Colon Adenocarcinoma in a Retrograde Intussusception: A Case Report and Literature Review

Background: Intussusception is defined as a telescoping of a proximal gastrointestinal segment with its mesentery to a distal one, only 5% occur in adults and in colon the probability that it is caused by a malignant disease is up to 65%. Only 1% occurs in a retrograde manner, the rest occur in an anterograde manner. Aim: Describe the clinical presentation of an intussusception in the adult patient as well as its most frequent causes and possible complications that influence decision making for a definitive treatment. Case Presentation: A 66-year-old woman diagnosed with colon adenocarcinoma who underwent elective transverse colectomy and colonic anastomosis with an incidental finding of a transverse colon tumor in a retrograde intussusception was studied. Conclusion: In any adult patient with an intussusception especially in colon a neoplasia should be suspected and the affected segment should be resected without being reduced due to the risk of perforation and tumor dissemination.

Adult sigmoid intussusception resembling rectal prolapse:A case report

BACKGROUND Rectal prolapse arises from benign etiology.When symptoms of internal intussusception mirror those of rectal prolapse,a misdiagnosis is possible,especially under limited clinical presentation.It is crucial to recognize and differentiate rectal prolapse from internal intussusception because the two diagnoses have different prognoses.Here,we describe a case of adult sigmoid intussusception presenting as rectal prolapse.CASE SUMMARY A 64-year-old woman with no known medical history visited a gastrointestinal outpatient department due to hard bloody stool defecation for 1 wk followed by constipation for 3 d.Colonoscopy revealed a huge polypoid ulcerated tumor at the sigmoid colon with lumen stenosis.The patient was admitted due to postprocedural dull abdominal pain.Due to failed colonoscopy reduction and stent insertion,the patient underwent sigmoid colon resection with primary end-to-end anastomosis,with the transverse colostomy pathological report showing adenocarcinoma,pT3N0M0.She recovered well from the operation and was discharged with regular outpatient clinic follow-up.CONCLUSION Presentation and manifestation of sigmoid intussusception may resemble that of rectal prolapse,necessitating careful observation due to distinct prognostic implications.

Appendiceal intussusception complicated by adenocarcinoma of the cecum:A case report

BACKGROUND Appendiceal intussusception is a pathological condition in which the appendix is inverted into the cecum,which may cause symptoms that resemble those of other gastrointestinal disorders and may induce intestinal obstruction.The rarity of this case presentation is the co-occurrence of appendiceal intussusception and cecal adenocarcinoma,a combination that to our knowledge has not previously been reported in the medical literature.This case provides new insights into the complexities of diagnosing and managing overlapping pathologies.CASE SUMMARY A 25-year-old woman presented with persistent periumbilical pain and bloody stools.An initial biopsy showed cecal cancer;however,subsequent colonoscopy and computed tomography findings raised the suspicion of appendiceal intussus-ception,which was later confirmed postoperatively.This unique case was charac-terized by a combination of intussusception and adenocarcinoma of the cecum.The intervention included a laparoscopic right hemicolectomy,which led to the histopathological diagnosis of mucinous adenocarcinoma with appendiceal intussusception.The patient recovered well postoperatively and was advised to initiate adjuvant chemotherapy.This case highlights not only the importance of considering appendiceal intussusception in the differential diagnosis,but also the possibility of appendicitis and the atypical presentation of neoplastic lesions.CONCLUSIONS Physicians should consider the possibility of appendiceal intussusception in cases of atypical appendicitis,particularly when associated with neoplastic presentation.

Rare etiology of colonic intussusception involving an adult with emphysematous cystic enteropathy:A case report and review of literature

BACKGROUND Pneumatosis cystoides intestinalis(PCI),characterized by a collection of gas-filled cysts in the intestinal wall,is an uncommon but well-known condition in gastroenterology.Abdominal pain is the most frequent symptom associated with PCI.Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation.However,the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood.CASE SUMMARY A 52-year-old male,known with idiopathic PCI,presented seventeen months after initial diagnosis with a new right upper quadrant pain.A computed tomographyscan demonstrated a colonic intussusception at the hepatic flexure.PCI did not progress compared with initial investigation.The patient underwent an emergency right hemicolectomy.CONCLUSION Resection was recommended in this case because PCI proved to be persisting with no identified curable cause.Surgery allowed to address the underlying pathology,the potential relapse of intussusception,and the likely cause of recurrent abdominal pain,either invagination or PCI itself.

