Navigation Links
Antegrade bowel intussusception can cause recurrent, chronic postoperative intestinal obstruction
Date:11/13/2007

Several complications can be seen after pancreatic surgery, most notably bleeding, infections and anastomotic dehiscence. Bowel obstruction can also be seen due to internal hernias or anastomotic strictures. A more unusual etiology for bowel obstruction in this setting is intussusception.

Intussusception is often a pediatric condition. Adult cases have rarely been reported, and are usually caused by a lead point. The paper published by Dr. Luis Leons group on the November 28 issue of World Journal of Gastroenterology describes a rare case of adult intussusception without lead points. Cases without lead points are most often seen after gastric bypasses for morbid obesity or after biliary reconstruction for choledochal cysts. Intussusception occurring after pancreatic duct reconstructions is rare. The report represents the second report in the literature of such an occurrence.

This patient was quite a challenge for surgeons at the University of Arizona. She was a middle-aged female who presented with abdominal pain and vomiting of 24-hour duration. Her history was significant for pancreas divisum and chronic pancreatitis. Four years prior, she underwent a Whipple procedure as therapy for her pancreatic abnormalities. The indications to perform a Whipple procedure to correct pancreas divisum are questioned by the authors in their paper. She required revision one year later with a Puestow operation due to stricture of the pancreatico-intestinal anastomosis. Ever since, she had been experiencing intermittent abdominal pain for which she had been prescribed strong pain killers, with only partial relief. Upon arrival at the University of Arizona, severe tenderness to abdominal palpation was elicited. Emergent surgical intervention was deemed necessary. An intussusception just distal to the most distal Roux-en-Y connection was found, causing two loops of dilated small bowel up to 10-cm in maximal diameter, and also about 1 foot of non-perforated necrotic small bowel. The intussusception was antegrade, obstructing both Roux-en-Y reconstructions. No lead point lesions were seen. The intussuscepted intestine was reduced, the necrotic bowel resected, and a side-to-side anastomosis between the most distal aspect of the bowel and the Roux-en-Y reconstruction that was directed towards the Puestow procedure was performed. She was subsequently discharged without complications.

The chronic nature and severity of this patients symptoms made her diagnosis very challenging. Previously performed CT scans showed findings that, in retrospect, suggest transient short bowel segment intussusceptions. The authors postulate that this complication may be a severe variant of Roux-en-Y stasis syndrome. The myoelectric activity of the Roux limb is often dysfunctional, split and retrograde and of high amplitude. It is possible that the intussusception seen in this patient was the result of severe disruption of the intestinal pacemaker activity, which is even more likely in the absence of lead points.

Antegrade intussusception after pancreatic surgery is extremely rare. This report by Dr. Leons group is the second such occurrence. Their patient had previous episodes of abdominal pain and vomiting, which suggests that altered intestinal motility may have contributed to her presentation. Intussusception should always be considered in cases of bowel obstruction in adults after pancreatic reconstructions.


'/>"/>

Contact: You-De Chang
y.d.chang@wjgnet.com
86-108-538-1892
World Journal of Gastroenterology
Source:Eurekalert

Related medicine news :

1. Elsevier announces new journal on inflammatory bowel diseases
2. C-diff infection 4 times more likely to kill patients with inflammatory bowel disease
3. Mesalamine linked to cancer protection for high risk inflammatory bowel disease patients
4. Threshold for bowel surgery may be too high, warn experts
5. Drug for cluster headaches may cause heart problems
6. Study Points to Cause of Vioxx Heart Risk
7. Damp, Moldy Homes May Cause Depression
8. Constipations Many Causes and Cures
9. High Co-Pays Cause Seniors to Go Without Meds
10. 13 percent of women stop taking breast cancer drug because of side effects, U-M study finds
11. Vocal cord dysfunction may be caused by work
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... ... June 24, 2016 , ... Global law firm Greenberg ... Legal Elite. The attorneys chosen by their peers for this recognition are considered among ... Greenberg Traurig Shareholders received special honors as members of this year’s Legal Elite Hall ...
(Date:6/24/2016)... San Diego, CA (PRWEB) , ... June 24, 2016 , ... ... up with the American Cancer Society and the Road To Recovery® program to drive ... care to seniors and other adults to ensure the highest quality of life and ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... People across ... in Genome magazine’s Code Talker Award, an essay contest in which patients and their ... award to be presented at the 2016 National Society of Genetic Counselors (NSGC) Annual ...
(Date:6/24/2016)... ... 24, 2016 , ... The Haute Beauty Network, affiliated with ... as a prominent plastic surgeon and the network’s newest partner. , Dr. ... handsome men, look naturally attractive. Plastic surgery should be invisible.” He stands by ...
(Date:6/24/2016)... ... 2016 , ... Strategic Capital Partners, LLC (SCP) in concert ... capital for emerging technology companies. SCP has delivered investment events and professional ... than a million dollars of capital investment for five companies. The ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)...   Pulmatrix, Inc ., (NASDAQ: PULM ... announced today that it was added to the Russell ... comprehensive set of U.S. and global equity indexes on ... milestone for Pulmatrix," said Chief Executive Officer Robert ... progress in developing drugs for crucial unmet medical needs, ...
(Date:6/23/2016)... , June 23, 2016 Any dentist who ... challenges of the current process. Many of them do not ... the technical difficulties and high laboratory costs involved. And those ... offer it at such a high cost that the majority ... Dr. Parsa Zadeh , founder of Dental ...
(Date:6/23/2016)... , June 23, 2016 ... CAPR ), a biotechnology company focused on the ... announced that patient enrollment in its ongoing randomized ... has exceeded 50% of its 24-patient target. Capricor ... the third quarter of 2016, and to report ...
Breaking Medicine Technology: