Conservative Treatment of Puerpera with Severe Hemorrhagic Shock and Secondary Coagulopathy

AbstractAdult intussusception is a rare entity which is distinct from paediatric cases in incidence, aetiology, and management. It represents 5% of all intussusceptions and is the cause of 1% of all intestinal obstructions, 0,08% of all abdominal surgeries and 0,003-0,02% of all hospital admissions. Ileocolic intussusception in adults is a unique variant in which nearly 100% of cases have a malignant lead point. In our report, we described a case of a patient with ileocecal intussusception caused by a rare type of the gastrointestinal tumor. The female patient was admitted to hospital for occasional pain in the lower right quadrant of the abdomen followed by abdominal discomfort and appearance of blood in the stool. The result of CT scan of the abdomen and pelvis showed a tumor mass and intussusception at the ileocecal junction, which was confirmed peroperatively. Open right hemicolectomy was performed adhering to oncological principles. The final pathologic diagnosis indicated the gastrointestinal stromal tumor of the ileocecal valve. The diagnosis of intussusception in adults is delicate, and timely surgical treatment can be vital. Patients with the palpable abdominal mass, digestive tract obstruction, gastrointestinal bleeding, or lead point computed tomography must undergo a surgical examination. Given a high risk of malignancy, primary surgical resection using oncologic principles presents the best option for the treatment of ileocecal intussusception in adults.

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Adult Burkitt’s lymphoma presenting as intussusception: first UK case report

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0105 ◽

2017 ◽

Vol 99 (7) ◽

pp. e206-e208 ◽

Cited By ~ 1

Author(s):

R Simson ◽

A Planner ◽

Roderick Alexander

Keyword(s):

Epigastric Pain ◽

Recurrent Abdominal Pain ◽

Burkitt’S Lymphoma ◽

Right Hemicolectomy ◽

Burkitt's Lymphoma ◽

Adult Intussusception ◽

Lead Point ◽

History Of ◽

The Uk ◽

Specific Symptoms

Colonic intussusception is rare in adults and can present with non-specific symptoms that can make diagnosis difficult and delayed. Unlike in children, it is commonly due to a pathological lead point that is often malignant. This case is the first reported case of adult intussusception due to Burkitt's lymphoma in the UK. We describe the case of a 22-year-old woman who presented with 4-week history of intermittent epigastric pain. On the third hospital admission, the diagnosis was made by abdominal computed tomography, which showed the ‘target’ sign, suggestive of intussusception. A right hemicolectomy was performed and histology later confirmed Burkitt’s lymphoma. This case demonstrates the difficulty in diagnosing intussusception in adults, which must be considered in recurrent abdominal pain when more common causes have been ruled out. The rare diagnosis of Burkitt’s lymphoma made early diagnosis and treatment important.

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Ileocecal intussusception extending to left colon due to endometriosis

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0225 ◽

2018 ◽

Vol 100 (3) ◽

pp. e62-e63 ◽

Cited By ~ 4

Author(s):

M Rodriguez-Lopez ◽

M Bailon-Cuadrado ◽

FJ Tejero-Pintor ◽

E Choolani ◽

G Fernandez-Perez ◽

...

Keyword(s):

Adult Population ◽

Great Majority ◽

Right Hemicolectomy ◽

Left Colon ◽

Lead Point ◽

Ileocolic Intussusception ◽

Rare Presentation ◽

Bowel Involvement ◽

Ileocecal Intussusception ◽

Manual Extraction

Bowel involvement in endometriosis is uncommon and is most frequently located in the sigmoid colon and the rectum. We present a case in a 37-year-old woman of a cecal endometrioid mass complicated with an ileocolic intussusception which extended beyond the splenic colon flexure. Careful manual extraction allowed a reduction of the intussusceptum, followed by an oncological right hemicolectomy. The patient suffered postoperative ileus, which was spontaneously solved. Intussusception is infrequent in the adult population and usually involves the small bowel. The great majority of ileocolic intussusceptions have a malignant origin (cecal adenocarcinoma). An endometriotic mass located at the cecum as the lead point for ileocolic intussusception is an extremely rare presentation. On reviewing the literature, we found only 13 reports with no other cases extending beyond the splenic flexure, as occurred in our patient.

