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

In contrast with the incidence in Britain and the United States, about 50% of intussusceptions in Sri Lanka occur in adults, the maximum age incidence being in the fourth decade. Seventy-six cases of intussusception in adults are analysed in this paper, 62 of which were of the caecocolic type, which though only rarely described in the West, have also been frequently reported from other tropical countries. The clinical picture was characteristic, and a mass was palpable in 90% of the patients, facilitating diagnosis without ancillary investigations. On the basis of the histological examination of resected specimens it is concluded that amoebic granulomatous formation in the dependent "diverticulum" of the caecum is the predisposing cause of the caecocolic intussusception, accounting for the chronicity of a large number of cases. Irrespective of the duration of the illness, gangrene did not occur in any of the cases if this type, although resection was occasionally required on account of irreducibility. In view of the proliferation of fibrous tissue in the wall of the caecum, complete evagination of the intussusception can only be achieved by surgical exploration and manipulation, the results of which are excellent.
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PMID:Tropical intussusception in adults. 106 5

In a prospective evaluation of acute intestinal obstruction in emergency surgery, 3550 consecutive patients were studied. In the vast majority of patients (75%), obstruction was due to the external hernia, the inguinal hernia being by far the commonest type. However, the ascaris worm in children, volvulus of the sigmoid colon in adults, and intussusception in both children and adults, were significant causes of the disorder, and together accounted for 18% of the patients. Obstruction by the ascaris worm is easy to diagnose (by stool microscopy), and effective treatment (with antihelminthics) is readily available and cheap. A large number (90%) of the volvulus patients required resection for gangrene of the colon, thus arguing a strong case in support of laparotomy and inspection of the colon whenever feasible. A significant (41%) proportion of intussusception cases were adult, and in 33% of this group the lesion was associated with a tumour of the small bowel. The chief reason for death (10%) was late reporting to hospital.
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PMID:Tropical surgical abdominal emergencies: acute intestinal obstruction. 190 26

The authors report the first documented case of retrograde enteroenteric intussusception after a Roux-en-Y gastrectomy. Computed tomography demonstrated intussusception and gangrene of the bowel, in which the intussuscipiens was the afferent loop of the duodenojejunal segment and the intussusceptum was the efferent loop of the jejunum after bypass surgery.
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PMID:Retrograde intussusception of the bypassed duodenojejunal segment after Roux-en-Y gastrectomy: computed tomography findings. 203 56

High mortality rates associated with mesenteric ischaemia are a tremendous challenge. We reviewed 43 patients admitted to Chang Gung Memorial Hospital between 1981 and 1988. A total of 24 patients (55.8%) had thrombosis or embolus of the superior mesenteric artery, five patients (11.6%) had superior mesenteric vein thrombosis, and 14 patients (32.6%) had non-occlusive infarction. Patients with mechanical obstructions (volvulus, intussusception, tumour compression, aortic dissection) causing mesenteric ischaemia were excluded. The initial symptoms were not specific before signs of peritonitis presented. The tetrad of leucocytosis (88.4%), metabolic acidosis (88.6%), hyperamylasaemia (46.9%) and elevated phosphate (33.3%) was noted to be significant. There was a high association with previous cardiovascular diseases (78.2%). The plain abdominal X-ray, which was the most frequently used investigative tool, showed suggestive but non-specific findings. A total of 38 patients (88.4%) were operated upon. In six patients (14%) the exploratory laparotomy was open and closed because the bowel gangrene was too extensive. The total mortality rate was 55.8%. To improve prognosis, clinical awareness of the problem should be raised and the use of mesenteric angiography should be encouraged in an attempt to obtain an early diagnosis.
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PMID:The spectrum of acute intestinal vascular failure: a collective review of 43 cases in Taiwan. 210 56

The clinical features and operative findings in 37 infants and 29 older children with intussusception seen over a 10-year period were compared and contrasted. While most of the children presented acutely, 28% of older children had chronic intussusception compared with 5% in infants. Only about a third of all children had the four classical features of abdominal pain, vomiting, abdominal mass and bloody stool; the rest had two or three of the above features. Pain and palpable abdominal mass were more common features in older children while abdominal distension, constipation and diarrhoea were more prominent in infants. Fifty-four per cent of intussusceptions in infants were entero-colic while in older children 69% were colonic. All the intussusceptions in infants were idiopathic while in 14% of older children there were predisposing causes. Resection for gangrene/perforation was required in 30% of infants compared with 7% of older children.
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PMID:Intussusception in infants and older children: a comparison. 244 47

