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      Call for Papers: Artificial Intelligence in Gastroenterology

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      About Digestion: 3.0 Impact Factor I 7.9 CiteScore I 0.891 Scimago Journal & Country Rank (SJR)

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      Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma

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          Abstract

          Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well.

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          Most cited references11

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          Adult intussusception.

          T. Azar, D L Berger (1997)
          The objectives were to review adult intussusception, its diagnosis, and its treatment. Adult intussusception represents 1% of all bowel obstructions, 5% of all intussusceptions, and 0.003%-0.02% of all hospital admissions. Intussusception is a different entity in adults than it is in children. The records of all patients 18 years and older with the postoperative diagnosis of intussusception at the Massachusetts General Hospital during the years 1964 through 1993 were reviewed retrospectively. The 58 patients were divided into those with benign enteric, malignant enteric, benign colonic, and malignant colonic lesions associated with their intussusception. The diagnosis and treatment of each were reviewed. In 30 years at the Massachusetts General Hospital, there are 58 cases of surgically proven adult intussusception. The patients' mean age was 54.4 years. Most patients presented with symptoms consistent with bowel obstruction. There were 44 enteric and 14 colonic intussusceptions. Ninety-three percent of the intussusceptions were associated with a pathologic lesion. Forty-eight percent of the enteric lesions were malignant and 52% were benign. Forty-three percent of the colonic lesions were malignant and 57% were benign. Intussusception occurs rarely in adults. It presents with a variety of acute, intermittent, and chronic symptoms, thus making its preoperative diagnosis difficult. Computed tomography scanning proved to be the most useful diagnostic radiologic method. The diagnosis and treatment of adult intussusception are surgical. Surgical resection of the intussusception without reduction is the preferred treatment in adults, as almost half of both colonic and enteric intussusceptions are associated with malignancy.
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            Surgical management of intussusception in the adult.

            D. M. Nagorney, M. Sarr, D C McIlrath (1981)
            Controversy concerning the appropriate surgical management of intussusception in the adult prompted review of the Mayo Clinic's experience with this uncommon entity. During the last 23 years, 48 patients had documented intussusception: 24 instances of intussusception originating in the small intestine and 24 instances of intussusception originating in the colon. Two-thirds of the colonic intussusceptions were associated with primary carcinoma of the colon. Only one-third of the intussusceptions of the small intestine were harbingers of malignancy, and 70% of these lesions were metastatic. Because of these findings, we advocate resection of intussusceptions of the colon without initial surgical reduction, in order to minimize the operative manipulation of a potential malignancy. In the patient with intussusception of the small intestine, an associated primary malignancy is uncommon. Initial reduction, followed by limited surgical resection, is the preferred treatment. Surgical resection without reduction is favored only when an underlying primary malignancy is clinically suspected.
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              Tumor spectrum of adult intussusception.

              Ming-Hsien Chiang, Yann-Sheng Lin (2008)
              Adult intussusception is rare. Most general and colorectal surgeons are unfamiliar with its etiology and optimal management. Patients older than 16 years and diagnosed with intestinal intussusception between January 1990 and June 2006 were retrospectively reviewed. Data related to presentation, diagnosis, treatment, and pathology were analyzed. Seventy-two patients underwent surgery for intestinal intussusception. Neoplasm was identified as the cause of intussusception in 66 (92%) cases, and 6 (8%) were idiopathic. The incidence of malignant colonic intussusception (63%) was significantly higher than that of enteric intussusception (20%), P = 0.001. Primary colon adenocarcinoma (8 of 10 patients, 80%) and malignant lymphoma (2 of 10 patients, 20%) were the two most common underlying malignant lesions in the colon. Lipoma (15 of 40 patients, 38%) and Peutz-Jegher adenoma (10 of 40 patients, 25%) were the two most common lesions of benign small bowel neoplasms while 27% (3 of 11) of malignant enteric intussusception cases were malignant lymphoma and metastatic respectively. Lipoma is the most common benign tumor in both small and large bowel intussusception. Whereas 80% of tumors associated with small bowel intussusception were benign, two-thirds of colonic intussusceptions had resulted from primary adenocarcinoma. (c) 2008 Wiley-Liss, Inc.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Gastroenterol
                Journal ID (publisher-id): CRG
                Title: Case Reports in Gastroenterology
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                ISSN (Electronic): 1662-0631
                Publication date Collection: Sep-Dec 2009
                Publication date (Electronic): 21 November 2009
                Publication date PMC-release: 21 November 2009
                Volume: 3
                Issue: 3
                Pages: 377-381
                Affiliations
                [1] aDepartment of Surgery, Jikei University School of Medicine, Tokyo, Japan
                [2] bDepartment of Surgery, Nishisaitama-Chuo National Hospital, National Hospital Organization, Saitama, Japan
                [3] cDepartment of Pathology, Nishisaitama-Chuo National Hospital, National Hospital Organization, Saitama, Japan
                Author notes
                *Hiroaki Shiba, Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo 105-8461 (Japan), Tel. +81 3 3433 1111 ext. 3401, Fax +81 3 5472 4140, E-Mail hs0817@ 123456jikei.ac.jp
                Article
                Publisher ID: crg0003-0377
                DOI: 10.1159/000254859
                PMC ID: 2988933
                PubMed ID: 21103257
                SO-VID: c651da13-ba35-418d-93e7-43992364d026
                Copyright © Copyright © 2009 by S. Karger AG, Basel
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License ( http://creativecommons.org/licenses/by-nc-nd/3.0/). Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

                History
                Page count
                Figures: 3, References: 11, Pages: 5
                Categories
                Subject: Published: November 2009

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: intussusception,adult,lipoma
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: intussusception, adult, lipoma

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