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.

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.

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.

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.

The Value of Ultrasound in the Application of Water Enema in Intussusception

Objective:To introduce high-frequency ultrasound diagnostic technology to cooperate with diagnosis and treatment for patients with intussusception,and to observe its clinical application effect.Methods:The study took patients with intussusception as the object of observation,with a total of 52 cases participating,all of which were clinically admitted from December 2022 to December 2023.After enrollment,the patients underwent high-frequency ultrasound detection in sequence,recording the ultrasound imaging characteristics,and referring to the results of surgical or leaky saline enema reset to confirm the diagnosis(the gold standard)to assess the diagnostic efficacy of high-frequency ultrasound technology.Results:Comparing the confirmed diagnostic results of surgery or leaking saline enema restoration,the detection rate of high-frequency ultrasound technology was 98.07%(P>0.05).Among the 52 patients treated with hydropneumatic enema restoration with the cooperation of high-frequency ultrasound monitoring,39 patients were successfully reset in the first treatment(75.00%),while 9 patients were successfully reset(17.30%)after multiple treatments(≥2 times);the remaining 4 patients were unsuccessful and then converted to surgical treatment,and all of them were successfully treated and cured.Conclusion:For the diagnosis of intussusception,high-frequency color Doppler ultrasound has the advantages of high accuracy and simple operation,which provides a scientific and accurate reference basis for the clinical diagnosis and treatment of patients.

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.

罕见抗-Di^(b)致严重胎儿新生儿溶血病的实验室检测与相关研究

目的对1例高频抗体导致的胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)进行检测、鉴定及配血。方法对患儿进行新生儿溶血试验,对母亲进行血清学意外抗体鉴定,并对母亲红细胞进行常见高频抗原鉴定;对检出抗体进行IgG分型检测,并用流式细胞术进行单核细胞体外吞噬致敏红细胞试验,以检测抗体相关的吞噬率;对患儿母亲、父亲及舅舅进行相关红细胞血型基因测序;利用稀释的母亲血浆和抗人球卡法,在献血者中进行大规模相合血液的筛选。结果产妇鉴定为Di(b-)稀有血型,产生了抗-Di b(效价512)并导致了严重的HDFN;抗-Di b亚型分型为IgG1和IgG2型,单核细胞体外吞噬效率为88.83%(74.7/84.09);产妇亲属中没有相合献血者,后续从5520名献血者中筛选到2例Di(b-)相合血液,患儿接收输血治疗后康复出院。后续在51334名献血者中筛查到17名Di(b-)献血者,该数据表明Di(b-)在广州地区献血者中的分布频率约为三千分之一(0.033%,17/51334)。结论综合利用血型血清学及分子生物学方法诊断了抗-Di b所致的严重HDFN,建立了1种有效大规模筛查Di(b-)稀有血型的方法并找到相合血液,为建立Di(b-)稀有血型库奠定了基础。

4DI110型空压机的技术改造与操作优化

文章通过介绍新引进的4DI110型离心式空压机(以下简称“空压机”)试运行阶段开始以来的运行情况和气温变化对空压机出口流量造成的影响,分析空压机出口流量随气温变化而变化的规律,指出空压机防喘阀V3004阀不能自动调节出口压力,影响空分装置工况的稳定。为实现空压机出口压力的稳定,对其防喘阀V3004阀采取增设自动旁路阀V3008阀的技术改造,同时优化和完善相关逻辑控制并阐述了空压机经技术改造后的操作优化和取得的实际效果。

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.

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.

Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review

BACKGROUND: Ultrasound diagnosis of pediatric intussusception is feasible with limited operator training. The authors report the test characteristics of bedside ultrasound(BUS) for the diagnosis of pediatric intussusception at a single institution.METHODS: Inclusion criteria were: 1) patients of 0–18 years old were seen in the pediatric emergency department(ED) with a clinical presentation suspicious for intussusception; 2) BUS was performed to identify intussusception and bedside impression documented in the medical record; 3) a "formal" diagnostic study(such as computed tomography, ultrasound, or barium enema) was performed by the radiology department after BUS was completed. Electronic medical record and ED BUS archive were screened for potentially eligible ED visits between January 1st 2009 to October 3rd 2012. These records were then reviewed to identify patients for inclusion in the study. All emergency physicians who performed the BUS had undergone a minimum of 1-hour didactic training on the use of BUS to diagnose pediatric intussusception.RESULTS: A total of 1 631 charts were reviewed, with 49 meeting inclusion criteria. Five of those were later excluded for incomplete documentation or lack of saved BUS images. The prevalence of intussusception was 23%. The mean age of the subjects was 31 months. BUS was 100% sensitive(95%CI 66%–100%) and 94% specifi c(95%CI 79%–99%) for detection of pediatric intussusception compared to radiology study results. Positive and negative likelihood ratios were 16.5(95%CI 4.30%–63.21%) and 0(95%CI 0–0) respectively.CONCLUSIONS: BUS is an accurate means of diagnosing acute intussusception in pediatric patients. Further study might be indicated to confi rm such benefi ts.

