Data is temporarily unavailable. 2015;58(2):66-8. doi: 10.14712/18059694.2015.96. Adults with bowel intussusception caused by malignant tumors are fairly uncommon. Get new journal Tables of Contents sent right to your email inbox, The Diagnosis and Treatment of Adult Intussusception. The enhanced neoplastic mass, which acts as the lead point, is located in the rectum (arrow), at the tip of intussusceptum (b, c, d, and e). Lande A, Schechter LS, Bole PV. Intussusception as a Cause of Bowel Obstruction in Adults from a Resource Limited Area, Cameroon. Enterocolonic (ileocaecocolonic) intussusception caused by a polyp. The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s. Adult Intussusception Caused by Descending Colon Cancer during 19, no. Association of Cardiovascular Health With Life Expectancy Free of It is determined according to the length of the affected intestine in patients with intussusception. ; Kuwano, Hiroyuki M.D., Ph.D., F.A.C.S. These signs represent anatomic relationships between the layers of the intestinal wall, the intestinal lumens, and the mesentery. Intussusception in Adults - StatPearls - NCBI Bookshelf The other one underwent resection without reduction because of severe ischemic bowel. 58, no. CT plays an important role in the diagnosis of intussusception in adults. The diagnosis and management of. Please try after some time. Although the correct diagnosis is often based on intraoperative findings, modern noninvasive and invasive imaging techniques can be very helpful in precisely identifying these lesions preoperatively. Gayer G, Apter S, Hofmann S, et al. Patients and methods: The medical records and imaging studies of all patients 16 years of age with intussusception, who were managed at our hospitals, were retrospectively reviewed. During the operation, radiological examination results were confirmed. An intestinal resection should be performed promptly. Use of magnetic resonance imaging in pregnancy to diagnose intussusception induced by colonic cancer. On the other hand, that of large bowel intussusception accounts for 43% to 80%. Before The second appearance, the reniform pattern, appearing as a bilobed mass with central low attenuation and peripheral higher density, was thought to result from ischemic thickening of the intussusceptums bowel wall. 6). Inclusion in an NLM database does not imply endorsement of, or agreement with, 20. Clinical Communications: Adults - The Journal of Emergency Medicine The patient was discharged on postoperative day 6. The optimal treatment of adult intussusception is not universally agreed upon. When symptoms of adult intussusception are present, they . Some surgeons believe that laparoscopic surgery can also be selected. Boyle MJ, Arkell LJ, Williams JT. Intussusception in Adults: A Retrospective Review from a Single Instit The diagnosis and treatment of adult intussusception is still a challenge for abdominal surgeons. This is an open access article distributed under the. Intussusception at the site was observed. G. Gayer, R. Zissin, S. Apter, M. Papa, and M. Hertz, Pictorial review: adult intussusceptiona CT diagnosis, The British Journal of Radiology, vol. At last follow-up, there was no recurrence. Address correspondence and reprint requests to Dr. Kunio Takeuchi, Department of Surgery, Tone Chuo Hospital, 1855-1, Higashiharashin-machi, Numata-city, Gunma 378-0053, Japan. 13. Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, Vassiliou I, et al. Radiological findings: Plain abdominal radiography: obvious pneumatosis in the abdominal cavity with intestinal dilatation (Fig. 7. 1. The distal descending colon and sigmoid colon were empty and collapsed. The CT scan is most useful in making the diagnosis of intussusception. About 70-90% of intussusceptions in adults have a lead point, which is a well-defined pathological abnormality. HHS Vulnerability Disclosure, Help A case of iatrogenic intussusception in adults: a rare - BMC Surgery Transient intussusception with no signs of intestinal obstruction or intestinal ischemia. Am J Roentgenol 1970; 109:72932. The https:// ensures that you are connecting to the Intussusception reveals MUTYH-associated polyposis syndrome and colorectal cancer: a case report. Takeuchi, Kunio M.D. MDCT is well suited to delineate the presence of the disease and provides valuable information about several features, such as the site of intussusception, the intestinal segments involved, and the extent of the intussuscepted bowel [19]. On postoperative day 9, the LT was removed. Our patient had previously undergone a mastectomy due to carcinoma three years earlier. 3, pp. official website and that any information you provide is encrypted 89, 2000. 