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Jejunojejunal Intussusception Induced by a Gastrointestinal Stromal Tumor

Case Reports in Surgery ◽

10.1155/2012/173680 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ali H. Zakaria ◽

Salam Daradkeh

Keyword(s):

Gastrointestinal Tract ◽

Gastrointestinal Stromal Tumor ◽

Exploratory Laparotomy ◽

Stromal Tumor ◽

Therapeutic Interventions ◽

Adult Intussusception ◽

Lead Point ◽

Imaging Studies ◽

High Index Of Suspicion ◽

Intestinal Obstructions

Background. Adult intussusception is a rare entity representing less than 1% of all intestinal obstructions. Diagnosis of the condition is difficult requiring a high index of suspicion and the utilization of imaging studies, especially CT scans. Diagnostic laparoscopy and/or exploratory laparotomy can be used as a diagnostic and therapeutic intervention. In over 90% of cases, an underlying lead point is identified. In the patient described here, it was a gastrointestinal stromal tumor (GIST), a relatively rare mesenchymal tumor comprising only 0.2–1.0% of the gastrointestinal tract neoplasms and believed to originate from neoplastic transformation of the interstitial cells of Cajal. GISTs may occur anywhere along the gastrointestinal tract, but most commonly arise in the stomach and small intestine. Literature review revealed only few cases reporting GISTs as a leading point of adult's intussusception.Case Presentation. In this report, we are presenting a rare case of jejunojejunal intussusception in a 78-year-old female patient with a GIST located in the terminal jejunum being the leading point, demonstrating the importance of imaging studies, especially CT scan, laparoscopy, and exploratory laparotomy as diagnostic and therapeutic interventions.

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Small bowel intussusception in marijuana users

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa335 ◽

2020 ◽

Vol 2020 (9) ◽

Author(s):

Daniel Kakish ◽

Marwan Alaoudi ◽

Brian Welch ◽

David Fan ◽

Melissa Meghpara ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Acute Abdomen ◽

Bowel Obstruction ◽

Adult Intussusception ◽

Lead Point ◽

Review Of The Literature ◽

Pathologic Process ◽

Small Bowel Intussusception ◽

Intestinal Obstructions

Abstract Intussusception occurs when one portion of bowel ‘telescopes’ into another due to a lead point created by a range of benign or pathologic process. Intussusception mostly occurs in children. Although adult intussusception (AI) is rare, accounting for <5% of intestinal obstructions, it is more concerning in adults as malignancy accounts for nearly 65% of lead points in AI. Patients present with severe abdominal pain concerning for an acute abdomen along with a degree of bowel obstruction. We have experienced a total of 11 patients within recent years presenting with symptoms of an acute abdomen due to AI. None of these patients were found to have a pathologic process creating a lead point. However, we found that all of them were marijuana users. In this report, we compare their management, hospital course and review of the literature discussing proposed mechanisms that suggest an association between cannabis and intussusception.

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Adult Ileo-Ileo-Caecal Intussusception: Case Report and Literature Review

Case Reports in Surgery ◽

10.1155/2012/789378 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Sanjeev Singhal ◽

Anu Singhal ◽

Pankaj K. Arora ◽

Rahul Tugnait ◽

Bishwanath Tiwari ◽

...

