how to treat intussusception in adults
Rotavirus Vaccine and Intussusception | CDC Ned Tijdschr Geneeskd. For colonic intussusceptions, reduction was avoided in our patients. The study was performed in accordance with the Medical Ethics Committees requirements. Fujii Y, Taniguchi N, Itoh K. Intussusception induced by villous tumor of the colon: sonographic findings. Soccorso G, Puls F, Richards C, Pringle H, Nour S. A ganglioneuroma of the sigmoid colon presenting as leading point of intussusception in a child: a case report. Eight to twenty percent of cases are idiopathic, without a lead point lesion. Jen HC, Shew SB. Symptoms include abdominal pain, which may wax and wane, vomiting, bloating, and bloody stool. Intestinal Intussusception: Etiology, Diagnosis, and Treatment Patients were divided into 2 groups according to the lead point location: enteric intussusceptions and colonic intussusceptions. Overall, malignant lesions were encountered in 26% of enteric intussusceptions and 57% of colonic ones. Many authors have recently suggested a more selective approach in the management of enteric intussusceptions. Colonoscopic diagnosis of ileocolic intussusception in an adult. eCollection 2019 Aug. Gallegos-Sierra C, Belmonte-Chico Goerne MA, Ramrez-Jaimez J, de la Cruz-Temores S, Leonher-Ruezga KL. Nevertheless, it must be performed in selected patients given the high risk of perforation resulting from parietal ischemia and potentially necrosis [30, 31]. 2012 Jan 2. Laparoscopy is associated with faster recovery times, decreased length of stay, decreased time to full feeds, and lower requirements of pain medication. The https:// ensures that you are connecting to the Wang LT, Wu CC, Yu JC, Hsiao CW, Hsu CC, Jao SW. Clinical entity and treatment strategies for adult intussu-sceptions: 20 years' experience. Athanasios Marinis, Anneza Yiallourou, Lazaros Samanides, Nikolaos Dafnios, Georgios Anastasopoulos, Ioannis Vassiliou, Theodosios Theodosopoulos, Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vassilisis Sofias Ave., 11528, Athens, Greece. This activity focuses on an in-depth understanding of this rare yet life-threatening emergency. PMC Unauthorized use of these marks is strictly prohibited. [49] and Mateen et al. Traditionally, an attempt was not considered successful until the reducing agent, whether air, barium, or water-soluble contrast, was observed refluxing back into the terminal ileum, but evidence has shown that this is not entirely necessary. RESULTS Seven patients were identified who had a diagnosis of intussusception. Tareen F, Mc Laughlin D, Cianci F, Hoare SM, Sweeney B, Mortell A, et al. Adult bowel intussusception is a rare but challenging condition for the surgeon. It is the most common cause of intestinal obstruction in this age group and occurs roughly equally in male and female children < 4 years of age . Clinical presentation, investigation findings, operative details, and histological reports were collected and analyzed. 101(6):663-70. Most intussusceptions that failed to show reflux into the ileum were due to either an edematous or competent ileocecal valve. Intussusception usually involves the small bowel and rarely the large bowel. Conversely, colonic intussusceptions are more likely due to malignant etiologies in up to 66% of cases [23, 33]. This website also contains material copyrighted by 3rd parties. En bloc resection without reduction is recommended by other researchers considering the high rate of malignancy [38-40]. Park KJ, Choi HJ, Kim SH, Han SY, Hong SH, Cho JH, Kim HH. The site is secure. Abdominal radiography is not necessary in children with intussusception. Intestinal invagination in adults: preoperative diagnosis and management. and transmitted securely. The most frequently performed procedure was segmental intestinal resection (n = 16, 61%). The diagnosis and treatment of adult intussusception doi: 10.7759/cureus.23600. official website and that any information you provide is encrypted 2018 Jul-Sep;81(3):367-372. 2009 Jul-Dec. 6(2):131. Case Rep Surg. Large bowel obstruction. Axial contrast-enhanced CT scan showing a typical round target-shaped mass with bowel wall thickening. There is a small risk of intussusception from rotavirus vaccination, usually within a week after the first or second dose. 2010 Nov. 45(11):2175-80. 2017 Sep-Oct;85(5):444-448. doi: 10.1016/j.circir.2016.06.001. [QxMD MEDLINE Link]. In contrast, almost 90% of the cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point, such as carcinomas, polyps, Meckels diverticulum, colonic diverticulum, strictures or benign neoplasms, which are usually discovered intraoperatively[57]. Results of surgery in adult intussusceptions are generally good, but the long-term prognosis depends mainly on the underlying diseases [16, 20]. 