Intussusception of the small bowel secondary to malignant metastases in two 80-year-old people: a case series (original) (raw)
Adult intussusception: An institutional experience and review of literature
Archives of International Surgery, 2014
Background: In adults, intussusceptions represent an uncommon form of intestinal obstruction, diagnosed in only 1-5% of cases. It can be idiopathic or secondary to a pathology in the bowel, which may be a malignancy in 9.75% of small bowel intussusceptions and 50-60% of large bowel intussusceptions. The aim of this study was to make a 15 year institutional review of adult intussusceptions. Materials and Methods: Over a period of 15 years from January 1998 to December 2012, a total of 17 patients were diagnosed and managed as intussusceptions in our institution. A retrospective analysis of clinical, imaging and management data along with specimen and histopathological analysis was carried out. Results: The age range was 21-58 years (mean 35 years) with a male preponderance (11 males: 6 females). Intussusceptions affected the small bowel in 12/17 (70.59%) and the large bowel in 5/17 (29.41%) of cases. The most common clinical presentation was insidious abdominal pain with sub-acute obstruction in 15/17 (88.24) of cases. Computed tomography scan was diagnostic in 88.23% cases. Intestinal tuberculosis (TB) was the most common etiology in 23.53% of the patients. Small bowel intussusceptions were not associated with malignancy, but all cases due to post-operative causes or TB affected small bowel only. Malignancy was responsible for intussusceptions only in the large bowel. Conclusions: On analysis of our cases, we found that malignancy is responsible for intussusception only in the large bowel. Small bowel intussusceptions were not associated with malignancy, but all cases due to post-operative cause or TB affected small bowel only.
Intussusception in adults: Clinical characteristics, diagnosis and operative strategy
World Journal of Gastroenterology
To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. A retrospective review of patients aged > 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. There were 20 cases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine (85%). There were three (15%) cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. A...
Ileoileal intussusception due to metastatic melanoma
Case Reports International, 2019
Introduction: Intussusception in adults is rare, and can be classified into intussusception with a pathological lead point, or intussusception without a lead point. Case Report: This case report describes a 63-year-old male with a history of metastatic melanoma who presented with a two-month history of abdominal pain, which was due to an ileoileal intussusception with metastatic melanoma deposit at the lead point. He was managed with laparoscopic small bowel resection, leading to resolution of his symptoms. Conclusion: A low threshold for surgical exploration is recommended in adults with intussusception for definitive diagnosis of the cause and for symptom management.
Intestinal intussusception in a young women: unusual cause and specific management
World Journal of Surgical Oncology, 2015
Background: Intussusception in adults is a rare cause of abdominal pain that is often associated with organic pathology. We describe a case of ileocolic intussusception revealing a cecal adenocarcinoma in a young woman successfully managed by laparoscopic-assisted surgery adhering to oncological principles. Case presentation: A 30-year-old woman with a family history of colon adenocarcinoma in a young brother presented to our emergency department with a 2-month history of intermittent colicky abdominal pain accompanied by nausea and vomiting. Physical examination showed a palpable mass in the right lower quadrant of the abdomen. Computed tomography showed a 3-layered structure giving the characteristic target-shaped appearance in the ascending colon, highly suggestive for an ileocolic intussusception associated with right colic parietal thickening and an adjacent lymphadenopathy. Patient was planned for laparoscopic exploration and eventually definitive surgery. Intra-operatively, we found an ileocolic intussusception with thickening of the colic wall and slight proximal intestinal dilation. Multiple lymphadenopathies along the ileocecal artery were observed. Laparoscopic right hemicolectomy was performed following strict oncologic principles with "en bloc resection" and lymphadenectomy given the risk of an underlying malignancy. Considering this risk, previous reduction of the invaginated segments was not attempted and primary extracorporeal anastomosis was performed using manual sutures. Macroscopic examination of the resected specimen revealed a tumor mass of the caecal wall .The histological analysis identified a moderately differentiated tubular adenocarcinoma invading the serosa (T3) without permeation of the lymphatic or venous capillaries .No lymphatic metastasis of 28 nodes removed was seen. Postoperative course was uneventful and patient was discharged 5 days after surgery. Postoperative chest, abdomen, and pelvis CT scan were normal .Therefore, tumor is classified as stage II A (T3N0 M0).There was loss of MLH2 and MSH6 protein expression on immunohistochemistry findings reflecting a microsatellite instability phenotype, and the patient was followed up without adjuvant chemotherapy. Conclusion: Ileocolic intussusception rarely revealed a cancer in young adults. Laparoscopic surgery has a special interest in the diagnosis and treatment in this pathology. Oncogenetic consultation should be required in malignant lesion.
A comprehensive approach towards intussusceptions in 61-year-old female: A case report
Medical Science
Intussusceptions are a common condition seen in children and are rarely seen in adults the etiology is not clearly understood the common know etiology for intussusceptions are polyps, Mikel's diverticulum, carcinomas and idiopathic. The patient presents with nonspecific abdominal pain, vomiting, loss of weight, emaciation, weakness, diarrhoea and in long-standing may lead to anorexia. Due to the low specificity of radiographs, USG is the more specific diagnostic tool for locating the intussusceptions. Here we present a 61-yearold patient who reported to the hospital with pain in the abdomen for two months on clinical examination and USG the patient showed signs of ileocecal intussusceptions which was managed by surgical resection and followed by medication post-operatively the patient was observed for 20 days and the sutures were removed and the patient was discharged. We conclude that surgical resection in the cases of ileocecal intussusceptions proved to be the most effective tool for relieving the symptoms and improving the functionality of the patient.
Intussusception in adults: report of four cases and review of the literature
Case reports in gastroenterology, 2007
Intussusception in adults is a rare clinical entity. The individual surgeon will not often encounter this condition. A lead-point for adult intussusception exists in 90% of cases and is frequently malignant. We present four cases and discuss treatment and diagnostic modalities. A comprehensive review of the literature is given. All cases were treated by resection according to oncologic principles without previous reduction. Histological examination showed non-Hodgkin lymphoma, lipoma, clear cell sarcoma and adenocarcinoma as the lead-points.
Hippokratia, 2019
BACKGROUND Bowel intussusception in adults remains a rare and constant diagnostic challenge for surgeons. It has an incidence of around 2-3 new cases per million per year, and its primary cause is benign or malignant neoplasms of the small bowel and colon. This report aims to outline the importance of high clinical suspicion regarding intussusception in adults presenting with abdominal pain in the emergency department. Case report: This is a retrospective review of three cases of adult ileocecal intussusception that were treated in a single surgical department in three years (2015-2018). All patients underwent right hemicolectomy in keeping with the principles of surgical oncology. Each patient had a different clinical presentation, while, in terms of the underlining pathology, the first had an adenocarcinoma of the ascending colon, the second an adenocarcinoma of the ileocecal valve, and the third one an inflammatory fibroid polyp of the ileocecal valve, also known as Vanek's ...