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Query: UMLS:C0021933 (intussusception)
 3,822 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From July 1985 through January 1986, 43 patients underwent urinary diversion that included creation of a continent reservoir from an ileal segment, according to the method described originally by Kock. An important modification included removal of a narrow strip of mesentery for 8 cm along the afferent and efferent limbs of the pouch to allow adequate ileal intussusception and fixation of the nipple valves to prevent reflux and to ensure continence. A strip of PGA mesh serves as a collar to fix the afferent-efferent limb to the pouch once the intussusception technique has been accomplished. The use of a narrow Marlex strip allows fixation to the abdominal wall both lateral and medial to the stoma site (insert). This strip is important in preventing a parastomal hernia and helps fix the continence valve mechanism to the posterior abdominal wall. Previous urinary diversion was by ureterosigmoidostomy in 2 patients, standard ileal conduit in 8 and chronic dialysis after nephrectomy of solitary kidney and cystectomy in 1. A total of 32 patients underwent simultaneous anterior exenteration or radical cystectomy for pelvic malignancy. There were 4 postoperative deaths and early complications occurred in one patient. Late complications occurred in only 3 patients: they required reoperation and revision of the continence valve mechanism. The end result in 39 of 43 patients has been an overwhelming success. Patients perform self-catheterization every 4 to 6 hours during the day and once at night for volumes ranging up to 1,400 cc. Serum electolytes have remained normal in all patients. X-ray of the Kock pouch have shown no evidence of reflux, and all excretory urograms have demonstrated either normal upper tracts without obstruction or improvement in patients with preoperative hydronephrosis. Although preliminary, this clinical trial suggests that the quality of life for patients considered previously to be candidates for cutaneous diversion can be improved markedly by a modified Kock continent ileal reservoir. During the same time, 21 patients out of 278 patients who underwent creation of a Kock continent ileal urinary reservoir since August 1982, underwent revision of Kock pouch. Two of those required subsequent reoperation and revision of the continence valve mechanism. The end result in all patients has been an overwhelming success.
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PMID:[The Kock continent ileal urinary reservoir: surgical technic and clinical results]. 377 74

Adult intussusceptions due to metastatic intestinal-tumor are very rare. A 71-year-old man with an intussusception due to intestinal metastasis of renal carcinoma is reported. To our knowledge, this is the third such patient in the Japanese literature. The patient was suffered from an intestinal obstruction six months after his renal carcinoma was detected. Laparotomy was performed, revealing that he had developed a jejunojejunal intussusception due to metastasis of renal carcinoma. The early diagnosis of metastatic intestinal tumor is difficult. It is important to bear in mind that patients with malignant tumor may already have metastasis.
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PMID:[A case of intussusception due to intestinal metastasis of renal carcinoma]. 378 86

Intussusception in the adult is rare. The cases reported here illustrate the usual clinical development of the condition: incomplete, subacute, or chronic subobstruction. Intussusception is usually associated with a localized lesion, mostly a small bowel benign tumor, and a colonic malignant tumor. Diagnosis is effected using barium enema, ultrasonography, or CT scanning. Treatment of intussusception requires surgical intervention.
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PMID:Intussusception in adults--report of 3 cases. 398 33

These complications are uncommon, but can be very serious. They are dominated by perforations, in the case of barium enemas. The use of rigid canulas and/or balloons are often implicated in rectal perforations which occur most readily in rectal tissue damaged by a biopsy. Colonic perforations usually occur in damaged tissues (various forms of colitis, cancer, colostomy). The hydrostatic pressure seems to be incriminated as a precipitating factor in the development of spasms in the presence of an underlying obstruction. The other complications are much less common. In children, perforation usually occurs during reduction of an intestinal intussusception. The complications of embolisation of the abdominal arteries consist of necrosis; the left colonic flexure is at greatest risk because of its blood supply. Emergency embolisation can be performed provided certain rules are respected.
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PMID:[Colorectal complications of radiological examinations]. 409 2

The clinical records and histologic sections of 96 cases of primary small bowel malignancies (excluding lymphomas and periamullary lesions) were reviewed. The location, clinical presentation, pathologic findings, treatment and outcome are compared to the collected published experience, approximately 2400 cases. There were 48 adenocarcinomas, 37 carcinoids, and 11 leiomyosarcomas. Fifty-one men and 45 women ranged from 31 to 83 years old. Eighty-four caused symptoms leading to operative diagnosis; 12 carcinoids were incidental autopsy findings. The most common presentation was pain (33%) followed by weight loss (23%) obstruction (16%), hemorrhage (15%), jaundice (5%), intussusception (3%) and perforation (3%). Masses were felt in 30% of the cases, but were usually dilated bowel or intussusception rather than the tumor per se. Curative resection was attempted in 80 of 84 operatively diagnosed tumors. The 80% mortality among patients followed 5 years is attributed to the late appearance of symptoms and anatomic obstacles to a truly radical operation.
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PMID:Primary malignancies of the small bowel: a report of 96 cases and review of the literature. 484 46

Malignant melanoma is the most common malignancy to metastasize to the gastrointestinal tract. In a retrospective computer-assisted data search of over 2500 patients with melanoma registered over the past 10 years, 110 patients have been identified to have premortem gastrointestinal metastatic disease (metastatic disease identified at least 6 months before death). The small intestine (35%), colon (14.5%), and stomach (7%) are the most common sites for metastases. Polypoid or ulcerating masses and intramucosal nodules are typical radiologic presentations for gastric and colonic lesions, while over 50% of the small bowel metastases are polypoid masses that many times act as leading points for intussusception. Endoscopic studies are helpful in the preoperative diagnosis of these lesions. In a subset of 38 patients with symptomatic small bowel metastatic disease, complete resections were performed in 26% of patients, with palliative bypasses being performed in 40%, despite the fact that over 50% of the patients had documented visceral metastasis in other body sites. The operative morbidity rate was 15% with no operative deaths. Ninety percent of patients gained relief of symptoms, and overall survival from the time of confirmed small bowel disease averaged 17.3 months, with a range of 6 months to 9 years. It would seem that patients with melanoma with gastrointestinal metastatic disease can benefit from aggressive radiologic and endoscopic procedures for diagnosis and staging. Only through surgical interventions for symptomatic gastrointestinal disease can the quality of life be improved and life expectancy be extended.
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PMID:Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract. 620 81

