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Intussusception is a familiar diagnosis among the pediatric population; however, it is rarely consideredamong the adult population due to a myriad of life-threatening pathologies within the abdomen. We presentan adult female who presented to the emergency department (ED) with abdominal pain and constipation.Laboratory testing and a computed tomography (CT) scan of the abdomen were ordered. Laboratory testresults were notable for an elevated lymphocyte count as well as leukocyte esterase, white blood cells (WBC),and bacteria seen on urinalysis. The computed tomography scan detected a colo-colic intussusceptionsecondary to a benign mass within the bowel lumen. The mass was surgically resected and the patient hadan uneventful postoperative course. This unique case represents the occurrence of a pathology to which theadult population is not immune, and therefore should not be overlooked when evaluating a non-specific caseof abdominal pain.

Background: Intussusception of the appendiceal endometriosis is rare. Although approximately 200 cases of appendiceal intussusception have been reported in the literature, very few have ever been diagnosed preoperatively. Here, we report the case of intussusception of the appendiceal endometriosis with laparoscopic ileocecal resection. Case presentation: A woman in her 50s presented to the out-patients clinic with epigastric pain lasting for a several month. Contrast-enhanced computed tomography (CT) scanning revealed ileocolic intussusception in which a cecum polypoid mass lesion extended to the hepatic flexure of the ascending colon. A colonoscopy showed a large pedunculated polyp in the cecum. Laparoscopic ileocecal resection was performed. Pathology confirmed an invaginated appendix demonstrating endometriosis implants. Conclusions: Possible intrinsic causes of intussusception are varied, appendiceal intussusception secondary to endometriosis is extremely rare. Intussusception of the appendix is a rare finding, often mistaken for a polyp. We suggest considering inverted appendix as a differential diagnosis when investigating cecal lesions. [ABSTRACT FROM AUTHOR]

Neuromuscular and vascular hamartoma (NMVH) is an infrequent gastrointestinal lesion described in human and veterinary medical literature. The histologic features of this entity are haphazardly arranged fascicles of smooth muscle, nerve fibers, scattered ganglion cells, and hemangiomatous blood vessels. Here we describe 2 putative cases of NMVH in a 1.7-y-old, intact female Anatolian mixed-breed dog and a 4-mo-old intact male Akita dog. Both animals had gastrointestinal clinical signs, including hematochezia, and on exploratory laparotomy, intussusception was confirmed. Histologic examination confirmed NMVH within the cecal wall in both cases using a panel of immunohistochemical (IHC) markers for vascular structures (CD31), smooth muscle (alpha–smooth muscle actin [α-SMA]), and nerves (glial fibrillary acidic protein [GFAP] and S100). The complete surgical excision of the lesion in both animals was considered curative without persistent clinical signs 14 mo and 12 mo, respectively, after surgery. [ABSTRACT FROM AUTHOR]

Background: Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rotavac introduction in India and evaluated association of intussusception with enteric pathogens. Methods: In a case-control study nested within a large sentinel hospital-based surveillance program in India, stool samples from 272 children aged less than 2 years admitted for intussusception and 272 age-, gender- and location-matched controls were evaluated with Taqman array card based molecular assays to detect enteric viruses, bacterial enteropathogens and parasites. Matched case-control analysis with conditional logistic regression evaluated association of enteropathogens with intussusception. Population attributable fractions (PAF) were calculated for enteropathogens significantly associated with intussusception. Results: The most prevalent enteropathogens in cases and controls were enteroaggregative Escherichia coli, adenovirus 40/41, adenovirus C serotypes and enteroviruses. Children with intussusception were more likely to harbor adenovirus C serotypes (adjusted odds-ratio (aOR) = 1.74; 95% confidence interval (CI) 1.06–2.87) and enteroviruses (aOR = 1.77; 95% CI 1.05–2.97) than controls. Rotavirus was not associated with increased intussusception risk. Adenovirus C (PAF = 16.9%; 95% CI 4.7% − 27.6%) and enteroviruses (PAF = 14.7%; 95% CI 4.2% − 24.1%) had the highest population attributable fraction for intussusception. Conclusion: Adenovirus C serotypes and enteroviruses were significantly associated with intussusception in Indian children. Rotavirus was not associated with risk of intussusception. [ABSTRACT FROM AUTHOR]

