Search

Purpose : Intussusception is a common pediatric surgical emergency and non-operative reduction is its first line of management. We aimed to compare 3 contemporary techniques of intussusception reduction. Methods : A retrospective study was performed in 3 tertiary care centers in India from January 2017 through December 2019. In the 3 centers, the primary reduction techniques were ultrasound-guided saline reduction (USR), fluoroscopy-guided pneumatic reduction (FPR), and fluoroscopy-guided barium reduction (FBR), respectively. As per these techniques used, we compared clinical characteristics, such as the successful reduction. Results : A total of 255 patients underwent one of the 3 reduction techniques in the study period. Reduction was successful in 90.3%, 85.1%, and 87.7% in the USR, FPR, and FBR groups, respectively (P = 0.961). Mean time to reduction was shorter in the FPR group (30.8 ± 8.9 seconds), compared with the USR (575.0 ± 242.3 seconds) and FBR groups (495.0 ± 118.4 seconds; P < 0.001). Recurrence rates were 11.8%, 20.3%, and 15.8% in the USR, FPR, and FBR groups, respectively (P = 0.522). No association was found between the patients’ age or symptom duration and the successful reduction. One patient in the USR group, 3 in the FPR group, and 4 in the FBR group reported second recurrences. Perforation occurred in 1 patient in the FPR group while no complications occurred in the other groups. There was no in-hospital mortality. Conclusion : All 3 techniques are equally effective, with FPR requiring a shorter time than the other 2 techniques. The reduction technique should be chosen based on the strengths and weaknesses of each technique, as well as local availability.

Colonic intussusception is often reported to be related to malignancy in adults. Colonoscopy itself with or without polypectomy is known to be a rare cause of colonic intussusception. We encountered case in which an individual was diagnosed with intussusception following colonoscopy. The patient was a 44-year-old female who, on the same day, had undergone a colonoscopy including endoscopic mucosal resection for a polyp in the ascending colon. She visited the emergency room with complaints of right-sided abdominal pain. Abdominal examination revealed peritoneal irritation in the right upper quadrant. Abdominal CT revealed colocolic intussusception near the hepatic flexure. This was suspected to have been induced by post-polypectomy electrocoagulation syndrome. A laparoscopic right hemicolectomy was performed because conducting a reduction trial through colonoscopy involves a high risk of peritonitis, in addition to a low likelihood of spontaneous reduction of intussusception due to the additional edema and ischemia resulting from the polypectomy. The patient was discharged without complications six days after the surgery. Though some cases have been reported, there is no treatment strategy for intussusception following colonoscopy. Therefore, we report this case of colonic intussusception following colonoscopy, which was found to be caused by Post-polypectomy Electrocoagulation Syndrome, with a literature review.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal (GI) tract (1% to 2% of GI malignant tumors). They are most commonly located in the stomach (50 to 60%) and rarely in the small intestine (20-25% of all cases). The hallmark of most GISTs is their positivity for KIT (CD117) and DOG-1. Intussusception occurs rarely in adults with an incidence of approximately 2-3 per 1L per year. It represents 5% of all intussusceptions and is the cause of 1% of all intestinal obstructions. Ileocolic intussusception in adults is a unique variant in which most cases have a malignant lead point. In our case, we report an elderly patient presenting with intestinal obstruction, and imaging showed ileocecal intussusception with a solid nodular growth arising from the ileum. On exploration, the tumor was intraluminal arising from the ileum with ileocecal intussusception. Adhering to oncological principles, a right hemicolectomy was performed. The final pathologic diagnosis indicated the GIST of the ileum. Immunohistochemistry (IHC) showed CD117 negative and DOG-1 positive. Bowel obstruction due to intussusception in adults is rare. GIST in the ileum causing intussusception is unusual with a poorer prognosis than other GISTs. Intussusception in adults obstructing with small intestinal GIST which is CD117 negative makes it interesting and even rare. The diagnosis of intussusception and GISTs causing obstruction in adults is delicate, and timely surgical treatment can be vital. Given a high risk of malignancy, primary surgical resection using oncologic principles presents the best option in this scenario.

Bowel obstruction is known to be caused by intussusception, which is far more common in pediatric patients. The majority of people with adult intussusception require a predisposing cause, which might be a benign lesion, a malignant lesion, or an irregularity of the intestinal wall such as inflammatory bowel disease. Adult intussusception is a very rare condition. We present the case of a patient presenting with upper abdominal pain, nausea, vomiting, and weakness. The patient had ongoing mild intermittent abdominal pain for months which was investigated with an upper gastrointestinal endoscopy that showed gastritis. There were features of peritonism on clinical examination and this was associated with raised inflammatory markers. A contrast-enhanced multidetector computed tomography (MDCT) scan showed a long-segment telescoping of the ileum into the cecum with ascending colon with proximal bowel distension suggesting bowel obstruction: Ileocolic intussusception. The patient underwent emergency surgical resection with a double-barrel stoma. Histopathology assessment did not identify a causative factor for the intussusception. An uncommon instance of adult idiopathic enteroenteric intussusception is presented here. The diagnosis can be established with the use of the clinical history of chronic intermittent abdominal pain, entire abdomen ultrasonography, and abdomen MDCT. In patients who are unstable and exhibit indications of peritonitis, surgery remains the only choice, even though a more cautious strategy is outlined in the literature. Adult intussusception is a rare and challenging diagnosis to make. Individuals suffering from intussusception may experience prolonged bouts of sporadic abdominal pain that intensify suddenly as a result of acute obstruction. The most helpful investigative technique for confirming the intussusception diagnosis is CT.

