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G Mavrakis - One of the best experts on this subject based on the ideXlab platform.

  • Small Bowel Intussusception due to metastatic malignant melanoma a case report
    Techniques in Coloproctology, 2004
    Co-Authors: N Gatsoulis, N Roukounakis, I Kafetzis, S Gasteratos, G Mavrakis
    Abstract:

    Small Bowel metastatic deposits attributed to malignant melanoma are found in 2–5% of patients with malignant melanoma of the skin. Ileo-ileo Intussusception caused by metastatic melanoma is a very rare condition. The prognosis of metastatic melanoma is poor. We report a case of a cutaneous malignant melanoma which metastasised to the Small Bowel causing enteroenteric Intussusception. This case refers to a 66-year-old male patient who underwent surgery for suspected enteric Intussusception. This diagnosis was suggested by computer tomography scan. The patient had had previous surgery for a primary malignant melanoma in the eyelid of the right eye. Segmental intestinal resection with regional lymph node dissection and ileo-ileo anastomosis was performed. Metastatic melanoma in the gastrointestinal tract should be suspected in patients with history of melanoma of the skin and acute gastrointestinal symptoms. Immediate laparotomy and excision of the affected Bowel segment is the appropriate treatment.

Minchi Chen - One of the best experts on this subject based on the ideXlab platform.

  • pediatric Small Bowel Intussusception disease feasibility of screening for surgery with early computed tomographic evaluation
    Surgery, 2010
    Co-Authors: Maomeng Tiao, Chiesong Hsieh, Fuchen Huang, Chungcheng Huang, Shinyee Lee, Minchi Chen
    Abstract:

    Background This study investigated the feasibility of early computed tomographic (CT) evaluation and the operative results of pediatric Small Bowel Intussusception with deteriorating ischemic or obstructive symptoms, so-called Small Bowel Intussusception disease (SBID). Methods Between 1988 and 1999, among 18 patients surgically proven SBID (conventional group), 12 mimicked ileocolic Intussusception and were conventionally managed with abdominal radiography, ultrasonography, reduction enema, and eventually operation. Between 2000 and 2008, we applied a modified approach with inclusion of early CT evaluation if ultrasonography showed a target lesion suspicious for SBID (diameter ≤3.0 cm and/or atypically located in the paraumbilical or left abdomen). Among 15 surgically proven SBID patients (early CT group), 13 underwent early operation after CT confirmation. The clinical, imaging, and operative findings were compared between the 2 groups. Results There were no significant differences between the 2 groups in age, gender, clinical presentations, leukocyte count, ultrasonographic features, locations of SBID, or the presence of lead points. Most patients presented with vomiting, abdominal pain, or irritable crying. In comparison with the conventional group, early CT group patients had a significantly shorter duration between admission and surgery (31.44 ± 30.39 vs 7.47 ± 5.95 hours; P Conclusion Pediatric SBID may present with nonspecific symptoms and may mimic ileocolic Intussusception leading to delayed operative intervention. Early CT evaluation of patients with suspicious SBID ultrasonographic features is effective in avoiding futile reduction enema and significantly reducing the waiting time for operative management and the resultant incidence of Bowel complications.

  • Small Bowel Intussusception in symptomatic pediatric patients experiences with 19 surgically proven cases
    World Journal of Surgery, 2002
    Co-Authors: Tzeyu Lee, Maomeng Tiao, Yungliang Wan, Minchi Chen, Chiesong Shieh, Chidi Liang, Jiinhaur Chuang
    Abstract:

    Nineteen cases of surgically proven symptomatic pediatric Small Bowel Intussusceptions (SBI) were retrospectively reviewed. Clinical presentations included vomiting (89.5%), abdominal pain and/or irritable crying (89.5%), fever (52.6%), bloody stools (26.3%), palpable abdominal masses (15.8%), hematemesis (10.5%), jaundice (5.3%), and seizures (5.3%). The duration between symptom onset and hospitalization ranged between 20 and 336 hours (average 75.8 hours). Two patients with suspected appendicitis and Small Bowel obstruction were operated on promptly. Sonograms revealed target lesions (average diameter 2.9 cm) suggestive of Intussusception in 13 out of 17 patients, with 10 lesions located in the paraumbilical or left abdominal regions. Barium enemas in 12 of these 13 patients demonstrated no colonic lesions. Diagnosis and surgery were delayed in 16 patients (average delay = 32 hours). The remaining 1 patient with positive sonographic findings underwent early surgery after computed tomographic (CT) confirmation of SBI. Surgery revealed ileoileal Intussusceptions in 11 patients, jejunojejunal in 4, jejunoileal in 3, and duodenojejunal in 1. Eight patients had lead points. Bowel complications (ischemia, necrosis, or perforation) occurred in 8 patients. The duration between symptom onset and surgery in patients with Bowel complications was significantly longer than for patients without complications (p = 0.0026). In conclusion, delayed diagnosis and surgical treatment in symptomatic pediatric patients with SBI were common, leading to a high rate (42%) of Bowel complications. Sonographic demonstration of a 2-3 cm target lesion, especially if paraumbilical or left abdominal, is suggestive of SBI and may obviate the need for a barium enema; however, CT is helpful for confirming SBI. In symptomatic SBI, once diagnosed, early surgical referral is strongly recommended.