Background: Adult colonic intussusceptions are relatively rare and are mostly caused by organic structures that serve as lead points. However, the pathogenesis of adult intussusception is not fully understood, and no cases of retrograde colonic intussusception without pathological abnormalities or associations with colonoscopy have been reported. Case Report: A 74-year-old woman presented with abdominal distension and constipation. Abdominal computed tomography (CT) revealed marked dilatation of the right and sigmoid colon, initially suggesting volvulus of the sigmoid colon. Observation of the left colon revealed no abnormal findings on the colonoscopy. Due to the persistence of abdominal symptoms from right colon dilatation, another colonoscopy was performed, and a transanal drainage tube was inserted into the transverse colon. Enterography showed a steep contrast interruption in the descending colon, which was missed at this time. The patient's abdominal pain worsened 3 days after removal of the drainage tube. Retrograde intussusception of the sigmoid colon was discovered on abdominal CT, and a laparoscopic left hemicolectomy was performed. Pathological examination revealed multiple ulcers in the superimposed area, but no abnormal organic findings that could be considered as a lead point were found. In this case, the stretching technique and/or shear stress on the sigmoid colon by a second colonoscopy may have contributed to the development of this condition. Conclusions: This is the first report of colonoscopy-associated retrograde colonic intussusception without organic abnormalities. Although much is unknown about the pathogenesis in this case, it may provide new insights into the pathogenesis of intussusception. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the clinical application of delayed repeated air enema (DRE) with sedation in pediatric intussusception. We retrospectively assessed cases of idiopathic intussusception treated with air enema reduction at the emergency department of Beijing Children's Hospital affiliated to Capital Medical University from January 2016 to August 2019. The included cases were assigned to the success or failure groups based on the outcomes of DRE with sedation. General patient information, clinical manifestations, test results, and surgical conditions were collected for comparative analysis. A total of 3052 cases were initially diagnosed with intussusception and underwent air enema reduction. Ultimately, 211 cases were included, with 162 in the success group and 49 in the failure group. The success rate of DRE with sedation was 76.8% (162/211), with an overall reduction success rate of 97.8% (2984/3052). Univariate logistic regression analysis showed that patients in the failure group had a significantly higher proportion of patients with age ≤1 year, bloody stools, and left-sided intussusception before DRE compared to the success group (OR = 2.3, 95%CI: 1.1∼4.6, P = 0.023; OR = 3.4, 95%CI: 1.6∼7.2, P = 0.002 and OR = 12.6, 95%CI: 4.6∼34.6, P < 0.001). Multiple logistic regression analysis based on these three factors revealed that the risk of DRE failure was 10.1 times higher in cases with the left-sided intussusception before DRE. DRE with sedation can improve the overall enema reduction success rate for intussusception and has good feasibility and safety profiles. Left-sided intussusception before DRE is an independent risk factor for enema failure. [ABSTRACT FROM AUTHOR]

Abstract Background Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rotavac introduction in India and evaluated association of intussusception with enteric pathogens. Methods In a case-control study nested within a large sentinel hospital-based surveillance program in India, stool samples from 272 children aged less than 2 years admitted for intussusception and 272 age-, gender- and location-matched controls were evaluated with Taqman array card based molecular assays to detect enteric viruses, bacterial enteropathogens and parasites. Matched case-control analysis with conditional logistic regression evaluated association of enteropathogens with intussusception. Population attributable fractions (PAF) were calculated for enteropathogens significantly associated with intussusception. Results The most prevalent enteropathogens in cases and controls were enteroaggregative Escherichia coli, adenovirus 40/41, adenovirus C serotypes and enteroviruses. Children with intussusception were more likely to harbor adenovirus C serotypes (adjusted odds-ratio (aOR) = 1.74; 95% confidence interval (CI) 1.06–2.87) and enteroviruses (aOR = 1.77; 95% CI 1.05–2.97) than controls. Rotavirus was not associated with increased intussusception risk. Adenovirus C (PAF = 16.9%; 95% CI 4.7% − 27.6%) and enteroviruses (PAF = 14.7%; 95% CI 4.2% − 24.1%) had the highest population attributable fraction for intussusception. Conclusion Adenovirus C serotypes and enteroviruses were significantly associated with intussusception in Indian children. Rotavirus was not associated with risk of intussusception.

One of the variants of clinical manifestation of Meckel’s diverticulum in pediatric patients is intestinal intussusception. In this case, the surgical intervention option may be laparoscopic disinvagination and resection of the diverticulum (if the clinic is equipped accordingly) or video-assisted surgery.This article presents a clinical observation of the diagnosis and simultaneous treatment of Meckel’s diverticulitis complicated by small-colonic intussusception and necrosis of the ileum, secondary appendicitis in combination with bilateral inguinal hernia in a 5-year-old girl. The described observation demonstrates the features of the intraoperative picture and surgical treatment, and describes in detail the effective treatment tactics and the course of surgical intervention.The described variant of simultaneous treatment of surgical diseases does not affect the course of the surgical period, and also made it possible to avoid repeated intervention (hernioplasty), reduced the anesthetic load (general anesthesia) and neutralized possible surgical stress.

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.

