Colo-Colic
Intussusception By Richard
lntuasusception OnI)
S,,
in children
and William
have B lead point,
A rare cause of intussusception
ing :I patient whose co10 -colic intussuscrption
A six-qrar
old white
of lethargy.
hematochezin.
male *as
occasional
diverticulum.
hemangioma.4
a polyp.
’ We
or a
are report-
was secondary to a hrmangiomu.
admitted
vomiting,
5”,, of cases being co10 colic ‘.’
e.g. Meckel’s
is a congenital
CASE
history
B. Kiesewetter
IS most often ileo colic with only
lo”,, of intussusceptions
dupllcation.‘.J
J. Bower
Due to a Hemangioma
REPORT to Children’s
intermittent
Hospital
crampy
Since age 3, the patient passed small
of Pittsburgh
abdominal
amounts
pain,
with
a 2 mo
and occasional
of blood per rectum
evrrq
6 to
8 months. Abdominal
examination
revealed a 5 cm left lower quadrant
mass. The
mass was mild14 tender
and mobile. The mass could not bc palpated rectally and there was no blood in the rectum. sounds were present. There was mild abdominal
distension
but no guarding.
Bowl
No cutaneous Iesinm
wcrc present. A diagnosis
of intussusception
distended transverse
v+hich was interpreted
Fig.
1.
ception
ng
near
flexure.
splenic
.1ddrerv
of an intussusception.
This
was reduced to the
enema
annular
From the Surgical
of the abdomen showed u
and a mass was seen in the sigmold
intussus-
barium
by
made and plain tilms
x-ray
of
demonstrati
L’niversily
as the intussuscrptum
Abdominal
reduc tion
after
was tentatively
colon. A barium enema was administered
lesion
Clinic
of Pirtsburgh
of rhe Children’s
Hospital
01‘ Pitrsburgh
School oJ’ Medicine, Pittsburgh.
~wrrevpondem~e
10 William
B. Kievewecier.
and the Department
of Surgert~.
Pennsylvania. M.D..
Sur,~t,on-in-(‘hir/.
Children’\
tlo\virol.
/.?S Dt~otr~ .~I., Pirr.~hur,qh. P.4 I5_‘/3.
Journal of Pedrotric Surgery, Vol. 12, No. 5 (October), 1977
7?7
778
BOWER
Fig.
2.
circumferential,
Gross
AND KIESEWETTER
specimen rubmucosal
showing heman-
gioma.
splenic flexure where a partially obstructing lesion or incompletely reduced intussusception was encountered (Fig. I). the intussusception was found to be Abdominal exploration was indicated and at operation. completely reduced but a 3 cm x 5 cm mass was palpable near the splenic flexure. The serosal surface of the colon appeared normal. A wedge resection of the splenic flexure and its mesentery was done with the diagnosis of possible neoplasm after exploration showed no other abnormalities. The patient did well and was discharged on the seventh postoperative day. Gross examination of the resected specimen showed a circumferential lesion which appeared to be submucosal (Fig. 2) with one area of ulceration. The mesentery contained several nodes (0.5-I cm) diameter. Microscopically, a hemangioma with thick-walled vessels was found. No evidence of malignancy was present.
DISCUSSION A recent review shows only 58 cases of hemangioma of the colon.5 Most hemangiomas of the colon have bleeding as their initial symptom and the bleeding may be mild as in this case or may be massive. In larger hemangiomas the bleeding is occasionally related to thrombocytopenia which results from platelet trapping.4 In addition to bleeding, hemangiomas can cause obstruction of the colon by tumor bulk. intramural hemorrhage, or by intussusception. Perforation of the colon, secondary to a hemangioma. has also been reported.’ When a hemangioma is found to be the lead point of an intussusception. a segmental resection or excision of the hemangioma is required. REFERENCES I. Gross Childhood.
RE: The Surgery of Infancy and Philadelphia, Saunders, 1953, p 282
2. Larson E, Miller RC: Clinical aspects intussusception. Am J Surg 124:69, 1972 3. Ein S: Leading susception. J Pediatr
points in childhood Surg 11:209. 1976
of
intus-
4. Abrahamson J. Shandling B: Intestinal hemangiomata in childhood and a syndrome
for diagnosis: A collective review. J Pediatr Surg 8:487, 1973 5. Head H, Baker J, Muir RW: Hemangioma of the colon. Am J Surg 126:691, 1973 6. Weinstein EC, Moertel CC. Waugh JM: lntussuscepting hemangiomas of the gastrointestinal tract. Ann Surg 157:265, 1963 7. Haas L: Neonatal perforation of the colon. Arch Dis Child 33:362. 1958
Intussusception By Richard
lntuasusception OnI)
S,,
in children
and William
have B lead point,
A rare cause of intussusception
ing :I patient whose co10 -colic intussuscrption
A six-qrar
old white
of lethargy.
hematochezin.
male *as
occasional
diverticulum.
hemangioma.4
a polyp.