103 patients with intestinal gangrene were treated over a ten-year period in Ile-Ife, Nigeria. The various causes of the intestinal gangrene were herniae (63%), intussusception (20%), adhesions (12%), volvulus (3%) and mesenteric vascular occlusion (2%). The presence of pre-operative shock, purulent and faeculent peritonitis, intra-peritoneal perforation of bowel and involvement of long bowel segments in the gangrene process; constitutes the important prognostic factors. The presence of a pre-operative febrile response also influences the course of the disease while the age and sex of the patient, the duration of symptoms and the portion of bowel involved showed no relationship with the ultimate outcome. It is recommended that the patients with the ominous prognostic factors constitute a high risk group and should be given intensive care to ensure survival.
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PMID:Prognostic factors in intestinal gangrene. 271 52

One hundred and three patients with intestinal gangrene were managed in Ile-Ife, Nigeria over a 10-year period. The overall mortality in the series was 25.2%. Strangulated hernias were responsible for 65 cases (63%), intussusception 20.4%, adhesions 11.7% and volvulus 2.9%. Avoidable deaths resulted from anastomotic breakdown and inadequate preoperative fluid therapy. Primary intestinal resection and end-to-end anastomosis of large bowel involved in gangrene gave very good results. It was found to be quite safe and economical, and avoided the inconveniences and complications of a colostomy.
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PMID:Experience with 103 cases of intestinal gangrene in Ile-Ife, Nigeria. 292 10

Strong evidence in the literature suggests that improvements in the management and outcome of small bowel obstruction result from early diagnosis, better fluid and electrolyte replacement, use of antibiotics, and early surgical intervention. This paper reviews the outcomes of 49 male and 31 female patients who were operated on for small bowel obstruction. The average age was 38 years (range, 3 to 87 years); the average hospital stay was 13 days. There was one death. The causes of obstruction included postoperative adhesions (78 percent), strangulated external hernia (11 percent), gangrenous bowel (4 percent), intussusception (2.5 percent), appendiceal mass (3.5 percent), and Meckel's diverticulum (1 percent). The outcome was worse with late presentation, perforation or gangrene of the bowel, and delayed surgery.
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PMID:Small bowel obstruction: review of nine years of experience. 650 26

A retrospective study of the clinical features and surgical management of 98 cases of paediatric intussusception treated in New Zealand during the past 16 years is presented. The classic triad of vomiting, rectal bleeding and abdominal pain occurred in only 20 percent of patients. Barium enema examination was used in 67 patients but successful reduction was achieved in only 13. Laparotomy was performed in 85 patients with 1 operative death. Gangrenous bowel was found in 17 patients and 24 required bowel resection with no associated mortality. This high rate of bowel resection appears to be related to the long duration of symptoms before the diagnosis was established. It is concluded that earlier diagnosis is the single factor most likely to reduce morbidity.
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PMID:Intussusception: analysis of 98 cases. 727 91

This study reviews all childhood intussusceptions treated over a 6 year period in a regional centre with six visiting general surgeons and two paediatricians. Clinical presentation, management, complications and outcomes were noted and an attempt was made to follow up all cases. There were 20 patients, with a median age of 6 months (range 10 weeks to 17 months). Only one patient had all four classical features of intussusception (pain, vomiting, 'red currant jelly' stools and abdominal mass). Seven patients were managed successfully by barium enema reduction, but 14 required operation, four following failed radiological reduction. There was one intestinal perforation due to attempted barium enema reduction and one patient required a reoperation for ileal gangrene following operative reduction. There were no deaths and there have been no subsequent recurrent intussusceptions although three cases were lost to follow up. There was a delay in diagnosis in some cases (average duration from onset to diagnosis was 34 h). Although delay was incurred by parents in some cases and in peripheral hospitals in others, there is a need for greater awareness by surgeons of the significance of subtle features such as pallor and lethargy in a child with persistent vomiting. Delay in diagnosis is likely to lead to an increased need for primary surgical intervention. Adverse features (age > 3 months or < 2 years; symptoms > 24 h; small bowel obstruction; dehydration > 5%) were predictive of an increased likelihood of surgical resection, and may help avoid inappropriate attempts at radiological reduction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Childhood intussusception in a regional hospital. 794 69


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