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The Value of Ultrasound in the Application of Water Enema in intussusception

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Journal of Clinical and Nursing Research 2024年第5期8卷 108-113页

作者： Min Li Pu’er People’s Hospital Yunnan Province 665000China

Objective:To introduce high-frequency ultrasound diagnostic technology to cooperate with diagnosis and treatment for patients with intussusception,and to observe its clinical application effect.Methods:The study took patients with intussusception as the object of observation,with a total of 52 cases participating,all of which were clinically admitted from December 2022 to December 2023.After enrollment,the patients underwent high-frequency ultrasound detection in sequence,recording the ultrasound imaging characteristics,and referring to the results of surgical or leaky saline enema reset to confirm the diagnosis(the gold standard)to assess the diagnostic efficacy of high-frequency ultrasound technology.Results:Comparing the confirmed diagnostic results of surgery or leaking saline enema restoration,the detection rate of high-frequency ultrasound technology was 98.07%(P>0.05).Among the 52 patients treated with hydropneumatic enema restoration with the cooperation of high-frequency ultrasound monitoring,39 patients were successfully reset in the first treatment(75.00%),while 9 patients were successfully reset(17.30%)after multiple treatments(≥2 times);the remaining 4 patients were unsuccessful and then converted to surgical treatment,and all of them were successfully treated and cured.Conclusion:For the diagnosis of intussusception,high-frequency color Doppler ultrasound has the advantages of high accuracy and simple operation,which provides a scientific and accurate reference basis for the clinical diagnosis and treatment of patients.

关键词： Ultrasound intussusception Enema Diagnostic efficiency

Clinical Research of Transumbilical Singleport Laparoscopic Treatment For Pediatric intussusception

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Expert Review of Chinese Medical

Expert Review of Chinese Medical 2024年第2期2卷 43-47页

作者： Jing Bai Xianzong Xiang Dalian Children's Hospital Affiliated to Dalian Medical University College of Pharmacy and Nursing Hubei Medical University

Objective:To explore the feasibility and clinical efficacy of single port laparoscopic surgery through the umbilical cord for the treatment of pediatric intussusception.Method:Clinical data of 38 cases of pediatric intussusception treated with umbilical single port laparoscopic surgery from December 2017 to June 2019 were collected.The surgical method involves placing Trocar through the umbilical incision to establish pneumoperitoneum,inserting a single hole with a 0°laparoscopic operating channel,exploring intussusception,and performing non-invasive forceps to completely reduce it.After the reduction of intussusception,if intestinal malformation is found,the umbilical incision can be expanded to lift the diseased intestinal tract out of the abdominal cavity for resection.At the same time,clinical data of 24 children who underwent traditional porous laparoscopic intussusception surgery during the same period were collected,and the surgical time,intraoperative blood loss,postoperative hospital stay,and satisfaction score of incision aesthetics were compared between the two groups of children.Result:Both groups of patients successfully completed the surgery,and compared with the porous laparoscopic group,the single hole laparoscopic group had a shorter surgical time[(32.4±8.6)minutes vs.(40.6±9.8)minutes,Pintussusception.Conclusion:Transumbilical single port laparoscopic surgery is a safe and effective method for children with intussusception,which is characterized by small trauma,fast recovery,short operation time,and better aesthetic effect.

关键词： intussusception single-port laparoscopy child

Surgical treatments of recurrent small intestine metastatic melanoma manifesting with gastrointestinal hemorrhage and intussusception:A case report

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World Journal of Gastrointestinal Oncology 2023年第1期15卷 205-214页

作者： Wen-Juan Fan Heng-Hui Cheng Wang Wei Department of Gastroenterology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases Wuhan 430030Hubei ProvinceChina Institution of Pathology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030Hubei ProvinceChina

BACKGROUND Melanoma is the most aggressive form of skin cancer,with a tendency to metastasize to any organ.Malignant melanoma is the most frequent cause of skin cancer-related deaths worldwide.Small intestine cancers especially small intestine metastases are relatively rare.Small intestine metastases are seldom described and likely underdiagnosed.intussusception is most common in pediatric age,and in adults are almost 5%of all cases.CASE SUMMARY A 75-year-old man with a history of acral malignant melanoma was admitted to the Gastroenterology Department of our hospital,complaining of intermittent melena for 1 mo.Magnetic resonance enterography showed partial thickening of the jejunal wall and formation of a soft tissue mass,indicating a neoplastic lesion with jejunojejunal intussusception.The patient underwent partial small bowel resection.Pathological findings and immunohistochemical staining indicated small intestine metastatic melanoma.The patient refused further anti-tumor treatment after the surgery.Ten months after the first surgery,the patient presented with melena again.Computed tomography enterography showed the anastomotic stoma was normal without thickening of the intestinal wall,and routine conservative treatment was given.Three months later,the patient developed melena again.The patient underwent a second surgery,and multiple metastatic melanoma lesions were found.The patient refused adjuvant anti-tumor treatment and was alive at the latest follow-up.CONCLUSION Small intestine metastatic melanoma should be suspected in any patient with a history of malignant melanoma and gastrointestinal symptoms.

