Appendiceal Intussusception Mimicking Cecal Mass and Fecal Matter: A Report of Two Rare Cases

Haug, James; Katkar, Amol; Covelli, James

doi:10.1155/2018/4809650

Cited by 6 publications

(10 citation statements)

References 7 publications

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“…[ 5 ] The CT scan may be helpful in diagnosis of the appendiceal intussusception as it reveals excellent anatomic details and reconstructions. A target, layered and sausage-shaped appearance may be observed on CT. [ 17 ] A mushroom or polypoid caecal lesion may be observed on colonoscopy. [ 18 ] There is some literature regarding the appearance of appendiceal intussusception on sonography, [ 6 ] but it is not detailed enough in characterizations and differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Preoperative sonographic diagnosis of McSwain type V appendiceal intussusception

Duan¹,

Peng²,

Liu³

et al. 2020

Medicine

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Rationale: Appendiceal intussusception is a rare disease. The definite preoperative diagnosis of appendiceal intussusception is rare and challenging. Here, we present a case of McSwain type V appendiceal intussusception in a 10-year-old boy. To our best knowledge, this is the first case report of a type V appendiceal intussusception that was preoperatively confirmed with sonography. Here, we have described in detail the ultrasound features and differential diagnosis of this rare disease. Patient concerns: A 10-year-old boy presented with 3 days of recurrent intermittent mild abdominal pain. The result of ultrasonography suggested an ileocolic intussusception and a therapeutic air-contrast enema was requested to reduce the intussusception but failed at a local hospital. Diagnoses: Physical exam revealed mild tenderness in the lower right quadrant of the abdomen. However, ultrasonography showed a target-sign in cross section and a finger-like appearance in the longitudinal view. A diagnosis of McSwain type V appendiceal intussusception was made. Interventions: The patient underwent an appendectomy after successful manual reduction on laparotomy. The appendix was successfully resected. Outcomes: Intraoperatively, the appendix was completely inverted in the cecum, and the preoperative sonographic findings were confirmed. During follow-up, there were no signs of recurrence. Lessons: Pre-operatively, on ultrasound a type V appendiceal intussusception is usually misdiagnosed as an ileocolic intussusception. Radiologists must execute caution to avoid over reliance on the sonographic findings of intussusception, especially when there is a mismatch with clinical symptoms. It is especially important to accurately understand the surgical-anatomic configuration of type V appendiceal intussusception that creates a “target-sign” and a “finger-like” layout on ultrasonography.

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Section: Discussionmentioning

confidence: 99%

Preoperative sonographic diagnosis of McSwain type V appendiceal intussusception

Duan¹,

Peng²,

Liu³

et al. 2020

Medicine

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“… Primul tip imită tabloul clinic clasic de apendicită acută [6,21]; ca urmare, este adesea confundat cu această patologie;  Al doilea tip prezintă semnele tipice de invaginare, care includ durere abdominală, vome, însoțite sau nu de tulburări de scaun, precum diaree și melenă [21];  Al treilea tip include simptome, cum ar fi: melena, vome și durerea recurentă în cadranul inferior drept, care sunt descrise de pacienți pentru, cu persistența săptămâni sau chiar câteva luni [21,96];  Al patrulea tip include pacienții care rămân complet asimptomatici [21,84] și sunt diagnosticați incidental cu anomalie în cadrul unui examen profilactic sau al unei evaluări clinice pentru alte patologii [21,85]. Prin urmare, prezentarea clinică este adesea vagă și nespecifică [16], mimând apendicita acută sau alte patologii abdominale cronice caracterizate prin dureri abdominale [8,45,56,59]. Majoritatea studiilor relevă că pacienții prezintă semne clinice print durerii abdominale a cadranului inferior drept descris în aproximativ 78% din cazuri; într-o perioadă de zile, săptămâni, luni sau poate avea caracter ciclic cu cea mai mare intensitate după ciclurile menstruale [42, 45, 46-52, 55, 59, 61, 70].…”