Clinical Research of Transumbilical Singleport Laparoscopic Treatment For Pediatric Intussusception

Objective:To explore the feasibility and clinical efficacy of single port laparoscopic surgery through the umbilical cord for the treatment of pediatric intussusception.Method:Clinical data of 38 cases of pediatric intussusception treated with umbilical single port laparoscopic surgery from December 2017 to June 2019 were collected.The surgical method involves placing Trocar through the umbilical incision to establish pneumoperitoneum,inserting a single hole with a 0°laparoscopic operating channel,exploring intussusception,and performing non-invasive forceps to completely reduce it.After the reduction of intussusception,if intestinal malformation is found,the umbilical incision can be expanded to lift the diseased intestinal tract out of the abdominal cavity for resection.At the same time,clinical data of 24 children who underwent traditional porous laparoscopic intussusception surgery during the same period were collected,and the surgical time,intraoperative blood loss,postoperative hospital stay,and satisfaction score of incision aesthetics were compared between the two groups of children.Result:Both groups of patients successfully completed the surgery,and compared with the porous laparoscopic group,the single hole laparoscopic group had a shorter surgical time[(32.4±8.6)minutes vs.(40.6±9.8)minutes,P<0.05],decreased bleeding volume[(5.5±1.5)mL vs.(8.6±2.2)mL,P<0.05],significantly shortened postoperative hospital stay[(4.6±1.2)d vs.(6.2±1.4)d,P<0.05],and significantly increased satisfaction score with incision aesthetics[(4.2±0.8)points vs.(3.2±0.7)points,P<0.05].Follow up for 6 months to 2 years showed no recurrence of intussusception.Conclusion:Transumbilical single port laparoscopic surgery is a safe and effective method for children with intussusception,which is characterized by small trauma,fast recovery,short operation time,and better aesthetic effect.

Surgical treatments of recurrent small intestine metastatic melanoma manifesting with gastrointestinal hemorrhage and intussusception:A case report

BACKGROUND Melanoma is the most aggressive form of skin cancer,with a tendency to metastasize to any organ.Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide.Small intestine cancers especially small intestine metastases are relatively rare.Small intestine metastases are seldom described and likely underdiagnosed.Intussusception is most common in pediatric age,and in adults are almost 5%of all cases.CASE SUMMARY A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital,complaining of intermittent melena for 1 mo.Magnetic resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass,indicating a neoplastic lesion with jejunojejunal intussusception.The patient underwent partial small bowel resection.Pathological findings and immunohistochemical staining indicated small intestine metastatic melanoma.The patient refused further anti-tumor treatment after the surgery.Ten months after the first surgery,the patient presented with melena again.Computed tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall,and routine conservative treatment was given.Three months later,the patient developed melena again.The patient underwent a second surgery,and multiple metastatic melanoma lesions were found.The patient refused adjuvant anti-tumor treatment and was alive at the latest follow-up.CONCLUSION Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.

Cohort analysis of pediatric intussusception score to diagnose intussusception

BACKGROUND Intussusception is a primary cause of intestinal obstruction in young children.Delayed diagnosis is associated with increased morbidity.Ultrasonography(USG)is the gold standard for diagnosis,but it is operator dependent and often unavailable in limited resource areas.AIM To study the clinical characteristics of intussusception including management and evaluation of the diagnostic accuracy of abdominal radiography(AR)and the promising parameters found in the pediatric intussusception score(PIS).METHODS Children with suspected intussusception in our center from 2006 to 2018 were recruited.Clinical manifestations,investigations,and treatment outcomes were recorded.AR images were interpreted by a pediatric radiologist.Diagnosis of intussusception was composed of compatible USG and response with reduction.The diagnostic value of the proposed PIS was evaluated.RESULTS Ninety-seven children were diagnosed with intussusception(2.06±2.67 years,62.9%male),of whom 74%were<2 years old and 37.1%were referrals.The common manifestations of intussusception were irritability or abdominal pain(86.7%)and vomiting(59.2%).Children aged 6 mo to 2 years,pallor,palpable abdominal mass,and positive AR were the parameters that could discriminate intussusception from other mimics(P<0.05).Referral case was the only significant parameter for failure to reduce intussusception(P<0.05).AR to diagnose intussusception had a sensitivity of 59.2%.The proposed PIS,a combination of clinical irritability or abdominal pain,children aged 6 mo to 2 years,and compatible AR,had a sensitivity of 85.7%.CONCLUSION AR alone provides poor screening for intussusception.The proposed PIS in combination with common manifestations and AR data was shown to increase the diagnostic sensitivity,leading to timely clinical management.

Burkitt Lymphoma Presenting as Ileocolic Intussusception in an Adult

Adult intussusception is rare, highly associated with a malignant lead point, and often requires emergent surgical management. We report the case of a 44-year-old male who presented with generalized abdominal pain and was found to have early ileocolic intussusception secondary to a large ileocecal mass. Biopsies of the mass and an enlarged cardiophrenic lymph node, as well as pleural fluid cytology were all consistent with Burkitt lymphoma (BL). Curiously, the patient’s abdominal exam was reassuring, and the intussusception and malignant bowel obstruction resolved over 36 hours with conservative management alone. With a Burkitt lymphoma international prognostic index (BL-IPI) score of 2, the patient proceeded to treatment with combination chemoimmunotherapy and attained a complete response after four cycles. There was no bowel perforation or recurrent intussusception throughout treatment. Thus, this report marks the first reported case of adult BL-associated intussusception to resolve with non-invasive management and establishes a precedent for conservative management in select patients.