Background: Primary intussusception causes intestinal obstruction in early childhood. Diet has been implicated as a causative agent and this is ascribed to the high prevalence observed during weaning; however, there is no consensus regarding the major causative factors. This study aimed to determine the type of diet during weaning as a predisposing etiological factor of intussusception. Objective: The objective of this study was to determine if there is any association during weaning with four groups of infants being those on exclusive breastfeeding, intake of infant formula, infants weaned completely, and on cereals or a mixture of all three in patients with intussusception at two Nigerian tertiary institutions. In addition, the clinical characteristics of presentation at our center were noted. Materials and Methods: This was a descriptive cross-sectional review of the records of patients aged 3–24 months who were diagnosed with intussusception using ultrasonography within a duration of two years. The information extracted included specific symptoms of the condition, type of feeding before the onset of intussusception, frequency, and association of these feeding patterns with intussusception, laboratory findings, radiological findings, and type of intussusception. Results: Exclusively breastfed infants (63%) had the highest rates of intussusception while those with the lowest incidence were completely weaned on cereals (4.5%), in between these groups were infants who were fed with formula. Among the formula group, almost half (13%) were those fed by a particular local formula. An abdominal ultrasound scan established a diagnosis in all except one patient that was confirmed at surgery. The main laboratory findings were hyponatremia and anemia. Conclusion: Diet was found to be associated with the onset of intussusception in this study, particularly in exclusively breastfed babies, and lowest in those on cereals. Early diagnosis of suspected intussusception in infants can be facilitated by making ultrasound compulsory. Hyponatremia and anemia are suggestive of late presentation of the condition.

Background. Intussusception of the small intestine loop through gastroenteroanastomosis is considered a rare but potentially dangerous complication that can occur after gastroenteroanastomosis surgery. This complication is extremely seldom associated with pancreaticoduodenectomy.Case description. A 44-year male patient underwent pancreaticoduodenectomy for common bile duct cancer on 07.10.2019, followed by adjuvant chemotherapy. On April 14, 2021 he was admitted for the next course of chemotherapy and complained of pain in the epigastric region and nausea, that appeared a few days ago, thus, he was appointed an urgent additional examination. Gastroscopy revealed a loop of small intestine, prolapsing into the lumen of the gastric remnant through the gastroenteroanastomosis. The fixed loop of intestine precluded endoscopic disinvagination from being performed. Computed tomography confirmed intussusception of the small intestine loop through gastroenteroanastomosis. The patient underwent emergency surgery. Laparotomy revealed a 40 cm intussusception of the small intestine loop through gastroenteroanastomosis into the gastric remnant. The intestine loop was accurately disinvaginated and proved to be viable. The intestine loop was additionally fixed to prevent re-intussusception. After the complication-free postoperative period, the patient was discharged on day 6. The follow-up examination in 6 months revealed no signs of intussusception recurrence according to computed tomography. The paper reviewed the internationally published cases of jejunogastric intussusception after pancreaticoduodenectomys.Conclusion. Jejunogastric intussusception refers to an extremely rare complication after a previously performed pancreaticoduodenectomy. A risk of the complications is to be recognized, since their timely diagnosis and surgical treatment enable successful outcome to be achieved.

Abstract Background Intussusception with intestinal malrotation is termed as Waugh’s syndrome. The incidence of Waugh’s syndrome is less than 1%. There are very few reported cases. Once presented, it is a pediatric surgical emergency. Case presentation We present here two cases of Waugh’s syndrome: an 11-month-old male patient of Punjabi descent and a 4-month-old female patient of Afghan descent who presented to us with abdominal pain and bleeding per rectum. Abdominal sonography revealed an intussusception with a target sign. They were explored and perioperatively had intestinal malrotation alongside intussusception, thus a diagnosis of Waugh’s syndrome was made. A right hemicolectomy and Ladd’s procedure was performed. Conclusion Waugh syndrome is a rare congenital anomaly but can present with vague abdominal symptoms. Once presented, it is a pediatric surgical emergency. The patient should be optimized followed by surgical exploration.

Abstract Both developed and developing countries carry a large burden of pediatric intussusception. Sentinel site surveillance-based studies have highlighted the difference in the regional incidence of intussusception. The objectives of this manuscript were to geospatially map the locations of hospital-confirmed childhood intussusception cases reported from sentinel hospitals, identify clustering and dispersion, and reveal the potential causes of the underlying pattern. Geospatial analysis revealed positive clustering patterns, i.e., a Moran’s I of 0.071 at a statistically significant (p value

Objective Bowel perforation is a major, yet unstudied complication of ultrasound-guided hydrostatic enema reduction (UGHR). In this study, we aimed to explore the risk factors and determine the clinical characteristics of bowel perforation during UGHR for paediatric intussusception (P-UGHR).Methods We retrospectively analysed the medical records of patients who underwent UGHR for intussusception at our institution between January 2011 and December 2021. The patients were divided into the P-UGHR and no P-UGHR groups. Univariate and multivariate logistic regression analyses were performed to analyse the risk factors for P-UGHR, and the clinical characteristics of patients with P-UGHR were determined.Results The final analysis included 4961 intussusception episodes. We identified 15 patients [eight male (53.3%); median age, 8.73 months; age range, 3–17 months] with P-UGHR. All P-UGHR cases involved colonic perforations without necrosis distal to the intussusception mass. The perforations were located in the ascending [40% (6/15)], transverse [46.7% (7/15)] or descending colon [13.3% (2/15)]. Age ≤10.5 months [odds ratio (OR), 3.636; 90% confidence interval (CI), 1.274–10.38; P = 0.043], bloody stools (OR, 4.189; 90% CI, 1.352–12.978; P = 0.037) and symptom duration >17.5 h (OR, 0.188; 90% CI, 0.053–0.666; P = 0.03) were independent risk factors for P-UGHR.Conclusion Age ≤10.5 months, bloody stools and symptom duration >17.5 h were independent risk factors for P-UGHR. Caution should be exercised during UGHR in patients aged ≤10.5 months, with bloody stools or symptom duration >17.5 h.

