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Lymphangiomas are rare benign lymphatic malformations. Even though these neoplasms can arise from any location and age, most of them are dominant in the head and neck of children. On the other hand, lymphangiomas are exceedingly rare in adults, especially in the gastrointestinal tract. Gastrointestinal tract lymphangiomas account for only about 1% of lymphatic malformations. Although there have been increasing cases of gastrointestinal lymphangiomas reported in recent years, cecal lymphangiomas causing intussusception in adults are rarely mentioned. In this article, we report a 27-year-old female patient with cecal lymphangiomas detected by imaging modalities and confirmed via postoperative histopathological examination.

We present a case of a 7-year-old girl with Rapunzel syndrome, a rare complication of trichobezoar, initially presenting with nonspecific symptoms. Diagnostic challenges led to delayed intervention. Surgical removal of the trichobezoar was successful, but postoperative complications included jejunojejunal intussusception, highlighting the necessity for vigilant follow-up and comprehensive psychiatric evaluation. The emergence of intussusception emphasizes the profound impact of underlying psychiatric disorders, such as trichotillomania and trichophagia, which contribute to trichobezoar formation. These conditions necessitate ongoing psychiatric management to address behavioral factors that predispose to recurrent bezoar formation and associated gastrointestinal complications. Effective follow-up strategies should encompass immediate postoperative care and long-term psychiatric support to optimize patient outcomes and minimize the risk of recurrent intussusception. [ABSTRACT FROM AUTHOR]

Heterotopic pancreas (HP) is a rare condition where pancreatic tissue is found outside its usual location, usually within the gastrointestinal tract. While typically asymptomatic, HP can cause complications like gastrointestinal bleeding and intussusception, especially in adults, posing diagnostic and therapeutic challenges. A 31-year-old male presented with severe abdominal pain, nausea, and vomiting. Initial imaging revealed significant ileal and cecal wall thickening. Despite antibiotic therapy, his condition worsened, necessitating exploratory laparotomy. Intraoperative findings showed ileal intussusception near the cecum, leading to ileocecal resection and ileo-colic anastomosis. Pathological examination confirmed HP as the cause of intussusception. This case underscores the importance of considering HP in adult intussusception. Timely surgical intervention is critical to prevent severe complications. At a two-year follow-up, he remained symptom-free, highlighting the necessity for prompt diagnosis and management. [ABSTRACT FROM AUTHOR]

The intestinal obstruction presenting as an emergency case when undergoes exploratory laparotomy present with multiple etiology associated such like intussusception that usually more common in infants and rare in adults. Similarly, lipoma the most common benign tumor over the body are rare in gastrointestinal, comprising about 3%. This paper presents a case report of a 51-year-old woman who presented with symptoms of bowel obstruction caused by ileo-ileal intussusception secondary to submucosal lipoma with the linking etiology of this gastrointestinal lipoma to be the causative factor for bowel obstruction resulting into the intussusception, yet another rare disease in adult as presentation. Thus, emphasizing the importance of considering such diagnosis in similar clinical scenarios. [ABSTRACT FROM AUTHOR]

Intussusception is the most common paediatric abdominal emergency in young children. Even though red current jelly stool is the pathognomonic feature, it only presents in less than 15% of cases. The clinical diagnosis is often missed as the presentation can mimics others. A recurrent case within 48 hours of reduction is even rare and can be falsely suspected as a normal post-reductive presentation. We highlighted a recurrence of intussusception in a 3-year-old boy, who was initially well after being discharged to home. Medical attention was sought initially but was informed that the clinical presentation could be resolved in a few days. Nevertheless, a second opinion has been sought in view of the persistent frequency pattern. Without delay, readmission of the child was arranged for surgical reduction. Regardless of the mild severity of gastrointestinal symptoms, the possibility of recurrence of intussusception should be suspected despite the presumed success of the initial intervention. [ABSTRACT FROM AUTHOR]

Henoch Schönlein purpura (HSP), also known as IgA vasculitis, is a systemic small‐vessel vasculitis typically occurring in children 3–15 years of age, with peak incidence at 4–6 years. It is characterized by a constellation of symptoms including palpable purpura, arthralgias or arthritis, abdominal pain including intussusception, and renal involvement. We report a patient with these clinical findings whose IgA immunofluorescence was negative but with a presumptive diagnosis of HSP at 16 months of age, significantly younger than the classic population. This condition rarely affects this age group, and we highlight the importance of considering vasculitis in children of all ages, as a failure to diagnose could lead to insufficient long‐term monitoring, particularly regarding renal function. [ABSTRACT FROM AUTHOR]

Small bowel lipomas are benign submucosal neoplasm composed mainly of mature adipose tissue. Despite their rare occurrence, lipomas are the second most common benign tumour of the small intestine. These tumours are mostly small in size and remain clinically asymptomatic. However, larger lesions tend to be more symptomatic, presenting with complications such as intussusception, bleeding or obstruction. Definitive surgical or endoscopic intervention is indicated in such symptomatic lipomas. Herein, we describe a rare case of ileal lipoma presenting with ileo-ileal intussusception and a life-threatening haemorrhage that was managed by laparoscopic-assisted ileal resection.

