Adult intussusception: a continuously unveiling clinical complex illustrating both acute (emergency) and chronic disease management

Abstract

Introduction Adult intussusception is a rare cause of intestinal obstruction. Its occurrence often presents clinicians with a diagnostic conundrum owing to its broad variation in clinical presentation. Over the last half century, studies have continuously contributed to the better understanding of the aetiology, diagnosis and treatment. The aim of this review is to discuss acute and chronic disease management in adult intussusception. Discussion The aetiology has multiple dimensions to its description. These include its location in the gastrointestinal tract, presence or absence of a physical or functional initiating lesion (lead point) and the behavioural characteristics of this lead point, be it benign or malignant. The symptoms and signs of intussusception are wide ranging, making it have a presentation anywhere between an acute and a chronic intestinal obstruction. Radiological investigations for diagnosis can be quite accurate in the hands of skilled and experienced radiologists. The hallmark of treatment is open or laparoscopic (operative) surgery. Conclusion This clinical entity calls for a high index of suspicion coupled with relevant radiological investigations in its diagnosis. We are observing a trend in which unique aetiologies are being unveiled to add to an evegrowing list. Even with the standard treatment being essentially surgical, there is an increasing trend towards the use of novel surgical methods such as advanced colonoscopic and laparoscopic techniques. All these factors have prompted us to generate a critical review of the literature on adult intussusception so as to give a better holistic picture of the essential critical clinical care.

Adult sigmoidorectal intussusception related to colonic lipoma: A rare case report with an atypical presentation

“…Adult intussusception is a rare clinical condition which constitutes less than 5% of all cases of intussusception and 1–3% of all cases of intestinal obstruction [1] . Intussusception is a process in which a proximal segment of bowel telescopes or invaginates into an adjacent distal segment.…”

“…The pathophysiology usually involves a lesion in the bowel wall or an irritant in its lumen serving as a lead point that may change the normal peristaltic pattern and initiate the invagination leading to intussusception. Intussusception that occurs in absence of a lead point is classified as primary or idiopathic and is more likely to occur in the small intestines, or as secondary when a lead point is identified [1,4] .…”

“…In adults, intussusception has an identifiable etiology in 90% of cases [6] . In the small intestine, benign lesions represent the majority of lead points, and only 25–30% are malignant lesions [1,7] . Conversely, 60–65% of cases of intussusception occurring in the large bowel have a malignant etiology [1] .…”

“…Intussusception in adults is rare and accounts for less than 5% of all intussusception cases [1] . Colonic lipoma is rare, and can serve as the lead point for intussusception [2,3] .Adult intussusception cases present with nonspecific signs and symptoms and CT scan is the most sensitive diagnostic modality.…”

Acute intussusception on a lipoma of the left colon: report of a case

“…Indeed, adult intussusception constitutes less than 5% of all cases of intussusceptions and 1%-3% of all cases of intestinal obstruction. [2] It affects small bowel in 48%-70% of cases, both ileum and caecum in 25%-40% of cases, and colon alone in only 5%-8% of cases. [3] Unlike in the child where symptomatic intussusception is almost always idiopathic, in adults symptomatic intussusception is most frequently secondary to an endo-luminal lesion.…”