Management Of Adult Intussusception Research Articles

Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management

ObjectiveIntestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. Materials and methodsThis retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged <16 years. Thus, 21 cases in adults (mean age, 57 years) were analyzed. ResultsThe most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumours were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). ConclusionsCT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its aetiology and therapeutic management.

Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico

ObjectiveIntestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. Materials and methodsThis retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. ResultsThe most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). ConclusionsCT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.

Management of Adult Intussusception-A Case Series Experience from a Tertiary Center.

The management of intussusception is controversial. Clinical presentation, with the aid of imaging modalities, enables a better selection of patients for the appropriate treatment algorithm. Conservative management versus surgical intervention with bowel resection is considered accordingly. Retrospective review of a computerized database of patients who were admitted with intussusception between January 1, 2010, and December 31, 2020, in a single tertiary center in Israel. Patients who were treated conservatively were compared to those who underwent surgery. Patients who underwent bowel resection were compared to those that had surgery without a resection. A total of 76 patients were diagnosed with intussusception, and 49 were operated. Bowel resection was performed in 32 cases. 20/76(26%) were successfully managed conservatively. Patients with a lead point (OR = 5.59) and colonic involvement (OR = 13.72) had a higher likelihood for resection. The likelihood of bowel resection was found to be significantly lower with proximal small bowel intussusception (OR = 0.071). Young patients presenting with intussusception may be treated conservatively when adequate criteria are met in order to avoid unnecessary surgical interventions.

Laparoscopic Resection of an Acute Rectosigmoid Intussusception Due to a Giant Pedunculated Lipoma

Intussusception is the invagination and telescopic migration of a proximal segment of the gastrointestinal tract distally and is classically described in the paediatric age group, accounting for 95% of reported cases. Intussusception in adults is highly uncommon; its aetiology involves a wide spectrum of pathologies, namely, concerning malignancy and differing management pathways. In the management of adult intussusception, consideration must be given to the potential malignant nature of the lesion, as reducing a malignant segment could render dissemination. Intussusception with non-malignant lesions like lipomas has been described, usually involving the right and transverse colons. In this case report, we review a rare case of adult colorectal intussusception secondary to a submucosal sigmoid lipoma.

Telescoping intestines intussusception in adults

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.

An appraisal of the presentation and management of adult intussusception at a Nigerian Tertiary Hospital

Intussusception in adults is considered rare in surgical practice. It is the causative lesion in a small proportion of cases of intestinal obstruction and lower gastrointestinal bleeding. In the last decade, the incidence of adult intussusception appears to be increasing at our centre. This study aims to document the pattern of presentation and management outcome of adult intussusception at our institution during the last decade. We also observed the occurring trends of this lesion. This was a 10-year retrospective study of consecutive adult patients with intussusception seen at our institution from July 2008 to June 2018. Information on biodata, clinicopathological features and management outcome retrieved from case notes and pathology records were analysed on a personal computer using SPSS version 23. Twenty adult patients who had intussusception were seen during this period. There were 9 (45%) males and 11 (55%) females giving a male-to-female ratio of 1:1.2. The mean age of presentation was 45 (range 18-66) years. Clinical features were abdominal pain (85%), abdominal distension (80%), vomiting (70%), rectal bleeding (70%) and palpable abdominal mass (35%). Majority of patients (70%) presented with features of intestinal obstruction. Idiopathic intussusception (55%) accounted for more than half of the cases with the jejunoileal variety (30%) as the most common pathological type. One patient who had intussusception in the postoperative period was treated with manual reduction at laparotomy. Bowel resections were performed in the remaining 19 (95%) patients. Adult intussusception is still uncommon in our general surgical practice. Bowel resection is the mainstay of treatment.