’ We
or a
are report-
was secondary to a hrmangiomu.
admitted
vomiting,
5”,, of cases being co10 colic ‘.’
e.g. Meckel’s
is a congenital
CASE
history
B. Kiesewetter
IS most often ileo colic with only
lo”,, of intussusceptions
dupllcation.‘.J
J. Bower
Due to a Hemangioma
REPORT to Children’s
intermittent
Hospital
crampy
Since age 3, the patient passed small
of Pittsburgh
abdominal
amounts
pain,
with
a 2 mo
and occasional
of blood per rectum
evrrq
6 to
8 months. Abdominal
examination
revealed a 5 cm left lower quadrant
mass. The
mass was mild14 tender
and mobile. The mass could not bc palpated rectally and there was no blood in the rectum. sounds were present. There was mild abdominal
distension
but no guarding.
Bowl
No cutaneous Iesinm
wcrc present. A diagnosis
of intussusception
distended transverse
v+hich was interpreted
Fig.
1.
ception
ng
near
flexure.
splenic
.1ddrerv
of an intussusception.
This
was reduced to the
enema
annular
From the Surgical
of the abdomen showed u
and a mass was seen in the sigmold
intussus-
barium
by
made and plain tilms
x-ray
of
demonstrati
L’niversily
as the intussuscrptum
Abdominal
reduc tion
after
was tentatively
colon. A barium enema was administered
lesion
Clinic
of Pirtsburgh
of rhe Children’s
Hospital
01‘ Pitrsburgh
School oJ’ Medicine, Pittsburgh.
~wrrevpondem~e
10 William
B. Kievewecier.
and the Department
of Surgert~.
Pennsylvania. M.D..
Sur,~t,on-in-(‘hir/.
Children’\
tlo\virol.
/.?S Dt~otr~ .~I., Pirr.~hur,qh. P.4 I5_‘/3.
Journal of Pedrotric Surgery, Vol. 12, No. 5 (October), 1977
7?7
778
BOWER
Fig.
2.
circumferential,
Gross
AND KIESEWETTER
specimen rubmucosal
showing heman-
gioma.
splenic flexure where a partially obstructing lesion or incompletely reduced intussusception was encountered (Fig. I). the intussusception was found to be Abdominal exploration was indicated and at operation. completely reduced but a 3 cm x 5 cm mass was palpable near the splenic flexure. The serosal surface of the colon appeared normal. A wedge resection of the splenic flexure and its mesentery was done with the diagnosis of possible neoplasm after exploration showed no other abnormalities. The patient did well and was discharged on the seventh postoperative day. Gross examination of the resected specimen showed a circumferential lesion which appeared to be submucosal (Fig. 2) with one area of ulceration. The mesentery contained several nodes (0.5-I cm) diameter. Microscopically, a hemangioma with thick-walled vessels was found. No evidence of malignancy was present.
DISCUSSION A recent review shows only 58 cases of hemangioma of the colon.5 Most hemangiomas of the colon have bleeding as their initial symptom and the bleeding may be mild as in this case or may be massive. In larger hemangiomas the bleeding is occasionally related to thrombocytopenia which results from platelet trapping.4 In addition to bleeding, hemangiomas can cause obstruction of the colon by tumor bulk. intramural hemorrhage, or by intussusception. Perforation of the colon, secondary to a hemangioma. has also been reported.’ When a hemangioma is found to be the lead point of an intussusception. a segmental resection or excision of the hemangioma is required. REFERENCES I. Gross Childhood.
RE: The Surgery of Infancy and Philadelphia, Saunders, 1953, p 282
2. Larson E, Miller RC: Clinical aspects intussusception. Am J Surg 124:69, 1972 3. Ein S: Leading susception. J Pediatr
points in childhood Surg 11:209. 1976
of
intus-
4. Abrahamson J. Shandling B: Intestinal hemangiomata in childhood and a syndrome
for diagnosis: A collective review. J Pediatr Surg 8:487, 1973 5. Head H, Baker J, Muir RW: Hemangioma of the colon. Am J Surg 126:691, 1973 6. Weinstein EC, Moertel CC. Waugh JM: lntussuscepting hemangiomas of the gastrointestinal tract. Ann Surg 157:265, 1963 7. Haas L: Neonatal perforation of the colon. Arch Dis Child 33:362. 1958
