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Clinical Case Summary

Introduction: Adult intussusception, the telescoping of one segment of the small intestine into another, is an uncommon cause of intestinal obstruction. Unlike the more frequent ileocolic intussusception, jejuno-jejunal intussusception is even rarer. In adults, intussusception often has a lead point, such as a polyp.[1][2][3]
Case presentation: A 48-year-old male presented with a three-day history of progressively worsening crampy abdominal pain, nausea, and vomiting. He denied fever, bloody stools, or recent changes in bowel habits. Past medical history was unremarkable. Physical examination revealed moderate abdominal distention and tenderness in the upper abdomen.
Laboratory tests showed mild leukocytosis, but other findings were within normal limits. An abdominal X-ray demonstrated nonspecific bowel gas pattern. Due to ongoing concerns and suspected bowel obstruction, an abdominal ultrasound was performed.
The ultrasound revealed a characteristic finding known as the "target sign" within the epigastric area. This sign appears as a concentric ring pattern with a central echogenic core, suggestive of intussusception.
Given the high risk of bowel ischemia , the patient underwent an emergency laparoscopic exploration. Laparoscopy revealed an jejunal intussusception caused by a pedunculated polyp. The involved bowel segment and the polyp were successfully resected laparoscopically.
Histopathological examination of the resected polyp revealed a benign hyperplastic polyp. The patient recovered well post-operatively and was discharged home on postoperative day three.
Conclusion: Intussusception in adults should be considered in the differential diagnosis of patients with acute abdominal pain and suspected bowel obstruction. Ultrasound can be a valuable tool in identifying the characteristic signs of intussusception and may even suggest the presence of a lead point, such as a polyp.

References

1. Panzera F, Di Venere B, Rizzi M, Biscagia A, Pratico CA, Nasti G, Mardighani A, Nunes TF, Inchingolo R. Bowel intussusception in adult: Prevalence, diagnostic tools and therapy. World J Methodol. 2021 May 20;11(3):81-87. doi: 10.5662/wjm.v11.i3.81. eCollection 2021 May 20. PMID:34026581
2. Lin NH, Liao WH. Echography of intussusception in an adult. Quant Imaging Med Surg. 2023 Jan 1;13(1):536-537. doi: 10.21037/qims-22-266. Epub 2022 Nov 9. PMID: 36620131
3. Sun M, Li Z, Shu Z, Wu Q, Liu X. Adult intussusception: a challenge to laparoscopic surgery? PeerJ. 2022 Nov 30; 10:e14495. doi: 10.7717/peerj.14495. eCollection 2022. PMID: 36518277

ADULT JEJUNO-JEJUNAL INTUSSUSCEPTION DUE TO INTESTINAL POLYP: A DIAGNOSTIC CHALLENGE WITH ULTRASOUND

Valeriya Kotsiubenko 1, Dmitro Yaroshuk 2

1 Kyiv Emergency Hospital, Kyiv, Ukraine

2 Bogomolets National Medical University, Kyiv, Ukraine

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Clinical Case

Session

Clinical Cases (Posters)

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below the level that allows the normal digestion of nutrients. Pancreatic disease and surgery are the main causes of PEI. However, other conditions and upper gastrointestinal surgery can also affect the digestive function of the pancreas. PEI can cause symptoms of nutritional malabsorption and deficiencies, which affect the quality of life and increase morbidity and mortality. These guidelines were developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. After a systematic literature review, the evidence was evaluated according to the Oxford Center for Evidence-Based Medicine and the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted on using the Delphi method. The diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzyme replacement therapy (PERT), together with dietary advice and support, are the cornerstones of PEI therapy. PERT is indicated in patients with PEI that is secondary to pancreatic disease, pancreatic surgery, or other metabolic or gastroenterological conditions. Specific recommendations concerning the management of PEI under various clinical conditions are provided based on evidence and expert opinions. This evidence-based guideline summarizes the prevalence, clinical impact, and general diagnostic and therapeutic approaches for PEI, as well as the specifics of PEI in different clinical conditions. Finally, the unmet needs for future research are discussed.

European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations

Juan Enrique Dominguez-Munoz

Publishers

European Society for Primary Care Gastroenterology, European Society of Digestive Oncology, European Society for Paediatric Gastroenterology, Hepatology and Nutrition, The European Society for Clinical Nutrition and Metabolism, European Digestive Surgery, European Pancreatic Club

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

United European Gastroenterol J. 2024; 1–48. https://doi.org/10.1002/ueg2.12674

Published

2024

UEG Mistakes In Articles

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Pancreatic cystic neoplasms (PCN) are a frequent and clinically challenging condition. PCN prevalence increases with age and reports estimate that they may be present in 2–45% of the general population. In addition, the biological behaviour of the various types of PCN differs (ranging from benign to malignant [table 1]), requiring different surveillance and therapeutic approaches. Correct management of PCN is, therefore, critical for avoiding progression to cancer, but at the same time avoiding unneeded close and long-term follow-up, unnecessary invasive diagnostic procedures and overtreatment.