Intestinal anisakiasis can cause intussusception in adults:An extremely rare condition

We report an extremely rare case of adult intussusception caused by anisakiasis. A 41-year-old man was admitted into our hospital for right lower abdominal colicky pain. Ultrasonography and computed tomography revealed the presence of intussusception. As pneumodynamic resolution by colonoscopy failed, surgery was performed. The anisakis body was found in the submucosal layer of the resection specimen. The patient was discharged 9 d after the operation. Anisakiasis may cause intussusception in any country where sushi or sashimi now exists as a popular food. If suspicious, detailed clinical interview as to food intake prior to symptom development is crucial.

Enteric duplication cyst as a leading point for ileoileal intussusception in an adult:A rare cause of complete small intestinal obstruction

Duplication of alimentary tract(DAT) presenting as an ileoileal intussusception is a very rare clinical entity.Herein,a case of an ileoileal intussusception due to DAT is presented.A 32-year-old woman was hospitalized due to diffuse,intermittent abdominal pain,vomiting and constipation for 3 d associated with abdominal distention.Plain abdominal X-ray revealed dilated small bowel.Abdominal computed tomography showed grossly dilated small bowel with "sausage" and "doughnut" signs of small bowel intussusception.She underwent laparotomy,with findings of ileoileal intussusception due to a cystic lesion adjacent to the mesenteric side.Resection of the cystic lesion along with the affected segment of intestine,with an end to end anastomosis was performed.The histopathology was consistent with enteric duplication cyst.This case highlights the DAT,although,an uncommon cause of adult ileoileal intussusception should be considered in the differential diagnosis of intussusception in adults,particularly when the leading point is a cystic lesion.

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.

Intussusception in adults:Clinical characteristics,diagnosis and operative strategies

AIM:To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity.METHODS: A retrospective review of patients aged >18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. RESULTS: There were 20 cases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine (85%). There were three (15%) cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. CONCLUSION: Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.

Periampullary carcinoma presenting as duodenojejunal intussusception: a diagnostic and therapeutic dilemma

BACKGROUND:An intussusception is the invagination of one segment of the intestine into another.It is more common in children,but a rare clinical entity in adults, where the condition is almost always caused by tumors. METHODS:A 51-year-old female presented with symptoms of gastric outlet obstruction associated with significant weight loss,but no jaundice.Routine hematological and biochemical investigation,including tumor markers,were normal.Abdominal ultrasound revealed duodenojejunal intussusception,and subsequent CT of the abdomen confirmed it. RESULTS:She underwent a laparotomy,which confirmed duodenojejunal intussusception.On reducing the intussusception and performing a duodenotomy,a periampullary mass was confirmed.Hence,she underwent a pylorus-preserving pancreaticoduodenectomy.Histology confirmed periampullary adenocarcinoma. CONCLUSIONS:Adult intussusceptions are mostly caused by tumors.Contrast CT is the investigation of choice, although ultrasound can be used.One should have a low threshold for suspecting malignancy,obtain frozen section histology,and seek appropriate help at an early stage.

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.

Gastrointestinal stromal tumor causing small bowel intussusception in a patient with Crohn’s disease

We report a case of jejunoileal intussusception in a 42-year-old patient with Crohn's disease caused by a gastrointestinal stromal tumor. The patient complained of vague diffuse abdominal pain for a period of 4 mo. Intussusception was suspected at computer tomography and magnetic resonance imaging scans. Segmental resection of the small intestine was performed. Pathological examination of the surgical specimen revealed a gastrointestinal stromal tumor as well as aphthous ulcerations and areas of inflammation, which were characteristic of Crohn's disease. This is the f irst report of small bowel intussusception due to a gastrointestinal stromal tumor coexisting with Crohn's disease.

Ileocecal intussusception caused by two different tumors - which is the culprit lesion? A case report

BACKGROUND Ileocecal intussusception caused by two different tumors is rare,according to a literature review.We describe a case of a male patient with a cauliflower-like mass in the middle of the transverse colon observed by colonoscopy before surgery.It was considered to be intussusception caused by colon cancer.However,a substantial lipomatous mass was seen in the distal end of the intussusception by computed tomography before surgery,which posed a challenge in the preoperative diagnosis.CASE SUMMARY We report a 72-year-old male patient with intussusception.The patient underwent right hemicolectomy and cholecystectomy in our hospital on April 29,2019.During operation,the ileum was inserted into the ascending colon by about 15 cm,and a tumor with a diameter of approximately 3.0 cm was observed in the distal part of the intestine.An atypical liposarcoma/highly differentiated liposarcoma in the adipose tissue was suspected in the postoperative pathology,and a lipoma was diagnosed after MDM2 gene testing.A 4.0 cm×5.0 cm polypoid mass was seen immediately adjacent to the mass,and the postoperative pathology report suggested a high-level tubular adenoma.The patient was eventually cured and discharged with an uneventful follow-up.CONCLUSION Intussusception caused by two different types of masses is extremely rare.At present,surgery is the best treatment once intussusception is diagnosed.