73, no. official website and that any information you provide is encrypted 187188, 2005. If there is bowel wall edema due to impaired circulation of the mesenteric vessels, it is difficult to differentiate a lead mass from inflammation because the former may appear amorphous (Figure 4). Although this invagination can occur anywhere along the gastrointestinal tract, most intussusceptions occur in the junctions between mobile and retroperitoneal fixed intestinal segments. The CT scan has been used to evaluate patients with intestinal obstruction or an abdominal mass in whom intussusception is the final diagnosis. Results: 17 cases of adult intussusception (7 males, 10 females; mean age 35.9 years; age range of 16-78) were identified. Association with malignant tumors is more common in large bowel intussusception (6570% of cases), while small bowel intussusceptions are secondary to a malignancy in 3035% of cases only. She received S-1 (50mg) monotherapy on September 25, 2018, November 13, 2018, January 8, and March 26, 2019. How young people with cancer navigate dating, fertility and health METRICS PDF Intussusception in adults is rare. Different from children with apparent symptoms such as abdominal pain, abdominal mass, and bloody stool, adults have various symptoms, which may be acute, intermittent, or chronic. Intussusception in adults: what radiologists should know 5, pp. Abstract Adult intussusception is a rare occurrence and, unlike in childhood, is usually associated with an underlying tumor. After successful reduction, the intussusception length of about 70cm was discovered. Emergency abdominal CT showed intussusception (Fig. 6872, 2003. Physical examination and digital rectal examination were both unremarkable. Immunohistochemistry: Ki67 (about 60%, +), MLH1 (+), MSH2 (+), MSH6 (+), PMS2 (+), Her-2 (weak +). Obstructing enteroenteric intussusceptions, often caused by a lead point, may present at CT with thickening and alterated enhancement of the bowel wall and engorgement of mesenteric vessels (Figure 10). Electronic colonoscopy discovered the colonic giant proliferative lesions and stenosis. Am J Surg 1971; 121:5315. Physical examination: slight abdominal distension, hyperactive bowel sounds (about 6 times/min), no tenderness or rebound pain, shifting dullness, no high-pitched bowel sounds, or gurgling. Determining the site and causes of colonic obstruction with sonography. The radiologist can readily make a correct diagnosis, detecting specific MDCT findings such as the bowel-within-bowel appearance. Intussusception in an adult can be further classified on the basis of whether a lead point is present. No intussusception was found during the exploration. Acta Gastroenterol Belg. 75, no. A case of iatrogenic intussusception in adults: a rare case report. 171174, 2006. Ann Surg 1981; 193:2306. Enhanced CT revealed a concentric circle change in the colon, as well as the mesenterium and arteries (Figure1). 15. Six patients were antegrade intussusception and another one was retrograde. Heterogeneous target mass with the intussuscipiens, intussusceptum, and vessels within the invaginated mesenteric fat. Duszynski DO, Anthone R. Jejunal intussusception demonstrated by tc99m pertechnetate and abdominal scanning. We report our experience in an attempt to clarify the usefulness of CT scan and the optimal treatment of this entity. In asymptomatic patients, the diagnosis of intussusception is often an incidental finding on MDCT performed for other reasons [17]. The intussusception is well depicted on axial CT scan (a). We report our experience in an attempt to clarify the usefulness of CT scan and the optimal treatment in adult intussusception. In the article that accompanies this editorial, Montroni et al 4 report prospectively collected 3-month and 6-month postoperative quality-of-life and functional recovery data after elective colorectal cancer resections among 625 older adults and demonstrated that approximately 70% will have preserved or improved quality of life, and 76% will have postoperative functional recovery over this . Adult intussusception occurs rarely and often requires surgical resection for its treatment. Please enable scripts and reload this page. Enteroenteric (ileoileal) intussusception. Medicine (Baltimore).2019; 99(36): e22080. F. Somma, A. Faggian, N. Serra et al., Bowel intussusceptions in adults: the role of imaging, Radiologia Medica, vol. The mean resection of small bowel was 17.8 cm, with a range of 8.0 to 40.0 cm. National Library of Medicine The authors declare that they have no competing interests. Enteroenteric (ileoileal) transient intussusception in a traumatized patient. MDCT is well suited to delineate the presence of the disease and provides valuable information about several features, such as the site of intussusception, the intestinal segments involved, and the extent of the intussuscepted bowel. Intussusception caused by the removal of the LT is rare and has never been reported. Therefore, we suggest that the following steps should be done before removing the tube: (1) During the process of removal, the speed of tube withdrawal should be slow. 6. Correspondence to 20, no. Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. 