Intussusception

Other complications may include gastroesophageal reflux, dysmotility, intussusception, volvulus, atresia, rectal prolapse, and complications related to corrective surgery for meconium ileus.6... 

Intestinal obstruction may be manifested as meconium ileus, distal intestinal obstruction syndrome, or intussusception on abdominal x-ray or computed tomography scan. Rectal prolapse may be noted on physical exam. 

The first rotavirus vaccine was a tetravalent rhesus rotavirus strain. It was licensed in the United States in 1998 and subsequently withdrawn from the market due to an association with intussusception. A pentavalent human-bovine reassortant rotavirus vaccine was approved by the FDA in February 2006. The exact mechanism by which the vaccine produces an immune response is unknown however, this live virus vaccine replicates in the small intestines and induces immunity. 

Intussusception The folding of one part of the intestine into the lumen of an immediately adjoining part or the enfolding of one segment of the intestine within another. 

In a 3-week study in which disulfoton was applied to the shorn, unabraded skin of rabbits and left for 6 hours, 5 days/week, necropsy of the rabbits that died within 2 weeks during treatment (100%) with the high dose of 6.5 mg/kg/day revealed marked intussusception of the ileum of one female (Flucke 1986). The gastrointestinal tract of the high dose rabbits or of rabbits similarly treated with <1.6 mg/kg/day for 3 weeks were not examined histologically. 

Rotavirus — the most common cause of severe diarrhea in infanfs, with approximately 125 million cases worldwide per year and 600,000 deaths — vaccines have been linked with intussusceptions (a problem with the intestine in which one portion of the bowel slides into the next) at a rate of between 1 in 5000 and 1 in 11,000 infants. The only rotavirus vaccine approved in the United States, RotaShield (Wyeth-Ayerst), was withdrawn from market on October 22, 1999, about 1 year after licensure. 

Obstruction of the intestines, intestinal adhesions and intussusception are acute abdominal syndromes and they have severe pathological consequences. They cause accumulation of feces, Qi, blood, heat and fire-toxin in the intestines. As well as regular western medical treatment, certain intestinal adhesions, intussusception and the primary stage of simple or partial intestinal obstruction can be treated with Chinese herbal medicine. 

A 53-year-old man developed ileocecal intussusception due to an edematous ischemic cecum, due to enterocolic lymphocytic phlebitis, with numerous associated thrombi. The phlebitis involved not only the ischemic area but also other sites, notably the entire right colon, terminal ileum, and appendix. All layers of the bowel wall were involved. The mesenteric veins were also prominently affected, but the arteries were spared. There was a marked lymphocytic infiltrate involving the epithelium of the entire right colon, ileum, and appendix. 

Murphy TV, Smith PJ, Gargiullo PM, Schwartz B (2003), The first rotavirus vaccine and intussusception epidemiological studies and policy decisions, J. Infect. Dis. 187 1309-1313. 

Short bowel Intestinal resection (e.g. for Crohn s disease, volvulus, intussusception or infarction) Jejunoileal bypass for obesity... 

Complications Potential complications include the perforation of the intestinal wall (covered or open), stenosis and stricture as well as intussusception or haemorrhage. 

Intussusception probably causally related to rotavirus vaccine (SEDA-23, 354) prompted studies to answer the question of whether polio vaccine could also cause intussusception. A workshop held in Atlanta on 15-16 June 2000 brought together experts from various fields with the primary investigators of the studies. The participants concluded that the available evidence favored rejection of a causal relation between OPV and intussusception (40). 

Anonymous. Oral poliovirus vaccine (OPV) and intussusception. Wkly Epidemiol Rec 2000 75(43) 345-7. 

Natural rotavirus itself is a causative agent for intussusception (3). In rotavirus disease in Japan, hjrperplasia of the intestinal lymphoid tissue is a common pathological finding in necropsy cases, and is identical with that... 

The rate of hospitalization for intussusception among infants aged less than 12 months during 1991-97 (before RRV-TV licensure) was 51 per 100 000 infant-years in New York. The manufacturer had distributed about 1.8 million doses of RRV-TV as of June 1 1999, and estimated that 1.5 million doses (83%) had been administered. Given this information, 14-16 intussusception cases among infants would be expected by chance alone during the week after the administration of any dose of RRV-TV. Fourteen of the 15 case-patients were vaccinated before June 1 1999, and of those, 11 developed intussusception within 1 week of receiving RRV-TV. 

The epidemiology of hospitalizations and deaths associated with intussusception among US infants has been described (7). Such data could be useful for further clinical trials with newly developed rotavirus vaccines. 

Further studies have confirmed that there is an increased risk of intussusception associated with the use of rhesus rotavirus tetravalent vaccine (RRV-TV). The association has been assessed in infants in 19 states of the USA (8). Each infant hospitalized with intussusception between 1 November 1998 and 30 June 1999 was matched according to age with four healthy controls who had been born at the same hospital. The authors estimated that one case of intussusception would occur for every 4670-9474 infants immunized. 

In a retrospective cohort study in 10 managed care organizations there was an increased risk of intussusception in immunized children (9). The risk was greatest at 3-7 days after the first dose of RRV-TV. 

Current prelicensure trials of newly developed rotavirus vaccines are taking into consideration the experiences gained during the licensure process of Rotashield. Phase 3 clinical trials have included over 10 000 volunteers in order to exclude the potential risk of intussusception. 

Centers for Disease Control and Prevention (CDC). Intussusception among recipients of rotavirus vaccine—... 

Parashar UD, Holman RC, Cummings KC, Staggs NW, Cums AT, Zimmerman CM, Kaufman SF, Lewis JE, Vugia DJ, PoweU KE, Glass RI. Trends in intussusception-associated hospitalizations and deaths among US infants. Pediatrics 2000 106(6) 1413-21. 

Kramarz P, France EK, Destefano F, Black SB, Shinefield H, Ward JI, Chang EJ, Chen RT, Shatin D, Hill J, Lieu T, Ogren JM. Population-based study of rotavirus vaccination and intussusception. Pediatr Infect Dis J 2001 20(4) 4I0-16. 

Intussusception after rotavirus vaccine was described as an example to underline the value of passive surveillance systems as an indicator for carefully designed follow-up studies. 

Rotavirus A. Intussusception B. Any sequel (including death) of the above events C. Events described in the manufacturers package insert as contraindications to additional doses of the vaccine 30 days Not applicable See package insert... 

Growth in Area and Thickness.—The cell wall when first formed is limited in both extent and thickness. As the protoplast within enlarges new particles are placed within the wall by the process called intussusception. This increases its area. New particles, also, are deposited on its surface which gradually increases its thickness. The latter process is known as growth by apposition. 

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