Telescoping intestines intussusception in adults

Abstract

Introduction: Intussusception in adults is a rare entity. Being one of the most common causes of intestinal obstruction in children, it accounts for only 5% of all cases of intussusceptions and about 1%-5% of bowel obstruction in adults. A minority of cases are idiopathic, without a lead point lesion. Postoperative adhesions, meckel’s diverticulum, inflammatory bowel disease, benign and malignant tumors, metastatic neoplasms or even iatrogenic presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery account for the various causes of secondary intussusception in 70%-90% of cases. Computerized tomography (CT) is often considered as one of the most useful, sensitive imaging modality in the diagnosis of intussusception. AIM: To study and describe the different pathological causes, clinical features and management of intussusception in adults. Materials & methods: A retrospective study was conducted to evaluate the various causes of intussusception. All patients above the age of 18yrs presenting with a clinical diagnosis of intussusception, between Jan 2008 and June 2015 were included in the study. Results: There were 15 cases of adult intussusception. A male predominance was noted and the mean age was 41.7 years. Majority of the patients presented with abdominal pain, abdominal distension, nausea and vomiting. The commonest site of intussception was the ileo-colic junction (46.7%, 7cases). There were four jejuno-jejunal cases (26.7%) and two ileo-ileal cases (13.3%). There were also two other cases of colonic intussusception, not involving the ileo-colic junction (13.3%). Among the pathological causes of intussusception, four cases were secondary to diffuse large B cell lymphoma (DLBCL), four due to submucosal lipomas, two cases secondary to peutz jegher polyps, one case of carcinoid involving the appendix, three cases due to inflammatory causes and one being idiopathic. All cases were treated surgically. Conclusion: Malignant lesions account for majority of causes of adult intussusception involving the colon. Adult intussusception is a challenging condition for the surgeon and is very often a preoperative diagnostic problem when compared to that in children. Because of the high incidence of malignancy in colonic intussusceptions, a segmental bowel resection is generally undertaken.