Correspondence
Retrograde Duodenoduodenal Intussusception: An Uncommon Complication of Peptic Ulcer Ayşe Kefeli, Sebahat Basyigit, Abdullah Ozgur Yeniova, Metin Uzman, Bora Aktaş Department of Gastroenterology, Kecioren Research and Training Hospital, Ankara, Turkey
To the Editor: A 58‑year‑old man was presented with the complaints of epigastric pain, nonbilious vomiting, and progressive distension of the abdomen for the last 1 month. There was no significant history. Physical examination was within normal limit except abdominal distension with hyperactive peristalsis. Laboratory examinations were normal except blood urea nitrogen: 35 mg/dl, creatinine: 1.45 mg/dl, hemoglobin: 10.5 g/dl, and leukocyte counts: 17,000/mm3.
Intussusception is the invagination of a segment of the intestine into another. It is rare in adults (1–5%).[1] Retrograde intussusception which is described as the invagination through the proximal direction is very uncommon accounting for only 5% of the whole cases of intussusception.[2] Clinical symptoms of duodenoduodenal intussusception include epigastric pain, abdominal mass, gastrointestinal bleeding, and enteral obstruction.[1]
Ultrasonography showed gastric distension and a 12 mm in size, lobulated wall thickening in the gastric outlet. Upper gastrointestinal endoscopy revealed dilated stomach with food residue, gaping pylorus with hyperemic mucosa, and a 15 mm in size ulcered lesion protruding into the lumen of the duodenal bulb [Figure 1]. The endoscope could not be achieved in the second part of the duodenum. Body and antral biopsies were performed endoscopically by specialized gastrointestinal pathologists for Helicobacter pylori (H. pylori). Abdominal magnetic resonance imaging showed enlarged stomach and “target sign” in the right upper quadrant of the abdomen convenient with the duodenoduodenal intussusception without definite cause for the intussusception [Figure 2]. High‑dose proton pump inhibitor (pantoprazole 40 mg b.i.d.) was given to the patient. Eradication therapy was initiated for H. pylori after the reporting of histological examination.
Mechanical factors such as adhesions, long mesentery, gastric dismotility, and sudden increase in abdominal pressure may be responsible for the etiopathogenesis of reverse intussusception. It is a well‑described complication that occurs in late course after the gastrointestinal surgery.[2] In our case, adhesion secondary to inflammation may cause reverse intussusception. This is the first reported case of retrograde duodenoduodenal intussusception as
At follow‑up, his complaints were regressed and control endoscopy showed ulcer healing and resolution of the intussusception on the sixth day of therapy [Figure 1].
Figure 2: Abdominal magnetic resonance imaging showed enlarged stomach and “target sign” in the right upper quadrant of the abdomen convenient with the duodenoduodenal intussusception without definite cause for the intussusception.
Figure 1: In the left picture, a 15 mm in size ulcered lesion protruding into the lumen of the duodenal bulb was seen in upper gastrointestinal endoscopy; in the right picture, ulcer healing and resolution of the intussusception were shown by control endoscopy. Access this article online Quick Response Code:
Website: www.cmj.org
Address for correspondence: Dr. Ayşe Kefeli, Department of Gastroenterology, Kecioren Research and Training Hospital, Ankara, Turkey E‑Mail: [email protected] This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. © 2015 Chinese Medical Journal ¦ Produced by Wolters Kluwer ‑ Medknow
DOI: 10.4103/0366-6999.168085
Chinese Medical Journal ¦ November 5, 2015 ¦ Volume 128 ¦ Issue 21
Received: 11‑04‑2015 Edited by: Yi Cui How to cite this article: Kefeli A, Basyigit S, Yeniova AO, Uzman M, Aktaş B. Retrograde Duodenoduodenal Intussusception: An Uncommon Complication of Peptic Ulcer. Chin Med J 2015;128:2981-2. 2981
a complication of duodenal ulcer. Adhesions resulting from the inflammation can lead the intussusception in our case.