Objective: To evaluate seasonal variability and outcome of intussusception in the pediatric population. Study type, settings & duration: A Prospective Observational study was conducted in Department of Neonatal and Pediatric Surgery, The Children’s Hospital, PIMS, Islamabad for a period of one year from August 2022 to July 2023. Methodology: After approval from the ethical review committee, the study was conducted in children who presented in the ER and OPD during our study time period, aged between 3 to 18 months and with ultrasound confirmed intussusception. The diagnosis of intussusception was made based on clinical diagnosis and imaging results. All patients diagnosed with intussusception during the study period were included in the study after fulfilling inclusion criteria. The data collected from patients included the age (in months), gender, time interval from symptoms to hospital presentation, presenting symptoms, month patients presented, procedure performed and complications of treatment. Statistical Package for Social Science (SPSS) version 23 was used for data entry and analysis. For the sake of this research, the weather in Pakistan is divided into four seasons: winter (December to February), autumn (September to November), summer including rainy monsoon (June to August) and spring (March to May). Results: We enrolled 94 patients with mean age was 7.39±3.08 months. Out of 94 patients 58 (61.7%) patients were male and 36 (38.3%) patients were female. In duration from symptoms to hospital presentation 52.1% patients were reported after 48 hours. 44 (46.8%) cases of intussusception were reported in summer season including monsoon i.e..........

Context: Complicated intussusception is associated with life-threatening intestinal gangrene and peritonitis. In critically ill children, a primary ileocolic anastomosis may increase their morbidity and mortality and, thus, a temporary ileostomy may be a safer option. Objective: The purpose of this study is to report the indications, outcomes, and complications after temporary ileostomies for infants with ileocolic intussusception in our institution. Materials and methods: This was a retrospective study of infants who had ileostomies created in our institution following complicated ileocolic intussusceptions between January 2014 and December 2022. The indications, postoperative complications, duration of hospital stay, and recovery were noted and compared. Results: Thirty-four infants had ileostomies created for complicated ileocolic intussusception during this period. There were 13 girls and 21 boys aged 3-10 months (median = 6 months). The indications for ileostomy were intestinal gangrene, colonic perforation, peritonitis, and haemodynamic instability. Ileostomies were created in the primary surgery in 24 patients while 10 had stomas created as a secondary procedure following an anastomotic dehiscence. Postoperative complications occurred in 25 patients (73.5%). Four children died shortly after surgery from the primary disease, while one child died from re-feeding syndrome. Children who required stoma creation following dehiscence of a primary anastomosis had more complications, a longer hospital stay, and a longer delay in commencing feeds. However, there was no difference in mortality rates or time of stoma closure. Conclusion: Temporary ileostomies could potentially reduce intussusception-related mortality and morbidity, ultimately improving the outcome of very ill infants.

Key Clinical Message Adult intussusception commonly has a leading point. In the colon, malignancy is a prevalent etiology for the leading point; however, benign tumors should also be considered. We present a case of colorectal intussusception caused by a giant lipoma. Abstract Intussusception in adults is comparatively infrequent in contrast to children, and in adult colonic intussusception, malignancy is the predominant cause of the leading point. Lipoma, an uncommon tumor in the gastrointestinal tract, rarely induces colonic intussusception in adults. We present the case of a 55‐year‐old Cambodian man experiencing cramping abdominal pain. He presented with mild abdominal distension with tenderness in the lower abdomen. On the rectal examination a large palpable mass was detected three to four centimeters from the anal verge. Abdominal computerized tomography revealed a collapsed sigmoid colon with mesenteric fat invaginated into the lumen of the upper rectum. Emergency laparotomy was performed and during the surgery the sigmoid intussusception spontaneously reduced. A mass was identified in the mid‐sigmoid colon, leading to the decision for segmental resection of the sigmoid colon with the mass and subsequent end‐to‐end anastomosis. Histological examination results confirmed the mass as a lipoma. Colorectal intussusception in adults due to a lipoma is a relatively rare, with only a few reported cases in the literature.

Abstract Introduction Adult Intussusception is an uncommon diagnosis, with one to three cases occurring in a population of 1,000,000 per year, primarily due to underlying pathological lead points, of which 70% are malignant. Lipoma is the most common benign tumour, and primary adenocarcinoma is the most common malignant one. Early diagnosis and treatment are essential to reducing poor outcomes, including ischemia, perforation, and sepsis. Computed tomography imaging is a modality of choice for diagnosis. With a diagnostic accuracy of up to 100% and a specificity of up to 71%. Surgical intervention is the definitive treatment, and the decision is taken according to the situation. Case presentation A 61-year-old Black African female presented to our surgical casualty with intermittent colicky abdominal pain for 1 month. After that, she started to experience abdominal swelling in the right iliac fossa. A CT scan confirmed the presence of colo-colic Intussusception, cecum-ascending-transverse colon. Laparotomy was scheduled, and a right hemicolectomy was done accordingly. Diagnosis of adenocarcinoma (Dukes stage B2) was made histologically. Conclusion Intussusception in adults is a challenging diagnosis requiring high clinical suspicion and has a high incidence of fatal complications. Colonic cancer can be worsening by any infection and chronic medical problem. CT imaging is the lifesaving modality of choice for diagnosis. Good patient outcomes depend on timely diagnosis and recruitment of a multi-disciplinary team.

Introduction: Peutz-Jeghers syndrome is a rare autosomal dominant inherited disorder characterized by hamartomatous intestinal polyps and mucocutaneous pigmentation. Most cases appear to be linked to the mutation of the STK11 gene. Patients are at a lifetime risk of gastrointestinal and non-gastrointestinal cancers.

Key Clinical Message The report urges considering rare neoplastic tumor, like IMT, in intussusception cases and underscores the vital role of comprehensive and swift diagnosis in influencing treatment choices and patient results. Abstract We present a case of a 36‐year‐old male who presented with abdominal pain and vomiting. Inflammatory markers were elevated in routine investigations, while other laboratory parameters were within normal limits. Ultrasound imaging revealed a target lesion, which required further evaluation with a CT scan and confirmed ileocolic intussusception. An exploratory laparotomy showed a solid lesion measuring 5 by 6 cm in the cecum, along with evidence of ileocolic intussusception. A standard right hemicolectomy was performed, and the postoperative course was uneventful. Histopathological examination showed an inflammatory myofibroblastic tumor with nodular hyperplasia. The report highlighted the importance of assessing rare neoplastic causes in patients with intussusception.