This case report discusses the clinical presentation, imaging findings, and successful management of a rare case of intussusception in a 6-month-old female infant referred to a regional hospital in Ghana. The patient presented with vomiting, lethargy, fever, and currant jelly stool. Differential diagnoses considered included Merkel diverticulum, volvulus, lymphadenopathy, and hypertrophic pyloric stenosis. Ultrasound imaging revealed a concentric lesion with characteristic signs of intussusception. Ileo-caeco coli intussusception was confirmed as the diagnosis. Surgical management was used for this patient. The postsurgery phase was without any complications. The patient recovered well and was discharged with a switch to oral medications. Infant intussusception is still a disease with a low morbidity rate.

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.

Background: Intussusception in young and old children is different. A study of clinical features, associations, and outcomes of these cases would enhance understanding to guide proper management. Objectives: Analysis of the epidemiology, associations, clinical features, and management outcomes of intussusception in children younger than 2 years. Patients and Methods: A retrospective descriptive study on intussusception patients younger than 2 years was conducted from January 2018 to December 2022 in the department of pediatric surgery at a tertiary center. Demographic details, clinical features, and management outcomes data were collected and analyzed. Results: A total of patients were 133 with mean, median, and modal age of 9.5, 7, and 6 months, respectively; the maximum incidence was in March. 81.95% of cases were idiopathic; important lead points were Meckel diverticulum, inflamed appendix, roundworm, cecal duplication, and intraluminal polyps. Two postoperative cases occurred in Wilms’ tumor and congenital diaphragmatic hernia patients, whereas two postrotavirus vaccination cases were seen. Ten (7.5%) had associated malrotation which necessitated Ladd’s procedure. Only 15 cases presenting early responded to nonoperative treatment (9/15 hydrostatic reduction and 6/15 conservative management); among late presenters, 12.71% had manual reduction, 68.64% had resection and anastomosis while in 16.95%, temporary stoma was needed. Wound infection, burst abdomen, subacute intestinal obstruction, recurrent intussusception, peristomal excoriation, and stomal prolapse were a few complications along with one death. Conclusion: Intussusception in children younger than 2 years is a heterogeneous group. Although mostly idiopathic, several associations and well-defined lead points require additional intervention. Early diagnosis and prompt intervention ensure a favorable outcome with fewer complications.

Adult intussusceptions are a rare cause of abdominal obstruction and are usually associated with a neoplastic disease; idiopathic forms are extremely rare. We report a case of enterocolic intussusception in a young woman who experienced symptoms of abdominal obstruction. Imaging findings were reported. On histological examination, no underlying diseases were found. The patient presented at the hospital for computed tomography because of persistent abdominal pain. Computed tomography revealed an enterocolic invagination involving the ileocecal valve and cecum and widespread edematous thickening of the colonic parietal walls. Idiopathic enterocolic intussusception is an uncommon abdominal urgency in adults. Symptoms can be vague and persistent, delaying an accurate diagnosis. Imaging is crucial in these circumstances to make a diagnosis. Some computed tomography findings, such as a target-like bulk, may be suggestive.

Background: Intestinal intussusception is the most common cause of intestinal obstruction in infants and children under 3 years of age. Any delay in diagnosis or management can lead to intestinal ischaemia and perforation. The aim of this study is to determine the sociodemographic and clinical risk factors associated with bowel resection in infants and children with intussusception. Materials and Methods: This is a retrospective analytical study of 118 patients operated at the Hassan II Hospital and University of Fez between 1 January 2008 and 1 January 2018. A comparison of risk factors between patients with and without bowel resection was performed using multivariate logistic regression. Results: One hundred and eighteen patients met the inclusion criteria. Of these, 44% had undergone bowel resection. Age >2 years (P = 0.006), duration of symptoms progression of more than 2 days (P = 0.002), bilious vomiting (P = 0.04) and palpation of an abdominal mass (P = 0.01) were significantly associated with bowel resection. Multivariate logistic regression showed that age

Intussusception is a condition in which the proximal segment of the bowel telescopes into the distal segment. 90% of the cases, especially in infants and toddlers, do not have any lead point and are due to lymphoid hypertrophy, following a viral infection. The presence of polyps in the form of lead point in children is rare. In fact, multiple polyps presenting as multiple sites intussusception are much rarer. We report a case of multiple intussusceptions in a 11-year-old female who presented with complaints of pain abdomen and blood-mixed stool. On imaging examination, she was found to having multiple polyps serving as a possible lead point, and was managed with hydroreduction. Imaging in case of multiple intussusception typically reveals concentric rings of bowel within the bowel giving a “target sign” on axial scans and a “pseudo-kidney sign” on coronal/sagittal CT scans. Our case report shows that, multiple intussusception due to multiple polyps can be a possibility for acute pain abdomen in children.