Adult intussusception: unusual cause

Adult intussusception is a rare entity which accounts for 1-5% of intestinal obstructions in adults and just 5% of all cases of intussusception. The basic pathology and management of intussusception in adults differs from paediatric intussusception. Here we present an interesting case of adult intussusception with an unusual cause. A 33-year-old female presented with features of intestinal obstruction. Colonoscopy was done outside our institution which reported a smooth polypoidal mass in the terminal ileum, biopsy report was pending at that time. CT abdomen revealed dilated small bowel with narrowing in the ileo caecal junction. We proceeded with laparotomy. Intraoperatively dilated ileum with intussusception of the ileocecal junction into the ascending colon was found. Right hemicolectomy with ileotransverse colon anastomosis was done. Histopathology revealed Polyp with intussusception, 5cm from ileocecal junction, with sheets of lymphoid cells showing moderate pleomorphism, infiltrating submucosa, muscularis propria, and serosa, margins uninvolved with lymph node- 3/32 positivity. Immunohistochemistry suggested B- cell lymphoma with CD20 positivity and Bcl 2 focal positivity. Routine treatment of Lymphoma after confirming with biopsy have been Chemotherapy. Role of surgeon in lymphoma is presently limited to biopsy, but there are situations like obstruction and perforation, where surgeon should take the lead role

Ileocolic intussusception caused by a lipoma in an adult

Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.

Adult idiopathic ileocolic intussusception: A case report

Introduction: Intussusception is a rare cause of acute abdomen in adults. Traditionally, management of adult intussusception has mandated surgical interventions due to a high incidence of malignant lesion resulting in intussusception. However, recent literature challenges the traditional view of mandatory surgical interventions for all adult intussusceptions due to an increasing number of benign and idiopathic cases. These benign and idiopathic cases of adult intussusceptions are more readily identified partly due to recent widespread use of computed tomography imaging technique. With the growing number of idiopathic cases, recent literature recommends against the traditional mandatory operative exploration of all adult intussusceptions, only advocating surgical interventions for selected cases. Case Report: A 38-year-old female presented with an acute onset of severe right-sided abdominal pain with associated nausea, vomiting and rectal bleeding to our emergency department. Her computed tomography scan of abdomen and pelvis showed an ileocolic intussusception which had advanced to the level of the hepatic flexure without any mass

Intussusception in Adults: The Role of MDCT in the Identification of the Site and Cause of Obstruction

Unlike pediatric intussusception, intestinal intussusception is infrequent in adults and it is often secondary to a pathological condition. The growing use of Multi-Detector Computed Tomography (MDCT) in abdominal imaging has increased the number of radiological diagnoses of intussusception, even in transient and nonobstructing cases. MDCT is well suited to delineate the presence of the disease and provides valuable information about several features, such as the site of intussusception, the intestinal segments involved, and the extent of the intussuscepted bowel. Moreover, MDCT can demonstrate the complications of intussusceptions, represented by bowel wall ischemia and perforation, which are mandatory to promptly refer for surgery. However, not all intussusceptions need an operative treatment. In this paper, we review the current role of MDCT in the diagnosis and management of intussusception in adults, focusing on features, as the presence of a leading point, that may guide an accurate selection of patients for surgery.

Adult Intussusception

Recurrent abdominal pain is a common and challenging presenting chief complaint in the Emergency Department. Intussusception in adults, although rare, is an important etiology to consider. The diagnosis can often be delayed because of the nonspecific and intermittent nature of symptoms in adults. This report presents the case of a 37-year-old man with multiple Emergency Department visits for abdominal pain and with negative results for prior imaging studies, who was eventually diagnosed with intussusception after 5 years of recurrent symptoms. The case study is followed by a review of the literature regarding the diagnosis and management of intussusception in adults.

Significant parameters for surgery in adult intussusception

INTUSSUSCEPTION is defined as the telescoping of a proximal segment of bowel into the lumen of the adjacent distal segment. It was first reported in 1674 by Barbette of Amsterdam and remains a relatively rare entity in the adult population. Only 5% of all intussusceptions are found in adults and they comprise 1--5% of all cases of intestinal obstructions. The exact mechanism precipitating an intussusception is still unknown. It is believed that any lesion in the bowel wall or irritant within the bowel lumen may alter the normal peristalsis pattern and cause an invagination leading to intussusception. The diagnosis is difficult as the symptoms may be nonspecific. Therefore, radiographic imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), have been the mainstay of diagnosis. The clinical significance of a radiographic finding of intussusception is unknown. Findings can be due to true intussusceptions with leadpoints verified on exploration or to transient intestinal telescoping without clinical sequelae at all. Often, these radiographic findings are discovered during imaging for unrelated reasons. Deciding how to manage these patients on the basis of a radiographic finding is a clinical dilemma. This study examines the clinical outcomes of patients found to have intussusception on CT. We identified those clinical factors which may be associated with true intussusception and the need for prompt surgical intervention, and aim to establish guidelines for management of adult intussusception (AI).