Background: Intussusception mainly affects infants and toddlers, though it can affect any age of the pediatric population. Intussusception has been successfully diagnosed using B-mode ultrasonography. Once, hydrostatic or pneumatic intussusception reduction under image guidance was used to treat these children. But this needs a critical assessment of the preserved bowel viability before the procedure. There are several criteria based on ultrasonography for predicting bowel reducibility during hydrostatic or pneumatic reduction. Our study aimed to demonstrate the role of color Doppler ultrasound in predicting the viability of the intestine in children with intussusception. Materials and Methods: Thirty children under 14 years of age with clinical symptoms suggestive of intussusception were evaluated on color Doppler and power Doppler ultrasonography to predict the viability of bowel loops in children with intussusception. The compression technique was used for graded compression, and the patients were followed for clinical/surgical outcomes. Sensitivity, specificity, positive predictive value, negative predictive value, the strength of agreement of trapped fluid, vascularity at apex, and power Doppler for predicting viability of bowel loops were statistically analyzed. Results: In 17 (56.67%) children, vascularity at the apex of the intussusceptum loop was absent. Vascularity at the apex was present in only 13 of 30 patients (43.33%). On the final clinical/surgical outcome, 17 (56.67%) of patients had necrosis of the bowel loop. Bowel loops were viable in only 13 of 30 patients (43.33%). Of patients who had viability of bowel loops, 76.92% of patients did not have trapped fluid. If the trapped fluid was absent, there was a 100.00% probability of viability of bowel loops; if trapped fluid was present, there was an 85.00% chance of necrosis. Among patients who had necrosis, 100.00% of patients had trapped fluid. In predicting bowel loops’ viability, vascularity’s sensitivity and specificity at the apex on color Doppler were maximum: sensitivity 100% (75.29%–100.00%) and specificity 100% (80.49%–100.00%). In predicting the viability of bowel loops, the sensitivity and specificity of power Doppler at the apex of the intussusceptum loop were maximum: sensitivity 100% (75.29%–100.00%) and specificity 100% (80.49%–100.00%) each. Excellent agreement was seen between final diagnosis and vascularity at the apex with kappa 1 and P value

Introduction: Intussusception is the prolapse of one gastrointestinal segment into an adjacent part. Its incidence in adults is less than 10%. Objective: To presents a case of adult entero-enteric intussusception caused by small bowel submucosal lipoma. Clinical case: A 66-year-old male patient with vague clinical manifestation that presented in a computed tomography scan typical invagination image, it showed the classical "target" and "sausage-like" images. He underwent surgery, where the diagnosis of adult entero-enteric intussusception was confirmed and then an en-bloc resection was performed. Anatomopathological examination revealed a submucosal lipoma of the jejunum. Gastrointestinal lipomas have an incidence of 0.035% - 4.4%. Conclusion: This is a rare case, not only because the intussusception is uncommon in adults but for the lead point found in it.

Key Clinical Message Intussusception is the telescoping or invagination of the proximal part of the gastrointestinal tract into an adjacent section. It is rare in adults, accounting for 1% of adult bowel obstruction. Adult presentation of intussusception is variable, with nonspecific, vague symptoms like abdominal pain, nausea, vomiting, and rectal bleeding. Abdominal computed tomography (CT) scans have the highest sensitivity in the diagnosis of intussusception. The classical findings of intussusception are the target sign and mesenteric vessels lined within the bowel lumen. An abdominal CT scan can reveal a cloverleaf figuration, fluid‐filled ileal loops, superior mesenteric venous (SMV) occlusion, and concerns about ongoing sealed perforation or fistulization. Our patient is an 86‐year‐old female who was diagnosed with a jejunal–jejunal long‐segment intussusception, gastro‐enteric fistula, and SMV occlusion with distal reconstitution. The patient responded well to conservative treatment and was discharged for follow‐up.

Key Clinical Message Feeding jejunostomy (FJ) is one of the frequently performed surgical procedures for enteral nutrition, but intussusception a very rare complication with quite challenging clinical outcome. It symbolizes a surgical emergency requiring prompt diagnosis. Abstract Feeding jejunostomy (FJ) is a minor surgical intervention, which might lead to consequences that are potentially fatal. Mechanical issues such as infection, tube dislocation or migration, electrolyte and fluid imbalances, as well as complaints of gastrointestinal tract, are the most frequent consequences. A 76‐year‐old female, who is a known case of carcinoma (CA) esophagus: Stage 4 with Eastern Cooperative Oncology Group (ECOG) Class 3 presented with complaints of difficulty in swallowing and vomiting. As a part of palliative treatment, FJ is done and patient was discharged on postoperative day (POD) 2. Patient again presented to emergency department after 2 months with complaints of pain abdomen, unable to pass flatus and stools for 2 days. Contrast‐enhanced computed tomography was done, which revealed intussusception of jejunum with lead point as tip of feeding tube. Intussusception of jejunal loops is noted 20 centimeters distal to the site of insertion of FJ tube with tip of feeding tube as lead point. Reduction of bowel loops was achieved by gentle compression of distal part and are found to be viable. FJ tube was then removed and repositioned after which the obstruction got relieved. Intussusception is an extremely rare complication of FJ, where the clinical presentation can be likely to the various causes of small bowel obstruction. The fatal complications like intussusception in FJ can be prevented by remembering some technical considerations, such as attaching a 4–5 cm segment of the jejunum to the abdominal wall rather than a single‐point fixation and maintaining a minimum distance of 15 cm between the duodenojejunal (DJ) flexure and the FJ site.

Rotavin-M1 (POLYVAC) was licensed in Vietnam in 2012. The association of Rotavin-M1 with intussusception, a rare adverse event associated with rotavirus vaccines, and with adverse events following immunization (AEFI) have not been evaluated and monitored under conditions of routine use. From February 2017 to May 2021, we conducted a pilot introduction of Rotavin-M1 into the routine vaccination program in two provinces. Surveillance for intussusception was conducted at six sentinel hospitals. AEFI reports at 30 min and 7 days after vaccination were recorded. Among 443 children ®, ComBE Five®) compared to Rotavin-M1 without pentavalent vaccines. There was no association between intussusception and Rotavin-M1. The vaccine was generally safe when administered alone and when co-administered with other vaccines.

