Successful laparoscopic approach for idiopathic adult colo-colonic intussusception: a case report

Abstract Background Adult intussusception is recognized as an abdominal emergency. More than 90% of adult patients with intussusception have distinct causes that are related to benign or malignant tumors. In contrast, idiopathic intussusceptions, which are observed in children, are rare conditions in adult. Especially, colo-colonic idiopathic intussusceptions are rare among them. Surgery is traditionally considered the primary treatment option. Recently, laparoscopic surgery has been reported to be safe and feasible. However, laparoscopic surgical reduction, which is a common procedure in pediatric surgery, is not common in adult intussusception. Case presentation We report a 34-year-old man who presented with sudden abdominal pain. Computed tomography revealed the target sign in the transverse colon. There was no evidence of bowel obstruction, bowel wall edema, or tumor. We diagnosed idiopathic intussusception and selected laparoscopic procedure because of the strong abdominal pain experienced by the patient. There were no signs of perforation, bowel wall ischemia, or tumor in abdominal cavity. We confirmed idiopathic colo-colonic anterograde intussusception. Laparoscopic surgical reduction was achieved by a combination of delicate direct pressure on the anal side of the transverse colon and gentle pulling on the oral side. The patient’s postoperative course was uneventful. Conclusions We achieved successful surgical reduction laparoscopically because of an accurate preoperative diagnosis based on characteristic computed tomography features and appropriate surgical technique. Laparoscopic procedure and surgical reduction is considered to be an effective treatment strategy for adult idiopathic intussusceptions with severe symptoms.

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Computed tomography findings of bowel wall thickening: its significance and relationship to endoscopic abnormalities

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13171221498983 ◽

2012 ◽

Vol 94 (1) ◽

pp. 23-27 ◽

Cited By ~ 8

Author(s):

MM Uzzaman ◽

A Alam ◽

MS Nair ◽

R Borgstein ◽

L Meleagros

Keyword(s):

Computed Tomography ◽

Rectal Bleeding ◽

Transverse Colon ◽

Bowel Wall ◽

Malignant Lesion ◽

Wall Thickening ◽

Neoplastic Disease ◽

Endoscopic Evaluation ◽

Neoplastic Lesion ◽

Bowel Wall Thickening

INTRODUCTION The aim of this study was to conduct retrospective analysis of abdominopelvic computed tomography (CT) reports, identifying those patients in whom bowel wall thickening (BWT) was observed, and to correlate these reports with subsequent endoscopic evaluation. METHODS Formal reports for all patients undergoing abdominopelvic CT between February 2007 and September 2009 were reviewed. Where patients were identified as having colorectal ‘wall thickening’, results of subsequent endoscopic evaluations were documented. Only those patients with a report of BWT who had follow-up endoscopy (colonoscopy, sigmoidoscopy) were included in the analysis. RESULTS A total of 165 patients were included. Abnormalities on endoscopy at the exact site of the BWT on CT were found in 95 patients (57.58%); in 36 cases (21.82%) this was a malignant lesion. BWT of the transverse colon was significantly more likely to correspond to an endoscopic finding of cancer than other sites (p=0.034). Rectal bleeding was reported significantly more often in patients with BWT and neoplastic disease on endoscopy compared with those with normal endoscopy (p=0.04). Excluding patients with inflammatory/diverticular lesions, 59.02% of Caucasians had a neoplastic lesion at the site of reported BWT, significantly higher than the other ethnic groups (p=0.008). There were 38 patients (23.03%) who did not present with bowel symptoms and, of these, 6 were diagnosed subsequently with colorectal cancer. CONCLUSIONS This study supports endoscopic evaluation to investigate patients with CT evidence of BWT, especially in cases involving the transverse colon, in Caucasian patients or in association with symptoms of rectal bleeding.

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Volvulus of the liver with intrathoracic herniation

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184903324 ◽

2014 ◽

Vol 96 (7) ◽

pp. e27-e29 ◽

Cited By ~ 2

Author(s):

G Moussa ◽

PM Thomson ◽

A Bohra

Keyword(s):

