Adult enteric intussusception: Additional observations on enteroclysis

Abstract

Enteroclysis patterns encountered in four patients with adult intestinal intussusception of different etiology--including a leiomyoma, a Peutz-Jeghers hamartoma, a metastatic colon carcinoma, and adhesions--were analyzed and compared to surgical and pathological findings. Emphasis was given not only to radiological signs indicative of impaired circulation but also to the preoperative evaluation of the stimulating cause. A "stretched spring" pattern, corresponding to increased distance between large and thick concentric rings, was found to conform to a stage of strangulation with exudation, whereas sharply demarcated fine rings in close proximity were suggestive of the absence of vascular impairment. The morphology of the underlying lesion was also shown to conform to the dynamic appearance of the intussusception. Benign submucosal, intraluminal tumors led to a long, rather permanent intussusception, with the tumor being the leading point; whereas intussusception associated with annular malignancies or adhesions was shorter and transient or partial, as fixation was present. The cause of the intussusception was correctly identified preoperatively in each case; the vascular compromise involved was also indicated, and the correlation between radiological appearances and morphology at pathology specimens was excellent.

Lipoma induced jejunojejunal intussusception

“…Rarely, a mass lesion or intraluminal air trapped between the walls of the intussusceptum and intussuscipiens (air crescent sign) can be shown in the plain abdominal radiograph but both findings lack specificity and sensitivity to diagnose intussusception [15] . Barium meal or enema may demonstrate the intussusception with the characteristic finding of the coiled spring appearance while the stretched spring sign has been associated with vascular compromise [16] . Barium examinations are restricted to the work up of a patient with subtle findings and should be avoided in the acute setting due to the risk of bowel rupture and barium peritonitis.…”

“…The treatment plan for adult intussusception consists of segmental resection and primary restoration of the continuity of the gastrointestinal tract, given the high incidence of str uctural causes and the 6% to 30% malignant nature of the lesions in adults [3][4][5][6][7][12][13][14][15][16] . However, the extent of resection and whether or not the intussusception should be initially reduced remain controversial.…”

Idiopathic ileoileal intussusception in an adult with spontaneous reduction during enteroclysis: a case report

“…Because a negative sonogram does not exclude intussusception in adults, it should be followed by enteroclysis, contrast enema, and/or CT. Intussusception in enteroclysis is rarely reported. The examination may show a complete or incomplete cessation of contrast media flow, accompanied by a stretched-spring or onionskin pattern, when small amounts of contrast medium enter the space between the intussusceptum and bowel wall [4]. Usually the head of the contrast column appears concave, and a target sign and onionskin pattern are possible [6].…”

“…In adulthood, intussusception is rare, causing only 1% of all bowel obstructions [1, 2]. More than 90% of cases have been associated with predisposing factors, usually enteric neoplasms or diverticula [3,4]. Because of the high incidence of underlying pathology and of recurrent obstruction and ischemic injury, surgery is required.…”

Small Bowel Review ‐ Part II

“…When a computed tomographic scan of the abdomen is used for diagnosing complete obstruction of the small bowel, the sensitivity for small bowel obstruction was 100% (79). Enteroclysis may be useful to determine the cause and presence of enteric intussusception in the adult (80).…”