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.

Intussusception is a rare condition in adults, unlike in children, with a variety of etiologies. In most cases, it is secondary to tumors. acute intussusception on lipoma is very exceptional. We report a case of 68-year-old female patient, diagnosed with intestinal intussusception on lipoma.

Abstract We report a case of an adult ileocolic intussusception secondary to an inflammatory fibroid polyp (IFP), a rare and unexpected association between a surgical condition, and an underlying histopathological process. Intussusception is an uncommon surgical diagnosis in adults, and an IFP is rare mesenchymal tumour. Surgical intervention of the intussusception in an adult patient, given the uncertain aetiology of the lead point, is recommended as gold standard.

Abstract Background Intussusception presents a significant emergency that often necessitates bowel resection, leading to severe complications and management challenges. This study aims to investigate and establish a scoring system to enhance the prediction of bowel resection necessity in pediatric intussusception patients. Methods This retrospective study analyzed 660 hospitalized patients with intussusception who underwent surgical management at a pediatric hospital in Southwest China from April 2008 to December 2020. The necessity of bowel resection was assessed and categorized in this cohort. Variables associated with bowel resection were examined using univariate and multivariate logistic regression analyses. Based on these analyses, a scoring system was developed, grounded on the summation of the coefficients (β). Results Among the 660 patients meeting the inclusion criteria, 218 required bowel resection during surgery. Bowel resection occurrence was linked to an extended duration of symptoms (Odds Ratio [OR] = 2.14; 95% Confidence Interval [CI], 1.03–5.23; P = 0.0015), the presence of gross bloody stool (OR = 8.98; 95% CI, 1.76–48.75, P

Jie Liu,1,2,* Yongkai Wang,3,* Zhihui Jiang,4,* Guangqi Duan,1 Xiaowen Mao,5 Danping Zeng2 1Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, People’s Republic of China; 2Department of General Surgery and Urology, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China; 3Department of Hepatobiliary Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, People’s Republic of China; 4Department of General Surgery, Qingdao Women and Children’s Hospital, Qingdao, People’s Republic of China; 5Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Danping Zeng, Department of General surgery and urology, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, No. 225, Xinyang Road, Nanning City, Guangxi Zhuang Autonomous Region, 530003, People’s Republic of China, Email zengdp000@icloud.com Xiaowen Mao, Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei, Tongji Medical College, Huazhong University of Science and Technology, 746 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, 430070, People’s Republic of China, Email xiaowenmao0927@163.comPurpose: The objective of this study was to develop and validate a nomogram for predicting the need for surgical intervention in pediatric intussusception after pneumatic reduction.Patients and Methods: This retrospective study analyzed the clinical data of children with acute intussusception admitted to four hospitals in China from January 2019 to January 2022. Based on the results of pneumatic reduction, the patients were divided into two groups: the successful reduction group (control group) and the failed reduction group (operation group). The total sample was randomly divided into a training set and a validation set in a 7:3 ratio. Logistic regression analysis was performed to establish a predictive model for surgical risk.Results: A total of 1041 samples were included in this study, with 852 in the control group and 189 in the operation group. Among the total sample, 728 cases were used for training and 313 cases were used for validation. Logistic regression analysis of the training set identified age, time of abdominal pain, presence or absence of hematostoecia, C-reactive protein value from blood test on admission, and nested position indicated by B-ultrasound as independent predictors of intussusception intervention. Based on the five independent risk factors identified through multivariate logistic regression, a nomogram was successfully constructed to predict the failure of resetting by air enema under X-ray.Conclusion: A nomogram was developed to predict the need for surgical intervention after intussusception pneumatic reduction in children. The nomogram was based on clinical risk factors including age, time of abdominal pain, presence or absence of blood in stool, value of C-reactive protein in blood test on admission, and nested position indicated by B-ultrasound. Our internal validation demonstrated that this nomogram can serve as a useful tool for identifying risk factors associated with failure of air enema in children with intussusception.Keywords: pediatric, intussusception, pneumatic reduction, nomogram, surgical intervention

