RESUMEN
Burkitt lymphoma is a non-Hodgkin B-cell lymphoma with a high prevalence in the pediatric population. Abdominal manifestations are well known in sporadic Burkitt lymphoma and vary from nonspecific symptoms to intestinal obstruction due to intussusception; however, mass-like splenic involvement has been scarcely described. OBJECTIVE: To present a case of a patient with a splenic mass whose histopathological analysis revealed Burkitt lymphoma. CLINICAL CASE: A 13-year-old female patient presented with abdominal pain, progressive weight loss, and fever. Imaging studies showed a splenic mass, intestinal thickening, and ileal intussusception. Histopathological analysis of spleen biopsy revealed Burkitt lymphoma. After the first cycle of chemotherapy (BFM95-NHL protocol), abdominal symptoms resolved; no other signs suggestive of intussusception were observed, as well as a significant reduction of the splenic mass was observed. CONCLUSIONS: Burkitt lymphoma in pediatric patients can present as a well-defined splenic tumor, causing no splenomegaly. In addition, its management does not require surgery since it can be resolved with chemotherapy.
Asunto(s)
Linfoma de Burkitt , Neoplasias del Bazo , Humanos , Linfoma de Burkitt/diagnóstico , Linfoma de Burkitt/patología , Linfoma de Burkitt/complicaciones , Linfoma de Burkitt/tratamiento farmacológico , Femenino , Adolescente , Neoplasias del Bazo/patología , Neoplasias del Bazo/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Intususcepción/diagnóstico , Intususcepción/etiología , Dolor Abdominal/etiologíaRESUMEN
The gold standard for bariatric surgery is the laparoscopic gastric bypass, which consists in forming a small gastric pouch and a Roux-en-Y anastomosis. We present the case of a 41-year-old female who underwent a laparoscopic gastric bypass 8 years prior to her admission to the emergency room, where she arrived complaining of severe and colicky epigastric abdominal pain. The abdominal computed tomography showed a jejuno-jejunal intussusception, for which the patient underwent urgent exploratory laparotomy with intussusception reduction. Intestinal intussusception is a possible postoperative complication of a Roux-en-Y gastric bypass.
El Método de referencia en la cirugía bariátrica es el bypass gástrico laparoscópico, que consiste en la creación de una bolsa gástrica pequeña, anastomosada al tracto digestivo mediante una Y de Roux. Presentamos el caso de una mujer de 41 años con el antecedente de un bypass gástrico laparoscópico realizado 8 años antes, quien ingresó al servicio de urgencias refiriendo dolor abdominal grave. La tomografía computarizada abdominal evidenció una intususcepción a nivel de la anastomosis yeyuno-yeyuno, por lo que se realizó una laparotomía exploradora con reducción de la intususcepción. Se debe considerar la intususcepción intestinal como complicación posoperatoria de bypass gástrico.
Asunto(s)
Derivación Gástrica , Intususcepción , Enfermedades del Yeyuno , Laparoscopía , Obesidad Mórbida , Humanos , Femenino , Adulto , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugía , Laparoscopía/métodos , Enfermedades del Yeyuno/diagnóstico por imagen , Enfermedades del Yeyuno/etiología , Enfermedades del Yeyuno/cirugía , Anastomosis en-Y de Roux/efectos adversos , Dolor Abdominal/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicacionesAsunto(s)
Aspergilosis , Trasplante de Células Madre Hematopoyéticas , Intususcepción , Trasplante Autólogo , Humanos , Persona de Mediana Edad , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Aspergilosis/microbiología , Aspergilosis/complicaciones , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Huésped Inmunocomprometido , Intususcepción/etiología , Intususcepción/cirugía , Intususcepción/microbiologíaRESUMEN
Intestinal intussusception in adult patients is a rare entity, which corresponds to about 5% of all causes of intestinal obstruction, its diagnosis is not easy given the lack of specific symptoms of patients who present it. This is mainly based on the findings of imaging studies, surgical management is the cornerstone of treatment of this pathology and its success will be determined by timely diagnosis as well as by the expertise of the treating surgeon. This article presents the case of a 62-year-old male patient who consults due to nonspecific abdominal pain and irritative urinary symptoms, who due to persistence of abdominal pain despite medical management is taken to surgery where it is diagnosed intraoperatively. an intestinal intussusception at the level of the distal ileum.
