Bowel intussusceptions in adults: the role of imaging

Abstract

Intestinal intussusception in adults is a rare condition, accounting for about 0.003-0.02% of all hospital admissions. This condition in adults represents only 5% of all cases of intussusceptions and is different from paediatric intussusception, which is usually idiopathic. In contrast, almost 90% of cases in adults are secondary to various pathologies that serve as a lead point, such as polyps, Meckel's diverticulum, colonic diverticulum, or malignant or benign neoplasm. The aim of the present study was to assess the capabilities of multislice computed tomography (MSCT) in the diagnosis and correct characterisation of intussusception, especially in distinguishing between intussusceptions with a lead point and those without. Indeed, although the MSCT findings that help to differentiate between lead point and non-lead point intussusceptions have not been well studied, abdominal MSCT remains the most sensitive radiological tool to confirm bowel intussusceptions. Moreover, differentiating intussusceptions with a lead point condition from those without is crucial for directing the patient towards the most appropriate treatment, avoiding surgery when not necessary.

Rare presentation of ileocolic intussusception secondary to mantle cell lymphoma

“…Chiang and Lin conducted a retrospective study in a Taiwanese hospital which showed that 51 of 72 adult bowel intussusceptions were enteric in nature, 11 of which were due to malignancy; lymphoma accounted for 3 of the 11 cases 3. Somma et al demonstrated that the target sign as well as the ‘sausage shape’ on an abdominal multislice CT are highly suggestive of intussusception 18. In our case, the patient underwent the abdominal CT in a timely manner to reach the correct diagnosis.…”

Adult with Ileocolic Intussusceptions

“…Contrast enemas would occasionally be utilized to diagnose colocolonic intussusception, but definitive diagnosis was usually made at the time of operative exploration. Computed Tomography (CT) scanning has allowed for more accurate preoperative diagnosis, with a sensitivity and specificity of 80% and 100%, respectively [2]. The classic "target sign" or "sausage" appearance are highly specific, and in recent years there have been attempts to incorporate other radiological findings, including the presence and appearance of any suspicious 'lead point' lesions and the location of the intussusception (entero-enteric, ileo-cecal, or colo-colonic) to help better categorize the likelihood of underlying malignancy [3,4].…”

Abdominal Hernias, Giant Colon Diverticulum, GIST, Intestinal Pneumatosis, Colon Ischemia, Cold Intussusception, Gallstone Ileus, and Foreign Bodies: Our Experience and Literature Review of Incidental Gastrointestinal MDCT Findings

“…There are three patterns of intussusception that are expression of different stages of the same disease: the target-like pattern (early intussusception with only minimal obstruction and no sign of ischemia); the reniform-pattern (bilobed density with peripheral high attenuation and lower attenuation centrally); and the sausage-shape pattern (alternating areas of low and high attenuation related to the bowel wall, mesenteric fat and fluid, intraluminal fluid, contrast material, or air) [28] (Figure 7). …”