Purpose: We present four cases of malignant melanoma metastases in GIT. The symptoms which led to the hospitalization of the patients were ileus in two cases, hematemesis and hematochezia. Results: We performed operative treatment - small intestinal resection because of intussusception followed by anastomosis in three patients and in one patient, liver resection and bitruncular sigmostomy. The histopathology revealed metastases for malignant melanoma. All of the patients had previous operation for a skin form of malignant melanoma, and chemotherapy or immunotherapy was performed. The patients had a postoperative period without complications. Conclusions: Malignant melanoma is a widely common disease. It is the third neoplastic diseases which give metastases in the small intestine. Malignant melanoma metastases in the GIT are initially asymptomatic, but in time, they manifest with clinical presentation of ileus or bleeding from the GI tract.

Intussusception is one of the common conditions in children presenting with abdominal pain. The exact etiology of intussusception is unknown. Lead point is not identified in the majority of cases in children. Commonly, radiographic evidence suggests the presence of a target sign is diagnosis of intussusception. However, the presence of a double target sign in the case of intussusception is rare and depicts the presence of double intussusception. We present a case report of a 1-year-old child who presented to the emergency department with excessive crying for more than 10 hours. After the initial clinical assessment and acute management, an abdominal ultrasound revealed a double target sign on the sub-hepatic and left para-umbilical region which suggested double intussusception. No lead point was identified in our case. Early diagnosis and prompt treatment are the mainstay of management in such cases.

Abstract Background This study explores the effectiveness of ultrasonography (USG)-guided saline enema reduction for ileocecal intussusception. It investigates factors, ascertainable through physical examination, ultrasound, and medical history, that impact the success of the procedure and the likelihood of recurrence. Results Conducted at a tertiary referral center, the study included 323 pediatric cases diagnosed with intussusception between 2017 and 2023. Patient data, symptoms, signs, and outcomes were collected. Hydrostatic saline enema, performed under USG guidance, served as the primary non-operative treatment. Logistic regression models assessed the impact of clinical factors on success and recurrence rates. Out of 323 patients examined for eligibility, 184 met inclusion criteria and were analyzed. Successful reduction with saline enema was achieved in 86.7%. In-hospital recurrence occurred in 17.1%, notably higher for intussusceptions extending into the rectum (p 24 (p = 0.4) and 48–72 (p = 0.2) hours did not decrease chances for successful reduction. Conclusions Prolonged symptom duration of over 24 and 48–72 h should not be a definitive contraindication for non-operative treatment. Cumulation of symptoms typical for intussusception might reduce the chances of success. These findings contribute valuable insights into optimizing non-operative strategies for managing pediatric intussusception.

Abstract Background Summarizing the clinical features of children with intussusception secondary to small bowel tumours and enhancing awareness of the disease. Methods Retrospective summary of children with intussusception admitted to our emergency department from January 2016 to January 2022, who underwent surgery and were diagnosed with small bowel tumours. Summarize the types of tumours, clinical presentation, treatment, and prognosis. Results Thirty-one patients were included in our study, 24 males and 7 females, with an age of onset ranging from 1 m to 11y 5 m. Post-operative pathology revealed 4 types of small intestinal tumour, 17 lymphomas, 10 adenomas, 4 inflammatory myofibroblastomas and 1 lipoma. The majority of tumours in the small bowel occur in the ileum (83.9%, 26/31). Abdominal pain, vomiting and bloody stools were the most common clinical signs. Operative findings indicated that the small bowel (54.8%, 17/31) and ileocolic gut were the main sites of intussusception. Two types of procedure were applied: segmental bowel resection (28 cases) and wedge resection of mass in bowel wall (3 cases). All patients recovered well postoperatively, with no surgical complications observed. However, the primary diseases leading to intussusception showed slight differences in long-term prognosis due to variations in tumor types. Conclusions Lymphoma is the most common cause of intussusception in pediatric patients with small bowel tumours, followed by adenoma. Small bowel tumours in children tend to occur in the ileum. Therefore, the treatment of SBT patients not only requires surgeons to address symptoms through surgery and obtain tissue samples but also relies heavily on the expertise of pathologists for accurate diagnosis. This has a significant impact on the overall prognosis of these patients.