Pediatric case of colonic perivascular epithelioid cell tumor complicated with intussusception and anal incarceration:A case report

BACKGROUND Perivascular epithelioid cell tumor(PEComa)represents a group of rare mesenchymal tumors.PEComa can occur in many organs but is rare in the colorectum,especially in children.Furthermore,PEComa is a rare cause of intussusception,the telescoping of a segment of the gastrointestinal tract into an adjacent one.We describe a rare case of pediatric PEComa complicated with intussusception and anal incarceration,and conduct a review of the current literature.CASE SUMMARY A 12-year-old girl presented with abdominal pain and abdominal ultrasound suggested intussusception.Endoscopic direct-vision intussusception treatment and colonoscopy was performed.A spherical tumor was discovered in the transverse colon and removed by surgery.Postoperative pathologic analyses revealed that the tumor volume was 5.0 cm×4.5 cm×3.0 cm and the tumor tissue was located in the submucosa of the colon,arranged in an alveolar pattern.The cell morphology was regular,no neoplastic necrosis was observed,and nuclear fission was rare.The immunohistochemical staining results were as follows:Human melanoma black 45(HMB 45)(+),cluster of differentiation 31(CD31)(+),cytokeratin(-),melanoma-associated antigen recognized by T cells(-),smooth muscle actin(-),molleya(-),desmin(-),S-100(-),CD117(-),and Ki67(positive rate in hot spot<5%).Combined with the results of pathology and immunohistochemistry,we diagnosed the tumor as PEComa.Postoperative recovery was good at the 4 mo follow-up.CONCLUSION The diagnosis of PEComa mainly depends on pathology and immunohistochemistry.Radical resection is the preferred treatment method.

Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception

AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.

Anterograde jejunojejunal intussusception resulted in acute efferent loop syndrome after subtotal gastrectomy

Postoperative intussusception is an unusual clinical entity in adults,and is rarely encountered as a complication following gastric surgery.The most common type after gastric surgery is retrograde jejunogastric intussusception,and jejunojejunal intussusception has been rarely reported.We report a case of anterograde jejunojejunal intussusception after radical subtotal gastrectomy with Billroth Ⅱ anastomosis in a 38-year-old Korean woman with early gastric cancer,and include a review of the literature on this unusual complication.

Inverted Meckel’s diverticulum manifested as adult intussusception: Age does not matter

Adult intussusception due to Meckel’s diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report two cases of intussusception due to MD in adults. A diverticulectomy using a TA stapler was performed in the first patient. In the second patient extensive fibrosis of the adjacent mesentery and thickening of jejunal mucosa were observed, so a segmental resection of the small bowel or affected ileal part and a hand-sewn anastomosis was performed. The postoperative period along with the long term follow-up was uneventful for both patients. The decision between diverticulectomy vs bowel resection can be based on the intussuscepted bowel condition. Early surgical intervention may ensure a favorable outcome.

Single port laparoscopic right hemicolectomy for ileocolic intussusception

A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.

Gastroduodenal intussusception due to gastric schwannoma treated by billroth Ⅱ distal gastrectomy:One case report

Schwannomas are rarely observed in the gastrointestinal tract.The most common symptoms of a gastric schwannoma are abdominal pain or dyspepsia,gastrointestinal bleeding,and an abdominal mass.Many gastric schwannomas are asymptomatic and are discovered incidentally or at postmortem.The diagnosis of a schwannoma is based on immunohistochemical positivity for S-100 protein.Wepresent a case report of a rare complication of gastric schwannoma causing gastroduodenal intussusception that was successfully managed by a BillrothⅡdistal gastrectomy.In this rare case,the patient had intermittent,colicky abdominal pain,nausea,and vomiting for over 4wk accompanied by a weight loss.A diagnosis of gastric intussusception was made by computed tomography.A BillrothⅡdistal gastrectomy was then performed,and complete en bloc removal(R0 resection)was achieved.Pathology confirmed a gastric schwannoma through positive immunohistochemical staining for S-100 protein.

Ileal lipoma-a rare cause of ileocolic intussusception in adults:Case report and literature review

The occurrence of intussusception in adults is rare,accounting for less than 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction.The condition is found in less than 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction.The child to adult ratio is more than 20:1.We report a rare case of ileocolic intussusception in an adult secondary to an ileal lipoma.