Minimal Access Surgery For Adult Intussusception With Subacute Intestinal Obstruction

In adults, 1% to 5% of bowel obstruction is caused by intussusception. In adult intussusception, there will be a demonstrable cause in 90% of cases, acting as the lead point. Laparoscopy is becoming more and more popular in its management. We present our series of intussusception in adults managed laparoscopically. Between 1996 and 2006, we have treated 12 adults with intussusception who presented with acute or subacute intestinal obstruction. Computed tomographic scan confirmed the diagnosis in all cases. Laparoscopic-assisted resection with primary anastomosis was successfully performed for all cases. Males were more common, average being 38 years. Two patients had colonic carcinoma, as the leading point and the rest were benign tumors. There were no conversions or anastomotic leaks in any patient. The basic principles of surgery involve straightening or removing the involved section of bowel. The outcome of surgery depends on the stage of the intussusception at diagnosis and the underlying cause. If no underlying cause is found in these cases, no specific treatment is required. With early treatment, the outcome is generally excellent. Laparoscopy is a valuable diagnostic and therapeutic tool in the management of adult intussusception. It provides all the benefits of minimal access surgery.

Approach to Management of Intussusception in Adults: A New Paradigm in the Computed Tomography Era

Intussusception has been considered an operative indication in adults as a result of the risk of ischemia and the possibility of a malignant lead point. Computed tomographic (CT) scans can reveal unsuspected intussusception. All CT reports from July 1999 to December 2005 were scanned electronically for letter strings to include the keyword intussusception. Identified CT scans were analyzed to characterize the intussusception and associated findings. Clinical, laboratory, pathological, and follow-up variables were gleaned from medical records. Findings were analyzed by treatment and findings at operation. Review of 380,999 CT reports yielded 170 (0.04%) adult patients (mean age, 41 years) with intussusceptions described as enteroenteric in 149 (87.6%), ileocecal in eight (4.7%), colocolonic in 10 (5.9%), and gastroenteric in three (1.8%). Radiological features included mean length of 4.4 cm (range, 0.8-20.5 cm) and diameter of 3.2 cm (range, 1.6-11.5 cm). Twenty-nine (17.1%) had a lead point, and 12 (7.1%) had bowel obstruction. Clinically, 88 (48.2%) patients reported abdominal pain, 52 (30.6%) had nausea and/or vomiting, and 74 (43.5%) had objective findings on abdominal examination. Thirty of 170 (17.6%) patients underwent operation, but only 15 (8.8%) patients had pathologic findings that correlated with CT findings. Seven had,enteroenteric intussusceptions from benign neoplasms (two), adhesions (one), local inflammation (one), previous anastomosis (one), Crohn's disease (one), and idiopathic (one). Three had ileocolic disease, including cecal cancer (one), metastatic melanoma (one) and idiopathic (one; whereas five patients had colocolonic intussusception from colon cancer (three), tubulovillous adenoma (one), and local inflammation (one). Of the 15 without intussusception at exploration, five had pathology related to trauma, four had nonincarcerated internal hernia after Roux-en-Y gastric bypass, four had negative explorations, one had adhesions, and one had appendicitis that did not correlate with CT findings. No patient in the observation group required subsequent operative exploration for intussusception at mean 14.1 months (range, 0.25-67.5 months) follow up. All operative patients demonstrated gastrointestinal symptoms versus 55.3 per cent of the observation group (P < 0.006). Analysis of CT features demonstrated differences among patients observed without operation, those without intussusception at exploration, and confirmed intussusception with regard to mean intussusception length 3.8 versus 3.8 versus 9.6 cm, diameter 3.0 versus 3.2 versus 4.8 cm, lead point 12.1 per cent versus 30 per cent versus 53.3 per cent, and proximal obstruction 3.8 per cent versus 0 per cent versus 46.7 per cent, respectively. Intussusceptions in adults discovered by CT scanning do not always mandate exploration. Most cases can be treated expectantly despite the presence of gastrointestinal symptoms. Close follow up is recommended with imaging and/or endoscopic surveillance. Length and diameter of the intussusception, presence of a lead point, or bowel obstruction on CT are predictive of findings that warrant exploration.