Keyword(s):

Unusual Case ◽

Postoperative Recovery ◽

Acute Intestinal Obstruction ◽

Adult Intussusception ◽

Emergency Laparotomy ◽

Lead Point ◽

Rare Entity ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Intestinal Obstructions

Adult intussusception is a rare entity accounting for only 5% of all intussusceptions and causes approximately 1% of all adult intestinal obstructions. Unlike paediatric intussusceptions which are usually idiopathic, there is usually a lead point pathology which might be malignant in up to 50% cases. We present an unusual case of adult intussusception which was not diagnosed on any investigation including computerized tomographic (CT) scan and magnetic resonance imaging (MRI). It was a case of ileo-ileo-cecal intussusception caused by a large lipoma38 mm×43 mm×61 mm. It was treated by emergency laparotomy for acute intestinal obstruction. A conservative resection with ileostomy was performed with good postoperative recovery.

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Adult intussusception secondary to an appendiceal tumour in a patient with ulcerative colitis: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01017-2 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

M. G. Davey ◽

E. T. Conlon ◽

G. Forde ◽

V. M. Byrnes ◽

P. A. Carroll

Keyword(s):

Ulcerative Colitis ◽

Normal Mucosa ◽

Right Hemicolectomy ◽

Sudden Onset ◽

Hepatic Flexure ◽

Adult Intussusception ◽

Low Grade ◽

Appendiceal Tumour ◽

History Of ◽

Ileocecal Intussusception

Abstract Background Intussusception in adult patients is uncommon and appendiceal lead points are particularly rare. Case presentation We present the case of a 42-year-old male with a history of ulcerative colitis, presenting with sudden onset abdominal pain and bloody diarrhoea. Endoscopy revealed grossly normal mucosa in the descending colon with a congested polypoid mass in the proximal transverse colon. Computed tomography revealed ileocecal intussusception at the hepatic flexure. A right hemicolectomy was performed, where a grossly dilated appendix was noted, resected and sent for histopathological evaluation. Results revealed low-grade appendiceal mucinous neoplasm. Post-operatively, the patient remained symptom free, however required reintroduction of biologic therapy due to relapse of his ulcerative colitis 12 weeks later. Conclusion This case depicts a rare acute surgical presentation and reminds physicians and surgeons of the importance of ‘thinking outside the box’ in clinical practice.

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Adult intussusception: unusual cause

International Surgery Journal ◽

10.18203/2349-2902.isj20172416 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2088

Author(s):

Senthil Kumar A. C. ◽

Malar Vannan M.

Keyword(s):

Muscularis Propria ◽

B Cell Lymphoma ◽

Right Hemicolectomy ◽

Interesting Case ◽

Lymphoid Cells ◽

Adult Intussusception ◽

Colon Anastomosis ◽

Ileocecal Junction ◽

Biopsy Report ◽

Intestinal Obstructions

Adult intussusception is a rare entity which accounts for 1-5% of intestinal obstructions in adults and just 5% of all cases of intussusception. The basic pathology and management of intussusception in adults differs from paediatric intussusception. Here we present an interesting case of adult intussusception with an unusual cause. A 33-year-old female presented with features of intestinal obstruction. Colonoscopy was done outside our institution which reported a smooth polypoidal mass in the terminal ileum, biopsy report was pending at that time. CT abdomen revealed dilated small bowel with narrowing in the ileo caecal junction. We proceeded with laparotomy. Intraoperatively dilated ileum with intussusception of the ileocecal junction into the ascending colon was found. Right hemicolectomy with ileotransverse colon anastomosis was done. Histopathology revealed Polyp with intussusception, 5cm from ileocecal junction, with sheets of lymphoid cells showing moderate pleomorphism, infiltrating submucosa, muscularis propria, and serosa, margins uninvolved with lymph node- 3/32 positivity. Immunohistochemistry suggested B- cell lymphoma with CD20 positivity and Bcl 2 focal positivity. Routine treatment of Lymphoma after confirming with biopsy have been Chemotherapy. Role of surgeon in lymphoma is presently limited to biopsy, but there are situations like obstruction and perforation, where surgeon should take the lead role

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Goblet Cell Carcinoids of the Appendix

The Scientific World JOURNAL ◽

10.1155/2013/543696 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 23

Author(s):

Nanna Holt ◽

Henning Grønbæk

Keyword(s):