Abdominal Pain ◽

Transverse Colon ◽

Abdominal Cavity ◽

Liver Perfusion ◽

Previous History ◽

Interesting Case ◽

Oval Window ◽

Uneventful Recovery ◽

Pericardial Window ◽

History Of

Introduction We present a rare case of a liver volvulus, stomach and transverse colon herniating through the diaphragm. This scenario has not been reported previously. We discuss the presentation and management of this interesting case. Case history A 65-year-old woman with a history of sarcoidosis and recurrent pericardial effusions, treated previously with a subxiphoid pericardial oval window fenestration, presented with acute upper abdominal pain radiating to the chest. High contrast computed tomography showed a volvulus of the liver with consequent venous congestion, and herniation of the liver, stomach and transverse colon through an anterior diaphragmatic defect. With liver perfusion threatened, an urgent laparoscopic repair was performed. The stomach and transverse colon were reduced, and the twisted left lobe of the liver was unrotated and reduced into the abdominal cavity. A double-sided synthetic mesh was used to repair the defect. The patient made an uneventful recovery. Conclusions This is a novel complication of a patient presenting with abdominal pain with a previous history of pericardial window fenestration. A laparoscopic reduction and repair can be performed safely with excellent postoperative results.

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Chilaiditi’s Syndrome—What Every Endoscopist Should Know

Reports ◽

10.3390/reports3020011 ◽

2020 ◽

Vol 3 (2) ◽

pp. 11

Author(s):

Jayan George ◽

Ashleigh V Genever ◽

Timothy J White

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Chest Radiograph ◽

Transverse Colon ◽

Bowel Perforation ◽

Severe Abdominal Pain ◽

Radiographic Sign ◽

Chilaiditi’S Syndrome ◽

Chilaiditi’S Sign ◽

Chilaiditi's Syndrome

Chilaiditi’s syndrome is a rare and often asymptomatic anomaly, typically found as an incidental radiographic sign (gas under the diaphragm) due to hepato-diaphragmatic interposition of the transverse colon. We report a case of Chilaiditi’s syndrome following colonoscopy presenting with severe abdominal pain, dyspnoea and radiograph findings similar to the presence of bowel perforation (appearance of gas under the hemidiaphragm on erect chest radiograph). Computed tomography (CT) evidence of Chilaiditi’s sign prevented unnecessary laparotomy.

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Ulcerating Ileocolitis in Severe Amatoxin Poisoning

Case Reports in Gastrointestinal Medicine ◽

10.1155/2015/632085 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Matthias Peter Hilty ◽

Marcel Halama ◽

Anne-Katrin Zimmermann ◽

Marco Maggiorini ◽

Andreas Geier

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Hepatic Failure ◽

Acute Gastroenteritis ◽

Large Bowel ◽

Bowel Wall ◽

Watery Diarrhea ◽

Infectious Agents ◽

Gastrointestinal Complications

Amatoxin poisoning is still associated with a great potential for complications and a high mortality. While the occurrence of acute gastroenteritis within the first 24 hours after amatoxin ingestion is well described, only very few descriptions of late gastrointestinal complications of amatoxin poisoning exist worldwide. We present the case of a 57-year-old female patient with severe amatoxin poisoning causing fulminant but reversible hepatic failure that on day 8 after mushroom ingestion developed severe abdominal pain and watery diarrhea. Ulcerating ileocolitis was identified by computed tomography identifying a thickening of the bowel wall of the entire ileum and biopsies taken from the ileum and large bowel revealing distinct ileitis and proximally accentuated colitis. The absence of discernible alternative etiologies such as infectious agents makes a causal relationship between the ulcerating ileocolitis and the amatoxin poisoning likely. Diarrhea and varying abdominal pain persisted over several weeks and clinical follow-up after six months showed a completely symptom-free patient. The case presented highlights the importance to consider the possibility of rare complications ofAmanitaintoxication in order to be able to respond to them early and adequately.

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The recurrence of colonic volvulus due to nonrotation after intestinal resection in adulthood: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0710-x ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Yusuke Sakimura ◽

Hirotaka Kitamura ◽

Noriyuki Inaki ◽

Hiroyuki Bando

Keyword(s):