Introduction Rotavirus is a leading cause of severe diarrheal disease and death in children under five years of age worldwide. Vaccination is one of the most important public health interventions to reduce this significant burden.Areas covered This literature review examined vaccination coverage, hospitalization rate, mortality, genotypic distribution, immunogenicity, cost-effectiveness, and risk versus benefit of rotavirus vaccination in children in South America. Nine out of twelve countries in South America currently include a rotavirus vaccine in their national immunization program with coverage rates in 2022 above 90%.Expert opinion Introduction of the rotavirus vaccination has led to a marked reduction in hospitalizations and deaths from diarrheal diseases in children under 5 years, particularly infants under 1 year, in several South American countries. In Brazil, hospitalizations decreased by 59% and deaths by 21% (30–38% in infants). In Peru, hospitalizations in infants fell by 46% and deaths by 37% (56% in infants). Overall, data suggest that rotavirus vaccination has reduced rotavirus deaths by 15–50% in various South American countries. There is some evidence that immunity wanes after the age of 1-year old. Ongoing surveillance of vaccine coverage and changes in morbidity and mortality is important to maximize protection against this disease.

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.

A jejunal intussusception as a presentation of retroperitoneal liposarcoma (RLPS) is a rare occurrence. The majority of RLPS are presented as an abdominal mass, however, having a jejunal obstruction is an interesting case. The aim is to describe the management of jejunal intussusception secondary to atypical lipomatous tumours with concurrent RLPS. A 61-year-old lady presented with a sudden onset of intestinal obstruction with 1 month of constitutional symptoms and an enlarging right lumbar mass. Computed tomography showed a small bowel intussusception with diffuse peritoneal and retroperitoneal lipomatosis. Emergency exploratory laparotomy, segmental bowel resection, and partial excision of intraperitoneal mesenteric lipoma were performed. A stage En-bloc resection of the RLPS and right nephrectomy was done later. However, she refused for subsequent surgery. A complete resection is the gold standard in managing RLPS. In this report, the management is rendered not to the standard as the patient first presented with intestinal obstruction requiring emergency reduction with a piecemeal resection. A stage surgery was required to determine a promising prognosis, but the patient refused such surgery. A small bowel intussusception in adults is rare but is mostly caused by a tumor or neoplasm. Early recognition of the complexity of the case should be preempted and referred to the tertiary team for further definitive surgery. Patient exhaustion from the subsequent surgery might hamper the only management available for the case.

Trichobezoar is a rare surgical condition that mostly occurs in the stomach and often causes a surgical emergency when left untreated. It is often predisposed by psychiatric conditions, mental retardation, previous gastric surgery, or abnormal anatomy. Trichobezoar progresses extremely slowly and is diagnosed through imaging such as a barium series, endoscopy, or computed tomography. Surgical removal is typically required. The patient in this case was a 12-year-old girl who presented with symptoms of abdominal pain, vomiting, nausea and constipation. She was found to be anaemic and underweight. Contrast-enhanced Computed Tomography (CECT) diagnosed acute intussusception and small bowel obstruction, which were treated by emergency laparotomy. During the operation, a large primary ileal trichobezoar was found in the distal part of the ileum with hair strands extending up to the transverse colon. The absence of masses elsewhere made the diagnosis even more peculiar, as primary intestinal trichobezoar is highly uncommon. Primary closure of the enterotomy was performed as it was viable, and the postoperative period was uneventful. A history of trichophagia was elicited, and a psychiatric assessment of the patient was conducted. Behavioural therapy was initiated for the trichophagia. In conclusion, trichobezoar is a rare surgical entity with modifiable predisposing factors that require a multidisciplinary management approach.

Abstract Background Clostridioides difficile infection is associated with antibiotic use and manifests as diarrhea; however, emerging cases of fulminant diarrhea caused by binary toxin-producing C. difficile unrelated to prior antibiotic exposure have been reported. Although fulminant colitis caused by C. difficile has been documented, instances of intussusception remain scarce. Here, we present a case of adult intussusception with severe hypokalemia and pneumonia resulting from a community-acquired C. difficile infection in Japan. Case presentation An 82-year-old male presented with dizziness, progressive weakness, and diarrhea. Initial vital signs indicated severe respiratory and circulatory distress, and laboratory findings revealed hypokalemia, pneumonia, and septic shock. Imaging confirmed intussusception of the ascending colon. Although colonoscopy suggested a potential tumor, no malignancy was found. The C. difficile rapid test result was positive, indicating community-acquired C. difficile infection. Treatment with vancomycin was initiated; however, intussusception relapsed. Surgical intervention was successful and led to clinical improvement. The patient's complex pathophysiology involved community-acquired C. difficile-induced severe diarrhea, hypokalemia, hypermetabolic alkalosis, and subsequent intussusception. Although adult intussusception is uncommon, this case was uniquely linked to binary toxin-producing C. difficile. The identified strain, SUH1, belonged to a novel sequence type (ST1105) and clade 3, suggesting a highly virulent clone. Resistome analysis aligned with phenotypic susceptibility to metronidazole and vancomycin, confirming their treatment efficacy. Conclusion This case report highlights a binary toxin-producing C. difficile that caused intussusception. The consideration of community-acquired C. difficile in the differential diagnosis of severe enteritis is necessary, even in Japan.

