Adult intussusception—a CT diagnosis

Gayer, Gabriela; Zissin, Rivka; Apter, Sara; Papa, Maurizio; Hertz, Marjorie

doi:10.1259/bjr.75.890.750185

Cited by 225 publications

(199 citation statements)

References 12 publications

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“…Case Report mass (10). In contrast, the most common imaging modalities used to image enteric duplication cysts is US.…”

Section: Discussionmentioning

confidence: 99%

An ileal duplication cyst manifested as an ileocolic intussusception in an adult

Kim¹,

Sung²,

Park³

et al. 2015

Turk J Gastroenterol

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An enteric duplication cyst presenting as enterocolic intussusception is an exceptional clinical entity. We herein report a rare case of an ileal duplication cyst that manifested as an ileocolic intussusception. A 19-year-old woman was hospitalized due to right upper quadrant pain. Colonoscopy revealed a polypoid mass protruding into the colonic lumen. Ultrasonography demonstrated intussusception with a teardrop-shaped cystic mass at the tip. Computed tomography also showed ileocolic intussusception with a 2.5 cm-sized round cystic mass at the tip of intussusceptum. Microscopically, the cystic wall consisted of a well-defined smooth muscle coat and heterotopic gastric mucosa, consistent with an enteric duplication cyst. This case highlights an ileal duplication cyst as an uncommon cause of adult ileocolic intussusception. To the best of our knowledge, this is the first case of enteric duplication cyst identified as a pathological lead point for enterocolic intussusception in an adult. Enteric duplication cysts should be included in the differential diagnosis of cystic-leading lesions for adult intussusceptions. Keywords: Enteric duplication cyst, enterocolic intussusception, adult INTRODUCTIONIntussusception occurs when a portion of the digestive tract becomes telescoped into the adjacent bowel segment. This condition usually occurs in children between 6 months and 2 years of age. In the past, intussusception was a severe condition with high morbidity and mortality rates. Currently, prompt diagnosis and effective treatment lead to a favorable outcome in most cases. Enteric duplication cysts are an uncommon congenital abnormality that manifest before 2 years of age in 80% of cases and that can occur anywhere along the gastrointestinal tract on the mesenteric side. The presenting signs and symptoms of enteric duplication cysts include abdominal distension, vomiting, bleeding, a palpable abdominal mass and urinary infrequency. The clinical manifestations are usually intestinal obstruction from adjacent pressure, volvulus and rarely intussusception (1). A thorough review of the literature revealed a few case reports of enteric duplication cysts causing enterocolic intussusception in infants (2-5); however, no such cases have been reported in adults to the best of our knowledge. We herein report a rare case of an ileal duplication cyst manifested as an ileocolic intussusception in a young adult woman. CASE PRESENTATIONA 19-year-old woman without medical or surgical history was hospitalized due to right upper quadrant pain. Physical examination revealed a tender palpable mass in the right upper quadrant of the abdomen. Laboratory results were within the normal range. Colonoscopy revealed a polypoid mass protruding into the colonic lumen ( Figure 1a). Ultrasonography (US) showed intussusception with a teardrop-shaped cystic mass at the tip, which had a double-layered wall consisting of a hypoechoic outer layer and an echogenic inner layer (Figure 1b). Computed tomography (CT) demonstrated ileocolic intussuscept...

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“…Case Report mass (10). In contrast, the most common imaging modalities used to image enteric duplication cysts is US.…”

Section: Discussionmentioning

confidence: 99%

An ileal duplication cyst manifested as an ileocolic intussusception in an adult

Kim¹,

Sung²,

Park³

et al. 2015

Turk J Gastroenterol

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“…Intussusception was preoperatively diagnosed by abdominal ultrasonography with the target and doughnut signs on transverse view and the pseudokidney sign in the longitudinal view [1] . Intussusception was preoperatively diagnosed by multi-slice spiral computed tomography (CT) scans with the characteristic target or sausage sign, edematous bowel wall and mesentery in the lumen [4,5] .…”

Section: Methodsmentioning

confidence: 99%

“…Recently, with the signs of target or sausage, mesenteric fat and vessels, abdominal CT scan has been reported to be the most useful imaging technique, with a diagnostic accuracy is 58%-100% [3][4][5]7,8] . Recent studies have demonstrated the superiority of CT in revealing the site, level, and cause of intestinal obstructions and in demonstrating threatening signs of bowel nonviability [9,10] .…”

Section: Figure 3 Efferent Loop Intussusception With a Tubementioning

confidence: 99%

Adult intussusception: A retrospective review of 41 cases

Wang

Cui²,

Liu³

et al. 2009

WJG

220

263

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AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI). METHODS:A retrospective review of the clinical features, diagnosis, management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted. RESULTS:Forty-one patients with 44 intussusceptions were operated on, 24.4% had acute symptoms, 24.4% had subacute symptoms, and 51.2% had chronic symptoms. 70.7% of the patients presented with intestinal obstruction. There were 20 enteric, 15 ileocolic, eight colocolonic and one sigmoidorectal i n t u s s u s c e p t i o n s . 6 5 . 9 % o f i n t u s s u s c e p t i o n s were diagnosed preoperatively using a computed tomography (CT ) scan (90.5% accurate) and ultrasonography (60.0% accurate, rising to 91.7% for patients who had a palpable abdominal mass). Coloscopy located the occupying lesions of the lead point of ileocolic, colocolonic and sigmoidorectal intussusceptions. Four intussusceptions in three patients were simply reduced. Twenty-one patients underwent resection after primary reduction. There was no mortality and anastomosis leakage perioperatively. Except for one patient with multiple small bowel adenomas, which recurred 5 mo after surgery, no patients were recurrent within 6 mo.Pathologically, 54.5% of the intussusceptions had a tumor, of which 27.3% were malignant. 9.1% comprised nontumorous polyps. Four intussusceptions had a gastrojejunostomy with intestinal intubation, and four intussusceptions had no organic lesion. CONCLUSION:CT is the most effective and accurate diagnostic technique. Colonoscopy can detect most lead point lesions of non-enteric intussusceptions. Intestinal intubation should be avoided.

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“…However, obesity and the presence of massive air in the distended bowel loops limit the image quality and the subsequent diagnostic accuracy. Recently, with the target or sausage sign, abdominal CT scan has been reported to be the most useful imaging technique, with a diagnostic accuracy is 58%-100% [2,7,8,12,[17][18][19] . In our series 86.6% patients were diagnosed preoperatively by this technique.…”

Section: Discussionmentioning

confidence: 99%

Adult Intussusception: Diagnosis and Management Strategies. 10 Years Experience from North India

Iqbal¹

2017

JMSCR

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Adult intussusception—a CT diagnosis

Cited by 225 publications

References 12 publications

An ileal duplication cyst manifested as an ileocolic intussusception in an adult

An ileal duplication cyst manifested as an ileocolic intussusception in an adult

Adult intussusception: A retrospective review of 41 cases

Adult Intussusception: Diagnosis and Management Strategies. 10 Years Experience from North India

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