Intussusception in the Aged: Ileal-Ileal Type With Spontaneous Auto-Amputation and Expulsion of the Necrotic Segment

Abstract

Intussusception occurs infrequently in adults and rarely in the aged. Several recent statistical studies attest to this: Finklestein1 reviewed the records of the Beth Israel Hospital in Brooklyn for the 11 year period prior to 1938, and found only one adult case in 62,632 hospital admissions. Likewise, Miller reviewed 75,000 admissions to the Nashville General Hospital and found only one adult case. We have reviewed the records at the Cook County Hospital in Chicago for the 11 year period 1940 to 1950, inclusive, and found only four cases of adult intussusception among approximately 700,000 hospital admissions. This is to be contrasted with the report by Oberhelman and Condon3 who reviewed the records of the Childrens' Hospital of the Cook County Hospital in Chicago for the 21 year period 1925 to 1946, and found 95 cases in children among 141,580 admissions. These statistics reaffirm the earlier teachings that most cases of intussusception occur in children, particularly under two years of age. No statistics are available for studying the frequency in the aged but our review of the published adult cases indicates that this is rare. In the adult large bowel intussusception occurs more frequently than the enteric type which is most common in children. While occasional cases are found in which no definite etiology is discernible (idiopathic type), most adult cases have a specific etiologic factor such as tumor, diverticulum, ulceration, etc. The causes of intussusception are adequately listed by Iason.4 In the light of our present knowledge of the mechanics and pathologic physiology involved, intussusception must be considered an acute surgical condition at any age. However, occasionally the condition of the patient may contraindicate surgery, especially in the aged, or the correct diagnosis may not be immediately established because of the unusual or bizarre symptoms presented. In such cases, rarely, the intussuscepted segment (intussusceptum) may be spontaneously amputated, the gangrenous segment passed rectally and an adequate anastomosis may develop at the site of the amputation to re-establish bowel