Intestinal intussusception is a rare condition in adult. The early diagnosis is challenging and has chronic or acute subacute course. They often present with nonspecific symptoms. Colo-colonic intussusception in adults is often caused by malignant lesions colonic lipomas are rare mesenchymal tumors and the majority are asymptomatic and their size is usually

Key Clinical Message In children, intussusception may have a pathologic cause, such as Burkitt's lymphoma. As a result, we should be cautious of Burkitt's lymphoma in children with intussusception. Finally, the importance of histological assessment of resected tissues in pediatric operations, particularly those with intussusception, should be emphasized. Abstract A 2‐year‐old boy was diagnosed with ileocecal intussusception and underwent surgical treatment and appendectomy. Appendix histopathology revealed lymphoid cells with hyperchromatic nuclei, high mitotic activity, and starry sky appearance. The patient was diagnosed with Burkitt's lymphoma, which involves many organs, such as the appendix, liver, kidney, and bone marrow.

Abstract Rectal prolapse is typically a benign idiopathic condition. Rarely, rectal prolapse can be due to or associated with colorectal carcinoma. Here we present a middle‐aged gentleman with no previous medical or surgical history, who presented with rectal prolapse secondary to sigmoid adenocarcinoma.

Background and Objective: Intussusception is one of the most common causes of intestinal obstruction in children 5 months to 3 years, which is the most common cause of acute abdominal pain and its prevalence increases as a result of viral infection. In this report, were present a case of intussusception in a 17-years-old boy following COVID-19. Case Report: A 17-year-old adolescent boy with a known case of steroid-dependent nephrotic syndrome from the age of two has been referred to the emergency department with severe abdominal pain and vomiting. On ultrasound, renal mass and free fluids were shown. Ileocecal intussusception was observed and was repaired without any complications. Conclusion: Based on the results of this study, intussusception should be considered in every patient with nephrotic syndrome with COVID-19 infection.

Context: The ultrasound-guided reduction by saline enema is a preferred nonsurgical procedure for intussusception. In a government setup where bedside ultrasound and round-the-clock trained radiologist facilities are unavailable, bedside saline enema reduction (without ultrasound guidance) may be an option. Aims: To evaluate the efficacy of bedside hydrostatic saline enema reduction in the treatment of pediatric intussusception; the secondary aim was to identify the patient subset in which it is more useful. Settings and Design: A retrospective study was conducted from January 2019 to May 2021 in all children with ultrasound-confirmed intussusception at our center. Subjects and Methods: All children were considered for non-operative bedside reduction with saline enema, excluding those with signs of peritonitis and shock. We allowed a maximum of three attempts of saline enema reduction. Results: There were 375 patients admitted with the diagnosis of intussusception in our institute. Out of these, 42 patients were subjected to bedside hydrostatic saline enema reduction. The patients in this group were in the age range of 5 months to 14 years. The success rate of bedside hydrostatic saline enema reduction was 90.47% (38 out of 42 cases). No perforations occurred during the procedure. The duration of symptoms and age of the patients did not influence the successful reduction in our series (p > 0.05). The duration of admission attained a statistically significant difference (p < 0.05) between those who had a successful non-operative reduction and those who subsequently had an operative intervention, that is, reduction or resection. There was no mortality. Conclusion: Bedside hydrostatic normal saline enema reduction of intussusception is a suitable non-operative technique of managing childhood intussusception in the carefully selected subset of patients. The technique is simple, safe, and cost-effective in a resource-limited setup.

Intussusception is one of the common causes of acute abdomen in paediatric age bracket with ileocolic type being the most prevalent. This happens when a proximal segment of bowel (intussusceptum) telescopes into the lumen of the adjacent distal segment (intussuscepiens). Here we report six cases of intussusception in which five were in paediatric age group and one was adult. All children were admitted, resuscitated well, USG abdomen was done to confirm the diagnosis, written and informed consent for surgery and anaesthesia, was taken from parents. However, all were managed successfully by hydrostatic saline reduction under sedation. Only one child had recurrence after one year who was again treated conservatively. Adult case was managed by means of laparotomy by excision of benign polyp being the pathological lead point. We present this case series to analyse the spectrum of presentation, diagnostic and therapeutic options available with review of literature. Since primary care providers and family physicians are first responders, this case series would help them for differential diagnosis and prompt referrals for further management.

ABSTRACT Meckel’s diverticulum is the most common gastrointestinal tract anomaly. It arises from the incomplete closure of the omphalomesenteric conduit, which is a true diverticulum at the antimesenteric border of the ileum. Although the majority of patients are asymptomatic, they can present with inflammation, hemorrhage, intussusception, intestinal obstruction, and perforation, among others; this constitutes an important differential diagnosis for acute abdomen. A 19-year-old female sought medical attention because of intermittent diffuse abdominal pain for two months, nausea, and diarrhea. In the requested imaging tests, tomography, and enterotomography, a diagnosis of Meckel’s diverticulum with some degree of intussusception was suggested. The patient underwent elective surgical treatment without complications and was discharged on the second postoperative day with clinical improvement. In this section, we review publications on similar cases published in the last five years.

Abstract Intussusception is a surgical emergency that may result in the perforation of the intestinal wall if not immediately treated. Pathologic lead points, such as intestinal duplication, are present in 2.2%–15% of the cases.We describe a 4‐year‐old girl with a necrotic ileoileal intussusception diagnosed with a rare tubular ileal duplication.

Intussusception is a rare cause of intestinal obstruction in adults. It often occurs secondary to inflammatory bowel disease, postoperative adhesions, benign or malignant lesions, or iatrogenic causes. In few cases, it occurs idiopathically or spontaneously. The most sensitive imaging method for its diagnosis is computed tomography. The reduction can be applied in selected cases; however, the definitive treatment is surgical resection. In this study, we presented a case of spontaneous ileoileal intussusception in a 25-year-old female patient.

