Background: Jejuno-jejunal (J-J) intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB). Prompt diagnosis is critical as it may lead to obstruction and bowel necrosis, but clinical presentation is nonspecific. A definitive treatment plan has not been established with intussusception after RYGB.
What causes jejunal intussusception?
The exact cause of intussusception is unknown. In most cases, it is preceded by a virus that produces swelling of the lining of the intestine, which then slips into the intestine below. In some children, it is caused by a condition that the child is born with, such as a polyp or diverticulum.
How do you fix intussusception?
Treatment options for intussusception may include:A water soluble contrast or air enema. This is both a diagnostic procedure and a treatment. ... Surgery. If the intestine is torn, if an enema is unsuccessful in correcting the problem or if a lead point is the cause, surgery is necessary.
How serious is intussusception?
Intussusception is a life-threatening illness and occurs when a portion of the intestine folds like a telescope, with one segment slipping inside another segment. This causes an obstruction, preventing the passage of food that is being digested through the intestine.
How does intussusception happen?
Intussusception occurs when a portion of your child's intestine folds inside another segment — this causes an obstruction that prevents the passage of food, which is being digested. The walls of the two sections of intestine press on each other, causing irritation and swelling.
What are the classic signs of an intussusception?
Intussusception usually involves the small bowel and rarely the large bowel. Symptoms include crampy abdominal pain, which can be intermittent or constant, vomiting (can be bilious), bloating, and even bloody stool. [8][9][10] It may result in small or large bowel obstruction.
Will intussusception go away on its own?
Sometimes it goes away on its own. In some cases, surgery may be needed. If not treated, intussusception can be life-threatening. Intussusception can happen again, especially if it's not treated with surgery the first time.
Can you live with intussusception?
Intussusception can be a life-threatening condition. When one part of the intestine slides into another, food can't pass through. Blood can't get to the area either, which can cause a tear in the bowel, infection, and internal bleeding.
How long can intussusception go untreated?
The prognosis for intussusception is excellent if treated quickly, but if untreated it can lead to death within two to five days. The longer the intestine segment is prolapsed and the longer it goes without a blood supply, the less effective a non-surgical reduction.
How fast does intussusception progress?
The main symptom of intussusception is severe abdominal pain that comes and goes. Each episode tends to last two to three minutes. In between episodes, the child will look very pale, tired and floppy. After 12 hours or so the pain becomes more constant, and the child will usually go off food and may vomit.
What is the most common cause of intussusception?
The cause of most cases of intussusception in children is unknown. Though intussusception is rare in adults, most cases of adult intussusception are the result of an underlying medical condition, such as a tumor. In children, the intestines can usually be pushed back into position with a minor procedure.
What is the most common complication of intussusception?
What are the complications of intussusception?intestinal obstruction.dehydration link.lack of blood flow to the blocked part of the intestine and death of the blood-starved tissues.a perforation, or hole, in the wall of the intestine.peritonitis, an infection of the lining of the abdominal cavity.More items...
What viruses cause intussusception?
Adenovirus, in particular type C, has been consistently associated with intussusception in infants and young children [8–15]. Enterovirus, norovirus, and human herpesvirus 6 (HHV-6) have been shown to have statistically significant relationships with intussusception in some studies.
How long can intussusception go untreated?
The prognosis for intussusception is excellent if treated quickly, but if untreated it can lead to death within two to five days. The longer the intestine segment is prolapsed and the longer it goes without a blood supply, the less effective a non-surgical reduction.
How long does it take to recover from intussusception?
Your child should be fully recovered from the procedure in about four to six weeks. Most children who receive prompt (typically within 24 hours) treatment for intussusception fully recover and do not have any long-term effects or restrictions. If treatment is delayed for any reason, damage to the intestine can occur.
How long can intussusception last?
Symptoms of intussusception It could last for 15 to 20 minutes. It often gets worse as time goes on. Other signs your child may have intussusception include: Swelling in the abdomen.
Can you live with intussusception?