Colonic lipomas are relatively rare benign tumors which are composed of mature fat cells and occur most frequently in the large intestine. The occurrence of colonic lipomas in the transverse colon is relatively uncommon. Generally, colonic lipomas are asymptomatic, and many individuals might not experience any noticeable symptoms. Therefore, they are usually discovered incidentally during colonoscopy or as a result of diagnostic imaging prescribed for other reasons. The size and location of the lipoma could influence the clinical presentation. If symptoms occur, they include abdominal pain, changes in bowel habits, or gastrointestinal bleeding. The prognosis for colonic lipomas is generally excellent but it requires an individualized approach based on the specific characteristics of the tumor, the patient’s symptoms, and other clinical considerations. We report a case of a colonic intussusception caused by a colonic lipoma in an adult who underwent surgery, with an uneventful recovery.

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

Introduction: Postoperative complications of stomas in necrotizing enterocolitis (NEC) typically affect the proximal limb. Complications of the distal limb are rarely reported. Case presentation: A 17-day-old newborn underwent an end ileostomy and an ileal Hartmann's pouch due to necrotizing enterocolitis (NEC). Eight weeks after the surgery, he passed bloody stool through the anus. No drop in his hemoglobin level was observed. He was made NPO, and no further bloody stool was seen after 24 hours. Ten weeks post-surgery he developed acute vomiting, and a 10-cm segment of bowel was seen prolapsed through the anus. The end of the prolapsed bowel was blind, raising the suspicion of a complete prolapse of the ileal Hartmann's pouch. He was taken to the operating room for an exploratory laparotomy. We found that the ileal Hartmann's pouch had intussuscepted into the ileocecal valve, progressed through the colon and the rectum, and prolapsed through the anus. We reduced the bowel manually. The involved ileum and colon were markedly swollen, and partially necrotic. The necrotic segments were resected, and the ileostomy was reversed. The patient was discharged one month later and had no adverse complications at two months of follow up. Conclusion: Although rare, intussusception of an ileal Hartmann's pouch should be ruled out in patients that have a Hartmann's pouch and develop vomiting and bloody stool.

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.

Background: Intussusception presents a significant emergency that often necessitates bowel resection, leading to severe complications and management challenges. This study aims to investigate and establish a scoring system to enhance the prediction of bowel resection necessity in pediatric intussusception patients. Methods: This retrospective study analyzed 660 hospitalized patients with intussusception who underwent surgical management at a pediatric hospital in Southwest China from April 2008 to December 2020. The necessity of bowel resection was assessed and categorized in this cohort. Variables associated with bowel resection were examined using univariate and multivariate logistic regression analyses. Based on these analyses, a scoring system was developed, grounded on the summation of the coefficients (β). Results: Among the 660 patients meeting the inclusion criteria, 218 required bowel resection during surgery. Bowel resection occurrence was linked to an extended duration of symptoms (Odds Ratio [OR] = 2.14; 95% Confidence Interval [CI], 1.03–5.23; P = 0.0015), the presence of gross bloody stool (OR = 8.98; 95% CI, 1.76–48.75, P < 0.001), elevated C-reactive protein levels (OR = 4.79; 95% CI, 1.12–28.31, P = 0.0072), lactate clearance rate (LCR) (OR = 17.25; 95% CI, 2.36–80.35; P < 0.001), and the intussusception location (OR = 12.65; 95% CI, 1.46–62.67, P < 0.001), as determined by multivariate logistic regression analysis. A scoring system (totaling 14.02 points) was developed from the cumulative β coefficients, with a threshold of 5.22 effectively differentiating infants requiring surgical intervention from others with necrotizing enterocolitis (NEC), exhibiting a sensitivity of 78.3% and a specificity of 71.9%. Conclusions: This study successfully identified multiple risk factors for bowel resection and effectively used a scoring system to identify patients for optimal clinical management. [ABSTRACT FROM AUTHOR]

Adult colonic intussusception, is a rare entity that is typically associated with underlying organic pathologies, notably colorectal tumors, unlike pediatric cases, which are mostly idiopathic. We present a unique case of a 42-year-old female with ascending colon adenocarcinoma, where ileocecal intussusception served as the initial clinical manifestation. The patient's non-specific symptoms, familial history of colon cancer and subsequent diagnostic evaluations underscore the importance of considering malignancy in such presentations. Successful laparoscopic right hemicolectomy resolved the intussusception. This case, which is the first case to be reported in Sudan, highlights the clinical complexities of adult colonic intussusception, emphasizing the need for a heightened index of suspicion for underlying malignancy and the significance of timely surgical intervention. Furthermore, the challenges encountered in resource-limited settings underscore the necessity for genetic testing to guide familial screenings and identify hereditary factors contributing to colon cancer, providing valuable insights for clinicians managing similar cases. [ABSTRACT FROM AUTHOR]