2006 Jan 5. Intussusception occurs primarily in infants (boys more often than girls) but can also occur in adults and older children. When using barium or water-soluble contrast, the column of contrast should not exceed 100 cm above the level of the buttocks. The result is bowel obstruction and inflammatory changes ranging from thickening to ischemia of the bowel wall. Inversely, retrograde intussusception corresponded to telescoping of an intestinal segment into the lumen of another distal segment. Unable to load your collection due to an error, Unable to load your delegates due to an error. Pediatr Infect Dis J. Atypical endoscopic finding of colocolic intussusception: case report and literature review. [Entero-enteral invagination of the small intestine in adults. A diligent search for any lead points is warranted, especially if the patient is older than 2-3 years. sharing sensitive information, make sure youre on a federal Garry Wilkes, MBBS, FACEM Emergency Physician, Echuca Regional Health, Victoria; Clinical Associate Professor, University of Western Australia, AustraliaDisclosure: Nothing to disclose. Abstract Objective: The objectives were to review adult intussusception, its diagnosis, and its treatment. Zanardi LR, Haber P, Mootrey GT, et al. Two patients had colonic cancer and one had jejunal cancer. J Clin Gastroenterol. Jelenc F, Brencic E. Laparoscopically assisted resection of an ascending colon lipoma causing intermittent intussusception. The .gov means its official. [Contribution of imaging in intestinal intussusception in the adult. When you call to make an appointment, ask about performing the tape test. The characteristic features of CT scan include an unhomogeneous target or sausage- shaped soft- tissue mass with a layering effect (Figure (Figure1);1); mesenteric vessels within the bowel lumen are also typical[10]. Usually, surgical exploration is needed to verify the diagnosis and exclude an underlying malignancy. 1-3). Plain abdominal radiography, performed only in patients with acute clinical presentation, showed hydro-air levels typical of intestinal obstruction. In adults, the exact mechanism of bowel intussusception is unknown (primary or idiopathic) in 8%-20% of cases and is more likely to occur in the small intestine[4,10,11]. Pediatrics. Diarrhea in Children . [QxMD MEDLINE Link]. Moreover, in patients complicated with postoperative bowel obstruction due to an intussusception, reduction is also recommended, provided that the bowel appears non-ischemic and viable[4]. -, Eisen LK, Cunningham JD, Aufses AH. Some clinicians recommend taking the patient to surgical care if the first attempt fails, and other clinicians advocate 1 or 2 subsequent attempts within a few minutes to a few hours after the first attempt. Patients aged 5 months to 3 years who have intussusception rarely have a lead point (ie, idiopathic intussusception) and are usually responsive to nonoperative reduction. Acute abdominal pain is defined as pain lasting fewer than seven days and accounts for up to 10% of emergency department visits. Rectal prolapse was excluded from this classification. Introduction: Intussusception is a rare condition in adults. J Pediatr Surg. You may not have much time to prepare for an appointment. There is no known cause for most cases of intussusception. [QxMD MEDLINE Link]. Reduction attempt also failed in 2 patients due to hard irreducible underlying masses. 2015 Jul. Study: The other nonurgent patients (n = 18, 69%) were operated on the basis of elective surgery. Ultrasonography is considered a useful tool for the diagnosis of intussusception, both in children and in adults[26,27]. Our relatively higher rate can be explained by the frequent use of CT scan in our country, particularly in recent years. We report our experience in an attempt to clarify the usefulness of CT scan and the optimal treatment of this entity. A study by Flaum et al presented their experience in intussusception reductions using saline enema under ultrasound control and concluded that it is an efficient and safe procedure. A pathological lesion is usually found with a significant percentage of malignancy. If repeated attempts are unsuccessful, any progress in pushing back the intussusceptum toward the ileocecal valve during operative reduction is advantageous. Adult intussusception. All patients underwent surgical exploration. Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. Some have proposed patient discharge from the emergency department after a short period of observation. You are being redirected to Surgery is the definitive treatment of adult intussusceptions. It can lead to intestinal obstruction and exposes the patient to the risk of parietal ischemia, perforation, and peritonitis. Intussusception in adults is rare. However, interposition of air contained in distended loops and obesity can affect the image quality and the findings accuracy. Anyone with signs or symptoms of intussusception or its complications should get medical help right away. Involve a pediatric surgeon as early as possible to help coordinate the care and resuscitation of the child. Therapeutic enema is of no value in patients with small boweltosmall bowel intussusception, which usually occurs in older children who have other associated diseases (eg, HSP, hemophilia, Peutz-Jeghers syndrome, malignancies). Intussusception is a condition when a part of the intestine slides into an adjacent part of the intestine, like a telescope. However, a pathological lead point was found in only 10 patients out of the 21 (48%). These forms, more frequently without a detected pathological lead point, are secondary to transient peristaltic disorders and are likely to be resolved spontaneously. Patients treated with nonoperative reduction usually do not require any specific follow-up care unless problems exist. sharing sensitive information, make sure youre on a federal StatPearls [Internet] StatPearls Publishing; Treasure Island (FL): 2022. Methods History, physical exam, and lab values can aid in the process, but imaging is usually needed to make the diagnosis. J Laparoendosc Adv Surg Tech A. In the small intestine, an intussusception can be secondary either to the presence of intra- or extra-luminal lesions (inflammatory lesions, Meckels diverticulum, postoperative adhesions, lipoma, adenomatous polyps, lymphoma and metastases) or iatrogenic, e.g. Intraoperative findings. Adult intussusception in the last 25 years of modern imaging: is surgery still indicated? A Alfred Chahine, MD Associate Professor of Surgery and Pediatrics, George Washington University School of Medicine and Health Sciences; Attending Surgeon, Children's National Health System Out of the 9 malignant etiologies, primary adenocarcinoma was the most frequent (4 cases), and others included malignant lymphoma, leiomyosarcoma, gastrointestinal stromal tumor, and undifferentiated carcinoma. The other procedures were right hemicolectomy (n = 6, 23%), ileocecal resection (n = 2, 8%), segmental sigmoidectomy (n = 1, 4%), and proctosigmoidectomy (n = 1, 4%). [QxMD MEDLINE Link]. Intestinal resection with immediate anastomosis was the technique of choice for most patients. The male-to-female ratio was 1.6:1. We have successfully used this approach in 3 cases for segmental intestinal resection and in 1 case of right hemicolectomy with an uneventful postoperative course. Intussusception in Adults When an intestinal obstruction occurs in children, ultrasound is often the preferred type of imaging. eCollection 2022 Mar. Please confirm that you would like to log out of Medscape. 2023 Jun 23;7:e42775. Gastrointest Endosc. Pediatrics. At first, intussusceptum (arrow) was located on redundant transverse colon in pelvic cavity. the contents by NLM or the National Institutes of Health. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Correspondence to: Athanasios Marinis, MD, PhD, Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 54 Dimokritou STR, 13673, Acharnes, Athens, Greece. Hisham Nazer, MBBCh, FRCP, DTM&H Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, University of Jordan Faculty of Medicine, Jordan Fazio RA, Wickremesinghe PC, Arsura EL, Rando J. Endo-scopic removal of an intussuscepted appendix mimicking a polyp--an endoscopic hazard. World J Clin Cases. Intussusceptions have also been classified according to etiology (benign, malignant or idiopathic). Delay in performing surgery because of additional attempts at nonoperative reduction has been demonstrated to have no adverse effects on the rates of success of operative reduction and patient morbidity. First reported in 1674 by Barbette of Amsterdam[1] and further presented in a detailed report in 1789 by John Hunter[2] as introssusception, intussusception represents a rare form of bowel obstruction in the adult, which is defined as the telescoping of a proximal segment of the gastrointestinal (GI) tract, called intussusceptum, into the lumen of the adjacent distal segment of the GI tract, called intussuscipiens. Acta Chir Belg. A decreased rate of operative intussusception management is noted in specialized pediatric hospitals compared with nonpediatric hospitals. One case of enteric intussusception was jejuno-jejunal, 3 were jejuno-ileal, 12 were ileo-ileal, and 3 were ileocolic. Apropos of 2 cases]. Laparoscopy-assisted resection of ileoileal intussusception caused by intestinal lipoma. Intussusception is a type of bowel blockage; the condition is rare. Eight of them (31%) were admitted with acute intestinal obstruction and required emergency surgery. 8600 Rockville Pike 2012;2012:962683. 2008 Jul. Intussusception Treatment & Management - Diseases & Conditions
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how to treat intussusception in adults
