Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into an adjacent distal segment. This rare form of bowel obstruction occurs infrequently in adults.
We report a case of small Small bowel intussusception in adults intussusception in an adult male patient. We have also performed a literature review of this rare condition. A year-old Caucasian man presented to the emergency department with a 7-week history of intermittent right upper quadrant and epigastric abdominal pain. He had visited his general practitioner, who arranged a stool test for Helicobacter pylori.
This was found to be negative at a later stage. For few weeks before admission, the patient noticed that eating had exacerbated a cramp-like abdominal pain. However, he was managing his food up to two days prior to admission, when his abdominal symptoms worsened significantly. He became increasingly nauseated, belching a lot more than usual.
His bowels had been working normally up to 48 hours before admission but stopped abruptly at this point.
Despite this, he was still able to pass some flatus. He also vomited once in the emergency department. His past medical history included previous peptic ulcer disease, hypertension, type 2 diabetes diet controlleda right hip replacement, accident related subdural haematoma surgically evacuated at 37 years of age and osteoarthritis.
He had Small bowel intussusception in adults history of abdominal surgery. He was a non-smoker and his alcohol intake was around 40—60 units a week. He had no relevant family history. On admission, the patient was apyrexial, slightly tachycardic normotensive. Abdominal examination revealed some distension with diffuse mild tenderness and exaggerated bowel sounds.
No palpable hernia was felt during his abdominal examination.
His routine blood tests full blood count, renal and liver functions, and amylase were all within the normal range. However, the C-reactive protein level was slightly raised at His erect chest x-ray was essentially normal although the Small bowel intussusception in adults x-ray AXR showed dilated loops of small bowel with Small bowel intussusception in adults maximum diameter of 5cm. He also underwent computed tomography CT of the abdomen and pelvis.
This showed a small bowel intussusception target lesion as seen in Figure 1.
The patient subsequently went to theatre for a laparotomy, where a 6cm segment of non-gangrenous intussuscepted distal small bowel was found ie enteroenteric intussusceptionwith a palpable polyp causing the lead point of the intussusception Fig 2. No enlarged lymph nodes were Small bowel intussusception in adults in the mesentery of the affected small bowel.
The intussuscepted small bowel segment was resected without any reduction attempts. This was followed by a side-to-side small bowel stapled anastomosis.
The postoperative period was generally uneventful apart from a simple Small bowel intussusception in adults infection that was treated successfully with the appropriate antibiotics. The patient made a steady recovery and went home a few days later. The histopathology report confirmed the picture of small bowel intussusception and showed that the polyp was of an inflammatory fibrous origin with no evidence of dysplasia or malignancy.
The patient was followed up in the outpatient clinic few weeks later, when he was completely asymptomatic from the gastrointestinal point of view. Eventually, he was discharged completely from hospital follow-up. The search terms used were: Searches were screened and those studies thought to be relevant had full text versions retrieved. The references of all retrieved texts were searched for further relevant studies. Bowel intussusception is the telescoping of a proximal segment of
Small bowel intussusception in adults gastrointestinal tract into an adjacent distal segment.
Intussusception can occur at any age but is most common in children between 5 and 10 months of age. This may lead to lumen obstruction and ischaemia. Intussusception can be classified according to its location enteroenteric, ileocolic, ileocaecal or colocolic or according to aetiology benign, malignant or idiopathic. Ninety per cent of intussusceptions in adults occur in the small or large bowel and the remaining ten per cent involve the stomach or surgically created stomas.
The most common site is the small bowel while the least common types are coloanal and gastroduodenal intussusceptions. Trauma and operative factors eg anastomosis sites, adhesions, suture lines and feeding jejunostomy are also associated with small bowel intussusception in adults.
The symptoms in adults are usually chronic and depend on the site of the intussusception. Despite this, patients with relatively short history presentations like in our case report have also been described although these are much less common. Intermittent attacks of non-specific abdominal pain with or without bowel obstruction seem to be the most common presenting symptom. Other associated symptoms include nausea, vomiting and rectal bleeding. In addition, the finding of a
Small bowel intussusception in adults palpable abdominal mass has been reported with various Small bowel intussusception in adults in the literature.
Other associated symptoms such as weight loss and constipation may indicate the presence of an associated serious underlying pathology eg malignancy.
In children, the triad of abdominal pain, a palpable sausage-shaped abdominal mass and red jelly-like stool is a classic presentation of small bowel intussusception. Small bowel intussusception in adults, this triad is rarely seen in Small bowel intussusception in adults. Owing to its rarity and non-specific elusive presentations, the clinical diagnosis of intussusception in adults is often delayed and challenging.
Various imaging modalities have been used to help in establishing the diagnosis. Still, the diagnosis is frequently confirmed only during surgical intervention. CT of the abdomen seems to be the radiological investigation of choice, with a sensitivity of This has increased the detection rates of incidental gastrointestinal pathologies such as intussusception in adults. Moreover, abdominal CT helps in identification of the lead point lesions when present and other associated pathologies such as metastatic malignancies.
Kim et al stated: Lvoff et al performed an interesting study to investigate whether abdominal CT can be used to distinguish self-limiting cases of adult small bowel intussusception from those requiring surgery. Nevertheless, the study was retrospective in a single centre and there was a lack of pathological correlation.
Abdominal ultrasonography can also be used to check for small bowel intussusception in adults and children.
However, it is operator dependent. It is therefore more useful in children and perhaps thin adults. Plain AXR is usually considered to rule out bowel obstruction in the emergency setting. In cases with small bowel intussusception, AXR might show signs of bowel obstruction such as dilated loops of bowel or fluid level in the bowel lumen, and rarely a mass lesion or intraluminal air trapped between the walls of the intussusceptum and intussuscipiens air crescent sign.
