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      Single-incision laparoscopic surgery for jejuno-jejunal intussusception caused by an angiolipomatous polyp in an adult : A case report

      case-report
      , MD, PhD
      Medicine
      Wolters Kluwer Health
      angiolipomatous polyp, jejuno-jejunal intussusception, single-incision laparoscopic surgery

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          Abstract

          Rationale:

          Small bowel intussusception in adults is rare but is more likely to occur in the presence of a lead point. Surgical intervention is necessary in most cases, even if there is successful nonsurgical reduction of the intussusception.

          Patient concerns:

          A 54-year-old woman who was transferred to our emergency room with complaints of intermittent cramping pain of 4 days’ duration.

          Diagnosis:

          Abdominal contrast-enhanced computed tomography revealed a jejuno-jejunal intussusception due to an angiolipomatous polyp.

          Intervention:

          A single-incision laparoscopic surgery (SILS) was performed without the need for any additional incisions.

          Outcomes:

          She was uneventfully discharged on postoperative day 4.

          Lessons:

          The SILS procedure with adequate preoperative diagnosis by CT, with or without US, can offer good clinical outcomes for small bowel intussusception. Even surgeons who have little experience with laparoscopic intestinal anastomosis can consider SILS to treat small bowel intussusception in adults.

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          Most cited references12

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          Adult intussusception.

          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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            Adult intussusception: a retrospective review of 41 cases.

            To optimize the preoperative diagnosis and surgical management of adult intussusception (AI). A retrospective review of the clinical features, diagnosis, management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted. Forty-one patients with 44 intussusceptions were operated on, 24.4% had acute symptoms, 24.4% had subacute symptoms, and 51.2% had chronic symptoms. 70.7% of the patients presented with intestinal obstruction. There were 20 enteric, 15 ileocolic, eight colocolonic and one sigmoidorectal intussusceptions. 65.9% of intussusceptions were diagnosed preoperatively using a computed tomography (CT) scan (90.5% accurate) and ultrasonography (60.0% accurate, rising to 91.7% for patients who had a palpable abdominal mass). Coloscopy located the occupying lesions of the lead point of ileocolic, colocolonic and sigmoidorectal intussusceptions. Four intussusceptions in three patients were simply reduced. Twenty-one patients underwent resection after primary reduction. There was no mortality and anastomosis leakage perioperatively. Except for one patient with multiple small bowel adenomas, which recurred 5 mo after surgery, no patients were recurrent within 6 mo. Pathologically, 54.5% of the intussusceptions had a tumor, of which 27.3% were malignant. 9.1% comprised nontumorous polyps. Four intussusceptions had a gastrojejunostomy with intestinal intubation, and four intussusceptions had no organic lesion. CT is the most effective and accurate diagnostic technique. Colonoscopy can detect most lead point lesions of non-enteric intussusceptions. Intestinal intubation should be avoided.
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              Intussusception in adults: clinical characteristics, diagnosis and operative strategies.

              To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity. A retrospective review of patients aged > 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded. There were 20 cases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine (85%). There were three (15%) cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically. Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                December 2019
                16 December 2019
                : 98
                : 50
                : e18280
                Affiliations
                Department of Surgery, Jeju National University School of Medicine, Jeju-si, Jeju Special Self-Governing Province, Republic of Korea.
                Author notes
                []Correspondence: Young-Kyu Kim, Department of Surgery, Jeju National University School of Medicine, Aran 13gil 15 (Ara-1Dong) Jeju-si, Jeju Special Self-Governing Province 63241, Republic of Korea (e-mail: surgeon@ 123456jejunu.ac.kr ).
                Article
                MD-D-19-01760 18280
                10.1097/MD.0000000000018280
                6922439
                31852102
                c03a1cbc-1713-43b4-bfda-d59be7d27128
                Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 8 March 2019
                : 26 October 2019
                : 7 November 2019
                Categories
                4500
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                angiolipomatous polyp,jejuno-jejunal intussusception,single-incision laparoscopic surgery

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