Background: This study explores the effectiveness of ultrasonography (USG)-guided saline enema reduction for ileocecal intussusception. It investigates factors, ascertainable through physical examination, ultrasound, and medical history, that impact the success of the procedure and the likelihood of recurrence. Results: Conducted at a tertiary referral center, the study included 323 pediatric cases diagnosed with intussusception between 2017 and 2023. Patient data, symptoms, signs, and outcomes were collected. Hydrostatic saline enema, performed under USG guidance, served as the primary non-operative treatment. Logistic regression models assessed the impact of clinical factors on success and recurrence rates. Out of 323 patients examined for eligibility, 184 met inclusion criteria and were analyzed. Successful reduction with saline enema was achieved in 86.7%. In-hospital recurrence occurred in 17.1%, notably higher for intussusceptions extending into the rectum (p < 0.03). Pathologic lead point was identified in 33.3% of operated cases. The study revealed a correlation between the increasing number of symptoms (p < 0.001) and reduced success rates in enema reduction, with vomiting (p < 0.02), diarrhea (p < 0.05), and peritoneal fluid (p < 0.008) negatively affecting outcomes. Symptom duration of 1–9 h (p < 0.001) and 10–24 (p < 0.01) correlated with higher success rates, but prolonged symptom duration of > 24 (p = 0.4) and 48–72 (p = 0.2) hours did not decrease chances for successful reduction. Conclusions: Prolonged symptom duration of over 24 and 48–72 h should not be a definitive contraindication for non-operative treatment. Cumulation of symptoms typical for intussusception might reduce the chances of success. These findings contribute valuable insights into optimizing non-operative strategies for managing pediatric intussusception. [ABSTRACT FROM AUTHOR]

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. rainy season (June to August), 25 (26.6%) cases were reported in autumn season, 20 (21.3%) cases were reported in spring season and 5 (5.3%) cases were reported in winter season. Conclusion: Intussusception may occur at any time of year, but the results of current research reveal that an increase in the number of cases of intussusception seen during the summer season, which also includes the rainy monsoon. This covers the months of June through August. In addition, it is seen that delayed presentation is associated with more complicated outcomes, whereas early presentation correlates with fewer complications. [ABSTRACT FROM AUTHOR]

Background: Image-guided intussusception reduction has been practised internationally for many decades. The use of different modalities, delayed repeat attempts, and sedation/anaesthesia are unknown. Objective: To survey the practice of image-guided intussusception reduction. Materials and methods: A 20-point questionnaire created by the European Society of Paediatric Radiology (ESPR) Abdominal Imaging Taskforce was distributed via the ESPR members' mailing list and shared on social media between 28 March and 1 May 2023. Results: There were 69 responses from 65 worldwide institutions, with a mean of 18 intussusception reductions performed per year: 55/69 (80%) from 52 European institutions and 14/69 (20%) from 13 institutions outside of Europe. European centres reported using 19/52 (37%) fluoroscopy, 18/52 (35%) ultrasound, and 15/52 (28%) a mixture of both, with 30/52 (58%) offering a delayed repeat at 15 min to 24 h. Non-European centres reported using 5/13 (39%) fluoroscopy, 6/13 ultrasound (46%), and 2/13 (15%) a mixture of both, with 9/13 (69%) offering a delayed repeat attempt. Sedation or analgesia was used in 35/52 (67%) of European and 2/13 (15%) non-European institutions. Conclusion: There is wide variation in how image-guided intussusception reduction is performed, and in the use of sedation/anaesthesia. [ABSTRACT FROM AUTHOR]

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. 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 FROM AUTHOR]

Ultrasound is the criterion standard imaging modality for the diagnosis of intussusception. However, to our knowledge the utility of abdominal radiographs to concurrently screen for pneumoperitoneum or other abdominal pathology that could have a similar presentation has not been studied. Our institutional protocol requires the performance of AP supine and left lateral decubitus views of the abdomen prior to ultrasound evaluation for intussusception, providing an opportunity to examine the yield of abdominal radiographs in this setting. Our primary objective was to determine the rate of pneumoperitoneum on screening abdominal radiographs in children undergoing evaluation for intussusception. Our secondary objective was to determine the rate that other clinically significant pathology is found on these screening abdominal radiographs. We performed a retrospective chart review of all patients under 6 years of age who had any imaging ordered in our large urban pediatric emergency department to evaluate for suspected intussusception during the calendar years 2018–2020. 1115 patient encounters met our inclusion criteria. Among 1090 who had screening abdominal radiographs, 82 (8%) had findings concerning for intussusception. Of those not concerning for intussusception, 635 (58%) were read as normal, 263 (24%) showed moderate to large stool burden, 107 (10%) showed generalized bowel distention, and 22 (2%) showed abnormal gastric distention. Individually the remainder of all other findings compromised <1% of encounters and included radiopaque foreign body (8), intraabdominal calcification (4), pneumonia/effusion (3), pneumatosis intestinalis, abdominal mass (2), diaphragmatic hernia (1), rib fracture (1), appendicolith (1), feeding tube malposition (1), and bowel wall thickening (1). In one encounter the patient had a bowel perforation with pneumoperitoneum present secondary to ingestion of multiple magnets. Our study indicates that radiograph-detected pneumoperitoneum is rare in children with suspected intussusception. Constipation is the most common abnormal finding on screening radiographs. Other findings occur in approximately 15% of total cases, some of which require further workup. [ABSTRACT FROM AUTHOR]

Background: Summarizing the clinical features of children with intussusception secondary to small bowel tumours and enhancing awareness of the disease. Methods: Retrospective summary of children with intussusception admitted to our emergency department from January 2016 to January 2022, who underwent surgery and were diagnosed with small bowel tumours. Summarize the types of tumours, clinical presentation, treatment, and prognosis. Results: Thirty-one patients were included in our study, 24 males and 7 females, with an age of onset ranging from 1 m to 11y 5 m. Post-operative pathology revealed 4 types of small intestinal tumour, 17 lymphomas, 10 adenomas, 4 inflammatory myofibroblastomas and 1 lipoma. The majority of tumours in the small bowel occur in the ileum (83.9%, 26/31). Abdominal pain, vomiting and bloody stools were the most common clinical signs. Operative findings indicated that the small bowel (54.8%, 17/31) and ileocolic gut were the main sites of intussusception. Two types of procedure were applied: segmental bowel resection (28 cases) and wedge resection of mass in bowel wall (3 cases). All patients recovered well postoperatively, with no surgical complications observed. However, the primary diseases leading to intussusception showed slight differences in long-term prognosis due to variations in tumor types. Conclusions: Lymphoma is the most common cause of intussusception in pediatric patients with small bowel tumours, followed by adenoma. Small bowel tumours in children tend to occur in the ileum. Therefore, the treatment of SBT patients not only requires surgeons to address symptoms through surgery and obtain tissue samples but also relies heavily on the expertise of pathologists for accurate diagnosis. This has a significant impact on the overall prognosis of these patients. [ABSTRACT FROM AUTHOR]

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Most adult intussusceptions are secondary to various pathological conditions that serve as a lead point. Because of their serious nature, intussusceptions often require emergency surgery. We report a surgical case of amyloidosis associated with intussusception, probably due to polypoid protrusions and bleeding tendencies. An 80-year-old man with abdominal pain was suspected of having jejunal intussusception on computed tomography. He had been prescribed warfarin for atrial fibrillation, and excessive anticoagulation was observed with a prolonged prothrombin time/international normalized ratio of 5.44 at presentation. After the excessive anticoagulation was resolved, emergency surgery was performed. The intussuscepted jejunum was resected, and a 7 cm long dark-red pedunculated polyp was identified as the lead point, which was accompanied by multiple small pedunculated polyps. Histopathological examination showed that these were all hemorrhagic polyps. Amyloid depositions were observed in the muscularis mucosae, submucosa, and the walls of the blood vessels. Immunohistochemical analysis revealed immunoglobulin light chain amyloidosis. This case is informative to discuss the clinical sequelae of gastrointestinal amyloid deposition. [ABSTRACT FROM AUTHOR]

In January 2018, Afghanistan introduced the monovalent oral rotavirus vaccine (Rotarix) nationwide, administered as a 2-dose series at six and ten weeks of age. We describe characteristics of intussusception cases and assess potential intussusception risk associated with Rotarix vaccination in Afghan infants. Multi-center prospective active hospital-based surveillance for intussusception was conducted from May 2018 to March 2022 in four sentinel sites in Afghanistan. We applied the Brighton Level 1 criteria for intussusception and verified vaccination status by reviewing vaccine cards. We used the self-controlled case series (SCCS) methodology to compare intussusception incidence in the 1 to 21 days after each dose of Rotarix vaccination against non-risk periods. A total of 468 intussusception cases were identified in infants under 12 months, with 264 cases aged between 28 and 245 days having confirmed vaccination status contributing to the SCCS analysis. Most case-patients (98 %) required surgery for treatment, and over half (59 %) of those who underwent surgery required intestinal resection. Nineteen (7 %) case-patients died. Eighty-six percent of case-patients received the first dose of Rotarix, and 69 % received the second dose before intussusception symptom onset. There was no increased risk of intussusception in the 1–7 days (relative incidence: 0.9, 95 % CI: 0.1, 7.5), 8–21 days (1.3, 95 % CI: 0.4, 4.2), or 1–21 days (1.1, 95 % CI: 0.4, 3.4) following receipt of the first dose or in the 1–7 days (0.2, 95 % CI: 0.3, 1.8), 8–21 days (0.7, 95 % CI: 0.3, 1.5), or 1–21 days (0.6, 95 % CI: 0.3, 1.2) following the second dose. Rotarix vaccination was not associated with an increased intussusception risk, supporting its continued use in Afghanistan's immunization program. However, there was a high level of death and resection due to intussusception among Afghan infants. [ABSTRACT FROM AUTHOR]