Radiation has been given intraoperatively to various abdominal structures in dogs, using a fixed horizontal 11 MeV electron beam at the Armed Forces Radiobiologic Research Institute. Animals were irradiated with single doses of 2000, 3000 and 4500 rad to a field which extended from the bifurcation of the aorta to the rib cage. All animals were irradiated during laparotomy under general anesthesia. Because the clinical use of intraoperative radiotherapy in cancer treatment will occasionally require irradiation of anastomosed large vessels and blind loops of bowel, the tolerance of aortic anastomoses and the suture lines of blind loops of jejunum to irradiation were studied. Responses in these experiments were scored at times up to one year after irradiation. In separate experiments both aortic and intestinal anastomoses were performed on each animal for evaluation of short term response. Response was graded by arteriography, gastrointestinal roentgenography, blind loop bursting pressure, and pathologic findings at autopsy and microscopic evaluation. The dogs with aortic anastomoses showed adequate healing at all doses with no evidence of suture line weakening. On long-term follow-up one animal (2000 rad) had stenosis at the anastomosis and one animal (4500 rad) developed an arteriovenous fistula. Three of the animals that had an intestinal blind loop irradiated subsequently developed intussusception, with the irradiated loop acting as the lead point. One week after irradiation, bursting pressure of an intestinal blind loop was normal at 3000 rad, but markedly decreased at 4500 rad. No late complications were noted after the irradiation of the intestinal anastomosis. Thus, it appears that adequate healing can take place with minimal risk of suture line breakdown even after a high single dose of irradiation (up to 3000 rad) to an anastomotic site. No late complications were observed after irradiation of intestinal anastomoses, but one needs to be cautious with regards to possible late stenosis at the site of an irradiated vascular anastomosis.
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PMID:Tolerance of canine anastomoses to intraoperative radiation therapy. 640 41

The four common types of small bowel malignancies have different clinical presentations, routes of metastatic spread, and prognoses, and may require selective treatment. A review of our experience over a 16-year period revealed 45 cases: 16 adenocarcinomas, 13 carcinoids, nine leiomyosarcomas, five lymphomas, and two fibrosarcomas. Adenocarcinomas tend to occur in the upper part of the small intestine, cause obstruction and occult blood loss, and metastasize to the regional nodes and liver. Carcinoids generally begin in the distal portion of the small bowel, may form rather large metastatic masses and cause obstruction from a metastatic mass or intussusception, and are often multiple. Leiomyosarcomas develop in any part of the bowel, may present a primary mass, gross hemorrhage, or perforation, and have blood-borne metastases. Lymphomas tend to occur in the distal part of the small bowel, with pain or mass formation, and spread via the lymphatics. Critical analysis of the clinical presentation and findings should allow preoperative recognition of the specific pathologic type.
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PMID:Malignant tumors of the small bowel. 648 73

From August 1982 through January 1984, 51 patients underwent urinary diversion that included creation of a continent reservoir from an ileal segment, according to the method described originally by Kock. An important modification included removal of a narrow strip of mesentery for 8 cm. along the afferent and efferent limbs of the pouch to allow adequate ileal intussusception, and fixation to prevent reflux and to ensure continence. Previous urinary diversion was by ureterosigmoidostomy in 3 patients, standard ileal conduit in 7 and suprapubic cystotomy in 1. A total of 39 patients underwent simultaneous anterior exenteration for pelvic malignancy. There was 1 postoperative death and early complications occurred in 10 patients. Of these 10 patients 4 required reoperation: 2 for drainage of a pelvic abscess, 1 for conversion to a standard ileal conduit and 1 for bleeding. Late complications occurred in only 8 patients: 5 required reoperation and revision of the continence valve mechanism, and 3 required hospitalization for brief episodes of pyelonephritis. The end result in 49 of 50 patients has been an overwhelming success. Patients perform self-catheterization every 4 to 6 hours during the day and once at night for volumes ranging up to 1,400 cc. Serum electrolytes have remained normal and hyperchloremic acidosis has been encountered in only 1 patient who had had compromised renal function preoperatively with hyperchloremic acidosis as a result of previous ureterosigmoidostomy. X-rays of the Kock pouch have shown evidence of reflux in only 1 patient, and all excretory urograms have demonstrated either normal upper tracts without obstruction or improvement in patients with preoperative hydronephrosis. Although preliminary, this clinical trial suggests that the quality of life for patients considered previously to be candidates for cutaneous diversion can be improved markedly by a modified Kock continent ileal reservoir.
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PMID:Clinical experience with the Kock continent ileal reservoir for urinary diversion. 650 96

The role of ultrasound scanning in the diagnosis of cancer of the colon under emergency conditions such as intestinal obstruction, perforation or, more rarely, heavy colonic bleeding, is discussed. In any case, ultrasound scanning can quickly and rationally indicate choices for further assessment when possible. Characteristic ultrasonic images are described, and possible differential diagnoses are discussed briefly. The method seems significantly sensitive, although nonspecific, as it can give analogous images in cases of inflammatory pseudo-tumors, Crohn's disease, and adult intussusception.
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PMID:Ultrasonic detection of colonic carcinoma in emergency. 669 43


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