关键词： Melanoma Metastasis Gastrointestinal hemorrhage intussusception Small bowel resection Case report

Laparoscopic approach for managing intussusception in children:Analysis of 65 cases

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World Journal of Clinical Cases 2022年第3期10卷 830-839页

作者： Sheng-Miao Li Xiao-Ying Wu Chun-Fen Luo Lin-Jun Yu Department Pediatric Surgery Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhou 317000Zhejiang ProvinceChina

BACKGROUND intussusception can be managed by pneumatic reduction,ultrasound-guided hydrostatic reduction,open or laparoscopic surgery,but laparoscopy in such cases remains controversial.AIM To explore the clinical characteristics,effectiveness,and complications of surgical reduction for intussusception using laparoscopy in children.METHODS This study was a retrospective case series of pediatric patients with intussusception who underwent surgical reduction by laparoscopy from May 2011 to April 2016 at Taizhou Hospital of Zhejiang Province.Clinical characteristics(operation time,intraoperative blood loss,conversion rate of laparotomy,reasons for conversion,postoperative hospital stay,and adverse events)were described.RESULTS The 65 patients included 45 boys and 20 girls.The average age was 2.3 years(27.5±24.5 mo).Of the 65 patients,61 underwent surgical reduction by laparoscopy after a failed enema reduction of intussusception,and four underwent the procedure directly.All patients were treated successfully and 57(87.7%)patients underwent successful laparoscopic surgery,two of which had a spontaneous reduction.Among the remaining cases,one was converted to open surgery via right upper quadrant incision,and seven required enlarged umbilical incisions.Intestinal resection was performed in 5 patients because of abnormal bowel lesions.There were no complications(intestinal perforations,wound infections,or intestinal adhesions)during the follow-up of 3 years to 8 years.Two patients experienced a recurrence of intussusception;one was resolved with pneumatic reduction,and the other underwent a second laparoscopic surgery.CONCLUSION Laparoscopic approach for pediatric intussusception is feasible and safe.Bowel resection if required can be performed by extending umbilical incision without the conventional laparotomy.

关键词： Laparoscopy intussusception Air reduction Benefits Complications

Colo-colonic intussusception with post-polypectomy electrocoagulation syndrome:A case report

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World Journal of Clinical Cases 2022年第25期10卷 8939-8944页

作者： Jae Young Moon Min-Ro Lee Sung Kyun Yim Gi Won Ha Department of Surgery Jeonbuk National University HospitalJeonju 561-180JeonbukSouth Korea Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital Jeonju 561-180JeonbukSouth Korea Department of Internal Medicine Biomedical Research InstituteJeonbuk National University Hospital and Medical SchoolJeonju 54907JeonbukSouth Korea

BACKGROUND Post-polypectomy electrocoagulation syndrome(PPES)can occur after colonoscopic polypectomy and is usually treated conservatively with a positive prognosis.Nevertheless,there can be cases with complications developing.CASE SUMMARY A 58-year-old woman,who had no previous medical history,visited the Emergency Department of another hospital with symptoms of abdominal pain and fever,1 d after multiple colonoscopic polypectomies.An abdominopelvic computed tomography(CT)scan demonstrated colo-colonic intussusception,and she was transferred to our hospital to consider an operation.CT showed colocolonic intussusception with PPES and no evidence of obstruction.The physical examination showed localized mild tenderness on the right sided abdomen.The patient fasted and was admitted for treatment with intravenous antibiotics(piperacillin/tazobactam 4.5 g each 8 h,ornidazole 500 mg each 12 h).After admission,the symptoms got better and a follow-up CT scan demonstrated resolution of the PPES and intussusception.The patient was discharged on hospital day 9.CONCLUSION Colo-colic intussusception can occur with PPES,and it can be properly treated conservatively.