Intussusception can be a life-threatening condition. When one part of the intestine slides into another, food can't pass through. Blood can't get to the area either, which can cause a tear in the bowel, infection, and internal bleeding.
What is intussusception in gastrojejunostomy?
Intussusception is a common complication of the use of indwelling gastrojejunostomy tubes with a reported incidence of 16%. 101–103 Catheters with a distal pigtail appear to have a higher risk and typically cause antegrade jejunal intussusceptions, either along or at the end of the gastrojejunostomy tube. These patients usually present with high SBO and bilious vomiting but without abdominal pain or cramps. Incidental detection in an asymptomatic child is common, and the only treatment may be clinical monitoring.
What is the corkscrew configuration of the jejunojejunal intussusception?
A jejunojejunal intussusception forms a corkscrew configuration because of tension on the mesentery of the intussusceptum , and short to long segments can be involved. 259 Reduction is accomplished by slow traction on the intussusceptum and gentle massage of the distal end of the intussuscipiens. 259 If it is nonreducible, the entire intussusception can be removed by resection only, 98 although this can make ligation of mesenteric vessels difficult. 99
Why can't intussusceptions be reduced?
Some intussusceptions cannot be reduced because of the length of bowel involved, venous congestion, and edema. These cases require en bloc resection and anastomosis. Even if the intestinal segment appears viable, consider resection and anastomosis because of the possibility of mucosal necrosis, serosal inflammation, and postoperative adhesion formation.
What is an unusual intussusception?
An unusual intussusception is antegrade or retrograde jejunogastric intussusception through a gastroenterostomy causing gastric outlet obstruction. This intussusception almost always requires operative reduction and revision.
What is the most commonly described item impacted in rectum in children reported?
The most commonly described item impacted in rectum in children reported is the rectal thermometer. Most often, rectal thermometer retention occurs in infants and young children after obtaining a rectal temperature. This places the infant at high risk, especially if the thermometer contains mercury.
Can horses recover from intussusception?
97 Some horses can have a protracted recovery after surgery for a chronic ileocecal intussusception, with slow weight gain and mild episodes of colic. 97 Because A. perfoliata may be involved in the pathogenesis of ileocecal intussusceptions in horses, the treatment of affected horses and pasturemates with pyrantel pamoate and praziquantel is recommended. 97,254,270
Can a gastrostomy cure intussusception?
The diagnosis is often incidentally made on US or CT scan. Removal or conversion to a gastrostomy or nasogastric tube will cure the problem. Many of these intussusceptions are also transient and undergo spontaneous reduction, which suggests that their actual prevalence is probably underestimated. Rarely, there is need for a surgical procedure. 104
What is an unusual intussusception?
An unusual intussusception is antegrade or retrograde jejunogastric intussusception through a gastroenterostomy causing gastric outlet obstruction. This intussusception almost always requires operative reduction and revision.
What is the most common type of intussusception?
The most common type of intussusception is ileocolic (85%) ( Fig. 85-7 ). The second most common type (10%) is ileoileocolic and often characterized by complete bowel obstruction. The ileoileal portion invaginates into the cecum and colon and is more difficult to reduce. About 40% are found to have a PLP as its underlying cause. 48
How often do intussusceptions occur?
Jejunojejunal and ileoileal intussusceptions occur infrequently (2.5%) and usually have a PLP, except when they occur as a postoperative intussusception.
What is Fig 12.?
Fig. 12. A photograph of retrieved polyps extracted from the enterotomy for the 10 mm camera-port.
Can a gastrostomy cure intussusception?
The diagnosis is often incidentally made on US or CT scan. Removal or conversion to a gastrostomy or nasogastric tube will cure the problem. Many of these intussusceptions are also transient and undergo spontaneous reduction, which suggests that their actual prevalence is probably underestimated. Rarely, there is need for a surgical procedure. 104
Is ileoileal intussusception a PLP?
Jejunojejunal and ileoileal intussusceptions occur infrequently (2.5%) and usually have a PLP (see Fig. 83-5 ), except when they occur as a postoperative intussusception (see Fig. 83-8 ).
