Emergency surgery for enteric and colonic intussusception in adults

Abstract

BACKGROUND: Ninety percent of intussusceptions (ITSSs) in adults are secondary to other lesions, which are most likely malignant, especially in the colon. Symptoms are often chronic and non-specific, but acute courses with the need of an emergency operation are frequent. Nevertheless, in these cases the decision to what extent the resection should be done is not clear. METHODS: A retrospective analysis was performed to search for adult emergency patients with ITSS admitted to the University Hospital Salzburg between 1999 and 2009. RESULTS: ITSS with acute symptoms led to an emergency operation in 12 patients within 24 hours. Seven (58.3%) were males and the mean age was 49.9 years (range, 22–79). ITSS was verified intra-operatively in all patients. Enteric ITSS occurred in 7 (58.3%) and colonic ITSS in 5 (41.6%) patients. In 10 patients (83.3%) resection was performed, in two patients (16.7%), one in each group, the invagination was reduced only after malignancy was definitely ruled out intra-operatively. Pathologic lesions as the cause of ITSS were found in four cases of enteric (57.1%) and in four cases of colonic ITSS (80%), which were malignant in 14.3% and 60%, respectively. Resection was performed in an en-bloc manner following oncologic principles in all patients but one with Crohn's disease. The postoperative course was without complications in all patients and 11 patients (91.7%) are still alive at a median follow-up period of 5.5 years. CONCLUSION: En-bloc resection is feasible and safe even in emergency situations, an oncologic resection should be considered in all patients with colonic ITSS.