3)). Still, other investigations such as plain film X-ray and ultrasound have been used to help make the diagnosis. The classic triad of abdominal pain, bloody stools, and a palpable mass is rarely seen in these cases of intussusception, and therefore, it is important to take a multimodality selleck compound approach. The combined use of clinical history, physical exam, and radiographic images increases the sensitivity significantly and helps to plan the surgery in a more suitable time frame . Figure 1 (a) Illustration of intussusception. (b) Target sign: it indicates hyperemia of mucosa, muscularis, and serosa with submucosal edema. The high attenuation of mucosa, muscularis, and serosa is due to contrast enhancement, while the low attenuation of submucosa …
Figure 2 (a) Axial view of the CT scan showing intussusception with fat and blood vessels within the lumen of intestine (white arrow��target sign and pneumatosis). (b) Coronal view of the CT scan showing intussusception (white arrow��sausage-shaped … Figure 3 Sagittal view of the CT scan showing intussusception (white arrow��site of intussusception). Although our ability to detect and treat intussusception following gastric bypass surgery has improved, its etiology remains somewhat unclear. Most people still believe that intussusception is related to dysmotility, which develops secondary to the development of ectopic pacemakers. Other proposed mechanisms include development of new lead points such as sutures or staple lines and focal nodal hyperplasia. However, in the vast majority of cases, no identifiable lead points or aberrations in anatomy are detected [7, 9, 10].
2. Material and Methods A comprehensive search was conducted to identify the literature published worldwide including articles, reviews, case reports, and series and abstracts describing intussusception after gastric bypass surgery. We also included patients from our own clinical experience. We included all patients who underwent gastric bypass surgery for weight loss��both open and laparoscopic, confirmed diagnosis of intussusception��either preoperative or postoperative based on pathology. Patients with gastric bypass surgery for reasons other than weight loss, intussusception not associated with weight loss surgery, and diagnosis of intestinal obstruction due to causes other than intussusception were excluded in this review.
The data was extracted using a structured form that included information regarding demographic profile, medical history, weight loss, clinical presentation, radiographic imaging, diagnosis, management, and posttreatment course in these patients (Table 1). Table 1 Summary of patient profile. 3. Results Seventy one patients were identified including seven patients from our own series, in 29 studies published worldwide between the years 1991 and 2011. The majority of patients identified were females (n = 70, 98.6%), with the median age of 35.5 years (range, 20�C60 years). Sixty nine patients Batimastat (97.