Mistakes in pancreatic cystic neoplasms and how to avoid them

Marco Del Chiaro, Juan Enrique Dominguez-Munoz, Giovanni Marchegiani

Topics

Digestive Oncology Pancreas

Citation

Domínguez-Muñoz J.E. and Del Chiaro M. Mistakes in pancreatic cystic neoplasms and how to avoid them. UEG Education 2018; 18: 35–37.

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Main recommendations

Prophylaxis

1 ESGE recommends routine rectal administration of 100mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal antiinflammatory drug administration.

Strong recommendation, moderate quality evidence.

2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).

Strong recommendation, moderate quality evidence.

3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.

Weak recommendation, moderate quality evidence.

4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.

Strong recommendation, moderate quality evidence.

5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.

Weak recommendation, moderate quality evidence.

6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.

Weak recommendation, low quality evidence.

Treatment

7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.

Weak recommendation, low quality evidence.

8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.

Weak recommendation, low quality evidence.

9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.

Weak recommendation, low quality evidence.

ERCP-related adverse events:European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Jean-Marc Dumonceau

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy

Citation

Endoscopy. 2020 Feb;52(2):127-149

Published

2019

UEG Standards and Guidelines

Consensus

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Summary

These recommendations refer to the current management in pancreatic ductal adenocarcinoma (PDAC), a neoplasia characterised by an aggressive course and extremely poor prognosis. The recommendations regard diagnosis, surgical, adjuvant and palliative treatment, with consideration given to endoscopic and surgical methods. A vast majority of the statements are based on data obtained in clinical studies and experts’ recommendations on PDAC management, including the following guidelines: International Association of Pancreatology/European Pancreatic Club (IAP/EPC), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network (NCCN) and Polish Society of Gastroenterology (PSG) and The National Institute for Health and Care Excellence (NICE). All recommendations were voted on by members of the Working Group of the Polish Pancreatic Club. Results of the voting and brief comments are provided with each recommendation.

Keywords: pancreatic ductal adenocarcinoma; recommendations; guidelines; treatment; diagnosis

Diagnostic and therapeutic recommendations in pancreatic ductal adenocarcinoma. Recommendations of the Working Group of the Polish Pancreatic Club

Katarzyna Winter, Renata Talar-Wojnarowska, Andrzej Dabrowski, Malgorzata Degowska, Anita Gąsiorowska, Marek Durlik, Stanislaw Gluszek, Grazyna Jurkowska, Aleksandra Kaczka, Pawel Lampe, Tomasz Marek, Ewa Nowakowska-Dulawa, Anna Nasierowska-Guttmejer, Grazyna Rydzewska-Wyszkowska, Janusz Strzelczyk, Ewa Malecka-Wojciesko, Zbigniew Sledzinski

Guideline

Consensus

Topics

Digestive Oncology Endoscopy Histopathology Pancreas Radiology & Imaging Surgery

Citation

Prz Gastroenterol. 2019; 14(1): 1–18

Published

2019

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.

Keywords

Liver disease, Pregnancy, Pre-existing liver disease, Gestational liver disease, Medications in pregnancy, Pre-pregnancy counselling, Delivery, Contraception, Guideline

EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary

Citation

Journal of Hepatology, September 2023. vol. 79, 768–828

Published

2023

UEG Standards and Guidelines

Position Paper

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Abstract

The European Society of Gastrointestinal Endoscopy (ESGE) has developed performance measures and established a framework for quality assessment for gastrointestinal endoscopy in Europe. Most national societies actively undertake initiatives to implement and explicitly endorse these quality indicators. Given this, the ESGE proposes that, at a national level, strong leadership should exist to disseminate and implement quality parameters. Thus, understanding the potential barriers that may vary locally is of paramount importance. The ESGE suggests that each national society should prioritise quality and standards of care in gastrointestinal endoscopy in their activities and should survey/understand which measures area local priority to their members and make measuring quality intrinsic to daily endoscopy practice.

Keywords: Endoscopy service; Patient outcome; Performance measures; Quality; Quality indicator; Underperformance

Overcoming the barriers to dissemination and implementation of quality measures for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) position statement

Raf Bisschops

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Position Paper

Topics

Endoscopy

Citation

United European Gastroenterol J. 2021;9:120–126.

Published

2020

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