Asunto(s)
Obstrucción Intestinal , Intususcepción , Neoplasias , Masculino , Humanos , Anciano , Persona de Mediana Edad , Intususcepción/diagnóstico , Intususcepción/etiología , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Dolor Abdominal , ÍleonRESUMEN
Intussusception is the most common cause of gastrointestinal obstruction in children and typically presents with acute abdominal pain. Intussusception usually occurs in children under the age of 3 in the ileocecal region. Over the past 5 years, multiple patients at the Children's Hospital of Philadelphia have been diagnosed with both intussusception and biopsy-confirmed celiac disease (CD). Intussusception may be a presenting sign of pediatric CD and should raise clinical suspicion for celiac screening, especially if it is a small bowel-small bowel intussusception that occurs after the age of 3 in a malnourished patient.
Asunto(s)
Abdomen Agudo , Enfermedad Celíaca , Intususcepción , Humanos , Niño , Enfermedad Celíaca/complicaciones , Enfermedad Celíaca/diagnóstico , Intususcepción/diagnóstico , Intususcepción/etiología , Investigación , Dolor Abdominal/etiologíaRESUMEN
OBJECTIVES: One potential treatment for gastrojejunostomy (GJ) tube-related intussusception is bowel rest, whereby the GJ tube is replaced with a gastrostomy tube. The aim of this study was to determine whether bowel rest length was associated with decreased risk of re-intussusception. METHODS: Pediatric patients with GJ tube-related intussusceptions were identified during the study period of January 1, 2010 and August 1, 2021. Records were reviewed for demographics, symptoms, need for central access to initiate parenteral nutrition, and length of stay. Comparison was made between patients with intussusception recurrence within 30 days and those without. Those undergoing earlier replacement, defined as the first quartile of rest time, or 72 hours, were then compared to longer periods of bowel rest. RESULTS: Forty-six intussusceptions were included, with a median age of 2.8 years (interquartile range, IQR: 1.4-4.1) and weight of 12 kg (IQR: 8.9-15.4). All patients diagnosed as outpatient (54.3%) required hospital admission and 9 of 46 (19.6%) required central access. There were 7 recurrences (15.2%). There was no difference in recurrence based on time of bowel rest (5 days in those without vs 6 days in those with, P = 0.30) nor a difference in recurrence with <72 hours of bowel rest compared to >72 hours (1/15, 6.7% vs 6/31, 19.3%). Patients undergoing earlier exchange had a shorter median length of hospital stay (3 vs 8.5 days, P = 0.003). CONCLUSION: Length of bowel rest was not associated with recurrent GJ tube-related intussusceptions. If bowel rest is utilized, <72 hours may be sufficient to decrease length of hospital stay.
Asunto(s)
Derivación Gástrica , Intususcepción , Humanos , Niño , Lactante , Preescolar , Nutrición Enteral , Intususcepción/etiología , Intususcepción/cirugía , Derivación Gástrica/efectos adversos , Estudios Retrospectivos , Intubación Gastrointestinal , RecurrenciaRESUMEN
Meckel's diverticulum is the most common gastrointestinal tract anomaly. It arises from the incomplete closure of the omphalomesenteric conduit, which is a true diverticulum at the antimesenteric border of the ileum. Although the majority of patients are asymptomatic, they can present with inflammation, hemorrhage, intussusception, intestinal obstruction, and perforation, among others; this constitutes an important differential diagnosis for acute abdomen. A 19-year-old female sought medical attention because of intermittent diffuse abdominal pain for two months, nausea, and diarrhea. In the requested imaging tests, tomography, and enterotomography, a diagnosis of Meckel's diverticulum with some degree of intussusception was suggested. The patient underwent elective surgical treatment without complications and was discharged on the second postoperative day with clinical improvement. In this section, we review publications on similar cases published in the last five years.
Asunto(s)
Obstrucción Intestinal , Intususcepción , Divertículo Ileal , Femenino , Humanos , Adulto Joven , Adulto , Divertículo Ileal/complicaciones , Divertículo Ileal/diagnóstico por imagen , Divertículo Ileal/cirugía , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Dolor Abdominal/diagnóstico por imagen , Dolor Abdominal/etiología , Diagnóstico DiferencialRESUMEN
Intestinal intussusception is a pathology in which an intestinal segment and its mesentery are telescoped into an adjacent intestinal segment as a result of peristalsis, and in many cases cause intestinal obstruction. Its etiology can be variable, including intestinal diverticula, adhesion bands, vascular malformations, neoplasms, among others. The vast majority occur in pediatric patients, however, up to 5% of these are documented in adult patients and their main etiology in this age group are neoplasms. We present a case of intestinal intussusception secondary to Burkitt's lymphoma that received management at fourth level hospital in Bogotá, Colombia.