Abstract Intussusception is a condition in which a segment of the gastrointestinal tract invaginates into the lumen of another segment. Adult intussusception is less common than juvenile intussusception in terms of cause, appearance, and treatment. Because the clinical picture can be quite atypical and difficult to interpret, it is frequently misdiagnosed at first. Herein, we report the case of a previously healthy 23‐year‐old female patient who presented to the Emergency Department (ED) with acute abdominal pain, vomiting, and diarrhea for 1 day following her last menstrual period. Ileocecal intussusception was discovered throughout the investigation. She was rushed for open abdominal surgery. Meckel's diverticulum was found as a pathologic lead point in the resected specimen, with no evidence of malignancy. Although intussusception is rare in adults, it should be considered in patients who have nonspecific stomach pain.

Abstract Peutz–Jeghers syndrome is a rare but potentially life‐threating syndrome. We report here the case of a young girl who presented recurrent small bowel intussusceptions. Laparotomy exploration showed many jejunal polyps leading to jejunojejunal intussusceptions. These were removed via mini enterotomies and pathological examination concluded to Peutz–Jeghers polyps.

Introduction Pediatric intussusception is one of the most common causes of bowel obstruction in the pediatric population. Affected children have one section of the intestine sliding into the adjacent section. Intestinal ischemia-reperfusion injury (I/R) can occur during pediatric intussusception, and any delay in diagnosis or treatment can lead to loss of intestinal viability that requires bowel resection. The aim of the present study was to investigate whether transfer ribonucleic acid (tRNA)-derived fragments (tRFs) can serve as candidate biomarkers for pediatric intussusception. Material and methods Using high-throughput sequencing technology, we identified differentially expressed tRFs, and ultimately selected three tRFs to establish a signature as a predictive biomarker of pediatric intussusception. Selection of these three upregulated genes was verified using quantitative reverse-transcription polymerase chain reaction (qRT-PCR). We conducted receiver operator characteristic (ROC) curve analysis to evaluate the predictive accuracy of the selected genes for pediatric intussusception. Results We detected 732 tRFs and tRNA-derived stress-induced RNA (tiRNAs), 1705 microRNAs (miRNAs), 52 differentially expressed miRNAs, and 34 differentially expressed tRFs and tiRNAs between patients and controls. Compared with controls, we found 33 upregulated miRNAs, 24 upregulated tRFs and tiRNAs, 19 downregulated miRNAs, and 10 downregulated tRFs and tiRNAs in children with intussusception. Using qPCR, the expression trends of tRF-Leu-TAA-006, tRF-Gln-TTG-033 and tRF-Lys-TTT-028 were consistent with the sequencing results. AUCs of tRF-Leu-TAA-006, tRF-Gln-TTG-033 and tRF-Lys-TTT-028 were 0.984, 0.970 and 0.837, respectively. Conclusions Circulating tRF-Leu-TAA-006, tRF-Gln-TTG-033 and tRF-Lys-TTT-028 expression might be a novel potential biomarker for diagnosis of pediatric intussusception.

OBJECTIVE: To determine the success rate of ultrasound guided hydrostatic reduction of intussusception using normal saline as an alternative to laparotomy. METHODS: This prospective cross-sectional study was conducted at Pediatric Surgery department, Khyber Teaching Hospital, Peshawar from January-September 2018. Eighty patients aged between 3-24 months with clinical signs, symptoms and confirmatory sonographic evidence of intussusception were included in study. Procedure was carried out under ultrasound guidance using normal saline as medium for reduction. Maximum, three attempts were made each lasting 5-10 minutes. RESULTS: Mean age of patients was 11.9±4.8 months. Majority (n=60/80; 75%) of patients were males. Thirty-five percent of patients (n=28/80) presented on second day followed by 32.5% (n=26/80) on first day. Mean time for presentation was 2.1±0.9 days. Most common type of intussusception was Ileo-colic (n=72/80; 90%). Overall success rate was 82.5% (n=66/88). Success rate for patients presented within first day was 96.2% (n=25/26) as compared to 85.7% (n=24/28) in patients presented ≥1-2 days and 65.3% (17/26) in patients presented after two days. Reduction time of Intussusception ranged from 5-30 minutes with mean time of 17.5±1.4 minutes. In 76.3% (n=61/80) cases, intussusception was reduced within 20 minutes. In 14 (17.5%) patients, reduction could not be achieved (gangrenous gut=5, Meckel’s diverticulum=3, illeo-illeal intussusception=1, perforation=5). Recurrence rate of intussusception was 7.5% (n=6/80), including 4 (5%) cases within 24 hours and 2 (2.5%) cases within 2 months after reduction. CONCLUSION: Ultrasound guided hydrostatic reduction of intussusception is an effective way to reduce intussusception, especially in patients presenting within two days.

Ileocolic intussusception is an invagination of the terminal ileum into the large bowel. It is a common cause of acute abdominal pain and the most common cause of ileus in children. Most intussusceptions are idiopathic and occur within the first three years of life. In older children, they can more often appear due to a pathological lead point. The typical clinical signs of intussusception are colicky abdominal pain, vomiting and bloody stools. If the intussusception is prolonged, perforation can occur, leading to diffuse peritonitis and septic shock. Further progression of the disease can be fatal. Therefore, quick recognition and treatment of the intussusception are crucial. Unfortunately, the clinical signs are often not typical, hence, radiology plays an important role. In diagnostics, ultrasound examination of the abdomen is the method of choice. For treatment, ultra-sound-guided hydrostatic reduction is the method of choice for non-invasive treatment. Non-invasive radiological treatment is successful in around 80% of cases. When non-invasive treatment cannot resolve the condition, urgent surgery is required. The aim of this review article is to present in detail the radiological management of ileocolic intussus-ception in children.