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, a common cause of abdominal pain in children, often lacks clear underlying causes and is mostly idiopathic. Recurrence, though rare, raises clinical concerns, with rates escalating after each episode. Factors like pathological lead points and Henoch-Schönlein purpura (HSP) are associated with recurrent cases. On the other hand, the prevalence of Helicobacter pylori (H. pylori), often asymptomatic, in children has been declining. Although its infection is reported to be linked with HSP, its role in recurrent intussusception remains unexplored. Further research is needed to understand the interplay among H. pylori (culprit pathogen), HSP (trigger), and intractable intussusception so as to develop effective management strategies. Case presentation A two-year-old girl experienced four atypical episodes of intussusception at distinct locations, which later coincided with HSP. Despite treatment with steroids, recurrent intussusception persisted, suggesting that HSP itself was not a major cause for intractable presentations. Subsequent identification of H. pylori infection and treatment with triple therapy resulted in complete resolution of her recalcitrant intussusception. Conclusion This instructive case underscored a sequence wherein H. pylori infection triggered HSP, subsequently resulting in recurrent intussusception. While H. pylori infection is not common in young children, the coexistence of intractable intussusception and steroid-resistant recurrent HSP necessitates consideration of H. pylori infection as a potential underlying pathogen.

Angiogenesis, or the development of blood vessels by growing from already-formed vessels, is observed in embryonic development, physiological cyclical processes such as wound healing, the encapsulation of foreign bodies, tumor growth, and some other situations. In this review, we analyze the cellular mechanisms of angiogenesis, namely, angiogenesis by sprouting, ansiform (by loop formation) angiogenesis, coalescent angiogenesis, and angiogenesis by intussusception (splitting the capillary into two channels). The analysis of data revealed a lot of unanswered questions and contradictions. Here, we propose several new models of angiogenesis explaining these contradictions. [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Intussusception occurs when a proximal region of the intestine telescopes into a distal region. It is more common in the pediatric population, with only 5% of cases occurring in adults. The most frequent causes of adult intussusception are malignancy, polyps, or diverticula. A very rare cause is neuroendocrine tumor (NET). NETs are a diverse group of neoplasms that arise from endocrine cells throughout the body. Here, we present a case of a patient who presented with ileo-ileal intussusception due to a T3N1 NET, grade 1. Case Report: A 60-year-old man with a medical history of peptic ulcer disease presented for evaluation of lower abdominal pain, dark "maroon" colored stools, and hematemesis for the past 2 days. Computed tomography (CT) of the abdomen and pelvis showed ileo-ileal intussusception. Exploratory laparotomy revealed a small bowel mass approximately 30 cm from the ileocecal valve. After removal of 15 cm of small bowel and 13 lymph nodes, pathology confirmed the diagnosis of a T3N1 NET, grade 1. He was subsequently referred to the Oncology Department, where he was cleared, with no need for additional surveillance. Conclusions: In adult patients presenting with nonspecific abdominal pain and concern for small bowel obstruction, a CT scan can be helpful in diagnosing intussusception. When dealing with adult intussusception, the etiology needs to be carefully investigated to search for an underlying malignancy. In rare occasions, small bowel NETs can be the cause of intussusception and can therefore be identified early, before they metastasize and present with carcinoid syndrome. [ABSTRACT FROM AUTHOR]

Typical first-line management of children with intussusception is enema reduction; however, failure necessitates surgical intervention. The number of attempts varies by clinician, and predictors of failed nonoperative management are not routinely considered in practice. The purpose of this study is to create a scoring system that predicts risk of nonoperative failure and need for surgical intervention. Children diagnosed with intussusception upon presentation to the emergency department of a tertiary children's hospital between 2019 and 2022 were retrospectively identified. Univariable logistic regression identified predictors of nonoperative failure used as starting covariates for multivariable logistic regression with final model determined by backwards elimination. Regression coefficients for final predictors were used to create the scoring system and optimal cut-points were delineated. We identified 143 instances of ultrasound-documented intussusception of which 28 (19.6%) required operative intervention. Predictors of failed nonoperative management included age ≥4 y (odds ratio [OR] 32.83, 95% confidence interval [CI]: 1.91-564.23), ≥1 failed enema reduction attempts (OR 189.53, 95% CI: 19.07-1884.11), presenting heart rate ≥128 (OR 3.38, 95% CI: 0.74-15.36), presenting systolic blood pressure ≥115 mmHg (OR 6.59, 95% CI: 0.93-46.66), and trapped fluid between intussuscepted loops on ultrasound (OR 17.54, 95% CI: 0.77-397.51). Employing these factors, a novel risk scoring system was developed (area under the curve 0.96, 95% CI: 0.93-0.99). Scores range from 0 to 8; ≤2 have low (1.1%), 3-4 moderate (50.0%), and ≥5 high (100%) failure risk. Using known risk factors for enema failure, we produced a risk scoring system with outstanding discriminate ability for children with intussusception necessitating surgical intervention. Prospective validation is warranted prior to clinical integration. [ABSTRACT FROM AUTHOR]