关键词： intussusception Endoscopy Colonoscopy Colonic polyps Intestinal polyps Case report

Pediatric case of colonic perivascular epithelioid cell tumor complicated with intussusception and anal incarceration:A case report

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World Journal of Gastrointestinal Oncology 2022年第7期14卷 1348-1355页

作者： Luan Kou Wen-Wen Zheng Li Jia Xiao-Li Wang Ji-Hai Zhou Jiao-Rong Hao Zhu Liu Feng-Yu Gao Department of Gastroenterology Shandong Provincial Maternal and Child Health Care HospitalJinan 250014Shandong ProvinceChina

BACKGROUND Perivascular epithelioid cell tumor(PEComa)represents a group of rare mesenchymal tumors.PEComa can occur in many organs but is rare in the colorectum,especially in children.Furthermore,PEComa is a rare cause of intussusception,the telescoping of a segment of the gastrointestinal tract into an adjacent one.We describe a rare case of pediatric PEComa complicated with intussusception and anal incarceration,and conduct a review of the current literature.CASE SUMMARY A 12-year-old girl presented with abdominal pain and abdominal ultrasound suggested intussusception.Endoscopic direct-vision intussusception treatment and colonoscopy was performed.A spherical tumor was discovered in the transverse colon and removed by surgery.Postoperative pathologic analyses revealed that the tumor volume was 5.0 cm×4.5 cm×3.0 cm and the tumor tissue was located in the submucosa of the colon,arranged in an alveolar pattern.The cell morphology was regular,no neoplastic necrosis was observed,and nuclear fission was rare.The immunohistochemical staining results were as follows:Human melanoma black 45(HMB 45)(+),cluster of differentiation 31(CD31)(+),cytokeratin(-),melanoma-associated antigen recognized by T cells(-),smooth muscle actin(-),molleya(-),desmin(-),S-100(-),CD117(-),and Ki67(positive rate in hot spot<5%).Combined with the results of pathology and immunohistochemistry,we diagnosed the tumor as PEComa.Postoperative recovery was good at the 4 mo follow-up.CONCLUSION The diagnosis of PEComa mainly depends on pathology and immunohistochemistry.Radical resection is the preferred treatment method.

关键词： Perivascular epithelioid cell tumor Colonic intussusception Anal incarceration Endoscopic direct-vision intussusception treatment Case report

Cohort analysis of pediatric intussusception score to diagnose intussusception

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World Journal of Clinical Cases 2023年第21期11卷 5014-5022页

作者： Punwadee Rukwong Nathawit Wangviwat Teerasak Phewplung Palittiya Sintusek Department of Pediatrics Phrapokklao HospitalChantaburi 22000MeuangThailand Division of Laboratory Medicine King Chulalongkorn Memorial HospitalBangkok 10330Thailand Department of Radiology Chulalongkorn UniversityBangkok 10330Thailand Thai Pediatric Gastroenterology Hepatology and Immunology Research UnitDivision of GastroenterologyDepartment of PediatricsKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand

BACKGROUND intussusception is a primary cause of intestinal obstruction in young children.Delayed diagnosis is associated with increased morbidity.Ultrasonography(USG)is the gold standard for diagnosis,but it is operator dependent and often unavailable in limited resource areas.AIM To study the clinical characteristics of intussusception including management and evaluation of the diagnostic accuracy of abdominal radiography(AR)and the promising parameters found in the pediatric intussusception score(PIS).METHODS Children with suspected intussusception in our center from 2006 to 2018 were recruited.Clinical manifestations,investigations,and treatment outcomes were recorded.AR images were interpreted by a pediatric radiologist.Diagnosis of intussusception was composed of compatible USG and response with reduction.The diagnostic value of the proposed PIS was evaluated.RESULTS Ninety-seven children were diagnosed with intussusception(2.06±2.67 years,62.9%male),of whom 74%wereintussusception were irritability or abdominal pain(86.7%)and vomiting(59.2%).Children aged 6 mo to 2 years,pallor,palpable abdominal mass,and positive AR were the parameters that could discriminate intussusception from other mimics(Pintussusception(Pintussusception had a sensitivity of 59.2%.The proposed PIS,a combination of clinical irritability or abdominal pain,children aged 6 mo to 2 years,and compatible AR,had a sensitivity of 85.7%.CONCLUSION AR alone provides poor screening for intussusception.The proposed PIS in combination with common manifestations and AR data was shown to increase the diagnostic sensitivity,leading to timely clinical management.