Abstract Introduction Kawasaki disease is a common vasculitis of unknown etiology that occurs mainly in preschool children. It manifests as a self-limited acute febrile illness with other features including extremity changes, cervical lymphadenopathy, oropharyngeal changes, truncal rash, and conjunctivitis. Intestinal involvement is not uncommon, with abdominal pain and vomiting being the most frequently reported symptoms. Intussusception has been described as a manifestation or complication of this disease, but few reports exist in literature. Case presentation A 7-month-old boy of Asian origin who presented with vomiting and passage of bloody mucoid stool was diagnosed with intussusception that was successfully reduced during emergency laparotomy. The baby was discharged home post-surgery following clinical improvement. He was readmitted on the fourth postoperative day with fever, irritability, and diarrhea. He was investigated and treated for presumed intraabdominal sepsis with multiple antibiotics with no improvement. He gradually developed the mucocutaneous features of Kawasaki disease and was treated with intravenous immunoglobulin and aspirin with good outcome. Conclusion Intussusception and Kawasaki disease both commonly occur in children less than 2 years old. It is important to include Kawasaki disease as a differential diagnosis in children of this age who present with an acute febrile illness and gastrointestinal symptoms. A common underlying pathologic process could be contributing to both conditions.

Intussusception is an invagination of a proximal segment of the bowel into an immediately adjacent, distal portion of the bowel. Ileocolic intussusception is one of the most common causes of bowel obstruction in children. The peak incidence occurs in infants between five and seven months of age. The etiology of intussusception in children is typically idiopathic, approximately 5-10% of patients have a pathological lead point. Postoperative intussusception is one of the rare causes of intussusception. Children with ileocolic intussusception often present abdominal pain, palpable mass, rectal bleeding, fussiness, and emesis. The most effective imaging method for the diagnosis of intussusception is ultrasound. The treatment of ileocolic and ileoileal intussusceptions is different, the first type requires invasive treatment.

Abstract Small‐bowel surveillance is recommended from the age of 8 years in asymptomatic individuals with Peutz–Jeghers syndrome. Because intussusception and risk of strangulated ileus were noted in an 11‐year‐old patient, small‐bowel surveillance should be reliably performed from the age of 8 years to avoid urgent surgery.

Enteric intussusception in adults is usually associated with the presence of a lead point seen on abdominal computerized tomography. However, as intussusception in coeliac disease may not have a lead point, a surgical procedure is often indicated in order to exclude small bowel tumour. We present the case of a male patient who presented with asymptomatic small bowel intussusception. During exploratory laparoscopy, five enteric intussusceptions were detected and a suspicion for coeliac disease was raised. Postoperative duodenal biopsy and CD3 immunohistochemical staining confirmed the diagnosis of coeliac disease, Marsh type 1.

Abstract Background Inverted Meckel’s diverticulum refers to the condition in which the diverticulum inverts on itself. The reasons for such an inversion are poorly understood due to the rarity of the condition. We present a case of inverted Meckel’s diverticulum, an uncommon finding, as a cause of recurrent intussusception. Case presentation A 30-year old Indian woman presented with complaints of pain in the central abdomen for 3 days, accompanied with vomiting and loose stools. Computed tomography images were suggestive of intussusception with intestinal obstruction. Intra-operative findings were suggestive of an intussuscepted segment of ileum measuring 10 cm in length, proximal to ileocecal junction. Ileo–ileal anastomosis was performed after appropriate resection. Upon opening the specimen, we were surprised to find an inverted Meckel diverticulum with lipoma at one end causing the intussusception. The patient made an uneventful recovery and was discharged after 5 days. Conclusion The reasons for inversion include abnormal peristalsis around the diverticulum and non-fixity of the diverticulum itself. The inverted diverticulum itself can cause luminal compromise and acts as a lead point for intussusception leading to obstruction. Computed tomography remains the diagnostic tool of choice for identifying intestinal obstruction and intussusception. Although pathological signs, such as lipoma, can be identified, the identification of any inversion will require a proficient radiologist. Inverted Meckel’s diverticulum is a rare condition which is difficult to diagnose preoperatively. Treatment is surgical, whether diagnosed pre-operatively or intra-operatively, and includes segmental resection and anastomosis. This uncommon condition should be noted as one-off differential diagnosis for intussusception and intestinal obstruction.

Hemihyperplasia is a syndrome with overgrowth of limbs and associated with various genomic syndromes. Rarely patient presents with intestinal obstruction when it is associated with sub mucosal lipomas. Submucosal lipomas are common in colon. But whole of small and large bowel studded with them is very rare as in our case. It presents dilemma not only in diagnosis but in treatment also. Here we present a case of forty two years females with hemihyperplasia syndrome came to causality with recurrent intestinal obstruction. On CECT Abdomen diagnosis of intestinal obstruction due to intussusception was made. Whole of bowel is studded with submucosal lipomas. Patient was tried to manage conservatively but patient does not respond and Right Hemicolectomy was done of intussusception segment. Anastomosis leaked and on re-exploration end ileostomy was done. Obstruction due to Multiple Intestinal Lipomatosis (as a part of Genetic Syndrome) should be managed conservatively and if operative intervention is required avoid primary anastomosis.

Abstract Intestinal obstruction due to intussusception caused by intestinal lipomas is a rare condition in adults that needs urgent treatment. CT (Computerised Tomography) is the radiologic modality of choice for diagnosis. Surgery is the treatment of choice and has excellent outcome.

Aim: To evaluate the acute surgical conditions beyond acute appendicitis in children. Material and method: The children who underwent urgent abdominal surgery between January 2017-December 2020 are retrospectively evaluated. The newborns and patients with acute appendicitis are excluded. Results: A total of 595 patients underwent urgent abdominal surgery. Acute appendicitis was the final diagnosis in 468 of them (78.7%). The median age of the rest of the 127 patients (21.3%) was 8 years (0.96-17.75 years). Fourteen patients admitted with trauma (11%) (12 boys and 2 girls, median age; 12.66 years), and the most common cause was firearm injuries with the most common injured system was the gastrointestinal system. Among the patients without trauma, 62 were boys (54.6%) and 51 were girls (45.1%) (median age; 6.41 years). Intussusception was most common in the Infant and Young Child Group. Adhesive small bowel obstruction was most common in adolescent boys and the Child Group while adnexal torsion was most common in adolescent girls. Intussusception, adhesive small bowel obstruction and gastrointestinal perforation were encountered in all age groups Conclusion: Although acute appendicitis is the most common cause of acute abdomen in children, other causes are not uncommon and some need special attention as differential diagnosis and intervention are "more urgent" than others. Awareness of these "more urgent" conditions with respect to age groups may prevent complications, morbidity, and even mortality.