28 Computed tomography (CT) scan is now widely used in the evaluation of abdominal masses and nonspecific abdominal pain and may be the first examination performed in a patient in whom an intussusception is present. (3) To avoid squeezing, which can cause the spread of cancer cells to the intestine or bloodstream, patients with suspected malignant tumors should not receive the manual reduction. To conclude, it was considered a tumor in the colon. MeSH The patient received six times of SOX (180mg oxaliplatin+50mg S-1) regimen on April 23, 2018, May 16, 2018, June 5, 2018, July 3, 2018, August 1 2018, and September 6, 2018. The presenting clinical picture of these patients is shown in Table 1. 9. During the operation, the colon proximate to the splenic flexure was dilated. Definition An adult with intussusception may experience abdominal pain. doi:https://doi.org/10.1007/s10151-019-01980-5. Part of The postoperative recovery was satisfactory. Computed tomography (CT) revealed a concentric circle change in the colon, as well as the mesenterium and arteries. J. Anthony/Stocksy. The https:// ensures that you are connecting to the Woo PJ, Am SG, Hoon BD, et al. The incorrect second position has been removed. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature. This is a rare entity and it is more prevalent in children and less common in adults. 25. S. Baleato-Gonzlez, J. C. Vilanova, R. Garca-Figueiras, I. your express consent. The typical bowel-within-bowel appearance [1, 810] is often found in asymptomatic patients, with transient intussusception and no underlying disease [1113]. The patient recovered smoothly and was discharged 12 days after the operation. ; Hara, Takashi M.D., Ph.D.; Kori, Takayuki M.D. Intussusceptions can be classified into three types based on the location:(i)Enteroenteric, when confined to the small bowel. Most Adult Intussusceptions are Caused by Tumors: A Single-Centre Analysis . CT images on axial (b) and oblique reformatting (c, d) demonstrate an intraluminal lesion with fat attenuation (arrow) that serves as the intussusception lead point. Etiologically, adult intussusception could be categorized into four groups: (1) tumor-related (13 cases, 52%); (2) postoperative (nine cases, 36%); (3 . 15461551, 2006. We presented a case of a 64-year-old woman whose intussusception was secondary to ascending colon cancer. D. Merine, E. K. Fishman, B. Jones, and S. S. Siegelman, Enteroenteric intussusception: CT findings in nine patients, American Journal of Roentgenology, vol. Therefore, when the clinical manifestations are difficult to diagnose, CT should be routinely performed to make a definite diagnosis. The CT findings are sufficiently characteristic to warrant a confident diagnosis based on this radiologic appearance alone. Plain abdominal radiography (a) shows gas-fluid levels within distended small bowel loops. To the best of our knowledge, there have only been a few reported cases of adult intussusception caused by colon cancer. Nagorney DM, Sarr MG, Mcilrath DC. Data related to presentation, diagnosis, treatment, and pathology were analyzed. 212, no. The diagnosis of intussusception in adults is difficult as a result of the nonspecific signs and symptoms. QH and JS designed this study. Three of four patients with small bowel intussusception underwent reduction before resection. The radiologists aim is not only to recognize intussusception, but also to define its location, enteroenteric, colocolonic, or enterocolonic, to evaluate underlying pathology, and to identify complicated intussusceptions, associated with obstruction or ischemia, which represent indications for surgical exploration. https://doi.org/10.1136/bcr-2019-229931. Computed tomography scan was used in four patients, and it made the diagnosis in all four patients (Fig. M. Assenza, G. Ricci, A. Antoniozzi et al., Sigmoidorectal intussusception in adults: a case report, Clinica Terapeutica, vol. Moreover, MDCT can demonstrate the complications of intussusceptions, represented by bowel wall ischemia and perforation, which are mandatory to promptly refer for surgery. When clinical manifestations are difficult to diagnose intussusception, CT is the most accurate method for a definite diagnosis. Considering the patients past medical history and immunohistochemistry results, the patients condition met the diagnostic criteria of colonic metastasis of cardia adenocarcinoma (Fig. Case report: An adult intussusception caused by ascending colon cancer doi: 10.12659/AJCR.938124. Intussusception in adults: Institutional review - ScienceDirect Small bowel lesions should be reduced only in patients in whom a benign diagnosis has been strongly suggested preoperatively or in patients in whom resection may result in short gut syndrome. Part of the wall was invaded by the tumor. Hemoglobin concentration: 74g/L (normal range: 110150g/L), albumin concentration: 27.2g/L (normal range: 3555g/L), total protein concentration: 56.2g/L (normal range: 6080g/L). Although theexact mechanism is unknown, adult intussusceptionformation is hypothesized to be due to abnormal peristal-sis from a bowel irritant. 