La intususcepción intestinal es una patología en la que un segmento intestinal y su mesenterio se invaginan al segmento intestinal contiguo. Su etiología puede ser benigna, maligna o idiopática, dentro de las que se incluyen divertículos intestinales, bandas adherenciales, malformaciones vasculares y neoplasias, entre otras. La mayoría se presentan en pacientes pediátricos, pero hasta un 5% se documentan en pacientes adultos y su principal etiología en este grupo etario son las neoplasias. Presentamos un caso de intususcepción intestinal secundaria a linfoma de Burkitt que recibió manejo en un hospital de cuarto nivel en Bogotá, Colombia.
Asunto(s)
Linfoma de Burkitt , Obstrucción Intestinal , Intususcepción , Adulto , Humanos , Niño , Intususcepción/etiología , Intususcepción/cirugía , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/complicaciones , Linfoma de Burkitt/complicaciones , Hospitales , ColombiaRESUMEN
Resumen Objetivo: Reportar el caso de una paciente con intususcepción apendicular (IA), condición infrecuente, secundario a foco de endometriosis, patología que en los últimos años ha presentado un aumento en su incidencia. Material y Método: Historia clínica, imágenes preoperatorias e intraoperatorias obtenidas de la ficha clínica. Resultados: Mujer de 35 años con dolor abdominal crónico de 4 meses de evolución. Se realiza estudio colonoscópico evidenciando lesión de 15 x 8 mm en ostium apendicular intususceptada al lumen cecal, y enteroclisis por tomografía axial computarizada (TC) que confirma IA. Se realiza una resección ileocecal laparoscópica demostrando la invaginación del apéndice con biopsia que muestra un foco de endometrioma. Discusión: La IA es una condición infrecuente con una incidencia cercana al 0,01% en la población general. Las patologías benignas son la principal causa (77%), siendo la endometriosis la causa más frecuente. Conclusión: La IA por endometriosis es anecdótica, con sintomatología poco específica. Los estudios disponibles pueden orientar adecuadamente la presencia de IA, sin embargo, en algunas ocasiones puede confundirse con patologías neoplásicas, donde cobra importancia la cirugía para dilucidar la etiología.
Objective: To report the case of a patient with appendicular intussusception (AI), an infrequent condition secondary to a focus of endometriosis, a pathology that has increased incidence in recent years. Material and Method: Clinical case, history and images obtained from the clinical file and intraoperative records with the consent of the patient. Results: A 35-year-old woman with abdominal pain. Colonoscopy study showing a 15 × 8 mm lesion in the appendicular ostium intussuscepted to the cecal lumen, and a computerized tomography (CT) enteroclysis confirming AI. A laparoscopic ileocecal resection is performed, demonstrating invagination of the appendix secondary to an endometrioma focus. Discussion: AI is a rare condition, with an incidence close to 0.01% in the general population. Benign pathologies are the main cause (77%), endometriosis being the most frequent cause. Conclusion: AI due to endometriosis is anecdotal, with unspecific symptoms. The available studies can adequately guide the presence of AI, however, on some occasions it can be confused with neoplastic pathologies, where surgery is important to elucidate the etiology.
Asunto(s)
Humanos , Femenino , Adulto , Apéndice/patología , Enfermedades del Ciego/etiología , Endometriosis/complicaciones , Intususcepción/etiología , Tomografía Computarizada por Rayos X , Enfermedades del Ciego/diagnóstico , Colonoscopía , Endometriosis/diagnóstico , Intususcepción/diagnósticoRESUMEN
Colonic lipomas are infrequent, benign, non-epithelial, fatty neoplasms. Most of the colonic lipomas are asymptomatic, but around 25% of patients may develop symptoms. Nowadays, surgical resection of the involved segment is the treatment of choice. We report three cases of colonic intussusceptions caused by colonic lipomas in adult patients. The patients underwent surgical resection, and the diagnosis was confirmed by histopathological examination of the specimens.
Los lipomas colónicos son neoplasias benignas, adiposas, no epiteliales poco frecuentes. La mayoría de los lipomas de colon son asintomáticos, pero alrededor del 25% de los pacientes pueden desarrollar síntomas. En la actualidad, la resección quirúrgica del segmento afectado es el tratamiento de elección. Presentamos tres casos de intususcepción intestinal secundaria a lipomas colónicos en pacientes adultos. Los pacientes fueron sometidos a resección quirúrgica y el diagnóstico se confirmó mediante examen histopatológico.