关键词： intussusception Pediatric Specificity Sensitivity Abdominal radiography Diagnosis

Surgery for Cronkhite-Canada syndrome complicated with intussusception:A case report and review of literature

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World Journal of Gastrointestinal Surgery 2022年第2期14卷 200-210页

作者： Jie Dong Tian-Shi Ma Jiang-Feng Tu You-Wei Chen Cancer Center Department of GastroenterologyZhejiang Provincial People’s Hospital(Affiliated People’s HospitalHangzhou Medical College)Hangzhou 310014Zhejiang ProvinceChina Cancer Center Department of PathologyZhejiang Provincial People’s Hospital(Affiliated People’s HospitalHangzhou Medical College)Hangzhou 310014Zhejiang ProvinceChina

BACKGROUND Cronkhite-Canada syndrome(CCS)is a rare nonhereditary disease with a syndrome of multiple gastrointestinal polyps,skin pigmentation,hair loss,and fingernail/toenail dystrophy.intussusception is a serious condition with an occurrence rate of 5%in adults,which is mainly caused by intestinal tumors or other intestinal occupations.CASE SUMMARY A 57-year-old woman was admitted to our hospital due to abdominal distension and pain for the past year.Her nausea and vomiting symptoms had been aggravated for the past month.Previous transoral enteroscopy results one year prior showed chronic erosive gastritis protuberans,duodenitis,and jejunitis.She had sparse body hair and brown pigmentation on the skin of her hands and bilateral anterior tibias.The nails of both hands were pale and lacked luster,and the fingernail of her ring finger was longitudinally cracked.Gastroscopy showed extensive diffuse polypoid lump changes in the gastric body and antrum,of 0.5-3 cm in size.Colonoscopy showed multiple polypoid mucosal bulges in the terminal ileum and multiple polyps(0.3-5 cm)throughout the colon.The patient was diagnosed with CCS and underwent partial excision of the polyps,but she refused hormone therapy.One month later,the patient complained of nausea and vomiting,accompanied by abdominal pain and inability to pass gas or stool.Contrast-enhanced computed tomography of the abdomen showed gastrointestinal polyposis and ileocecal intussusception.She underwent stomach and bowel surgery.CONCLUSION CCS,as a rare disease with poor prognosis,should be treated aggressively.Systematic steroids,immunosuppressive agents,and biological agents were not applied;thus,the patient’s symptoms quickly progressed,and intussusception occurred.She had to undergo surgery.Improved compliance may lead to a better prognosis.

关键词： Cronkhite-Canada syndrome intussusception Treatment Prognosis Surgery Case report

intussusception due to hematogenous metastasis of hepatocellular carcinoma to the small intestine:A case report

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World Journal of Gastroenterology 2020年第42期26卷 6698-6705页

作者： Taro Mashiko Yoshihito Masuoka Akira Nakano Kota Tsuruya Shunji Hirose Kenichi Hirabayashi Tatehiro Kagawa Toshio Nakagohri Department of Gastroenterological Surgery Tokai University School of MedicineIsehara 2591193KanagawaJapan Department of Gastroenterology Tokai University School of MedicineIsehara 2591193KanagawaJapan Department of Pathology Tokai University School of MedicineIsehara 2591193KanagawaJapan

BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma(HCC)are the lungs,bones,adrenal glands,and regional lymph nodes.Hematogenous metastasis to the gastrointestinal(GI)tract is a rare condition in patients with HCC,and the prognosis is usually poor.We report,herein,an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy.CASE SUMMARY The patient was a 71-year-old man with a history of chronic hepatitis B,who had undergone three surgeries for HCC.He was treated with sorafenib for peritoneal metastases of HCC.He was admitted to our hospital with chief complaints of abdominal pain and vomiting.Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor,presenting with intussusception and small bowel obstruction.Conservative treatment was started,but due to repeated exacerbation of symptoms,surgery was planned on the 28th d of hospitalization.Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed.On histological examination,tumor cells were not observed on the serosal surface,but intravascular invasion of tumor cells was seen.Immunohistochemistry was positive for immunohistochemical markers,and a diagnosis of hematogenous metastasis of HCC to the ileum was made.He remains alive 82 mo after the first surgery.CONCLUSION Prognosis of HCC patients with GI tract metastasis is usually poor,but in some cases,multidisciplinary therapy may prolong survival.

关键词： Hepatocellular carcinoma Hematogenous metastases Extrahepatic metastasis Small intestinal metastasis intussusception Case report