Financial support and sponsorship Nil.
Conflicts of interest
There are no conflicts of interest.
References 1. Felix EL, Cohen MH, Bernstein AD, Schwartz JH. Adult intussusception; case report of recurrent intussusception and review of the literature. Am J Surg 1976;131:758‑61. 2. Chen LE, Bhalla S, Warner BW, Strasberg SM. Retrograde jejunoduodenal intussusception: A rare cause of acute pancreatitis after surgery for duodenal atresia. J Pediatr Surg 2008;43:e31‑3.
Corrigenda
Corrigendum: Comparison of C50 for Propofol-remifentanil Target-controlled Infusion and Bispectral Index at Loss of Consciousness and Response to Painful Stimulus in Elderly and Young Patients Due to the carelessness of the authors, in the article, “Comparison of C50 for Propofol-remifentanil Target-controlled Infusion and Bispectral Index at Loss of Consciousness and Response to Painful Stimulus in Elderly and Young Patients”, which appeared in the pages 1994-1999, Issue 15, Vol 128 of Chinese Medical Journal,[1] the word “Weight, kg” in Table 1 under the first column is incorrectly written instead of “Age, years”. Additionally, the numbers “19/33” and “25/27” in Table 1 under the second and third columns are incorrectly written instead it should be written as “19/21” and “23/17” respectively.
2982
These have now been corrected and reposted online.
Reference 1. Yang N, Zuo MZ, Yue Y, Wang Y, Shi Y, Zhang XN. Comparison of C50 for Propofol-remifentanil Target-controlled Infusion and Bispectral Index at Loss of Consciousness and Response to Painful Stimulus in Elderly and Young Patients. Chin Med J 2015;128:1994-9. DOI: 10.4103/0366-6999.168086
Chinese Medical Journal ¦ November 5, 2015 ¦ Volume 128 ¦ Issue 21
Retrograde Duodenoduodenal Intussusception: An Uncommon Complication of Peptic Ulcer Ayşe Kefeli, Sebahat Basyigit, Abdullah Ozgur Yeniova, Metin Uzman, Bora Aktaş Department of Gastroenterology, Kecioren Research and Training Hospital, Ankara, Turkey
To the Editor: A 58‑year‑old man was presented with the complaints of epigastric pain, nonbilious vomiting, and progressive distension of the abdomen for the last 1 month. There was no significant history. Physical examination was within normal limit except abdominal distension with hyperactive peristalsis. Laboratory examinations were normal except blood urea nitrogen: 35 mg/dl, creatinine: 1.45 mg/dl, hemoglobin: 10.5 g/dl, and leukocyte counts: 17,000/mm3.
Intussusception is the invagination of a segment of the intestine into another. It is rare in adults (1–5%).[1] Retrograde intussusception which is described as the invagination through the proximal direction is very uncommon accounting for only 5% of the whole cases of intussusception.[2] Clinical symptoms of duodenoduodenal intussusception include epigastric pain, abdominal mass, gastrointestinal bleeding, and enteral obstruction.[1]
Ultrasonography showed gastric distension and a 12 mm in size, lobulated wall thickening in the gastric outlet. Upper gastrointestinal endoscopy revealed dilated stomach with food residue, gaping pylorus with hyperemic mucosa, and a 15 mm in size ulcered lesion protruding into the lumen of the duodenal bulb [Figure 1]. The endoscope could not be achieved in the second part of the duodenum. Body and antral biopsies were performed endoscopically by specialized gastrointestinal pathologists for Helicobacter pylori (H. pylori). Abdominal magnetic resonance imaging showed enlarged stomach and “target sign” in the right upper quadrant of the abdomen convenient with the duodenoduodenal intussusception without definite cause for the intussusception [Figure 2]. High‑dose proton pump inhibitor (pantoprazole 40 mg b.i.d.) was given to the patient. Eradication therapy was initiated for H. pylori after the reporting of histological examination.