Abdominal Pain ◽

Transverse Colon ◽

Abdominal Cavity ◽

Intestinal Resection ◽

Lower Abdominal Pain ◽

Emergency Laparotomy ◽

Ascending Colon ◽

Colonic Volvulus ◽

Abdominal Symptoms ◽

Initial Surgery

Abstract Background Intestinal nonrotation is a rare congenital condition that causes fatal colonic volvulus at any age. Once volvulus attack occurs, radical surgical therapy is required for treatment and the prevention of recurrence. This report describes the case of an adult female patient with a recurrence of cecum volvulus due to intestinal nonrotation after transverse colon resection for colonic volvulus. Case presentation A 27-year-old female visited our emergency room (ER) with intermittent abdominal pain and nausea. Enhanced computed tomography (CT) showed enlargement of the level of the ascending and transverse colon and an obstruction with a whirlpool sign at the transverse colon. The small intestine was distributed on the right side of the abdominal cavity, and the large intestine occupied the left side. She was diagnosed with volvulus with intestinal nonrotation, and emergency surgery was performed. Surgical examination indicated that the ascending colon to the transverse colon was not fixed to the retroperitoneum, and the transverse colon was rotated 180° clockwise. The axis of the volvulus was a mesenteric adhesion of the transverse colon. The involved transverse colon was resected, and the intestine was reconstructed by functional end-to-end anastomosis (FEEA). Six years after the initial surgery, the patient presented to the ER with abdominal fullness and lower abdominal pain. Enhanced CT revealed that the cecum, ascending colon, and remaining transverse colon were dilated with an obstruction. The appendix was located in the left upper abdominal cavity. The clinical diagnosis was cecal volvulus with intestinal nonrotation. An emergency laparotomy revealed that the cecum was rotated 180° clockwise. The terminal ileum to the remaining transverse colon was resected, and FEEA was performed. Seven months later, she suffered obstruction of the intestine caused by an operative adhesion, and conservative treatment was successful. The patient has had no abdominal symptoms for one and a half years so far. Conclusions Surgeons should realize that nonrotation of the intestines induces volvulus in adulthood and should familiarize themselves with its clinical findings, appropriate treatment, and prognosis. Even after surgical treatment, awareness of the recurrence of volvulus should be maintained to avoid a late diagnosis.

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Adult intussusception as rare anomaly: case reports and management

International Surgery Journal ◽

10.18203/2349-2902.isj20194457 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3856

Author(s):

Kirti Savyasacchi Goyal ◽

Tejinder Pal Singh Sodhi ◽

Maneshwar Singh Utaal ◽

Nitish Dhawan ◽

Mani Garg

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Emergency Surgery ◽

Bowel Resection ◽

Case Reports ◽

Adult Intussusception ◽

Laparoscopic Management ◽

Diagnosis And Management ◽

Feasible Option ◽

Specific Symptoms

Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, aetiology, and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms and most cases are diagnosed at emergency surgery. Use of computed tomography in the evaluation of patients with abdominal pain, the condition can be diagnosed more reliably. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial. Laparoscopic management has been reported to be a safe and feasible option regardless of the etiology. This paper presents the diagnosis and management of two cases of adult intussusception, their presentation and management.

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Omental leiomyosarcoma with unusual giant cells in a Beagle dog — Short communication

Acta Veterinaria Hungarica ◽

10.1556/004.2016.022 ◽

2016 ◽

Vol 64 (2) ◽

pp. 222-228

Author(s):

Jun Sasaki ◽

Megumi Toyoshima ◽

Yasuhiko Okamura ◽

Masanobu Goryo

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Short Communication ◽

Smooth Muscle Actin ◽

Abdominal Cavity ◽

Giant Cells ◽

Greater Omentum ◽

Muscle Actin ◽

Beagle Dog ◽

History Of

A 10-year-old castrated male Beagle dog was presented with a 2-month history of intermittent vomiting and abdominal pain. The dog was referred to the Veterinary Teaching Hospital at Iwate University for further evaluation, and a splenic tumour was suspected on the basis of ultrasonography and computed tomography. Surgery identified a large, solid, light-pink mass on the greater omentum with blood-coloured ascites in the abdominal cavity, and resection was performed. Microscopically, the mass comprised spindle-shaped tumour cells and scattered osteoclast-like giant cells. Most spindle-shaped cells were positive for vimentin, desmin, and smooth muscle actin (α-SMA), whereas osteoclast-like giant cells were positive only for vimentin. On the basis of histopathological and immunohistochemical findings, a diagnosis of leiomyosarcoma was made. To the best of our knowledge, this represents the first report of leiomyosarcoma associated with osteoclast-like giant cells developing from the greater omentum in a dog.

