Adult intussusception: 14 case reports and their outcomes

Abstract

Aims: to analyze diagnostic and therapeutic options depending on the clinical symptoms, location, and lesions associated with intussusception, together with their follow-up and complications. Patients and methods: patients admitted to the Morales Meseguer General University Hospital (Murcia) between January 1995 and January 2009, and diagnosed with intestinal invagination. Data related to demographic and clinical features, complementary explorations, presumptive diagnosis, treatment, followup, and complications were collected. Results: there were 14 patients (7 males and 7 females; mean age: 41.9 years-range: 17-77) who presented with abdominal pain. The most reliable diagnostic technique was computed tomography (8 diagnoses from 10 CT scans). A preoperative diagnosis was established in 12 cases. Invaginations were ileocolic in 8 cases (the most common), enteric in 5, and colocolic in 2 (coexistence of 2 lesions in one patient). The etiology of these intussusceptions was idiopathic or secondary to a lesion acting as the lead point for invagination. Depending on the nature of this lead point, the cause of the enteric intussusceptions was benign in 3 cases and malignant in 2. Ileocolic invaginations were divided equally (4 benign and 4 malignant), and colocolic lesions were benign (2 cases). Conservative treatment was implemented for 4 patients and surgery for 10 (7 in emergency). Five right hemicolectomies, 3 small-bowel resections, 2 left hemicolectomies, and 1 ileocecal resection were performed. Surgical complications: 3 minor and 1 major (with malignant etiology and subsequent death). The lesion disappeared after 3 days to 6 weeks in patients with conservative management. Mean follow-up was 28.25 months (range: 5-72 months). Conclusions: a suitable imaging technique, preferably CT, is important for the diagnosis of intussusception. Surgery is usually necessary but we favor conservative treatment in selected cases.

Cannabis intake and intussusception: an accidental association?

“…Most times a causative organic lesion is found, of which more than a half are malignant, and for this reason intussusception in adults has been usually considered as an indication of surgery and intestinal resection (4,5). However, some cases have been described where the conservative approach in the absence of warning signs has been considered as an optimal alternative treatment (6). Some clinical and analytical variables that can be related to the presence of malignancy prior to surgery have been described, and they can help to decide when to opt for conservative management (7).…”

Small bowel MRI in adult patients: not just Crohn’s disease—a tutorial

“…It is primarily a paediatric condition, but rarely (up to 5%) may occur in adult patients with predominance in the small bowel [18]. …”

“…It is thought that up to 90% of adult intussusceptions have a pathological lead point and only 10% are idiopathic [17, 18]. However with the present widespread use of cross-sectional imaging, asymptomatic intussusceptions are more frequently recognised, and these are often without a lead point.…”

“…Cross-sectional imaging techniques help to distinguish intussusceptions with and without a lead point; however, exact determination of the underlying disease may remain challenging in some cases, including for MRI. The usual treatment of symptomatic intussusceptions with lead points in adults is surgery, with the underlying cause established at pathological examination [18].

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Intussusception of terminal ileum into cecum associated with endometriosis

“…Intussusception – invagination or telescoping of a segment of bowel into an adjacent one, is typically a paediatric condition. Only 5% of total incidence has been described in adults, and 1% from these cases result in intestinal obstruction . In contrast, endometriosis occurs in up to 20% of women of childbearing age, defined by presence of extra‐uterine cavity endometriosis tissue .…”