Endometriosis is among the most frequent causes of appendiceal intussusception. However, there are limited data about this condition. Still, clinical manifestations, diagnosis, and treatment are the same in almost all cases due to accidental implantation of endometrial tissue inside the appendiceal wall. Finally, the only choice of treatment is appendectomy. Here we describe a middle-aged woman with vague pelvic pain that underwent a laparoscopic cystectomy, and during surgery, we came across a mass-like appendix. The pathology report declared that some endometrial tissue inside the appendix confirms the diagnosis of appendiceal intussusception due to endometriosis.

Peutz-jeghers syndrome is a rare inherited autosomal dominant disease which is characterized by mucocutaneous pigmentation and multiple polyps in the gastrointestinal tract. We report a case of 10 years old female who was referred to us from surgical department for the evaluation of brownish pigmented macules over lips, face, palms and soles. Patient was presented with recurrent abdominal pain along with vomiting and blood mixed stool for a month. Ultrasound of abdomen revealed jejuno-jejunal intussusception for which laparotomy was done during which multiple polyps were visualized. Polypectomy was done and biopsy revealed it to be tubulovillous adenoma. Patient was diagnosed as Peutz-jeghers syndrome as there were multiple polyps in the jejunum along with the characteristics mucocutaneous involvement.

BACKGROUND AND OBJECTIVE: Intussusception is the most common cause of intestinal obstruction and one of the most common causes of abdominal emergencies in children, which can lead to significant mortality and morbidity if left untreated. Since vitamin D acts as a hormone in the body and plays an important role in preventing infectious and non-infectious diseases and regulating the intestinal immune response, this study was performed to investigate the relationship between vitamin D levels and the occurrence of intussusception. METHODS: This case-control study was performed on 86 children under 6 years old and above the neonatal age referred to Amirkola Children's Hospital in 2017-2018. The diagnosis of intussusception was made by ultrasound and the control group (without intussusception) was selected from patients with elective surgery other than intussusception. Vitamin D levels of children were assessed and compared in the two groups of children with and without intussusception. FINDINGS: In this study, 50 people were in the intussusception group and 36 people were in the control group. The mean age was 27.2±14.6 months in the intussusception group and 24.7±15.9 months in the control group (p=0.447). The mean serum 25-hydroxyvitamin D levels in children with intussusception was 36.5±14.4 ng/ml and in the control group was 32.7±13.1 ng/ml (p=0.212). CONCLUSION: According to the results of the present study, there was no association between serum 25-hydroxyvitamin D levels in children with and without intussusception and this vitamin was not associated with the occurrence of intussusception.

There are few reports on the therapeutic role of colonoscopy in correcting intussusception of childhood. In the present report, 15 children (14 boys and 1 girl) presented with acute intussusception and successfully treated by colonoscopy were presented. The patients were referred to the gastroenterology clinic of Ami-Al-Momenin Hospital, Zabol, Iran from 2015 to 2018. The mean age of the patients was 36.6±28.7 months. After stablishing the diagnosis, they underwent colonoscopic reduction of intussusception by an experienced gastroenterologist. Following 24 hours of the procedure, follow up sonography was performed. Overall, 6 recurrences were identified in 4 (26.7%) patients which were managed by a second colonoscopy. A second recurrence was detected in two patients who finally underwent surgical reduction. Regarding the role of colonoscopy in providing a visual and real-time setting, this can be used as either a primary option or an alternative to radiologic and surgical procedures of intussusception reduction in children.

Introduction/Objective. Recurrent colic abdominal pain (RCAP) is a common complaint in children. Children with this complaint are often referred to abdominal ultrasound (US). Examining the children with RCAP by US in our outpatient clinic we occasionally noticed transient enteroenteric intussusceptions (TEIs) with spontaneous resolution. The objectives of our prospective observational study were to determine the prevalence and evaluate the significance of TEIs in children with RCAP. Methods. From January 2016 to December 2017 we examined 358 children with RCAP by US. Age range was 1–17 years (mean age 7.7 years). TEIs were detected and the prevalence determined. The sensation of pain at the time of the US examination was noted. Results. We detected TEI in 41 children; the prevalence was 11.5%. Abdominal pain at the time of the presence of TEI was reported in 17.1% of these children. In the group of children without TEI detected, pain at the time of the examination was reported in only 6%. A statistically significant relationship was found between the presence of TEI and the pain at the time of the examination (p = 0.046). No child had other significant abdominal pathology. Conclusion. TEIs happen more commonly in children than previously thought. A rather high prevalence of TEIs in our study group of children with RCAP and the fact that higher percentage of children with detected TEI experienced pain at the time of the examination, are suggestive that TEIs may be one of the causes for the RCAP in children.

Intussusception is a medical condition, in which a proximal part of the intestine folds into the distal intestine. Adult intussusceptions are rare and account for approximately 5% of all cases of intussusceptions. The anatomical leading points include tumors, diverticulums, polyps, and strictures in 80-90% of adult intussusceptions, and 65% of colon intussusceptions and 30% of small bowel intussusceptions originate from malignant tumors. Treatments for adult intussusception have not been established, but most cases require surgical treatment. The gastrointestinal tract is the most common extranodal site for non-Hodgkin lymphoma. The symptoms are mostly non-specific, but they rarely lead to complications, such as bleeding, perforation, and intussusception. Furthermore, few cases of primary gastrointestinal lymphomas causing intussusception have been reported. This paper reports a case of small bowel diffuse large B cell lymphoma that caused ileocolic intussusception in a 69-year-old woman with no medical history. She underwent a small bowel resection and received six cycles of adjuvant chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. Since then, she has been in complete remission.