Goblet Cell ◽

Chromogranin A ◽

Abdominal Mass ◽

Distant Metastases ◽

High Volume ◽

Right Hemicolectomy ◽

Ca 125 ◽

Ki67 Index ◽

Proliferation Markers ◽

Mucinous Component

Goblet cell carcinoid (GCC) tumors are a rare subgroup of neuroendocrine tumors almost exclusively originating in the appendix. The tumor most often presents in the fifth or sixth decade with a clinical picture of appendicitis or in advanced cases an abdominal mass associated with abdominal pain. Histologically tumors are most often positive for chromogranin A and synaptophysin, however, less homogenous than for classic appendix carcinoids. The malignant potential is higher than that for the classic appendix carcinoids due to local spread and distant metastases at diagnosis and the proliferation markers (Ki67 index) may determine prognosis. Octreotide receptor scintigraphy is usually negative while CT/MRI scans may be useful. Chromogranin A is usually negative and other biomarkers related to the mucinous component or the tumor (CEA, CA-19-9, and CA-125) may be used. Surgery is the main treatment with appendectomy and right hemicolectomy while patients with disseminated disease should be treated with chemotherapy. Overall 5-year survival is approximately 75%. The diagnosis and treatment of GCC tumorss should be restricted to high volume NET centers in order to accumulate knowledge and improve survival in GCC NET patients. The aim of this paper is to update on epidemiology, clinical presentation, and diagnostic markers including Ki67 index, treatment, and survival.

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Adult intussusception associated with mesenteric Meckel’s diverticulum and antimesenteric ileal polyp

BMJ Case Reports ◽

10.1136/bcr-2019-230612 ◽

2019 ◽

Vol 12 (9) ◽

pp. e230612

Author(s):

Adrian K McGrath ◽

Fatimah Suliman ◽

Noel Thin ◽

Ashish Rohatgi

Keyword(s):

Small Bowel ◽

Primary Anastomosis ◽

Meckel’S Diverticulum ◽

Small Bowel Resection ◽

Meckel's Diverticulum ◽

Adult Intussusception ◽

Histopathological Analysis ◽

Lead Point ◽

Benign Polyp ◽

Antimesenteric Border

Meckel’s diverticulum is the most common congenital abnormality affecting the gastrointestinal tract, affecting 4% of the general population. It is classically located on the antimesenteric border of the ileum within 100 cm of the ileocaecal valve. Complications may include haemorrhage, bowel obstruction, diverticulitis, perforation and malignancy. This report explores the case of intussusception in an adult, in association with a mesenteric Meckel’s diverticulum and adjacent benign polyp. A 40-year-old man presented with acute abdominal pain, affecting the central abdomen and both flanks. CT imaging revealed small bowel intussusception, with either a Meckel’s diverticulum or polyp acting as a lead point. Intraoperatively, the intussusception had already resolved; however, an inflamed outpouching was identified on the mesenteric border of the ileum, with a firm mass palpable within the bowel lumen. A 70 mm small bowel resection and primary anastomosis were performed. Histopathological analysis confirmed an inflamed Meckel’s diverticulum as well as an adjacent diverticulum comprising a benign polyp.

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Adult Ileocolic Intussusception from the Appendix

Case Reports in Emergency Medicine ◽

10.1155/2019/3272618 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Natalie Green ◽

William Krantz ◽

Allison Tadros

Keyword(s):

Abdominal Pain ◽

Adult Patient ◽

Pediatric Patient ◽

Adult Patients ◽

Lead Point ◽

Ileocolic Intussusception ◽

Ileocecal Intussusception

Intussusception is more commonly considered in the pediatric patient with abdominal pain, but can occur in adults as well. Adult patients are more likely to have an underlying intra-abdominal pathology leading to the condition. We present an adult patient presenting with abdominal pain with ileocecal intussusception diagnosed on imaging and confirmed surgically. In this case, appendiceal pathology served as the lead point for the intussusception.

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