These findings nevertheless lack the specificity and sensitivity to diagnose intussusception. Barium studies have also been reported to diagnose bowel intussusception in adult patients with long-term nonspecific abdominal pain. However, these studies "Small bowel intussusception in adults" contraindicated in Small bowel intussusception in adults suspected to have bowel obstruction owing to the risk of perforation. Unlike the paediatric population, reduction of the intussuscepted bowel with barium or air is not indicated in adults.
This is due to the significant rate of other pathologies associated with bowel intussusception in adults. The high incidence of malignancy associated with colonic intussusception perhaps justifies performing a primary oncological resection of the affected bowel without reduction attempts. Reduction carries risks of perforation and the theoretical possibility of tumour Small bowel intussusception in adults. The fact that the incidence of malignancy associated with small bowel intussusception is less common than with the large bowel has resulted in a debate on whether to attempt reducing the intussuscepted small bowel before resection to save the small bowel length.
The accessibility of intraoperative histopathological tissue diagnosis facilities can also help in determining the extent of surgical resection. Some authors advise that simple reduction is acceptable in post-traumatic or idiopathic intussusceptions, where no pathological cause could be identified, obviously after the of bowel ischaemia or perforation.
Patients with multiple small intestinal polyps like those in Peutz-Jeghers syndrome are liable to have frequent intussusceptions. In such scenarios, a combined approach of limited intestinal resections and multiple snare polypectomies is advised to avoid developing short bowel syndrome. In summary, small bowel intussusception in adults commonly requires surgical resection of the affected bowel. Preoperative tissue diagnosis of the lead point lesion helps in performing limited resection in benign conditions.
However, this is not always available as the diagnosis of intussusception is frequently confirmed during surgical intervention. Small bowel intussusception in adults is rare and often challenging to diagnose owing the elusive, non-specific symptoms. A high index of clinical suspicion combined with the appropriate imaging might help in establishing an early diagnosis, excluding any associated malignancies and avoiding Small bowel intussusception in adults complications like perforation and peritonitis.
Abdominal CT seems to be the radiological investigation of choice, with its high sensitivity and specificity in this prospect. Nevertheless, the diagnosis is made frequently on the operating table.
In the presence of a lead point lesion but no preoperative tissue diagnosis, surgical intervention in the form of bowel resection without reduction is advisable. The authors would like to thank Gillian Dytrytch for her kind help that has contributed into the publication of this article. National Center for Biotechnology InformationU.
Ann R Coll Surg Engl. Published online Jan. Author information Article notes Copyright and License information Disclaimer.
Accepted Dec This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Intussusception is
Small bowel intussusception in adults telescoping of a segment of the gastrointestinal tract into an adjacent distal segment. Intussusception, Bowel obstruction, Bowel telescoping.
Case history A year-old Caucasian man presented to the emergency department with a 7-week history of intermittent right upper quadrant and epigastric abdominal pain. Open
Small bowel intussusception in adults a separate window. Discussion Epidemiology Bowel intussusception is the telescoping of a proximal segment of the gastrointestinal tract into an adjacent distal segment.
Loading data. The Royal College of Surgeons of England © Open Bottom Panel. Go to previous Content Download this Content Share this Content Add. Abstract. Adult intussusception occurs infrequently and differs from childhood A small bowel resection without reduction of the intussusception was performed.
Association with malignant tumors is more common in large bowel intussusception (65–70% of cases), while small bowel intussusceptions are.
Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into an adjacent distal portion. This rare form of bowel proscription occurs sporadically in adults. We cover a anyway a lest of meager bowel intussusception in an adult manful patient. We have to boot performed a literature consider of that rare state. A year-old Caucasian guy presented to the predicament department with a 7-week history of intermittent good upper quadrant and epigastric abdominal despair.
He had visited his general practitioner, who arranged a stool test repayment for Helicobacter pylori. This was found to be uninterested at a later present.
Laparoscopic reduction of intestinal intussusception in children
- However, bowel intussusception in adults is considered a rare In the small intestine, an...
- Intussusception of the bowel in adults: A review
- This rare form of bowel obstruction occurs infrequently in adults. We...
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Intussusception of the bowel is defined as the telescoping of a proximal fraction of the gastrointestinal treatise within the lumen of the adjacent segment. That condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. Eight to twenty percent of cases are idiopathic, without a lead point lesion. Computed tomography is the greater sensitive diagnostic modality and can distinguish between intussusceptions with and without a lead point.
Surgery is the definitive treatment of adult intussusceptions.
- INTUSSUSCEPTION IS A RARE, SERIOUS DISORDER IN WHICH ONE PART OF THE...
- SMALL BOWEL INTUSSSUCEPTION WITHOUT A LEAD POINT IS MORE COMMON THAN INTUSSUSCEPTION WITH A LEAD...
Small bowel intussusception in adults
Dating men but getting turned on by lesbian porn?Abstract. Adult intussusception occurs infrequently and differs from childhood A small bowel resection without reduction of the intussusception was performed. Small bowel intusssuception without a lead point is more common than intussusception with a lead point (,3)..
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Intussusception of the bowel...
Conclusions Small bowel intussusception in adults is rare and often challenging to diagnose owing the elusive, non-specific symptoms.
In such scenarios, a combined approach of limited intestinal resections and multiple snare polypectomies is advised to avoid developing short bowel syndrome. The latter appearance, the sausage-shaped pattern, was thought to result from alternating areas of low and high attenuation related to the bowel wall, mesenteric fat and fluid, intraluminal fluid, contrast material, or air. Rev Esp Enferm Dig. Historically, Sir Jonathan Hutchinson was the first to operate on a child with intussusception in [ 3 ].
Laparoscopically assisted resection of an ascending colon lipoma causing intermittent intussusception. 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.
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