Section: Aspect Clinicunclassified

“…Printre alte simptome și semne raportate sunt menționate grețuri [27,28,30,35,48,47,55] și vărsături [27,28,30,35,40,45,55,58,82], melenă [ 25,26,31,46,55,82,86], diaree [12,34,[47][48][49]54] sau constipație [21,49,55,86] (Tabelul IV). De asemenea în literatura de specialitate sunt evidențiate vertijuri [34], anorexie [86], oboseală [31], febră [28,40], anemie [26], hematurie [56] sau prezența mucusul în materiile fecale [21], însă sunt considerate a fi mai puțin frecvente. Evaluarea pacientului poate furniza informații suplimentare importante pentru clinicieni, cu toate acestea este mai puțin util în stabilirea diagnosticului IA [45].…”

Section: Aspect Clinicunclassified

“…Datorită variațiilor simptomelor clinice și a lipsei semnului patognomonic, rarității patologiei și diversității factorilor cauzatori, detectarea cu precizie a prezenței sau absenței invaginării apendicelui vermiform este dificilă [56] și, prin urmare, diagnosticul este rar descoperit înainte de intervenție chirurgicală [16,72]. Cu toate acestea, un diagnostic stabilit pre operator permite determinarea tacticii ulterioare de tratament și evitarea complicațiilor inutile [27] și a intervențiilor potențial catastrofale, cum ar fi: excizia endoscopică sau intervenția chirurgicală radicală, în cazurile de suspiciune de tumoră malignă [21].…”

Section: Aspect Diagnosticunclassified

“…Astfel, medici specialiști în domeniul endoscopiei ar trebui să fie conștienți de această afecțiune neobișnuită și să o ia în considerare în diagnosticul diferențial când un "polip" este vizibil în timpul colonoscopiei în regiunea cecului [21]. De asemenea autorii menționează că biopsia nu este recomandată în cazul suspiciunii de invaginare [39,56]. Cu excepția valorii de diagnostic, colonoscopia poate servi și ca opțiune de tratament [33].…”

Section: Aspect Diagnosticunclassified

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Appendiceal intussusception

Gheorghe

Malcova

Șor

et al. 2021

Surgery

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Appendiceal intussusception (AI) is an unusual and rarely reported clinical entity. It was first described by McKidd in a 7-year-old boy in 1858. Since then the literature on it has been confined to a few case reports and very small cases series, in totally about 300 cases being published. Because of variations of clinical symptoms and lack of pathognomonic sign, rarety of the pathology and diversity of causing factors, accurately detection of the presence or absence of appendiceal pathology is difficult. However, imagistic and endoscopic methods may be useful in AI detection and play a large and important role in differential diagnosis. Treatment of AI differs significantly depending on underlying pathological condition, benign or malignant.

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Forshal type IE appendiceal intussusception: A case report

Adhikari

Acharya

Kathayat

et al. 2021

International Journal of Surgery Case Reports

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Introduction Appendiceal intussusception is a rare condition. Clinical features are not specific for it. Patients may present with abdominal pain and vomiting. These symptoms represent a variety of abdominal pathology. Preoperative diagnosis is difficult because of the non-specific clinical features. We present a case report of a child who initially presented with ileocolic intussusception. Case presentation This is a case report of a 5-years-old boy with abdominal pain and vomiting. He had an ileocolic intussusception 2 days back, and was successfully managed by hydrostatic reduction and discharged. On ultrasonography, an intussusception was identified in the ileocaecal region. Hydrostatic reduction failed this time and laparotomy was performed. On laparotomy, there was complete intussusception of the appendix with normal ileocaecal junction. Appendectomy was performed. Post-operative period was uneventful. Discussion Appendiceal intussusceptions are mostly diagnosed intra-operatively. The clinical features may mimic various other acute and chronic abdominal conditions. Type IE appendiceal intussusception, as described by Forshal, is a rare condition. Appendectomy with a rim of the caecum is the procedure of choice. Conclusion Though ileocaecal intussusceptions are common in children, appendiceal intussusceptions are rare and are usually diagnosed during the operative procedure. Radiologists and pediatric surgeons should be aware of this rare entity. Appendectomy is the treatment of choice in most of the appendiceal intussusceptions.

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Appendiceal Intussusception Mimicking Cecal Mass and Fecal Matter: A Report of Two Rare Cases

Cited by 6 publications

References 7 publications

Preoperative sonographic diagnosis of McSwain type V appendiceal intussusception

Preoperative sonographic diagnosis of McSwain type V appendiceal intussusception

Appendiceal intussusception

Forshal type IE appendiceal intussusception: A case report

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