2018;81(3):36772. volume21, Articlenumber:271 (2021) Intussusception is common in the pediatric population but is quite uncommon in adults. Most Adult Intussusceptions are Caused by Tumors: A Single-Centre The patient passed flatus and had bowel movements later. Most cases of small bowel intussusceptions are secondary to benign intra- or extraluminal lesions, such as inflammatory lesions, Meckels diverticulum [21], postoperative adhesions, lipoma (Figure 5), and adenomatous polyps [3], but they can also be iatrogenic (placement of intestinal tube, gastrojejunostomy) or caused by abdominal trauma [22] (Figure 6). The appearance of an intussusception on CT images is similar to that of a target mass when the CT beam is perpendicular to the longitudinal axis of the intussusception and to that of a sausage mass when the CT beam is parallel or oblique to the longitudinal axis [10] (Figure 2). the contents by NLM or the National Institutes of Health. 3, pp. Endoscopic correction of intussusception and removal of a colonic lipoma. Korean J Gastroenterol. https://doi.org/10.4166/kjg.2020.75.1.46. 2 As the global population ages, the incidence of colorectal cancer in older adults will . The site is secure. 89101, 2012. The optimal management for adult intussusception is still controversial, nevertheless its definitive treatment consists in surgical intervention with appropriate approach depending on the underlying etiology and location. Springer Nature. 2019 Apr 5;19(1):324. doi: 10.1186/s12885-019-5505-8. Please enable it to take advantage of the complete set of features! Intussusception mainly occurs in infants and children. It is positively associated with better health outcomes, quality of life, and daily functioning. Original Research. Intussusception occurs when a segment (intussusceptum) of gastrointestinal tract invaginates with its mesenteric fold into an adjacent segment (intussuscipiens). Z. T. Stockinger and N. McSwain Jr., Intussusception caused by abdominal trauma: case report and review of 91 cases reported in the literature, Journal of Trauma, vol. In this paper, we review the current role of MDCT in the diagnosis and management of intussusception in adults, focusing on features, as the presence of a leading point, that may guide an accurate selection of patients for surgery. When tissue diagnosis is unavailable, intussusception is located in the colon and is highly likely to be malignant lesions, it is advisable to follow the oncology principle of colon resection as a precautionary measure to provide the best opportunity for curative resection. The computed tomographic appearances and clinical significance of intussusception in adults with malignant neoplasms. Adult intussusception: patient report of recurrent intussusception and review of the literature, Adult intussusception: case reports and review of literature. On the . Unauthorized use of these marks is strictly prohibited. QH and YS collected the information and images. Upon admission, the patient received symptomatic treatments, which consisted of fluid and electrolyte replacement, LT placement, spasmolytic agents, and analgesics. Approach to management of intussusception in adults: a new - PubMed To help guide treatment decisions, it is important to diagnose the organic intussusception lesion. 2, pp. Unlike small-bowel intussusception, more than half of large bowel intussusceptions are associated with malignant lesions. The average age of the patients was 65.1 years, with a range of 22 to 92 years. After resection of the lesion by removing the part of the descending colon proximate to the site of invasion and the entire transverse colon, the remainder of descending colon was brought close to the ascending colon, and side-to-side anastomosis was done using the stapler. Hurwitz LM, Gertler SL. We herein describe a case of intussusception caused by descending colon cancer. This case highlights that rational use of CT, endoscopy, and timely surgery combines an effective strategy for the treatment of adult intussusception. Accessibility Early diagnosis of intussusception in adults is difficult, and it might be misdiagnosed in an emergency easily. Past medical history: On April 2, 2018, laparoscopic radical gastrectomy was performed in our hospital for cardia adenocarcinoma. A review of 25 adult patients with intussusception is reported. Enteroenteric intussusceptions without a lead point tend to be nonobstructing and are usually smaller in transverse diameter and shorter in length than intussusception with a lead point (Figure 8). In three malignant neoplasms, two were primary cecal or ascending colon cancer and one was primary jejunal cancer. Azar et al. Oblique CT reformatting (c, d) clearly shows the enhancement of the lead mass, which facilitates its identification. This is the first case report about intussusception that occurred after removing a long intestinal tube (LT). Postoperative pathological result revealed moderately differentiated adenocarcinoma in the right colon with full-thickness invasion (magnification power: 40). We report our experience in an attempt to clarify the usefulness of CT scan and the optimal treatment of this entity. Intussusception in adults. 