Bowel Intussusception in Adults: Think Cancer!

Abstract

Intussusception is a rare phenomenon in adults and usually presents with bowel obstruction. Unlike child intussusception, adult intussusception is seldom idiopathic and frequently associated with secondary causes such as benign and malignant tumors. While most cases are treated surgically, emerging data suggest a more conservative management approach for patients with short-segment adult intussusception and without high-risk features such as bowel obstruction, mass seen on imaging, colon involvement, or constitutional symptoms of malignancy. We present a rare case of adult intussusception due to unsuspected adenocarcinoma of the jejunum, treated successfully with surgical resection followed by adjuvant chemotherapy. We favor the surgical rather than conservative approach for adult patients with intussusception to avoid missing unsuspected malignant tumors that are not readily visualized on imaging studies.

Colocolic Intussusception in an Adult Patient Secondary to Caecal Adenocarcinoma

“…When surgical intervention is performed, if underlying malignancy is suspected, oncologic en bloc resection of the involved intestine and the associated mesentery should be sought [ 12 ]. This is recommended to avoid perforations and possible dissemination of cancerous cells.…”

Ileoileal intussusception in the adult patient secondary to a fibroma: An organ-preserving approach to management

“…The vast majority of reported cases of AI advocate for surgical management [ 1–5 ]. This is due to the high likelihood of an underlying lesion acting as a lead point, which necessitates removal to prevent recurrence of intussusception [ 1 , 2 ]. However, in almost all cases, a small bowel resection was performed, even in the context of viable bowel, despite most yielding benign pathology [ 1–5 ].…”

“…Most cases of paediatric intussusception (PI) are idiopathic and can be managed with reduction by contrast enema [ 1 ]. However, adult intussusception (AI) is associated with underlying pathology in 90% of cases and thus almost always requires surgical intervention [ 2 ]. The infrequency of AI means that diagnosis can be delayed, which can have serious consequences.…”

Intussusception Presenting as Intestinal Obstruction in Pregnancy: A Case Report from a Tertiary Hospital in Ghana

“…The treatment of choice among adults is surgical resection [11,13,16,19,20,21,22,26,28,29]. This is because it is associated with a lead point in 90% of cases, 65% of which are malignant [10,17].…”

“…The use of radiological imaging (ultrasonography and Magnetic Resonance Imaging) in confirming diagnosis of intussusception in pregnancy cannot be overemphasized [8,11,13,14]. The treatment of choice for intussusception in adults is surgical resection, unlike in children where a more conservative approach is favored [11,13,16,19,20,21,22,26,28,29].…”