Asunto(s)
Neoplasias del Colon , Intususcepción , Lipoma , Adulto , Neoplasias del Colon/complicaciones , Humanos , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugía , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Lipoma/cirugíaRESUMEN
Endometriosis is the presence of normal endometrial tissue outside the uterus, which may appear in up to 15% of fertile female population. Bowel endometriosis is uncommon, and obstruction due to endometrial ileocolic intussusception is extremely rare. Herein, we report a case of a 27-year-old female who presented with bowel obstruction due to ileocolic intussusception secondary to endometriosis. A 27-year-old female, without pregnancies, and with a 1 year history of endometriosis presented to the emergency department referring severe abdominal pain in right lower quadrant, nausea and vomiting, she had medical history of prior episodes of mild abdominal pain due to endometriosis with OB/GYN follow-up. Physical examination revealed abdominal distension with decreased bowel movements to auscultation. A CT scan reported suspicion of intussusception. Colonoscopy was ordered, where an ileocolic intussusception was found. Diagnostic laparoscopy was performed, and the initial diagnosis was confirmed. A right hemicolectomy with extracorporeal anastomosis was achieved without any surgical complications. The patient was discharge on postoperative day 4 and continues doing well on a 12 month follow-up. Ileocolic intussusception due to endometriosis is a very rare condition, and it must be considered a differential diagnosis in female patients in reproductive age, when presenting with intestinal obstruction.
Asunto(s)
Endometriosis , Enfermedades del Íleon , Obstrucción Intestinal , Intususcepción , Adulto , Colectomía , Endometriosis/complicaciones , Endometriosis/diagnóstico por imagen , Endometriosis/cirugía , Femenino , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugíaRESUMEN
Splenosis is defined as the growth of ectopic splenic tissue, due to its direct seeding, usually seen after traumatic or surgical procedures to the spleen. It often occurs on highly vascularized surfaces such as the omentum or the mesentery, and grows in sessile form, supplied by adjacent vessels. Intestinal splenosis with endoluminal extension is extremely rare. We present a case of intestinal splenosis with endoluminal growth in a 14-year-old boy that provoked a small bowel intussusception requiring surgical resolution.
Asunto(s)
Intususcepción , Esplenosis , Adolescente , Humanos , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugía , Yeyuno/diagnóstico por imagen , Yeyuno/cirugía , Masculino , Epiplón , Esplenosis/diagnóstico por imagenRESUMEN
Intestinal intussusception occurs when a proximal segment of the intestine telescopes into the lumen of an adjacent distal segment, causing intestinal obstruction. It is a common cause of acute abdomen in the first two years of life, but rare in older children. A 16-year-old male with a diagnosis of cystic fibrosis presented with symptoms compatible with distal intestinal occlusion syndrome. He came at the cystic fibrosis clinic with a 5-day evolution of abdominal pain and a palpable mass in the right hypochondrium. Abdominal ultrasound and abdominal contrasted tomography were performed demonstrating ileocolonic invagination with signs of intestinal ischemia, necrosis and pneumatosis of the intestinal wall. He underwent surgery with resection of the terminal ileum and right hemicolon, and a tumor in the caecum was found. This is a rare cause of acute abdomen in young patients with cystic fibrosis and may be associated with an underlying organic cause.
La invaginación intestinal ocurre cuando un segmento proximal de intestino se repliega dentro de la luz de un segmento distal adyacente y provoca obstrucción intestinal. Es una causa común de abdomen agudo en los dos primeros años de la vida, pero raro en niños mayores. Un varón de 16 años, con diagnóstico de fibrosis quística, se presentó con un cuadro compatible con síndrome de oclusión intestinal distal. Consultó a la clínica con dolor abdominal y una masa palpable en el hipocondrio derecho. Se realizó ecografía abdominal y tomografía de abdomen contrastada, que demostraron invaginación íleo-colónica con signos de isquemia intestinal, necrosis y neumatosis de la pared intestinal. Fue intervenido: se realizó resección del íleon terminal y hemicolon derecho, y se detectó una tumoración en ciego. La invaginación íleo-colónica es una causa rara de abdomen agudo en pacientes adolescentes con fibrosis quística y puede estar asociada a una causa orgánica subyacente.
Asunto(s)
Fibrosis Quística/complicaciones , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/etiología , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Adolescente , Humanos , Masculino , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Intestinal intussusception is the most frequent cause of intestinal obstruction between 6 and 36 months of age, the majority being idiopathic. The association between celiac disease and intestinal intussusception in the pediatric population has been described. We present the case of a 23-month-old male admitted due to a failure to thrive. In his ultrasound study recurrent asymptomatic ileo-ileal invaginations were found.
La invaginación intestinal es la causa más frecuente de obstrucción intestinal entre los 6 y los 36 meses de edad. La mayoría son idiopáticas. Se ha descrito la asociación entre la enfermedad celíaca y la invaginación intestinal en la población pediátrica. Se presenta el caso de un varón de 23 meses ingresado por estancamiento ponderal en cuyo estudio ecográfico se observaron invaginaciones íleo-ileales asintomáticas repetidas.