique plays important role in diagnosing the condition. Conclusion: Ileoileal intussusceptions due to GIST are a rare clinical entity in adult intussusceptions and generally have a vague variable clinical presentation thus requiring high index of clinical judgement and suspicion with judicious use of imaging.

Inflammatory Myofibroblastic Tumor Presenting as a Partial Bowel Obstruction: A Case Report.

Intussusception, or telescoping of the bowel, is a rare condition in the adult population that can lead to serious complications, such as obstruction or ischemia. Most cases of intussusception are idiopathic and present with a pathognomonic "target sign" on imaging. Rarely, in adults, intussusceptions can be found with lead points, some of which may be neoplastic. Treatments for intussusception include air enemas or surgical intervention if enemas are unsuccessful in resolving the telescoped bowel. This case report discusses an atypical presentation of intussusception in an adult female with a "whirlpool sign" on imaging rather than the typical "target sign." She was found to have incorporation of mesenteric fat into telescoping bowel causing edema and partial bowel obstruction. The affected bowel was removed laparoscopically, and an end-to-end anastomosis was formed. Pathology of the resected bowel revealed a non-immunoreactive inflammatory myofibroblastic neoplasm as the lead point. Most inflammatory myofibroblastic tumors stain positive for desmin, smooth muscle actin, and anaplastic lymphoma kinase (ALK), whereas this patient was non-immunoreactive. The patient tolerated surgery well and is now pain-free with normal gastrointestinal function. This case report hopes to heighten awareness of atypical presentations of intussusceptions, the use of imaging to help aid in uncertain diagnoses, and the appropriate surgical treatment for symptomatic patients.

Bowel intussusception and adhesive intestinal obstruction in neurofibromatosis type 1.

We report the case that a patient with Neurofibromatosis type 1 experienced bowel intussusception and adhesive intestinal obstruction. Bowel intussusception was considered to be due to long intestinal tube and multiple intraabdominal lesions including gastrointestinal stromal tumors (GISTs).

Bowel intussusception caused by a percutaneously placed endoscopic gastrojejunostomy catheter: A case report.

BACKGROUND: In adults, bowel intussusception is a rare diagnosis and is mostly due to an organic bowel disorder. In rare cases, this is a complication of a percutaneously placed endoscopic gastro (jejunostomy) catheter. CASE SUMMARY: We describe a case of a 73-year-old patient with a history of myocardial infarction, chronic idiopathic constipation and Parkinson's disease. For the admission of his Parkinson's medication, a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) was placed. The patient presented three times at the emergency department of the hospital with intermittent abdominal pain with nausea and vomiting. There were no distinctive abnormalities from the physical and laboratory examinations. An abdominal computed tomography scan showed a small bowel intussusception. By push endoscopy, a jejunal bezoar at the tip of the PEG-J catheter was found to be the cause of small bowel intussusception. The intussusception was resolved after removing the bezoar during push enteroscopy. CONCLUSION: Endoscopic treatment of bowel intussusception caused by PEG-J catheter bezoar.

Rapunzel Syndrome: A Rare Case of Small Bowel Intussusception in a Child.

Trichobezoars are indigestible masses of ingested hair commonly found in the stomach, often presenting with symptoms related to gastric outlet obstruction and severity related to the mass's size and location. Gastrointestinal complications include ulceration, perforation, peritonitis, pancreatitis, obstructive jaundice, pneumatosis intestinalis, and intussusception. Management of trichobezoars differs from that of other forms of bezoars, which can often be addressed with chemical dissolution. Trichobezoars are high-density structures that are also resistant to enzymatic and pharmacotherapy degradation, and as such, they require endoscopic, or more commonly, surgical removal. Here, we present the diagnosis and surgical management of a 12-year-old female with a large trichobezoar causing gastric outlet obstruction, with an associated Rapunzel syndrome manifesting as multiple small intestinal intussusceptions.

Accurately distinguishing pediatric ileocolic intussusception from small-bowel intussusception using ultrasonography.

PURPOSE: The clinical treatment of ileocolic intussusception is different from that of small-bowel intussusception (SBI). This study aimed to analyze the differences between the two groups using ultrasonoscopy to avoid misdiagnosis. METHODS: We conducted a retrospective study of intussusception in patients aged 0-18 years from September 2018 to March 2020. Clinical and ultrasonoscopy data were reviewed. RESULTS: A total of 183 cases of intussusception were included in this study (123 cases of SBI and 60 of ileocolic intussusception). Ultrasonoscopy features that were significantly different between the two groups (p<0.05) included the lesion diameter, fat core thickness, outer wall thickness, lymph nodes inside intussusception, and lesion length. In the SBI group, 85% (104/123) of the normal ileocecal region was found in the right lower quadrant and 98% (120/123) of the normal ascending colon was found in the right side of the abdomen. In the ileocolic intussusception group, none of the normal ileocecal region was found and the ascending colon was found in only 5 cases (8%) (p<0.05). CONCLUSIONS: The use of ultrasonography is the most practical method to distinguish SBI from ileocolic intussusception. In addition to comparing the differences between lesions, conventional probing of the ileocecal region and ascending colon will help to accurately differentiate between the types of intussusception and avoid misdiagnosis. LEVELS OF EVIDENCE: Diagnostic.

Shortening and Plication of Entero-enterostomy for Intussusception in Roux-en-Y Gastric Bypass: Video Report.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered by a large percentage of bariatric surgeons' the operation of choice for obesity surgery as reported by Melvin (J Gastrointest Surg. 4:398-400, 2004). It is considered a generally safe procedure with a low percentage of complications. One of these complications is small bowel obstruction which has different etiologies. A rare cause of intestinal obstruction is intussusception at the entero-enterostomy as reported by Arapis et al. (Surg Obes Relat Dis. 1:23-33, 2019) and Sneineh et al. (OBES SURG 30:846-850, 2020). The accurate incidence of intussusception after LRYGB is unknown but Simper et al. (Surg Obes Relat Dis. 4:77-83, 2008) found a 0.15% incidence in their study. Diagnosis of intussusception requires a high index of suspicion because neither physical examination nor imaging is sensitive. CT scan might identify the problem, but a negative CT scan image does not rule out intussusception. Treatment of intussusception varies according to the clinical picture of the patient at the presentation. These variations may include conservative treatment up to resection of the entero-enterostomy and do a re-anastomosis as discussed by Daellenbach et al. (OBES SURG 21:253-263, 2011). The video aims to present an alternative option for surgical management of intussusception of the entero-enterostomy following LRYGB which to our knowledge was not published before.

Management of Incidentalomas.

Incidental findings are common in the evaluation of surgical patients. Understanding the appropriate assessment and management of these frequent occurrences is important for the provision of comprehensive quality care. This review details the epidemiology, considerations, and recommendations for management of common incidental manifestations in surgical patients, including Meckel diverticulum, adrenal incidentaloma, thyroid nodule, solitary pulmonary nodule, small bowel intussusception, gallstones, and incidental appendectomy.