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Background: Clostridioides difficile infection is associated with antibiotic use and manifests as diarrhea; however, emerging cases of fulminant diarrhea caused by binary toxin-producing C. difficile unrelated to prior antibiotic exposure have been reported. Although fulminant colitis caused by C. difficile has been documented, instances of intussusception remain scarce. Here, we present a case of adult intussusception with severe hypokalemia and pneumonia resulting from a community-acquired C. difficile infection in Japan. Case presentation: An 82-year-old male presented with dizziness, progressive weakness, and diarrhea. Initial vital signs indicated severe respiratory and circulatory distress, and laboratory findings revealed hypokalemia, pneumonia, and septic shock. Imaging confirmed intussusception of the ascending colon. Although colonoscopy suggested a potential tumor, no malignancy was found. The C. difficile rapid test result was positive, indicating community-acquired C. difficile infection. Treatment with vancomycin was initiated; however, intussusception relapsed. Surgical intervention was successful and led to clinical improvement. The patient's complex pathophysiology involved community-acquired C. difficile-induced severe diarrhea, hypokalemia, hypermetabolic alkalosis, and subsequent intussusception. Although adult intussusception is uncommon, this case was uniquely linked to binary toxin-producing C. difficile. The identified strain, SUH1, belonged to a novel sequence type (ST1105) and clade 3, suggesting a highly virulent clone. Resistome analysis aligned with phenotypic susceptibility to metronidazole and vancomycin, confirming their treatment efficacy. Conclusion: This case report highlights a binary toxin-producing C. difficile that caused intussusception. The consideration of community-acquired C. difficile in the differential diagnosis of severe enteritis is necessary, even in Japan. [ABSTRACT FROM AUTHOR]

Background Intussusception is the primary cause of acute bowel obstruction in infants. The majority of cases <2 years of age are classed as idiopathic, with viral infection implicated as one of the causes. Coronavirus disease 2019 (COVID-19) public health measures led to significant decreases in communicable disease prevalence. During these times, reductions in intussusception frequency were greater than would be expected with our previous understanding of its infectious etiology. Methods We conducted a retrospective, multistate, ecological study over a 12-year period. Monthly case numbers of "intussusception"-coded admissions (code K56.1; International Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) were acquired from state-wide admissions data sets from New South Wales, Victoria, and Queensland, representing 77.62% of the eligible Australian population. These counts within differing jurisdictional lockdowns were compared with non-lockdown periods in order to investigate a correlation between intussusception frequency and lockdown periods. Results We found a negative association between intussusception frequency and lockdown periods in both eligible states. The largest reductions were seen in the <2-year age groups, with Victoria experiencing a 62.7% reduction (rate ratio, 0.37; P <.001) and New South Wales a 40.1% reduction (0.599; P =.006) during lockdown times. Controls for variations in lockdown restrictions between both regional and metropolitan areas also showed expected decreases. Conclusions Our ecological study demonstrates significant decreases in the frequency of pediatric intussusception admissions during the COVID-19 lockdown periods. The unexpected magnitude of the reductions suggests that the true proportion of infectious disease-caused idiopathic intussusception is greatly underestimated. [ABSTRACT FROM AUTHOR]