  • sonographic features of Small Bowel Intussusception in pediatric patients
    Academic Emergency Medicine, 2001
    Co-Authors: Maomeng Tiao, Yungliang Wan, Tzeyu Lee, Minchi Chen, Chiesong Shieh, Jiinhuar Chuang
    Abstract:

    Objective Small-Bowel Intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI. Methods The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed. Results Most of the patients presented with nonspecific symptoms, including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal Intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively. Conclusions Small-Bowel Intussusception is often over-looked due to nonspecific clinical presentations. Sonographic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.

Kiyoshi Kikuchi - One of the best experts on this subject based on the ideXlab platform.

  • Intussusception of the Small Bowel associated with nephrotic syndrome
    Pediatric Nephrology, 2005
    Co-Authors: Koichi Asai, Shinichiro Tanaka, Noriko Tanaka, Kumi Tsumura, Fumihide Kato, Kiyoshi Kikuchi
    Abstract:

    We report the case of a 2-year-old boy who developed a Small Bowel Intussusception during treatment failure of his first episode of nephrotic syndrome. Despite the absence of typical symptoms other than abdominal pain, the Intussusception was diagnosed by ultrasonography and computed tomography and successfully reduced by air enema. No pathological lead point was discovered, and no symptoms of Henoch-Schonlein purpura developed later. Intussusception should be considered in the differential diagnosis of abdominal pain in patients with nephrotic syndrome, especially in patients exhibiting prolonged edema. Ultrasonography or computed tomography should be performed, even in the absence of other typical symptoms suggestive of Intussusception. We should also bear in mind that the Intussusception associated with nephrotic syndrome might occur at regions other than the typical ileocolic region, such as within the Small intestine.

Maomeng Tiao - One of the best experts on this subject based on the ideXlab platform.

  • pediatric Small Bowel Intussusception disease feasibility of screening for surgery with early computed tomographic evaluation
    Surgery, 2010
    Co-Authors: Maomeng Tiao, Chiesong Hsieh, Fuchen Huang, Chungcheng Huang, Shinyee Lee, Minchi Chen
    Abstract:

    Background This study investigated the feasibility of early computed tomographic (CT) evaluation and the operative results of pediatric Small Bowel Intussusception with deteriorating ischemic or obstructive symptoms, so-called Small Bowel Intussusception disease (SBID). Methods Between 1988 and 1999, among 18 patients surgically proven SBID (conventional group), 12 mimicked ileocolic Intussusception and were conventionally managed with abdominal radiography, ultrasonography, reduction enema, and eventually operation. Between 2000 and 2008, we applied a modified approach with inclusion of early CT evaluation if ultrasonography showed a target lesion suspicious for SBID (diameter ≤3.0 cm and/or atypically located in the paraumbilical or left abdomen). Among 15 surgically proven SBID patients (early CT group), 13 underwent early operation after CT confirmation. The clinical, imaging, and operative findings were compared between the 2 groups. Results There were no significant differences between the 2 groups in age, gender, clinical presentations, leukocyte count, ultrasonographic features, locations of SBID, or the presence of lead points. Most patients presented with vomiting, abdominal pain, or irritable crying. In comparison with the conventional group, early CT group patients had a significantly shorter duration between admission and surgery (31.44 ± 30.39 vs 7.47 ± 5.95 hours; P Conclusion Pediatric SBID may present with nonspecific symptoms and may mimic ileocolic Intussusception leading to delayed operative intervention. Early CT evaluation of patients with suspicious SBID ultrasonographic features is effective in avoiding futile reduction enema and significantly reducing the waiting time for operative management and the resultant incidence of Bowel complications.

