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- W1990975319 abstract "Question: A 51-year-old man had been robust until 2 days before admission when he had right lower quadrant abdominal dull pain accompanied with bloody stool passage. There was no weight loss, fever, nausea, vomiting, change in bowel habit, family history of malignancy, medication, or travel history. On physical examination, he had acute-ill looking and tenderness over McBurney's point. No palpable abdominal mass was noted. Laboratory studies showed positive fecal occult blood test but no anemia. An abdominal ultrasonography revealed concentric rings pattern with internal hyperechoic parts of the proximal right colon (Figure A). Colonofibroscopy showed 1 huge mass originating from the ileocecal valve into the ascending colon (Figure B). The surface of the colonic mass was filled with necrotic and erosive mucosa. What is the diagnosis?View Large Image Figure ViewerDownload Hi-res image Download (PPT) See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Computed tomography (CT) revealed ileocolic intussusceptions (Figure C). The intussusception was unable to be reduced surgically and he received right hemicolectomy (Figure D). The pathology report confirmed one 3-cm ileal lipoma approximately 8 cm proximal to the intussusception. Partial spontaneous release of the intussusception was noted. He is doing well after the surgery.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Intussusception is an uncommon but emergent condition in adults. More than 95% of cases occur in children.1Tan K.Y. Tan S.M. Tan A.G. et al.Adult intussusceptions: experience in Singapore.ANZ J Surg. 2003; 73: 1044-1047Crossref PubMed Scopus (70) Google Scholar The classical triad of abdominal pain, a sausage-shaped palpable mass, and passage of red currant jelly stools seen in children is rarely observed adults.2Azar T. Berger D.L. Adult intussusceptions.Ann Surg. 1997; 226: 134-138Crossref PubMed Scopus (662) Google Scholar Up to 90% of adult patients have a leading point.3Zubaidi A. Al-Saif F. Silverman R. Adult intussusceptions: a retrospective review.Dis Colon Rectum. 2006; 49: 1546-1551Crossref PubMed Scopus (127) Google Scholar More than two thirds have a malignant tumor; the commonest benign lesion is a colonic lipoma.3Zubaidi A. Al-Saif F. Silverman R. Adult intussusceptions: a retrospective review.Dis Colon Rectum. 2006; 49: 1546-1551Crossref PubMed Scopus (127) Google Scholar Other benign lesions reported include adenomatous and hamartomatous polyps, Meckel's diverticulum, duplication cysts, lymphomas, endometriosis, and inverted ischemic appendiceal remnant. The investigations include a barium enema (“claw sign”), ultrasonography (transverse view, “crescent-in-doughnut sign”; longitudinal view, “pseudo-kidney sign”) and CT scan (target lesion). The diagnosis by colonoscopy is always challenging because stromal tumors may have similar endoscopic pictures. Unlike pediatric patients, operative intervention is always required in adult patients." @default.
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- W1990975319 date "2009-07-01" @default.
- W1990975319 modified "2023-10-18" @default.
- W1990975319 title "A “Crescent-in-doughnut” Lesion at Right Lower Quadrant Abdomen" @default.
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- W1990975319 doi "https://doi.org/10.1053/j.gastro.2008.12.055" @default.
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