Colonic lipomas are relatively rare benign tumors which are composed of mature fat cells and occur most frequently in the large intestine. The occurrence of colonic lipomas in the transverse colon is relatively uncommon. Generally, colonic lipomas are asymptomatic, and many individuals might not experience any noticeable symptoms. Therefore, they are usually discovered incidentally during colonoscopy or as a result of diagnostic imaging prescribed for other reasons. The size and location of the lipoma could influence the clinical presentation. If symptoms occur, they include abdominal pain, changes in bowel habits, or gastrointestinal bleeding. The prognosis for colonic lipomas is generally excellent but it requires an individualized approach based on the specific characteristics of the tumor, the patient's symptoms, and other clinical considerations. We report a case of a colonic intussusception caused by a colonic lipoma in an adult who underwent surgery, with an uneventful recovery. [ABSTRACT FROM AUTHOR]

A 40-year-old female patient presented to a secondary facility with dull lower abdominal pain and a persistent low-grade fever. Her laboratory results showed elevated inflammation markers. A CT scan revealed two abscesses in the lesser pelvic region in direct contact with the apex of the appendix, the posterior wall of the uterus, and the right-side appendages. The patient responded well to intravenous antibiotics, and an MRI scan revealed the cause to be an appendiceal rupture. The patient was scheduled for an appendectomy. The procedure started laparoscopically but had to be converted to an open one with a midline infra-umbilical incision in order to protect the right appendages. A standard appendectomy was conducted, and the histology report revealed rupture of the appendix with concomitant wall inversion in the context of fibrous adhesions as well as obstruction due to a fecalith. Patient recovery and follow-up were excellent. Acute appendicitis, while frequently encountered in surgical practice, can present a diagnostic conundrum when it manifests in an atypical manner. This unique form of inversion appeared to confer a protective role against peritonitis, primarily through the mechanism of obstruction occurring centrally to the rupture. We suggest that this case should be included in current classifications as a partial inversion of the appendix after rupture and inflammation. [ABSTRACT FROM AUTHOR]

A 2‐year‐old Pomeranian‐Spitz dog (5.8 kg) was admitted with symptoms of uterine prolapse and lethargy 1 day after whelping three puppies. The prolapsed uterus was corrected, but the next day, prolapse reoccurred. To fix the cervix to the abdominal wall, the dog underwent a surgery operation where intussusception in the left horn of the uterus was found. Ovariohysterectomy was performed as the treatment of choice. The diagnosis of intussusception is challenging, and exploratory laparotomy is the reliable diagnostic approach. Although uterine intussusception is rare, it should be one of the important considerations in dogs within the post‐partum period. [ABSTRACT FROM AUTHOR]

Background Inverted left atrial appendage (iLAA) is an infrequent complication following cardiac surgery, seen both in children and adults. Following a recent encounter, this review article is aimed to remind the reader about its occurrence, clinical manifestations, differential diagnoses, and management options. Case summary A 3-month-old baby underwent successful surgical repair of a large ventricular septal defect. Intraoperative epicardial echocardiogram at the end of the case demonstrated an unexpected left atrial mass, raising suspicion of a thrombus adjacent to the mitral valve. Urgent re-establishment of cardiopulmonary bypass and exploration of the left atrium did not reveal a thrombus, but this was subsequently identified as an iLAA. This completely resolved after manual external reduction of the appendage. Discussion Published literature is confined to case reports only, with most cases observed post-operatively, but some occurring spontaneously. Awareness of this unusual manifestation is particularly important in the intraoperative period as it can usually be addressed without the need for further cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

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..........