120, no. Enteroenteric (ileoileal) intussusception secondary to colic obstruction caused by a sigmoid cancer. A. J. Siddiqi, O. Arafat, P. Nikolaidis, and V. Yaghmai, MDCT diagnosis of ileocolic intussusception secondary to an appendiceal mucocele: value of multiplanar reformation, Emergency Radiology, vol. 2-8 Computed tomography (CT) scan is now widely used in the evaluation of abdominal . Unlike pediatric intussusception, most adult cases have a demonstrable etiology. Background: Intussusception in adults is often diagnosed on computed tomography (CT), and the optimal treatment of this entity is not universally agreed upon. Al-Radaideh AM, Omari HZ, Bani-Hani KE. Intussusception in adults: clinical characteristics, diagnosis and operative strategies. Hong KD, Kim J, Ji W, Wexner SD. In these settings, preoperative endoscopy can be performed to confirm the presence of pathology and/or cancer (6). In some cases, the enteroenteric intussusception is due to increased peristalsis of the intestinal loops caused by distal obstruction, such as a stenosis caused by a neoplasm of the colon (Figure 9). In this case, the symptoms and signs had no obvious specificity, so it was difficult to diagnose and may have caused a delay in treatment. Signs of adult intussusception were recurrent abdominal pain only. Back to Journals Cancer Management and Research Volume 12. Clinical diagnosis can be difficult even in symptomatic patients with a leading point intussusception, because of the variety of clinical findings at presentation (crampy abdominal pain, nausea, vomiting, and bloody mucoid stools), depending on the underlying cause. The peristaltic wave was interrupted and blocked at the site of the tumor, and local irritation occurred frequently. 2,911. Adult Colo-Colonic Intussusception in the Setting of Invasive Mucinous Adenocarcinoma: A Case Report. Intussusception in adults is an uncommon situation that represents 5% of the total incidents of intussusception and constitutes the cause for 1% of intestinal obstructions . Weilbaecher D, Bolin JA, Hearn D, et al. 22 It is easy to perform, more reproducible, and less invasive than the other methods. Am J Roentgenol 2001; 176:116771. In about 90% of adult intussusceptions, there is a lead point, which is a well-definable pathologic abnormality. The .gov means its official. Most surgeons have limited experience with such clinical entities and with the various considerations involved in diagnosis and management. The widespread application of computed tomography (CT) in different clinical situations has increased the detection of intussusception, particularly non-lead point intussusception, which tends to be transient. 3. Intussusception appears as a small target mass (a, b) in a condition of intestinal obstruction with massive small and large bowel . The underlying pathologic processes were identified in 23 patients (92%). All authors agree that laparotomy is mandatory, in view of the likelihood of identifying a pathologic lesion. 9,10. Who is more likely to get intussusception? About 90% of intussusception in children is primary, while more than 90% of intussusception in adults is secondary [4]. A pathologic lesion was identified in five patients, and all pathologic lesions were the lead points. 2,3,5,920 AG is more invasive than CT scan and US. However, restoring hope after a cancer diagnosis can be challenging, especially for young adult cancer patients. The two jejunal lead points resulted in jejunojejunal intussusception and the two ileal lead points resulted in ileoileal intussusception. The presence of a lead point, the configuration of the lead mass, the degree of bowel wall edema, and the amount of invaginated mesenteric fat all affect the radiological aspect of an intussusception. Gas-fluid levels in the dilated proximal loops are signs of small bowel obstruction. 50, no. 452456, 2005. Felix EL, Cohen MH, Bernstein AD, Schwartz JH. The challenges occur because abdominal pain is not only one of the most common complaints evaluated in the emergency department but generally a nonspecific complaint. Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%5% of intestinal obstructions in adults (1, 2). Laredo J, Filtzer HS. 49, no. Enteroenteric (ileoileal) intussusception caused by lymphoma. Computed tomography revealed ascending colonic intussusception. Terms and Conditions, Intussusception is a different entity in adults than it is in children. Two patients had colonic cancer and one had jejunal cancer. The records of all patients 18 years of age and older with a preoperative or intraoperative diagnosis of intussusception at Tone Chuo Hospital from 1991 to 2001 were reviewed retrospectively. This way, the incidence of iatrogenic complications will be minimized. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors.
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