Adult intussusception: A case series and review

Abstract

AIMTo identify factors differentiating pathologic adult intussusception (AI) from benign causes and the need for an operative intervention. Current evidence available from the literature is discussed.METHODSThis is a case series of eleven patients over the age of 18 and a surgical consultation for “Intussusception” at a single veteran’s hospital over a five-year period (2011-2016). AI was diagnosed on computed tomography (CT) scan and or flexible endoscopy (colonoscopy). Surgical referrals were from the emergency room, endoscopy suites and the radiologists.RESULTSA total of 11 cases, 9 males and 2 females were diagnosed with AI. Median age was 58 years. Abdominal pain and change in bowel habits were most common symptoms. CT scan and or colonoscopy diagnosed AI, in ten/eleven (90%) patients. There were 6 small bowel-small bowel, 4 ileocecal, and 1 sigmoid-rectal AI. 8 patients (72%) needed an operation. Bowel resection was required and definitive pathology was diagnosed in 7 patients (63%). Five patients had malignant and 2 patients had benign etiology. Small bowel enteroscopy excluded pathology in 4 cases (37%) with AI. Younger patients tend to have a benign diagnosis.CONCLUSIONMajority of AI have malignant etiology however idiopathic intussusception is being seen more frequently. Operative intervention remains the mainstay however, certain small bowel intussusception especially in younger patients may be a benign, physiological, transient phenomenon and laparoscopy with reduction or watchful waiting may be an acceptable strategy. These patients should undergo endoscopic or capsule endoscopy to exclude intrinsic luminal lesions.

Transient Sigmoidorectal Intussusception Simulating Submucosal Tumor in a Healthy Woman: An Unusual Case and Review of the Literature

“…Intussusception can arise anywhere in the small intestine and colon. The terminology of intussusception reflects location of both the intussusceptum and intussuscipiens in the intestine: enteroenteric, appendiceal, appendiceal-ileocolic, ileocolic, colocolic, rectoanal, and stomal intussusception; rectoanal and stomal intussusception are considered as (extracorporeal) prolapse; and the coloanal intussusception can simulate a rectal prolapse and must be differentiated from rectal prolapse with careful clinical examination [8][9][10]. Whereas the majority of pediatric patients harbor a benign or physiologic process, 99% of adult intussusception patients harbor a pathological process [9].…”

“…Primary or idiopathic intussusception is frequently transient, whereas secondary intussusception due to a lead point is commonly permanent or recurrent [12]. About 20% of patients have no apparent etiology and are labelled as primary or idiopathic and intussusceptions without a lead point tend to be transient, self-limiting, and nonobstructing [8,9].…”

“…Likewise, the exact mechanism of sigmoidorectal intussusception in our case is unidentified because there was neither a lesion in the colon nor an irritant in its lumen to serve as lead point that could change the normal peristalsis pattern and initiate the invagination leading to intussusception. In this respect, sigmoidorectal intussusception, a distinctly very rare condition in adult patients associated with a pathological cause, acts as the lead point in the mechanism of intussusception; benign or malignant lesions predominantly managed by surgical resection; and when the colon is involved, surgical resection is recommended owing to the high risk of underlying malignant tumor, perforation and spillage [6,9].The peristalsis pushes the lesion, which functions as lead point, and leads to the intussusception of sigmoid in the rectal cavity.…”

Infantile Hemangioma Presenting as Colocolic Intussusception in an Infant Case Report with Review of Pathologic Lead Points

“…Pathologic lead point in intussusception occurs far less commonly in children, based on individual case studies and case series, than in adults where it has been reported in as high as 90% of cases [ 6 , 14 – 19 ]. A review of five pediatric series revealed that a PLP was found in less than 10% of cases ( Table 1 ).…”

A Surgical Conundrum in Feeding Jejunostomy–Jejunojejunal Intussusception: A Case Series

“…In about 90% of the cases in adults, there is a definitive organic lesion present, which causes intussusception. Depending upon the site of the lead point, they can be classified into entero-enteric, ileocolic, ileocecal, and colo-colic [ 3 ]. Among those cases, the postoperative intussusception is a special entity that can be idiopathic or may be associated with mucosal, intramural, or extrinsic causes.…”