Intussusception in adults: an unusual and challenging condition for surgeons

Intestinal intussusception in adults is a rare entity and there is an ongoing controversy regarding the optimal management of this problem. The purpose of this study was to determine the causes and management of intussusception in adults. A retrospective review of patients more than 18 years of age with a diagnosis of intestinal intussusception between January 1996 and December 2003 was conducted. Data related to presentation, diagnosis, treatment, and pathology were analyzed. A total of 13 patients were operated on due to intestinal intussusception. There were 6 men and 7 women with a mean age of 45 years (range 24--61 years). Abdominal pain was the most common presenting complaint (100%). Eight (61.5%) patients presented with acute symptoms and underwent emergency laparotomy. The diagnosis of gastrointestinal intussusception was made preoperatively only in 4 (30.7%) patients by abdominal ultrasonography and computerized tomography. The lead point of intussusception was located in the small intestine in 10 (76.9%) patients, in the colon in 2 (15.4%), and in the ileocecal valve in 1 (7.7%). A pathologic cause for the intussusception was identified in 12 (92.3%) cases and 1 (7.7%) was idiopathic. Of the cases with a defined cause, 58% of the cases were benign and 42% were malignant. Forty percent of cases of small bowel intussusception and 33.3% of cases of colonic intussusception were due to malignant lesions. All cases of small intestinal intussusception were reduced and no perforation occurred. Segmental intestinal resection was performed in 9 patients and excision of the Meckel's diverticulum was made in 1. In cases of colonic intussusception, reduction was not attempted and en-bloc resection was carried out. No perforation or spillage of the contents of the intussusception was observed. There was no surgical mortality. Adult intussusception is an unusual and challenging condition that represents a preoperative diagnostic difficulty. We think that colonic intussusceptions should be resected in an en-bloc manner without reduction due to the risk of perforation and spillage of micro-organisms and malignant cells, whereas cases of small intestinal intussusception can be reduced without complications unless there is strangulation.

Intussusception in adults: institutional review

Background: Intestinal intussusception in the adult is a rare entity that differs greatly in etiology from its pediatric counterpart. Controversy remains regarding the optimal management of this problem in the adult patient. The purpose of this study was to determine the cause(s) of intussusception and to determine the role of intestinal reduction in the management of intussusception in adults. Study Design: A retrospective review performed at The Mount Sinai Medical Center identified 27 patients, 16 years and older, with a diagnosis of intestinal intussusception. Data related to presentation, diagnosis, treatment, and pathology were analyzed. Results: There were 13 males and 14 females. The median age of the group was 52 years with a range of 16 to 90 years. Abdominal pain was the most common presenting complaint. A preoperative diagnosis was suspected in 11 of 27 patients (40%). There were 22 small bowel lesions and 5 colonic lesions. A pathologic cause was identified in 85% of patients with 8 of 22 (36%) small bowel and 4 of 5 (80%) of large bowel lesions being malignant. All small bowel cancers represented metastatic disease and all large bowel malignancies were primary adenocarcinomas. The median age of patients with malignant disease was 60 years; it was 44 years for those with benign disease. Operative treatment consisted of resection alone in 58% of patients and resection after reduction in 42%. Three patients were treated nonoperatively. Conclusions: Our data support a selective approach to the operative treatment of intussusception in adults. Colonic lesions should not be reduced before resection because they most likely represent a primary adenocarcinoma. Small bowel intussusception should be reduced only in patients in whom a benign diagnosis has been made preoperatively or in patients in whom resection may result in short gut syndrome.

The diagnosis and management of adult intussusception

Background While intussusception is relatively common in children, it is a rare clinical entity in adults, where the condition is almost always secondary to a definable lesion. Data sources Thirteen cases of intussusception occurring in individuals older than 16 were encountered at our institute between 1981 and 1994. Results Presenting signs/symptoms included recurrent bowel obstruction, intermittent pain, and red blood per rectum. Correct preoperative diagnosis was made in six patients using colonoscopy, flexible sigmoidoscopy, upper gastrointestinal (GI) series and computed tomography (CT). At surgery the lead point was identified in the small intestine in eight cases, in the colon in four cases, and one small intestinal intussusception was considered idiopathic. Twelve patients underwent laparotomy and one patient was both diagnosed and treated by colonoscopy alone. Conclusions Adult intussusception is an unusual cause of bowel obstruction. The likelihood of neoplasia, particularly in the colon as a cause, is high. Operative management is thus almost always necessary.