Unusual cause of intussusception

Voore, Naveen; Weisner, Larry

doi:10.1136/bcr-2015-212324

Cited by 8 publications

(9 citation statements)

References 2 publications

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“…The most common presenting symptom is abdominal pain, 14,16 with associated symptoms consistent with partial obstruction: nausea, vomiting, obstipation, gastrointestinal bleeding, change in bowel habits, constipation, or bloating. 15,17 Wang et al found abdominal cramping pain in nearly 80% of patients as a leading symptom; a palpable abdominal mass, however, was found in less than 9%. 10 Symptoms are typically acute, lasting days to weeks, 15 but rarely can be chronic, lasting years.…”

Section: Clinical Presentationmentioning

confidence: 99%

Intestinal Intussusception: Etiology, Diagnosis, and Treatment

Marsicovetere

Ivatury

White

et al. 2016

Clinics in Colon and Rectal Surgery

275

362

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Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment. The intussusceptum refers to the proximal segment that invaginates into the distal segment, or the intussuscipiens (recipient segment). Intussusception, more common in the small bowel and rarely involving only the large bowel, has historically presented as small bowel obstruction, although there is an increasing appreciation of cases of transient, asymptomatic intussusception within the era of abdominal CT scans. The natural history of intussusception starts with a lead point, typically neoplastic (such as lymphadenopathy, polyp, or cancer), which acts as a focal area of traction that draws the proximal bowel within the peristalsing distal bowel. Symptoms occur due to continued peristaltic contractions of the intussuscepted segment against the obstruction. With continued invagination resulting in edema, eventually the vascular flow to the bowel becomes compromised, resulting in ischemia to the affected segment that, left untreated, can result in necrosis and perforation.In the pediatric population, ileocolic intussusception is the most common type. The etiology of intussusception in children is typically idiopathic, often influenced by anatomic or infectious factors (►Table 1). The diagnosis and management in this population generally starts with nonoperative reduction of the intussusceptum using air or contrast enemas.In the adult population, intussusception is frequently due to a pathologic lead point, which can be intraluminal, mural, or extramural. As opposed to the pediatric population, the treatment of intussusception causing obstruction in adults typically involves surgery, often with bowel resection. Keywords AbstractIntussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. Idiopathic ileocolic intussusception is the most common form in children and is typically managed with nonoperative reduction via pneumatic and/or hydrostatic enemas. In the adult population, intussusception is uncommon and occurs more often in the small intestine than in the colon. It is associated with lead point pathology in most symptomatic cases presenting as bowel obstruction. When lead point pathology is present in adult small bowel intussusception, it is usually benign, though when malignant it is most frequently due to diffuse metastatic disease, for example, melanoma. In contrast, adult ileocolic and colonic intussusception lead point pathology is most frequently primary adenocarcinoma when malignant. The diagnosis is typically made intraoperatively or by cross-sectional imaging. With increasingly frequent CT/MRI of the adult abdomen in the current era, transient and/or asymptomatic intussusceptions are increasingly found and may often be appropriately observed without intervention. When intervention in the adult population is warranted, usually oncologic bowel resection is performed due to the association with lead point pathology.

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Section: Clinical Presentationmentioning

confidence: 99%

Intestinal Intussusception: Etiology, Diagnosis, and Treatment

Marsicovetere

Ivatury

White

et al. 2016

Clinics in Colon and Rectal Surgery

275

362

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“…Acute cholecystitis is present in 10–30% of patients at time of gallstone ileus [ 15 ]. Rare presentations of gallstone ileus reported in the literature include gangrenous appendicitis with a gallstone impacted at the base of the appendix [ 44 ], or intussusception with the stone serving as a lead point [ 45 , 46 ]. Most episodes of gallstone ileus tend to present as acute/subacute.…”

Section: Presentation and Clinical Diagnosismentioning

confidence: 99%

“…Rare presentations of gallstone ileus reported in the literature include gangrenous appendicitis with a gallstone impacted at the base of the appendix [ 44 ], or intussusception with the stone serving as a lead point [ 45 , 46 ].…”

Section: Presentation and Clinical Diagnosismentioning

confidence: 99%

Clinical and radiological diagnosis of gallstone ileus: a mini review

et al. 2017

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Gallstone ileus is a rare cause of bowel obstruction, which mainly affects the elderly population. The associated mortality is estimated to be up to 30%. The presentation of gallstone ileus is notoriously non-specific, and this often contributes to the delay in diagnosis. The diagnosis of gallstone ileus relies on a radiological approach, and herein we discuss the benefits and drawbacks of the use of different modalities of radiological imaging: plain abdominal films, computed tomography, magnetic resonance imaging, and ultrasound scanning. Based on our case experience and review of the literature, the authors conclude that although an effective first-line tool, plain abdominal films are not adequate for diagnosing gallstone ileus. In fact, the gold standard in an acutely unwell patient is computed tomography.

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“…The corresponding radiologic evidence of ectopic gallstone, bowel obstruction, and pneumobilia constitutes Rigler’s triad − the pathognomonic features of gallstone ileus. One case of gallstone ileus with secondary intussesception was found, with an unfavorable outcome reported [4]. Sixteen cases of gallstone ileus status post-cholecystectomy have been reported in the literature, but only one case of gallstone ileus presenting as intussusceptions.…”

Section: Introductionmentioning

confidence: 95%