Mechanical factors such as adhesions, long mesentery, gastric dismotility, and sudden increase in abdominal pressure may be responsible for the etiopathogenesis of reverse intussusception. It is a well‑described complication that occurs in late course after the gastrointestinal surgery.[2] In our case, adhesion secondary to inflammation may cause reverse intussusception. This is the first reported case of retrograde duodenoduodenal intussusception as
At follow‑up, his complaints were regressed and control endoscopy showed ulcer healing and resolution of the intussusception on the sixth day of therapy [Figure 1].
Figure 2: Abdominal magnetic resonance imaging showed enlarged stomach and “target sign” in the right upper quadrant of the abdomen convenient with the duodenoduodenal intussusception without definite cause for the intussusception.
Figure 1: In the left picture, a 15 mm in size ulcered lesion protruding into the lumen of the duodenal bulb was seen in upper gastrointestinal endoscopy; in the right picture, ulcer healing and resolution of the intussusception were shown by control endoscopy. Access this article online Quick Response Code:
Website: www.cmj.org
Address for correspondence: Dr. Ayşe Kefeli, Department of Gastroenterology, Kecioren Research and Training Hospital, Ankara, Turkey E‑Mail: [email protected] This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. © 2015 Chinese Medical Journal ¦ Produced by Wolters Kluwer ‑ Medknow
DOI: 10.4103/0366-6999.168085
Chinese Medical Journal ¦ November 5, 2015 ¦ Volume 128 ¦ Issue 21
Received: 11‑04‑2015 Edited by: Yi Cui How to cite this article: Kefeli A, Basyigit S, Yeniova AO, Uzman M, Aktaş B. Retrograde Duodenoduodenal Intussusception: An Uncommon Complication of Peptic Ulcer. Chin Med J 2015;128:2981-2. 2981
a complication of duodenal ulcer. Adhesions resulting from the inflammation can lead the intussusception in our case.
Financial support and sponsorship Nil.
Conflicts of interest
There are no conflicts of interest.
References 1. Felix EL, Cohen MH, Bernstein AD, Schwartz JH. Adult intussusception; case report of recurrent intussusception and review of the literature. Am J Surg 1976;131:758‑61. 2. Chen LE, Bhalla S, Warner BW, Strasberg SM. Retrograde jejunoduodenal intussusception: A rare cause of acute pancreatitis after surgery for duodenal atresia. J Pediatr Surg 2008;43:e31‑3.
Corrigenda
Corrigendum: Comparison of C50 for Propofol-remifentanil Target-controlled Infusion and Bispectral Index at Loss of Consciousness and Response to Painful Stimulus in Elderly and Young Patients Due to the carelessness of the authors, in the article, “Comparison of C50 for Propofol-remifentanil Target-controlled Infusion and Bispectral Index at Loss of Consciousness and Response to Painful Stimulus in Elderly and Young Patients”, which appeared in the pages 1994-1999, Issue 15, Vol 128 of Chinese Medical Journal,[1] the word “Weight, kg” in Table 1 under the first column is incorrectly written instead of “Age, years”. Additionally, the numbers “19/33” and “25/27” in Table 1 under the second and third columns are incorrectly written instead it should be written as “19/21” and “23/17” respectively.
2982
These have now been corrected and reposted online.
Reference 1. Yang N, Zuo MZ, Yue Y, Wang Y, Shi Y, Zhang XN. Comparison of C50 for Propofol-remifentanil Target-controlled Infusion and Bispectral Index at Loss of Consciousness and Response to Painful Stimulus in Elderly and Young Patients. Chin Med J 2015;128:1994-9. DOI: 10.4103/0366-6999.168086
Chinese Medical Journal ¦ November 5, 2015 ¦ Volume 128 ¦ Issue 21
