Transient Descending Colocolonic Intussusception Due to a Large Fecaloma in an Adult.
ABSTRACT: Intussusception typically occurs in infants and children, with adults representing 5% of cases. A 53-year-old African American woman presented with lower abdominal pain and tenderness. Computed tomography of the abdomen and pelvis demonstrated a 3.5 cm colocolonic intussusception in the descending colon. Emergent colonoscopy found solid stool in the mid descending colon. Water-soluble rectal enema showed a filling defect in the mid descending colon. Repeat colonoscopy demonstrated presence of a large fecaloma in left colon. Laxatives were initiated, and abdominal pain subsided. To our knowledge, this is the first report of colocolonic intussusception secondary to fecaloma.
Project description:OBJECTIVE: To highlight a new phenomenon that we have encountered in children during the past 5?years. Children in this group have a pathognomonic clinical picture of sudden acute severe abdominal colic during which the child is continuously screaming for 1-2?min. All these patients were initially diagnosed on clinical and ultrasonographic grounds as acute intussusception. Careful interpretation of the radiological findings revealed faecal impaction of the terminal ileum and caecum. DESIGN: This is a retrospective study looking at children presenting between 2009 and 2014 with acute severe abdominal colic pain. These were 11 patients aged 9?months to 5?years. We reviewed our experience in the management and diagnosis of these patients. RESULT: All patients were diagnosed initially as intussusception, which was confirmed by ultrasonography (US). US revealed an appearance mimicking intussusception, 3 cases of which were intermittent. This US appearance proved to be a hard stool filling the terminal ileum. In all patients, abdominal X-ray revealed stool at the right side of the colon filling the caecum. Diagnostic gastrografin enemas that were performed in four patients excluded intussusception and confirmed stool at the caecum and ascending colon. In none of those patients had contrast passed into the terminal ileum. There was dramatic response to fleet and/or gastrografin enemas. Five patients required a second dose of enema and two patients required three doses. CONCLUSIONS: We highlight a new phenomenon of severe abdominal pain caused by faecal impaction of the terminal ileum and caecum. Increased awareness of this condition helps to avoid unnecessary investigations and/or surgical exploration.
Project description:BACKGROUND:This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. METHODS:This retrospective study included 1-month- to 6-year-old children with clinically suspected intussusception, who underwent POCUS in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to broader standards: presenting any one of intermittent abdominal pain/irritability or bloody stool, or???2 symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy. POCUS results were interpreted and categorized as "negative" or "suspicious," and a radiologist performed confirmatory ultrasound in "suspicious" cases. RESULTS:We analyzed 575 POCUS scans from 549 patients (mean age, 25.5?months). Among the 92 "suspicious" cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7?h, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain (P?<?0.001), but less vomiting (P?=?0.001); the other clinical features showed no intergroup differences. CONCLUSION:POCUS performed using the criteria set to broader standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.
Project description:<b>Rationale: </b>Appendiceal intussusception is a rare disease. The definite preoperative diagnosis of appendiceal intussusception is rare and challenging. Here, we present a case of McSwain type V appendiceal intussusception in a 10-year-old boy. To our best knowledge, this is the first case report of a type V appendiceal intussusception that was preoperatively confirmed with sonography. Here, we have described in detail the ultrasound features and differential diagnosis of this rare disease.<br><br><b>Patient concerns: </b>A 10-year-old boy presented with 3 days of recurrent intermittent mild abdominal pain. The result of ultrasonography suggested an ileocolic intussusception and a therapeutic air-contrast enema was requested to reduce the intussusception but failed at a local hospital.<br><br><b>Diagnoses: </b>Physical exam revealed mild tenderness in the lower right quadrant of the abdomen. However, ultrasonography showed a target-sign in cross section and a finger-like appearance in the longitudinal view. A diagnosis of McSwain type V appendiceal intussusception was made.<br><br><b>Interventions: </b>The patient underwent an appendectomy after successful manual reduction on laparotomy. The appendix was successfully resected.<br><br><b>Outcomes: </b>Intraoperatively, the appendix was completely inverted in the cecum, and the preoperative sonographic findings were confirmed. During follow-up, there were no signs of recurrence.<br><br><b>Lessons: </b>Pre-operatively, on ultrasound a type V appendiceal intussusception is usually misdiagnosed as an ileocolic intussusception. Radiologists must execute caution to avoid over reliance on the sonographic findings of intussusception, especially when there is a mismatch with clinical symptoms. It is especially important to accurately understand the surgical-anatomic configuration of type V appendiceal intussusception that creates a "target-sign" and a "finger-like" layout on ultrasonography.
Project description:Adult intussusception is rare, and 90% are due to a lead point secondary to a pathologic condition. Lymphangioma is an uncommon tumor of the lymphatic system and is rarely found within the small bowel. Small bowel lymphangioma causing intussuception in an adult is a rare occurrence, with three very distinct rare pathologies occurring simultaneously.A 70-year-old male patient with multiple pre-existing pathologies such as advanced ADPKD, multiple persistent tubulovillous colon polyps and colon cancer in situ, was hospitalized due to rapid weight loss of 20 lbs, hematemesis, and abdominal pain. He was subsequently found to have jejunal intussusception caused by two lymphangiomas of the small bowel. The portion of intussuscepted jejunum was resected and final diagnosis on pathology was two jejunal lymphangiomas.Lymphangiomas of the small bowel are rare, but increasing in incidence due to the accessibility of endoscopic evaluations. A hypothetical connection between lymphangioma and ADPKD is unknown, but both diseases are built on a foundation of cystogenesis. There is little known about the effect ADPKD on cystogenesis and tumor formation extra-renally, and there is a possible correlation between genetic mutations in polycystin and cystic tumors such as lymphangiomas.Lymphangioma, although rare in the small bowel, is a possible cause of intussusception and should be considered on the differential of abdominal pain in adults. The pathogenesis of polycystic kidney disease has implications that could predispose to cystic development beyond the kidney, and more research into the genetic mechanism behind the disease is necessary to support or deny this claim.