Primary colonic melanoma presenting as ileocecal intussusception: Case report and literature review

Primary malignant melanoma originating in the colon is an extremely rare disease.Herein,we report a case of primary melanoma of the ascending colon.The patient was a 57-year-old male who was admitted to our hospital for persistent abdominal pain and episodes of bloody stool,nausea and vomiting.A computed tomography scan revealed lower intestinal intussusception and enlarged lymph nodes in the abdominal cavity and retroperitoneum.During laparoscopic operation,multiple enlarged lymph nodes were found.Several segments of the proximal small intestine were incarcerated into the distal small intestine,forming an internal hernia and obstruction.The necrotic terminal ileum was invaginated into the ascending cecum.Subsequently,adhesive internal hernia reduction and palliative right hemicolectomy were performed.Pathologic examination of the excised specimen revealed a polypoid mass in the ascending colon.Histological examination showed epithelioid and spindle tumor cells with obvious cytoplasmic melanin deposition.Immunohistochemical staining revealed that the tumor cells were positive for S-100,HmB-45 and vimentin,confirming the diagnosis of melanoma.The patient history and a thorough postoperative investigation excluded the preexistence or coexistence of a primary lesion elsewhere in the skin,anus or oculus or at other sites.Thus,we consider our case to represent an aggressive primary colon melanoma presenting as ileocecal intussusception and intestinal obstruction.

Clinical observation of loupe-assisted intussusception vasoepididymostomy in the treatment of obstructive azoospermia(analysis of 49 case reports)

To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy(VE)in the treatment of epididymal obstructive azoospermia(EOA),we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy(LIVE)between 2000 and 2007.The data included the surgical method,postoperative motile sperm count per ejaculation,percentage of progressive motile sperm and patency and pregnancy outcomes.There were a total of 49 men undergoing scrotal exploration,and epididymal obstruction was found in all cases.Bilateral or unilateral anastomoses were performed in 40 and 6 men,respectively.The postoperative courses of 42 patients were followed up for more than 6 months,and the courses of 38 patients were followed up for more than 1 year.The overall patency and pregnancy rates were 71.4%and 26.3%,respectively.Moreover,progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput.Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis.We think that the loupe-assisted method,with a lower overall cost and a simplified surgical procedure,can achieve satisfactory patency outcomes and pregnancy results.Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.

Ileocolic intussusception caused by a lipoma in an adult

Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.

Ileal inflammatory fibroid polyp causing chronic ileocolic intussusception and mimicking cecal carcinoma

Inflammatory fibroid polyp(IFP) is a rare,idiopathic pseudotumorous lesion of the gastrointestinal tract.While mostly reported as solitary gastric lesions,multiple cases of small bowel IFPs are also reported.It is a documented cause of intussusception in adults.In the case reports of ileal inflammatory fibroid polyps with intussusception,an emergent presentation with small bowel obstruction has been most often described.Here we depict a case of ileal inflammatory fibroid polyp presenting with chronic intermittent ileocolic intussusception,anemia and weight loss with an endoscopic appearance mimicking necrotic cecal carcinoma.

Laparoscopic approach for managing intussusception in children:Analysis of 65 cases

BACKGROUND Intussusception can be managed by pneumatic reduction,ultrasound-guided hydrostatic reduction,open or laparoscopic surgery,but laparoscopy in such cases remains controversial.AIM To explore the clinical characteristics,effectiveness,and complications of surgical reduction for intussusception using laparoscopy in children.METHODS This study was a retrospective case series of pediatric patients with intussusception who underwent surgical reduction by laparoscopy from May 2011 to April 2016 at Taizhou Hospital of Zhejiang Province.Clinical characteristics(operation time,intraoperative blood loss,conversion rate of laparotomy,reasons for conversion,postoperative hospital stay,and adverse events)were described.RESULTS The 65 patients included 45 boys and 20 girls.The average age was 2.3 years(27.5±24.5 mo).Of the 65 patients,61 underwent surgical reduction by laparoscopy after a failed enema reduction of intussusception,and four underwent the procedure directly.All patients were treated successfully and 57(87.7%)patients underwent successful laparoscopic surgery,two of which had a spontaneous reduction.Among the remaining cases,one was converted to open surgery via right upper quadrant incision,and seven required enlarged umbilical incisions.Intestinal resection was performed in 5 patients because of abnormal bowel lesions.There were no complications(intestinal perforations,wound infections,or intestinal adhesions)during the follow-up of 3 years to 8 years.Two patients experienced a recurrence of intussusception;one was resolved with pneumatic reduction,and the other underwent a second laparoscopic surgery.CONCLUSION Laparoscopic approach for pediatric intussusception is feasible and safe.Bowel resection if required can be performed by extending umbilical incision without the conventional laparotomy.