BACKGROUND: The self-controlled case series (SCCS) is often used to monitor vaccine safety. The evaluation of intussusception after the rotavirus vaccine is complicated because the baseline rate varies with age. Time-varying baseline risk adjustments with data from unexposed cohorts are utilised. Self-controlled risk interval (SCRI), with a shorter observation period, can also mitigate the problem by studying a control period close to the risk period. OBJECTIVE: An Indian rotavirus vaccine has previously been studied using SCCS. The risk of intussusception in the high-risk windows (21 days after vaccination) was comparable to the background risk. The aim was to re-analyse data of an existing SCCS study using alternate statistical methods to examine vaccine safety. METHODS: We examined the mean age of intussusception in the vaccinated and the unvaccinated. We performed an SCRI analysis of the surveillance data from the SCCS study, limiting the observation period to 180 days. We analysed the time-to-intussusception from the last vaccination. Finally, we performed an SCCS analysis, excluding unvaccinated cases from the analysis. RESULTS: We found that the mean age of intussusception was significantly lower in the vaccinated (205 days) compared to the unvaccinated (223 days) (p-value 0.0026). The Incident Risk Ratio (IRR) on SCRI analysis was 1.62 (95% CI 1.07-2.44). There were significantly more intussusceptions in the first 30 days after vaccination compared to the next 30-day window. (92 vs 63 p-value = 0.009). We found that excluding unvaccinated infants from the SCCS analysis demonstrated significantly increased risk for the risk period 1–21 days after the 3rd dose (IRR 2.47, 95% CI 1.70-3.59). The risks of intussusception were missed in traditional SCCS analysis using unvaccinated infants as controls. CONCLUSION: Traditional risk adjustments using data from unexposed cohorts in SCCS may not be appropriate for investigating the risk of intussusception where vaccination lowers the mean age of intussusception. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Intussusception in adults is a rare manifestation after traumatic abdominal surgery, because after abdominal surgery patients often have functional bowel paralysis rather than increased intestinal motility. Case Report: 39-year-old male patient with acute intussusception appeared after surgery for diaphragmatic and splenic rupture. On day 7 postop, the patient has clinical manifestations of small bowel obstruction. Computed tomography image shows evidence of jejunum-jejunal intussusception. Exploratory laparotomy and resection of the necrotic bowel were performed. Rare cases such as intussusception should be observed postoperatively and in similar manifestations with careful examination of the characteristic CT findings, because of early detection and surgical intervention. with manual reduction can prevent the need for small bowel resection and possible unwanted complications. Discussion: Postoperative intussusception is rare and occurs primarily in the small intestine and should be indicated for emergency surgery in all cases, and this should be kept in mind by the surgeon and the resuscitator. The early diagnosis and intervention of patients increase the survival rate and the surgical efficiency. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Most adult cases of intussusception are caused by colorectal cancer, and emergency surgery is performed when symptoms such as abdominal pain and vomiting are present. The patient must customarily undergo both bowel decompression and radical surgery for colorectal cancer at the same time, and laparotomy is generally the procedure of choice. Case presentation: An 86-year-old woman presented to our hospital with diarrhea and bloody stools. Preoperative examination revealed the presence of a cancerous tumor in the advanced part of the transverse colon and bowel intussusception. Radical surgery was successfully performed using the laparoscopic single-port technique through a small incision at the umbilical site to treat intussusception caused by cecum cancer. Conclusions: With only one wound site at the umbilicus, this single-port laparoscopic approach is much less invasive than endoscopic surgery that requires four to five incision wounds to perform the procedure. Furthermore, the patient was discharged without major complications and this surgical technique could be of great benefit if established as a standard procedure in the future. [ABSTRACT FROM AUTHOR]

Introduction. Gastrointestinal stromal tumours (GISTs) are considered the most common mesenchymal lesions of the gastrointestinal tract, despite accounting for less than 1% of cancers diagnosed in this area. They frequently occur in the stomach and small intestine, rarely in the colon and esophagus. Case Report. The report concerns an unusual case of a patient referred to hospital with abdominal pain and suspected ileocecal intussusception. Ileus was confirmed during diagnostic evaluation. Surgical resection of the tumour mass was performed to release intestinal loops. Based on histology and immunohistochemical staining, GIST was diagnosed. Currently, the patient remains under constant clinical monitoring. Conclusions. The evolution of gastrointestinal stromal tumours is highly variable. Both the signs and symptoms and tumor localization in the described case are very unusual for this disease. Adequate diagnosis remains critical to implement appropriate therapeutic management. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Immunoglobulin A (IgA) vasculitis with intussusception is acute and severe vasculitis combined with acute abdomen in children. The diagnosis of the disease depends on the results of imaging examinations, and its treatment mainly includes enema and surgery. The literature summarized the detailed diagnosis and treatment data in previous literature reports. Methods: We described the clinical manifestations, ultrasonic features, and treatment of patients admitted to a single center and reviewed previous literature regarding cases with detailed clinical data in the PubMed database within the past 20 years. Results: The review included 36 patients, including 22 boys and 14 girls. A total of 32 patients were diagnosed using ultrasound (88.9%). The main sites of intussusception were the ileum and ileocolon in 16 (44.4%) and 11 (30.6%) cases, respectively. Thirteen patients (36.1%) were treated with enema, with 6 responding to the treatment. 26 patients (72.2%) underwent surgical treatment. Patients with ileal intussusception were more likely to be treated with surgery than those with colonic intussusception (P <.05). The single-center clinical data of 23 patients showed that there was no significant difference in laboratory test findings between patients with and without surgical treatment (P >.05). Patients with long insertion lengths were more likely to require surgery and resection (P <.05). Conclusions: Ultrasonography is the first-line investigation for diagnosis. The main sites of intussusception were ileum and ileocolon. The length of intubation was related to surgery; treatment is according to the intussusception site. Air enema is not suitable for intussusception of the small intestine. [ABSTRACT FROM AUTHOR]

