In the Era of Routine Use of CT Scan for Acute Abdominal Vain, Should All Adults with Small Bowel Intussusception Undergo Surgery?

Abstract

In contrast to adult colonic intussusception in which malignancy is the dominant cause, small bowel intussusceptions are mostly benign. Although surgery is the accepted standard treatment, its necessity in small bowel intussusceptions identified by CT scan is unknown. Twenty-three patients from 2005 to 2008 (16 males; median age, 44 years) with acute abdominal pain and CT-proven small bowel intussusception were studied. Factors associated with the necessity for surgery were determined. Among 11 patients who were managed operatively, surgery was deemed unnecessary in two patients based on negative explorations. Follow up in 10 of 12 patients managed nonoperatively was not associated with any recurrence of intussusception or malignancy (median follow up, 14 months). The only predictor of the need for surgery was CT evidence of small bowel obstruction and/or a radiologically identified lead point, which was present in 7 of 9 (78%) patients having a necessary operation and absent in 12 of 14 (86%) with no indication for surgery (P = 0.008). All small bowel intussusceptions found on CT scan in patients with acute abdominal pain do not require operative management. CT findings of small bowel obstruction and/or presence of a lead point are indications for surgery.

Prolapsed ileocolic intussusception in an adult : A bizarre presentation leading to delayed diagnosis in a low resource setting

“…However in adults Azar et al suggested that surgical resection is preferred as almost 50% of both colonic and enteric intussusception are associated with malignancy as the lead point (2). However with recent evidence it has been recommended that resectional surgery for adult intussusceptions should be selectively based on location and underlying pathology (15). For those above 60years with a colonic pathology where…”

“…Four hours prior to presentation to us the patient developed painful anal protrusion following strain to defecate, the protrusion was irreducible spontaneously nor by patients and his relatives, no previous history of anal protrusion in the past. No previous history of malignancy and precancerous lesions are highly likely resection should be done while for patients with small bowel lesions or known benign underlying diseases (such as tropical sprue, Crohns) where malignancy is not highly likely and a small bowel syndrome will most likely result, a non-resectional surgery is advocated if the bowels are viable (15). The patient reported had reduction of the prolapsed segment and right hemicolectomy and histology of the resected segment showed tubular adenoma of the caecum.…”

Management of intussusception in patients with melanoma

“…Traditionally, operative exploration has been recommended for patients with suspected intussusception to prevent or treat potential complications such as resultant bowel obstruction or GI bleeding . However, there is some evidence that asymptomatic patients with these imaging findings can be managed nonoperatively and closely observed . As melanoma survival continues to increase in the current era of improved immune and targeted therapies, the number of patients with advanced disease undergoing routine cross‐sectional imaging will also grow and it is reasonable to assume the incidence of intussusception in patients with metastatic melanoma will continue to rise.…”

Adult intussusceptions: preoperative predictive factors for malignant lead point

“…Along with increase in use of computed tomography, reports are increasing of nonsymptomatic intussusception and small intestinal intussusception without lead points, arousing controversy in whether or not surgical intervention is needed for these patients. However, there is no dispute on the need of surgical treatment for intussusception with the lead point [ 10 , 11 , 12 , 13 , 14 ]. In our study, five out of nine ultrasonographic exams and 25 out of 29 computed tomographic exams diagnosed intussusception preoperatively, and the lead point was identified in 23 cases with successful diagnosis in 22 cases confirmed after surgery.…”

“…If an evident cause for intussusception exists, surgical bowel resection must be considered. However, since small-intestinal intussusception is mostly benign in cause, manual reduction could be considered, but large intestinal intussusception is mostly caused by malignant neoplasms so bowel resection without manual reduction should be a prior option [ 3 , 5 , 6 , 7 , 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 19 ]. Manual reduction minimizes bowel resection which can prevent short bowel syndrome, but excessive attempts should be avoided in order to prevent bowel perforation or bowel edema.…”