関: sheath

WordNet

a protective covering (as for a knife or sword)
an enveloping structure or covering enclosing an animal or plant organ or part (同)case

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(刀などの)さや / (動・植物のある部分をおおう)さや;(ケーブルの)鎧装(がいそう)など・体にぴったり合った女性の衣服

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/25 21:26:44」(JST)

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An intussusception is a medical condition in which a part of the intestine invaginates (folds into) into another section of intestine, similar to the way the parts of a collapsible telescope slide into one another.^[1] This can often result in an obstruction. The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscipiens. Intussusception is a medical emergency and a patient should be seen immediately to reduce risk.

Signs and symptoms

Early symptoms can include periodic abdominal pain nausea, vomiting (sometimes green in color from bile), pulling legs to the chest area, and intermittent moderate to severe cramping abdominal pain. Pain is intermittent—not because the intussusception temporarily resolves, but because the intussuscepted bowel segment transiently stops contracting. Later signs include rectal bleeding, often with "red currant jelly" stool (stool mixed with blood and mucus), and lethargy. Physical examination may reveal a "sausage-shaped" mass, felt upon palpating the abdomen.^[2] Children, or those too young to communicate symptoms verbally, may cry, draw their knees up to their chest. or experience dyspnea (difficult or painful breathing) with paroxysms of pain.

Fever is not a symptom of intussusception. However, intussusception can cause a loop of bowel to become necrotic, secondary to ischemia due to compression to arterial blood supply. This leads to perforation and sepsis, which causes fever.

In rare cases, intussusception may be a complication of Henoch-Schönlein purpura (HSP), an immune-mediated vasculitis disease in children. Such patients who develop intussusception often present with severe abdominal pain in addition to the classic signs and symptoms of HSP.

Cause

Intussusception causes are not clearly established or understood. They can include infections, anatomical factors, and altered motility. Some researchers suspect infectious agents, including rotavirus, are causative factor, but studies and analysis have not conclusively established this. A review of sparse data on the possible association between natural rotavirus and intussusception has not demonstrated a possible association until very recently. In addition, ecological studies revealed that no seasonality exists for intussusception in the United States, whereas rotavirus has distinct wintertime peaks. In developing countries, patterns of intussusception may be quite variable and different from developed countries. This may likely be due to incomplete reporting of cases in developing countries. Rates of intussusception may also vary according to socioeconomic status in developing country.

Meckel's diverticulum
Polyp
Duplication
Appendix
Hyperplasia of Peyer's patches
Idiopathic

Pathophysiology

Scheme of intussusception

In the most frequent type of intussusception, the ileum enters the cecum. However, other types occur, such as when a part of the ileum or jejunum prolapses into itself. Almost all intussusceptions occur with the intussusceptum having been located proximally to the intussuscipiens. This is because peristaltic action of the intestine pulls the proximal segment into the distal segment. There are, however, rare reports of the opposite being true.

An anatomic lead point (that is, a piece of intestinal tissue that protrudes into the bowel lumen) is present in approximately 10% of intussusceptions.^[3]

The trapped section of bowel may have its blood supply cut off, which causes ischemia (lack of oxygen in the tissues). The mucosa (gut lining) is very sensitive to ischemia, and responds by sloughing off into the gut. This creates the classically described "red currant jelly" stool, which is a mixture of sloughed mucosa, blood, and mucus.^[4] A study reported that in actuality, only a minority of children with intussusception had stools that could be described as "red currant jelly," and hence intussusception should be considered in the differential diagnosis of children passing any type of bloody stool.^[5]

Diagnosis

Small intestinal invagination on computed tomography

An ultrasound shows a target sign—characteristic for intussusception

An Intussusception is often suspected based on history and physical exam, including observation of Dance's sign. Per rectal examination is particularly helpful in children as part of the intussusceptum may be felt by the finger. A definite diagnosis often requires confirmation by diagnostic imaging modalities. Ultrasound is the imaging modality of choice for diagnosis and exclusion of intussusception,due to its high accuracy and lack of radiation. A target-like mass, usually around 3 cm in diameter, confirms the diagnosis. This sign has a doughnut shape created by the hyperechoic central core of bowel and mesentery surrounded by the hypoechoic outer edematous bowel, seen on transverse sonography or computed tomography.^[6] In longitudinal imaging intussusception resembles a sandwich.^[6]

An x-ray of the abdomen may be indicated to check for intestinal obstruction or free intraperitoneal gas. The latter finding implies that bowel perforation has already occurred. Some institutions use air enema for diagnosis, as the same procedure can be used for treatment.^[7]^{[citation needed]}