Intussusceptions of the small intestine in adults is very rare and represents only 1% of all cases of intestinal obstruction; this condition is rarely described in the literature. Surgery is the procedure of choice in most cases. We report a case of ileo-ileal intussusceptions secondary to a melanoma metastatic tumor, occurring 4 years after surgery for malignant melanoma of the cheek. The diagnosis of intussusception was confirmed by abdominal CT-Scan. However, only palliative surgery was feasible for this patient. At seven months after his surgery, the patient is alive and in good general condition. Intussusception in adults is the main clinical presentation indicative of intestinal metastasis from malignant melanoma. After our review of the literature, it seems that this complication occurs mainly in male patients and the site of predilection for this metastasis is the jejunum.

Background: Meckel's diverticulum is one of the most common congenital malformations of the gastrointestinal tract. About three-fourths of Meckel's diverticulum are located in the distance ranging from 40 cm to 100 cm from the ileocecal valve. Most cases are lined with heterotopic mucosa (e.g., gastric, pancreatic, jejunal). Many cases are asymptomatic. Aim: This case report aims to present an ultrasound image for intussusception caused by the anatomical anomaly, namely Meckel's diverticulum. The article was written to integrate fundamental knowledge of anatomical variations or anomalies with clinical context. Case description: A 5-year-old girl previously diagnosed with obesity came to the hospital with severe abdominal pain. The abdomen, on palpation examination, was tender and painful. Diagnosis of intussusception was initially based on the history, clinical symptoms, and ultrasound imaging. The girl was finally qualified for surgery. During the procedure, the bowel invagination was performed, and Meckel's diverticulum was removed. The intestine was double-layered and intraoperatively confirmed intussusception with Meckel's diverticulum. Conclusions: Knowledge of anatomical anomalies is significant for practitioners. Meckel's diverticulum may be the cause of invagination intestines. CT or MRI is the test of choice when intussusception is suspected during a proliferative disease.

Abstract Background Intussusception is one of the most common acute abdominal conditions in pediatric patients, and if left untreated, it may result in intestinal necrosis and even death. The etiology of the disease is unknown and may be related to a variety of factors, and there are only limited reports of small bowel necrosis secondary to abnormal Peyer’s node hyperplasia after MMR vaccination. Case presentation In this report, we present two infants who had an abnormal proliferation of Peyer’s nodes secondary to intussusception eventually leading to small bowel necrosis after MMR vaccination. Conclusions Intestinal necrosis and infectious shock are the most common causes of infant mortality, and early detection and management are critical.

This report describes the case of a 56-year-old woman who presented at the emergency room with a 3-week history of severe, intermittent abdominal pain. A CT scan revealed colo-colic intussusception caused by a large, substenosing mass with predominant adipose density. Subsequent endoscopic examination with biopsy revealed a necrotic tissue covering the mass, without definitive histological characterization. A second biopsy led to the extremely rare diagnosis of colo-colic lipoma. While intussusception is rare in adults, it's important to consider it as a differential diagnosis, especially when presenting with abdominal pain and signs of bowel obstruction. Timely diagnosis and appropriate treatment are essential to prevent complications.

Purpose This study explored the feasibility of utilizing a deep learning artificial intelligence (AI) model to detect ileocolic intussusception on grayscale ultrasound images. Methods This retrospective observational study incorporated ultrasound images of children who underwent emergency ultrasonography for suspected ileocolic intussusception. After excluding video clips, Doppler images, and annotated images, 40,765 images from two tertiary hospitals were included (positive-to-negative ratio: hospital A, 2,775:35,373; hospital B, 140:2,477). Images from hospital A were split into a training set, a tuning set, and an internal test set (ITS) at a ratio of 7:1.5:1.5. Images from hospital B comprised an external test set (ETS). For each image indicating intussusception, two radiologists provided a bounding box as the ground-truth label. If intussusception was suspected in the input image, the model generated a bounding box with a confidence score (0-1) at the estimated lesion location. Average precision (AP) was used to evaluate overall model performance. The performance of practical thresholds for the model-generated confidence score, as determined from the ITS, was verified using the ETS. Results The AP values for the ITS and ETS were 0.952 and 0.936, respectively. Two confidence thresholds, CTopt and CTprecision, were set at 0.557 and 0.790, respectively. For the ETS, the perimage precision and recall were 95.7% and 80.0% with CTopt, and 98.4% and 44.3% with CTprecision. For per-patient diagnosis, the sensitivity and specificity were 100.0% and 97.1% with CTopt, and 100.0% and 99.0% with CTprecision. The average number of false positives per patient was 0.04 with CTopt and 0.01 for CTprecision. Conclusion The feasibility of using an AI model to diagnose ileocolic intussusception on ultrasonography was demonstrated. However, further study involving bias-free data is warranted for robust clinical validation.

Intussusception occurs when a part of the intestine enters another segment of the intestine causing bowel obstruction. It is common in children but not in adults with only