Location of Intussusception in Adults Predicts Malignant Etiology

Abstract

Introduction: Intussusception is defined by a proximal segment of the gastrointestinal tract invaginating into a more distal portion of bowel. This results in obstruction or intestinal vasculature compression which can lead to ischemia, infarction, or even perforation. Adult intussusception is a rare, accounting for 1-5% of the total intussusception cases. Identifiable structural lesions or lead points are identified in up to 30% of cases. In adults, close to 30-50% of all the cases are related to malignancy. Celiac disease has also been reported as a possible etiology for adult intussusception. Methods: We reviewed the records of all patients 18 years and older with an ICD-9 code of intussusception between 01/2010 - 05/2018. Patients with a diagnosis of rectal and gastric intussusception were excluded. Data was obtained from a review of patient charts, operative and pathology reports. Age, gender, race, proximal bowel dilation, and presence of celiac disease were recorded. Cases were categorized based on location and etiology (no neoplasm vs neoplasm). Univariate and multivariate regression analysis were conducted to identify predictors of neoplasm in these cases. Results: A total of 67 cases were identified, with 61% male, mean age of 50 years and 70% white. Small intestine was the site of intussusception in 54 cases (81%) as compared to 13 cases (19%) of colonic intussusception (Table-1). Proximal bowel loop dilation was seen in 25% of cases. 3 patients (4.5%) had associated Celiac disease. Neoplasms were the cause of intussusception in 22% of the cases. 77% of colonic intussusception cases were caused by neoplasms as compared to 9% of the small intestinal intussusception. Patients with neoplasms were older (57.7 versus 49 years). In both univariate and multivariate analysis, colonic location of intussusception was a significant predictor of malignancy with odds ratios of 33 (CI: 6.7-166) and 32 (CI: 6.7-159) respectively. Conclusion: Although small intestinal intussusception is more frequent in adults, colonic intussusception is more frequently associated with neoplasms. Patients with advanced age also have a higher incidence of neoplasms as the cause of intussusception. This reinforces the importance of a more comprehensive investigation for older adults who present with colonic intussusception.160 Figure 1 No Caption available.