Background: Intussusception, a common cause of abdominal pain in children, often lacks clear underlying causes and is mostly idiopathic. Recurrence, though rare, raises clinical concerns, with rates escalating after each episode. Factors like pathological lead points and Henoch-Schönlein purpura (HSP) are associated with recurrent cases. On the other hand, the prevalence of Helicobacter pylori (H. pylori), often asymptomatic, in children has been declining. Although its infection is reported to be linked with HSP, its role in recurrent intussusception remains unexplored. Further research is needed to understand the interplay among H. pylori (culprit pathogen), HSP (trigger), and intractable intussusception so as to develop effective management strategies. Case presentation: A two-year-old girl experienced four atypical episodes of intussusception at distinct locations, which later coincided with HSP. Despite treatment with steroids, recurrent intussusception persisted, suggesting that HSP itself was not a major cause for intractable presentations. Subsequent identification of H. pylori infection and treatment with triple therapy resulted in complete resolution of her recalcitrant intussusception. Conclusion: This instructive case underscored a sequence wherein H. pylori infection triggered HSP, subsequently resulting in recurrent intussusception. While H. pylori infection is not common in young children, the coexistence of intractable intussusception and steroid-resistant recurrent HSP necessitates consideration of H. pylori infection as a potential underlying pathogen. [ABSTRACT FROM AUTHOR]

A 65-year-old male patient came to our hospital complaining of melena. Abdominal CT revealed intestinal intussusception and a tumor in the rectosigmoid region was observed on lower gastrointestinal endoscopy. Accordingly, a diagnosis of intussusception due to rectal cancer was made. However, as the patient did not present with intestinal obstruction, it was decided to perform an elective surgery. Intraoperatively, the rectum was spontaneously repositioned by blunt compression. A laparoscopic procedure was employed to perform anterior resection. The patient had a good postoperative course and was discharged from the hospital on postoperative day 11. Intussusception due to rectal cancer is rare, but it is occasionally encountered in daily medical practice. Recent surgical cases of this disease are also reviewed in the current report. [ABSTRACT FROM AUTHOR]

A 2‐year‐old, male reindeer (Rangifer tarandus tarandus) presented for further investigations and treatment of acute colic signs. On clinical investigations, an ultrasonographic abdominal exam revealed multiple hypomotile, dilated and fluid‐filled small intestinal loops. Based on clinical findings and increased signs of abdominal pain, small intestine obstruction was suspected, and an exploratory laparotomy was performed. The animal was premedicated with medetomidine (0.003 mg/kg) and butorphanol (0.05 mg/kg) intravenously. General anaesthesia was induced with ketamine (2 mg/kg intravenously) and propofol (3 mg/kg intravenously), and maintained with isoflurane in oxygen. Additional analgesia was provided with methadone (0.1 mg/kg intravenously) and ketamine (0.5 mg/kg intravenously). A jejuno‐jejunal intussusception requiring resection of approximately 6 inches (15 cm) was identified and jejuno‐jejuno anastomosis was performed. Fluid resuscitation was administered for treatment of hypotension during general anaesthesia. Recovery from anaesthesia was uneventful. Nevertheless, the deer was euthanased 5 days later due to clinical deterioration. [ABSTRACT FROM AUTHOR]

Copyright of Journal of the Japanese Society of Pediatric Surgery is the property of Japanese Society of Pediatric Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Adult-onset intussusception, particularly associated with colonoscopy, is extremely rare. A 78-year-old man, referred to our hospital for colonic endoscopic mucosal resection (EMR), experienced subsequent dull abdominal pain, as well as elevated peripheral blood leukocytosis and C-reactive protein levels. Abdominal computed tomography (CT) revealed a colocolonic intussusception at the hepatic flexure. Emergency colonoscopy revealed ball-like swollen mucosa distal to the EMR site of the ascending colon. The mucosa was intact without necrosis. The endoscopic approach was able to temporarily release the intussusception. A transanal drainage tube was inserted through the endoscope to prevent relapse. Both CT and colonoscopy showed release of the intussusception. Our case underscores the importance of considering colocolonic intussusception in post-colonoscopy abdominal pain, advocating for endoscopic management after excluding mucosal necrosis. [ABSTRACT FROM AUTHOR]