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Abdominal actinomycosis mimicking a transverse colon malignancy: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-02812-7 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Gnanaselvam Pamathy ◽

Umesh Jayarajah ◽

Dayal Sathyajith Gamlaksha ◽

Roshana Constantine ◽

Anura S. K. Banagala

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Transverse Colon ◽

Rare Complication ◽

Stage Iv ◽

Exploratory Laparotomy ◽

Needle Aspiration ◽

Bacterial Disease ◽

Abdominal Actinomycosis ◽

Descending Colon

Abstract Background Actinomycosis is a rare inflammatory bacterial disease caused by Actinomyces species which can infrequently affect the large intestine. Disseminated actinomycosis is reported as a rare complication associated with intrauterine devices. We report a case of intra-abdominal actinomycosis mimicking a transverse colon malignancy. Case presentation A previously healthy 40-year-old Sinhalese woman was evaluated for intermittent colicky left-sided abdominal pain for 2 months’ duration. Computed tomography of the abdomen showed a circumferential thickening of the wall and narrowing of the lumen of the descending colon with evidence of extraluminal extension to the adjacent parietal peritoneum and abdominal wall suggestive of a stage IV neoplasm. An exploratory laparotomy with extended left hemicolectomy was performed. Macroscopic evaluation revealed a mass lesion with multiple abscesses attached to the transverse and descending colon. Histology was suggestive of actinomycosis with no evidence of malignancy. Conclusions Abdominal actinomycosis should be considered in a young patient with chronic abdominal pain. It should be understood that the presentation may be vague and highly variable. Computed tomography-guided biopsy/fine needle aspiration or laparoscopy and biopsy may be useful in arriving at a diagnosis and can prevent unnecessary surgical intervention.

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Internal hernia as one of the causes of abdominal pain

Clinical Practice ◽

10.17816/clinpract10227-35 ◽

2019 ◽

Vol 10 (2) ◽

pp. 27-35

Author(s):

V. M. Kitaev ◽

E. G. Koshelev ◽

O. V. Sokolova ◽

G. Yu. Belyaev ◽

A. A. Egorov ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Abdominal Cavity ◽

Pain Syndrome ◽

Internal Hernias ◽

Diagnostic Difficulties ◽

Modern Classification ◽

Acute Small Bowel Obstruction ◽

Ct Data

Abdominal pain is often observed in clinical practice, causing diagnostic difficulties for doctors of different specialties. Internal hernias are a surgical pathology and may be the cause for the development of acute small bowel obstruction and the occurrence of pain. A modern classification of internal hernias is presented and their topographic-anatomical description is given. The analysis of the results of computed tomography (CT) scan of the abdominal cavity in 20 patients with an unidentified cause of abdominal pain was performed. According to the CT data, three patients had internal hernias that caused the development of pain syndrome. A pathological displacement of intestinal loops with partial disruption of intestinal permeability and curvature of the mesentery without critical disturbance of blood supply was demonstrated in 4 patients with abdominal pain. The findings suggest that CT may be the method of choice when examining patients with an unknown cause of abdominal pain syndrome.

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A prospective study of the lumps in the right hypochondrium

International Surgery Journal ◽

10.18203/2349-2902.isj20200818 ◽

2020 ◽

Vol 7 (3) ◽

pp. 757

Author(s):

Sudhir R. Jayakar ◽

Prashant V. Male ◽

Maitreyee M. Save ◽

Varun S. Shetty

Keyword(s):

Abdominal Pain ◽

Prospective Observational Study ◽

Clinical Presentation ◽

Malignant Tumors ◽

Abdominal Cavity ◽

Age Group ◽

Inclusion Criteria ◽

Gall Bladder Carcinoma ◽

The Right ◽

A Prospective Study

Background: The abdominal cavity can harbour a varied spectrum of diseases. Abdominal lumps are one of the commonest disorders in this region. The clinical presentation, diagnosis, minimal investigations and optimum treatment of the lumps in the right hypochondrium were studied in detail in present study.Methods: The prospective observational study was carried out for 24 months. 60 consecutive patients who satisfied the inclusion criteria were taken up for the study. Calculation and analysis of data was done by using MS Excel.Results: The lumps in the right hypochondrium were most common in the 31-40 years age group in the present study. Majority of the lumps were found to be intraperitoneal (65%), of which 45% were neoplastic in nature. 68.3% as compared to 31.7% of lumps had an organ of origin which was not anatomically situated in the right hypochondrium viz. from right kidney and right adrenal. Hepatic lumps were found to be the commonest (35%), of which 14.3% were malignant tumors. Gall bladder carcinoma was more common in 40-60 years with female preponderance. Only 26.7% patients presented with the complaint of lump in abdomen. The commonest complaint was pain in the abdomen followed by vomiting. In 88.3% cases surgery was undertaken for curative or palliative purposes.Conclusions: Of all the lumps in the right hypochondrium, intraperitoneal lumps were more common with abdominal pain as commonest presenting symptom. The commonest lumps were found to be hepatic lumps. Incidence of Neoplastic masses was more than infections and infestations.

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