Classification

Ileoileal - 5%
Ileocolic - 77%
Ileo-ileo-colic - 12%
Colocolic - 2%
Multiple - 1%
Retrograde - 0.2%
Others - 2.8%^[8]

Differential diagnosis

An Intussusception has two main differential diagnoses: acute gastroenteritis and rectal prolapse. Abdominal pain, vomiting, and stool with mucus and blood are present in acute gastroenteritis, but diarrhea is the leading symptom. Rectal prolapse can be differentiated by projecting mucosa that can be felt in continuity with the perianal skin, whereas in intussusception the finger may pass indefinitely into the depth of sulcus.

Treatment

The condition is not usually immediately life-threatening. The intussusception can be treated with either a barium or water-soluble contrast enema or an air-contrast enema, which both confirms the diagnosis of intussusception, and in most cases successfully reduces it. The success rate is over 80%. However, approximately 5–10% of these recur within 24 hours.^{[citation needed]}

Cases where it cannot be reduced by an enema or the intestine is damaged require surgical reduction. In a surgical reduction, the surgeon opens the abdomen and manually squeezes (rather than pulls) the part that has telescoped. If the surgeon cannot successfully reduce it, or the bowel is damaged, they resect the affected section. More often, the intussusception can be reduced by laparoscopy, pulling the segments of intestine apart with forceps.^{[citation needed]}

Prognosis

Intussusception may become a medical emergency if not treated early, as it eventually causes death if not reduced. In developing countries where medical hospitals are not easily accessible, especially when other problems complicate the intussusception, death becomes almost inevitable. When intussusception or any other severe medical problem is suspected, the person must be taken to a hospital immediately.^{[citation needed]}

The outlook for intussusception is excellent when treated quickly, but when untreated it can lead to death within two to five days. It requires fast treatment, because the longer the intestine segment is prolapsed the longer it goes without bloodflow, and the less effective a non-surgical reduction is. Prolonged intussusception also increases the likelihood of bowel ischemia and necrosis, requiring surgical resection.^{[citation needed]}

Epidemiology

The condition is diagnosed most often in infancy and early childhood. It strikes about 2,000 infants (one in every 1,900) in the United States in the first year of life. Its incidence begins to rise at about one to five months of life, peaks at four to nine months of age, and then gradually declines at around 18 months.

Intussusception occurs more frequently in boys than in girls, with a ratio of approximately 3:1.^[9]

In adults, intussusception represents the cause of approximately 1% of bowel obstructions and is frequently associated with neoplasm, malignant or otherwise.^[10]

References

^ Gylys, Barbara A. and Mary Ellen Wedding (2009), Medicasl Terminology Systems, F.A. Davis Company
^ Cera, SM (2008). "Intestinal Intussusception". Clin Colon Rectal Surg 21 (2): 106–13. doi:10.1055/s-2008-1075859. ISSN 1531-0043. PMID 20011406.
^ Chapter X.4. Intussusception from Case Based Pediatrics For Medical Students and Residents, by Lynette L. Young, MD. Department of Pediatrics, University of Hawaii John A. Burns School of Medicine. December 2002
^ Toso C, Erne M, Lenzlinger PM, Schmid JF, Büchel H, Melcher G, Morel P (2005). "Intussusception as a cause of bowel obstruction in adults" (PDF). Swiss Med Wkly 135 (5-6): 87–90. PMID 15729613.
^ Yamamoto, LG; Morita, SY; Boychuk, RB; Inaba, AS; Rosen, LM; Yee, LL; Young, LL (May 1997). "Stool appearance in intussusception: assessing the value of the term "currant jelly."". The American journal of emergency medicine 15 (3): 293–8. doi:10.1016/s0735-6757(97)90019-x. PMID 9148991.
^ ^a ^b Park NH, Park SI, Park CS, Lee EJ, Kim MS, Ryu JA, Bae JM (2007). "Ultrasonographic findings of small bowel intussusception, focusing on differentiation from ileocolic intussusception". Br J Radiol 80 (958): 798–802. doi:10.1259/bjr/61246651. ISSN 0007-1285. PMID 17875595.
^ Singh C , Prakash M., Adult Intussception : A Case Report, WebmedCentral RADIOLOGY 2011;2(7):WMC002052
^ Bailey & Love's/24th/1195
^ Lonnie King, M.D., FACEP (2006). "Pediatrics: Intussusception". Retrieved 2006-06-05.
^ Gayer G, Zissin R, Apter S, Papa M, Hertz M (2002). "Pictorial review: adult intussusception--a CT diagnosis". Br J Radiol 75 (890): 185–90. PMID 11893645.