Why does intussusception form?
It’s not always clear why intussusception forms, though in some cases, it’s due to a growth in the intestine , such as a polyp or tumor.
What causes intussusception in adults?
Additional causes in adults. A polyp, tumor, or scar tissue in the intestine may trigger intussusception in adults. A digestive disorder, such as Crohn’s disease, may also lead to intussusception. Weight loss surgery or other procedures on the intestine may cause intussusception, too.
What happens when a section of the intestine slides inside a nearby part?
Intussusception occurs when a section of intestine slides inside a nearby part. This movement causes the intestine to fold around itself, the way the parts of a telescope fit around each other. As a result, food and fluid have a harder time passing through the intestine. The condition can also reduce blood supply to the affected area, leading to: ...
What are the symptoms of adult intussusception?
When symptoms of adult intussusception are present, they may include abdominal pain as well as nausea and vomiting. These symptoms may come and go, often leading people to go weeks before seeking medical attention.
What is the process of intestines folding around each other?
Intussusception occurs when a section of the intestine slides inside a nearby part. This movement causes the intestine to fold around itself, the way the parts of a telescope fit around each other.
What is the primary approach for adults with intussusception and children who are very ill with the condition?
Surgery is the primary approach for adults with intussusception and children who are very ill with the condition.
How old is too old to have intussusception?
However, about 70 percent of cases occur during the first 2 years of life, while 90 percent occur in children up to 3 years old. Intussusception is also slightly more common in males.
What is the term for the intussusceptum?
An intussusception occurs when one bowel loop (intussusceptum) invaginates into another section of bowel (intussuscipiens), akin to a telescopic movement. It is mainly a childhood disease, however contributes to 1% of all adult intestinal obstructions. When it occurs in adults it is usually associated with a lead point like a neoplasm or polyp with the commonest benign neoplasm being a lipoma.
What is the intussuscepiens?
The intussuscepiens shows a segment of mildly thickwalled slightly enhancing intussusceptum of invaginated proximal jejunum with mesenteric fat, vessels and insignificant small lymph nodes. The intussusceptum does not show any obvious mass lesion or lead-point.
What is the long segment intussusception?
Long segment intussusception noted at the proximal jejunum causing subacute obstruction with subsequent proximal grosssly dilated jejunum which appears redundant (reaching up to the pelvis). This stretches the duodeno-jejunal junction along the midline (suggestive of mesenteric laxity) . These findings are compatible with jejunojenunal type of enteroenteric intussusception.
What Is Intussusception?
Intussusception is a painful form of bowel blockage in which one part of your intestine slides inside another part. It can cause swelling that can lead to intestinal damage.
What causes intussusception in adults?
Adhesions, or scar tissue in the intestines. Crohn's disease or other conditions that cause inflammation. Surgery on the intestinal tract, such as gastric bypass (a surgery for weight loss)
How often does intussusception hurt?
They may also pull their knees up to their chest. The pain happens occasionally at first, usually every 15 to 20 minutes. As time passes, the pain will happen more often and last longer.
What happens when you twist a tube back?
When you twist it one way, it extends fully. When you twist it back, the sections slide inside each other, making it smaller. Your intestines are long and tube-shaped as well. But unlike a telescope, the sections are meant to stay extended. Intussusception can be a life-threatening condition.
What is the best test to check for obstruction in the intestines?
Abdominal X-ray: This safe and painless test uses radiation to figure out whether your child has an obstruction in their intestines or bowel.
How to stabilize a child's intestines?
Your child may be stabilized with an IV line for fluids and a nasogastric tube. This tube is inserted into the stomach through the nose. It relieves pressure on the intestines. In addition to a physical exam, your doctor will likely order imaging tests to get a better look inside.
What to do if an enema doesn't fix intussusception?
If an enema doesn't fix the intussusception, surgery is the next step. A pediatric anesthesiologist (a specialist in pain relief and sedation in children) will put your child fully to sleep. If the surgery uses laparoscopy, the doctor will make small cuts in the belly and insert small instruments and a camera.