  • Small Bowel Intussusception in symptomatic pediatric patients experiences with 19 surgically proven cases
    World Journal of Surgery, 2002
    Co-Authors: Tzeyu Lee, Maomeng Tiao, Yungliang Wan, Minchi Chen, Chiesong Shieh, Chidi Liang, Jiinhaur Chuang
    Abstract:

    Nineteen cases of surgically proven symptomatic pediatric Small Bowel Intussusceptions (SBI) were retrospectively reviewed. Clinical presentations included vomiting (89.5%), abdominal pain and/or irritable crying (89.5%), fever (52.6%), bloody stools (26.3%), palpable abdominal masses (15.8%), hematemesis (10.5%), jaundice (5.3%), and seizures (5.3%). The duration between symptom onset and hospitalization ranged between 20 and 336 hours (average 75.8 hours). Two patients with suspected appendicitis and Small Bowel obstruction were operated on promptly. Sonograms revealed target lesions (average diameter 2.9 cm) suggestive of Intussusception in 13 out of 17 patients, with 10 lesions located in the paraumbilical or left abdominal regions. Barium enemas in 12 of these 13 patients demonstrated no colonic lesions. Diagnosis and surgery were delayed in 16 patients (average delay = 32 hours). The remaining 1 patient with positive sonographic findings underwent early surgery after computed tomographic (CT) confirmation of SBI. Surgery revealed ileoileal Intussusceptions in 11 patients, jejunojejunal in 4, jejunoileal in 3, and duodenojejunal in 1. Eight patients had lead points. Bowel complications (ischemia, necrosis, or perforation) occurred in 8 patients. The duration between symptom onset and surgery in patients with Bowel complications was significantly longer than for patients without complications (p = 0.0026). In conclusion, delayed diagnosis and surgical treatment in symptomatic pediatric patients with SBI were common, leading to a high rate (42%) of Bowel complications. Sonographic demonstration of a 2-3 cm target lesion, especially if paraumbilical or left abdominal, is suggestive of SBI and may obviate the need for a barium enema; however, CT is helpful for confirming SBI. In symptomatic SBI, once diagnosed, early surgical referral is strongly recommended.

  • sonographic features of Small Bowel Intussusception in pediatric patients
    Academic Emergency Medicine, 2001
    Co-Authors: Maomeng Tiao, Yungliang Wan, Tzeyu Lee, Minchi Chen, Chiesong Shieh, Jiinhuar Chuang
    Abstract:

    Objective Small-Bowel Intussusception (SBI) for pediatric patients is unusual and difficult to diagnose preoperatively. This study sought to determine the sonographic findings of pediatric SBI. Methods The sonographic features and surgical findings of 13 pediatric patients (7 boys, 6 girls; age range 4 months-15 years; average age 4 years and 2 months) with SBI encountered in the authors' hospital over a 12-year period were retrospectively reviewed. Results Most of the patients presented with nonspecific symptoms, including vomiting, abdominal pain, and/or irritable crying. Sonographic screening in the emergency department revealed a doughnut or crescent-in-doughnut sign, or a multiple-concentric-rings sign for 11 of the 13 patients, and the lesions appeared short. Eight lesions were found in the paraumbilical or left abdominal regions. Sonographic measurement of the size of the lesions from these 11 patients ranged from 2 cm to 3.7 cm (average 2.77 cm). Subsequent barium enemas were performed for these 11 patients, none of which revealed colon lesions. Surgery revealed ileoileal Intussusceptions for eight cases, jejunoileal for three, and jejunojejunal for the remaining two. Bowel ischemia or necrosis and pathologic lead points were demonstrated for seven and six patients, respectively, although none were recognized preoperatively. Conclusions Small-Bowel Intussusception is often over-looked due to nonspecific clinical presentations. Sonographic demonstration of a 2-3-cm sized, short, doughnut-like lesion, especially in the left abdomen or paraumbilical regions, should lead to strong suspicion of SBI.

Gyu Sang Song - One of the best experts on this subject based on the ideXlab platform.

  • Inflammatory Fibroid Polyp in the Jejunum Causing Small Bowel Intussusception
    Annals of coloproctology, 2015
    Co-Authors: Sung Hoon Kang, Seok Won Kim, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong, Jin Su Kim, Gyu Sang Song
    Abstract:

    Intussusceptions are defined as the telescoping of one segment of the gastrointestinal tract into an adjacent distal segment. In the Small Bowel, Intussusceptions are typically caused by benign processes, but can occasionally be caused by inflammatory fibroid polyps, which often present as Intussusception and Bowel obstruction. These polyps are rare, benign, tumorous lesions in the gastrointestinal tract and are typically observed in the stomach, but can occur anywhere in the gastrointestinal tract. Any case of a jejunojejunal Intussusception caused by inflammatory fibroid polyps is considered rare, and we report the case of a 51-year-old woman with an inflammatory fibroid polyp of the jejunum presenting as an Intussusception who was successfully treated with a resection.