UpToDate Contents

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1. 小児における腸重積症 intussusception in children
2. 成人における機械的小腸閉塞の疫学、臨床的特徴、および診断 epidemiology clinical features and diagnosis of mechanical small bowel obstruction in adults

English Journal

Adult colocolic intussusception and literature review.

Wilson A1, Elias G, Dupiton R.Author information 1Lincoln Medical and Mental Health Center, Fort Lee, N.J., USA.AbstractIntussusception occurs when a proximal segment of the gastrointestinal tract, called intussusceptum, telescopes into the lumen of an adjacent segment, also known as intussuscipiens. Although common in early childhood, intussusceptions are very rare in the adult population. Most intussusceptions in adults are due to a lead point, which is an identifiable pathological abnormality, in opposition to children which there are no identifiable pathological lead points. In contrast to childhood intussusception, in adults it is associated with malignant lesions, particularly in the large bowel rather than in the small bowel. Its preoperative diagnosis and treatment in adults is difficult because of nonspecific abdominal symptom and because it rarely presents with the classic triad of vomiting, abdominal pain and passage of blood per rectum. We present a 63-year-old female with an adenocarcinoma tumor being the lead point in a colocolic intussusception, who was diagnosed preoperatively with computed tomography and had a colonoscopy to rule out obstruction. She underwent right hemicolectomy with side-to-side ileocolic anastomosis and did well postoperatively. In addition, we also review the literature and discuss the value of radiological modalities, location and surgical management to try to improve the preoperative diagnosis. Computed tomography scanning with intravenous contrast is maybe the most accurate modality for diagnosis of intussusceptions in adults, and treatment is usually surgical resection without reduction, since most of the colonic lesions are malignant.
Case reports in gastroenterology.Case Rep Gastroenterol.2013 Sep 5;7(3):381-7. doi: 10.1159/000355155. eCollection 2013.
Intussusception occurs when a proximal segment of the gastrointestinal tract, called intussusceptum, telescopes into the lumen of an adjacent segment, also known as intussuscipiens. Although common in early childhood, intussusceptions are very rare in the adult population. Most intussusceptions in a
PMID 24163649

Ileoileal intussusception secondary to an ileal fibroma.

Chelimilla H1, Ihimoyan A, Carvajal S, Bhavna B.Author information 1Division of Gastroenterology, Bronx-Lebanon Hospital Center, Bronx, New York, N.Y., USA.AbstractIntussusception is defined as the telescoping of a segment of the gastrointestinal tract (intussusceptum) into an immediately adjacent distal bowel (intussuscipiens). Intussusception is a relatively rare cause of intestinal obstruction in adults. Unlike in children, a lead point is present in 90% of adult cases. The most common causes of small bowel intussusception are benign, usually hamartomas, lipomas, inflammatory polyps, adenomas and leiomyomas, in contrast to the large intestine where malignant tumors, usually adenocarcinomas, are more common. The clinical presentation of adult intussusception is non-specific with variable manifestations, predominantly those of intestinal obstruction, often making the diagnosis a challenge. The onset of symptoms may be acute, intermittent or chronic. We present a rare case of an ileal fibroma presenting with intussusception. A 43-year-old woman presented to our outpatient clinic with a history of recurrent abdominal pain. The clinical presentation and CT scan findings led to the diagnosis of ileoileal intussusception. Subsequently she underwent laparotomy which revealed an ileal fibroma as the lead point of the intussusception. Surgical exploration remains essential for diagnosis and treatment since in the majority of cases a pathologic lead point is identified. Ileal fibroma is an uncommon benign neoplasm of the small bowel and must be considered in the differential diagnosis for small bowel intussusception.
Case reports in gastroenterology.Case Rep Gastroenterol.2012 Sep;6(3):734-40. doi: 10.1159/000345806. Epub 2012 Sep 22.
Intussusception is defined as the telescoping of a segment of the gastrointestinal tract (intussusceptum) into an immediately adjacent distal bowel (intussuscipiens). Intussusception is a relatively rare cause of intestinal obstruction in adults. Unlike in children, a lead point is present in 90% of
PMID 23275765

Ultrasound guided hydrostatic reduction of intussusception in children at Korle Bu Teaching Hospital: an initial experience.