Project description:Intussusception, a process whereby a segment of the intestine telescopes into the adjoining intestinal lumen, is a rare source of pain in adults that present with nonspecific abdominal pain. Imaging is the mainstay for diagnosis, which requires prompt and accurate interpretation to prevent complications. The following report details the misdiagnosis of intussusception in a 54-year-old male, whom presented to the emergency department with a 4-day history of nonrelenting abdominal pain, nausea, vomiting, and constipation. Following blood tests, chest, and abdominal imaging, the patient was discharged with a suspected passed renal stone. He soon represented to the General Practitioner, however, with equivalent pain; prompting a review of the images. It was apparent that the initial radiologist failed to recognize the subtle presence of intussusception. This case highlights the necessary consideration of intussusception as a differential diagnosis in adult patients presenting with intermittent abdominal pain. The case further emphasizes that radiologists should be familiar with the subtler signs of intussusception.
Project description:In some settings, rotavirus vaccines have been associated with a low-level risk of intussusception, the most common cause of bowel obstruction in infants. As Vietnam prepares to introduce rotavirus vaccine into the national immunization program, we sought to better characterize the epidemiology of recurrent intussusception. We enrolled children <2?years of age who were hospitalized for intussusception retrospectively from January 2013 through December 2014 and prospectively from January 2015 through December 2016 at 2 hospitals in Vietnam. We enrolled 2477 children. Nearly all children were successfully treated by enema with low surgery rate (1%). We found 10% of children (n?=?254) experienced at least once recurrence (range: 1-6) and 57% of first recurrences happened within the first 12?weeks after treatment of the first episode. The median age at first intussusception was 13?months for children without a recurrent episode and 10?months for children with a recurrence. The symptoms of the recurrent cases were milder with less vomiting (67%), bloody stool (7%) and fever (10%) compared to the initial cases (p?<?0.01). We found the rate of recurrences following enema reduction of intussusception to be similar to that reported from other countries. Due to the high rate of intussusception and recurrent episodes in Vietnam, a better understanding of the cause of recurrent intussusception will be critical in assessing intussusception cases after rotavirus introduction.
Project description:Enema administration in the morning of routine colonoscopy is known to be useless. However, the potential bowel cleansing effects of distal colon emptying with enema prior to purgatives are not known. The aim of this study is to investigate the effects of enema use before purgatives in preparation for colonoscopy.Two hundred twenty-seven patients were randomly assigned into three groups; enema before purgative use, enema after purgative use, and no enema. Patients were compared in terms of age, sex, BMI, Rome III constipation criteria, history of abdominal surgery, tolerance to the preparation procedure, complications during preparation such as nausea, vomiting, headache and dizziness, cecal insertion time, total duration of colonoscopy, polyp determination rate and colonic cleansing based on the Boston Bowel Preparation Scale.One hundred two (44.9%) patients were male and 125 (55.1%) female. The mean age and BMI was 55.4±11.8 years and 28.8±4.7, respectively. No difference was observed between the groups in terms of sex, age, or BMI. The number of fulfilled Rome criteria and of previous abdominal surgeries were significantly higher in females than in men. Right colon Boston Bowel Preparation Scale score was higher in the group using enemas before purgatives than the scores of other groups. This improvement was statistically significant in the female patient group with higher constipation rate.Use of enemas before purgatives in patients with constipation significantly improves adequacy of right colon cleansing.
Project description:A 50-year-old Chinese man presented with abdominal pain associated with bloody mucoid stools, loss of appetite and weight loss. Contrast-enhanced computed tomography of the abdomen and pelvis revealed a colocolic intussusception secondary to a lipoma. The patient subsequently underwent a left hemicolectomy. Clinical and imaging findings of intussusception in adults are discussed in this article.
Project description:Enteral feedings through gastroenteric (GE) tubes are commonly utilised in patients with feeding difficulties and intolerance to gastric feeding. A variety of complications related to GE tubes have been described which rarely include small bowel intussusception. The case of a 23-year-old man with proximal small bowel intussusception related to an endoscopically placed low profile GE tube is described. The patient presented with abdominal pain and bilious vomiting. Symptoms resolved with tube shortening. This report includes a short review aimed at raising awareness about this complication with a discussion on diagnosis and management.
Project description:In children presenting to the emergency room with right lower quadrant pain, ultrasound is the preferred initial modality. In our patient, a 6-year-old male with a sudden onset of severe right lower quadrant pain, the differential is broad, including appendicitis and intussusception. In order to narrow our differential and secure the diagnosis, our first modality was ultrasonography. With the increased use of point-of-care ultrasound in the emergency department, the diagnosis of appendicitis and ileo-colic intussusception has been made more frequently. In addition, other entities such as transient small bowel intussusception may be identified. As in our case, obstruction secondary to intussusception must be ruled out with observation, serial abdominal exams, clinical improvement, or further imaging.