Adult intussusception: A retrospective review of 41 cases

Abstract

AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI). METHODS:A retrospective review of the clinical features, diagnosis, management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted. RESULTS:Forty-one patients with 44 intussusceptions were operated on, 24.4% had acute symptoms, 24.4% had subacute symptoms, and 51.2% had chronic symptoms. 70.7% of the patients presented with intestinal obstruction. There were 20 enteric, 15 ileocolic, eight colocolonic and one sigmoidorectal i n t u s s u s c e p t i o n s . 6 5 . 9 % o f i n t u s s u s c e p t i o n s were diagnosed preoperatively using a computed tomography (CT ) scan (90.5% accurate) and ultrasonography (60.0% accurate, rising to 91.7% for patients who had a palpable abdominal mass). Coloscopy located the occupying lesions of the lead point of ileocolic, colocolonic and sigmoidorectal intussusceptions. Four intussusceptions in three patients were simply reduced. Twenty-one patients underwent resection after primary reduction. There was no mortality and anastomosis leakage perioperatively. Except for one patient with multiple small bowel adenomas, which recurred 5 mo after surgery, no patients were recurrent within 6 mo.Pathologically, 54.5% of the intussusceptions had a tumor, of which 27.3% were malignant. 9.1% comprised nontumorous polyps. Four intussusceptions had a gastrojejunostomy with intestinal intubation, and four intussusceptions had no organic lesion. CONCLUSION:CT is the most effective and accurate diagnostic technique. Colonoscopy can detect most lead point lesions of non-enteric intussusceptions. Intestinal intubation should be avoided.

Idiopathic Sigmoid Intussusception Prolapse per Anus

“…In a retrospective review of 41 pediatric intussusception cases, 95.1% had abdominal pain, 26.8% had bloody stool and 34.1% had a palpable abdominal mass. However, the classic triad presentation was only seen in 9.8% of the adult patients in the study [4].…”

A rare case of adult Ileo-ileal intussusception due to inflammatory fibroid polyp

“…The primary imaging modality of choice is ultrasound scanning, which enables the diagnosis or exclusion of intussusception with a sensitivity of 98-100%, specificity of 88-89% and negative predictive value of 100%. 3,4 The majority of intussusceptions are diagnosed at surgery. In our case, the preoperative clinical findings and ultrasonic images suggested intussusception.…”

Adult Intussusception: Diagnosis and Management Strategies. 10 Years Experience from North India

“…Barium enema examination may be useful in patients with colonic or ileocolic intussusception in which a cup-shaped filling defect is a characteristic finding [9] . Colonoscopy is also a useful tool for evaluating intussusception, especially when the presenting symptoms indicate a large bowel obstruction [4,10,11,12] . It may not be advisable to perform endoscopic biopsy or polypectomy in those individuals with long-term symptoms because of the high risk of perforation, which is more likely to happen in the phase of chronic tissue ischemia, and perhaps necrosis because of vascular compromise in intussusception [13] .…”