Mensah Y1, Glover-Addy H, Etwire V, Appeadu-Mensah W, Twum M.Author information 1Department of Radiology, Korle Bu Teaching Hospital, P. O. Box KB 77, Korle Bu, Accra, Ghana. ybmensah@yahoo.comAbstractIntussusceptions is the telescoping or invagination of a portion of intestine (intussusceptum) into an adjacent segment (intussuscipiens). It is one of the common causes of bowel obstruction in infants and toddlers.Sonography has now been accepted as a method for guiding hydrostatic reduction of intussusception with tap water, normal saline or Ringer's lactate solution. This method is currently being used at Korle Bu Teaching Hospital. It is a very simple, efficient, economical and quick method of managing intussusception. The duration of the procedure ranges between two minutes and thirty minutes, with the majority being under ten minutes. A total of twenty intussusceptions were managed in eighteen patients over a nine month period. In fifteen patients (75%) the intussusception was reduced successfully. In five patients (25%), the procedure failed to reduce the intussusceptions.
Ghana medical journal.Ghana Med J.2011 Sep;45(3):128-31.
Intussusceptions is the telescoping or invagination of a portion of intestine (intussusceptum) into an adjacent segment (intussuscipiens). It is one of the common causes of bowel obstruction in infants and toddlers.Sonography has now been accepted as a method for guiding hydrostatic reduction of int
PMID 22282581

Japanese Journal

Fusion of intussusceptum and intussuscipiens in intrauterine intussusception : A rare type of intestinal atresia

IMAI Yukihiro,NISHIJIMA Eiji,MURAJI Toshihiro,HASHIMOTO Kimio,HAYASHI Yoshitake,ITOH Hiroshi
Pathology international 49(11), 962-967, 1999-11
NAID 10008346254

Related Pictures

★リンクテーブル★

リンク元	「sheath」「外筒」

「sheath」

Intussusception
	An intussuception as seen on CT
Classification and external resources
Specialty	Pediatrics, general surgery
ICD-10	K38.8, K56.1
ICD-9-CM	543.9, 560.0
OMIM	147710
DiseasesDB	6913
MedlinePlus	000958
eMedicine	emerg/385
MeSH	D007443

　　[★]

n.

外筒(シース)、葉鞘

関: intussuscipiens、leaf sheath

「外筒」

　　[★]

英: sheath、intussuscipiens
関: 葉鞘

[1] Gylys, Barbara A. and Mary Ellen Wedding (2009), Medicasl Terminology Systems, F.A. Davis Company

[Cera-2] Cera, SM (2008). "Intestinal Intussusception". Clin Colon Rectal Surg 21 (2): 106–13. doi:10.1055/s-2008-1075859. ISSN 1531-0043. PMID 20011406.

[3] Chapter X.4. Intussusception from Case Based Pediatrics For Medical Students and Residents, by Lynette L. Young, MD. Department of Pediatrics, University of Hawaii John A. Burns School of Medicine. December 2002

[Toso-4] Toso C, Erne M, Lenzlinger PM, Schmid JF, Büchel H, Melcher G, Morel P (2005). "Intussusception as a cause of bowel obstruction in adults" (PDF). Swiss Med Wkly 135 (5-6): 87–90. PMID 15729613.

[5] Yamamoto, LG; Morita, SY; Boychuk, RB; Inaba, AS; Rosen, LM; Yee, LL; Young, LL (May 1997). "Stool appearance in intussusception: assessing the value of the term "currant jelly."". The American journal of emergency medicine 15 (3): 293–8. doi:10.1016/s0735-6757(97)90019-x. PMID 9148991.

[Park-6] Park NH, Park SI, Park CS, Lee EJ, Kim MS, Ryu JA, Bae JM (2007). "Ultrasonographic findings of small bowel intussusception, focusing on differentiation from ileocolic intussusception". Br J Radiol 80 (958): 798–802. doi:10.1259/bjr/61246651. ISSN 0007-1285. PMID 17875595.

[7] Singh C , Prakash M., Adult Intussception : A Case Report, WebmedCentral RADIOLOGY 2011;2(7):WMC002052

[8] Bailey & Love's/24th/1195

[eMedicine.com-9] Lonnie King, M.D., FACEP (2006). "Pediatrics: Intussusception". Retrieved 2006-06-05.

[gayer-10] Gayer G, Zissin R, Apter S, Papa M, Hertz M (2002). "Pictorial review: adult intussusception--a CT diagnosis". Br J Radiol 75 (890): 185–90. PMID 11893645.

匿名

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案内

案内

intussuscipiens