Intussusception, With Special Reference to Adults

Eliot, Ellsworth; Corscaden, James A.

doi:10.1097/00000658-191102000-00002

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“…Prospective data are lacking in the literature because the diagnosis is only reported to occur in one in 20,000 to one in 45,000 hospital admissions annually, and only 4.5 per cent to 36 per cent of all intussusceptions are reported to occur in adults. [3][4][5][6][7][8][9][10][11][12][13] If a tumor of the small or a large bowel tumor is present, the likelihood of development of intussusception may be close to 4 per cent. 10 However, two large series of bowel obstruction traced the etiology to intussusception in only 1 per cent of cases.…”

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confidence: 99%

Approach to Management of Intussusception in Adults: A New Paradigm in the Computed Tomography Era

Rea

Lockhart

Yarbrough

et al. 2007

The American Surgeon™

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Intussusception has been considered an operative indication in adults as a result of the risk of ischemia and the possibility of a malignant lead point. Computed tomographic (CT) scans can reveal unsuspected intussusception. All CT reports from July 1999 to December 2005 were scanned electronically for letter strings to include the keyword intussusception. Identified CT scans were analyzed to characterize the intussusception and associated findings. Clinical, laboratory, pathological, and follow-up variables were gleaned from medical records. Findings were analyzed by treatment and findings at operation. Review of 380,999 CT reports yielded 170 (0.04%) adult patients (mean age, 41 years) with intussusceptions described as enteroenteric in 149 (87.6%), ileocecal in eight (4.7%), colocolonic in 10 (5.9%), and gastroenteric in three (1.8%). Radiological features included mean length of 4.4 cm (range, 0.8-20.5 cm) and diameter of 3.2 cm (range, 1.6-11.5 cm). Twenty-nine (17.1%) had a lead point, and 12 (7.1%) had bowel obstruction. Clinically, 88 (48.2%) patients reported abdominal pain, 52 (30.6%) had nausea and/or vomiting, and 74 (43.5%) had objective findings on abdominal examination. Thirty of 170 (17.6%) patients underwent operation, but only 15 (8.8%) patients had pathologic findings that correlated with CT findings. Seven had enteroenteric intussusceptions from benign neoplasms (two), adhesions (one), local inflammation (one), previous anastomosis (one), Crohn's disease (one), and idiopathic (one). Three had ileocolic disease, including cecal cancer (one), metastatic melanoma (one) and idiopathic (one; whereas five patients had colocolonic intussusception from colon cancer (three), tubulovillous adenoma (one), and local inflammation (one). Of the 15 without intussusception at exploration, five had pathology related to trauma, four had nonincarcerated internal hernia after Roux-en-Y gastric bypass, four had negative explorations, one had adhesions, and one had appendicitis that did not correlate with CT findings. No patient in the observation group required subsequent operative exploration for intussusception at mean 14.1 months (range, 0.25-67.5 months) follow up. All operative patients demonstrated gastrointestinal symptoms versus 55.3 per cent of the observation group ( P < 0.006). Analysis of CT features demonstrated differences among patients observed without operation, those without intussusception at exploration, and confirmed intussusception with regard to mean intussusception length 3.8 versus 3.8 versus 9.6 cm, diameter 3.0 versus 3.2 versus 4.8 cm, lead point 12.1 per cent versus 30 per cent versus 53.3 per cent, and proximal obstruction 3.8 per cent versus 0 per cent versus 46.7 per cent, respectively. Intussusceptions in adults discovered by CT scanning do not always mandate exploration. Most cases can be treated expectantly despite the presence of gastrointestinal symptoms. Close follow up is recommended with imaging and/or endoscopic surveillance. Length and diameter of the intussusception, presence of a lead point, or bowel obstruction on CT are predictive of findings that warrant exploration.

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confidence: 99%

Approach to Management of Intussusception in Adults: A New Paradigm in the Computed Tomography Era

Rea

Lockhart

Yarbrough

et al. 2007

The American Surgeon™

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“…Roper (1956), reviewing a further 134 cases, found 5-2% due to local inflammatory causes and 68% secondary to a tumour. These recent figures show a remarkable change from the 298 cases collected by Eliot and Corscaden in 1911. At that time 9-8 % were associated with an inflammatory lesion but only 34-2 % were secondary to a tumour.…”

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confidence: 84%

Intussusception in adults complicating specific inflammatory diseases of the intestine

Goodall¹

1963

Gut

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“…Two further surveys dealing with this subject may be quoted to illustrate the rarity of the condition. Eliot and Corscaden (1911) collected up to that time 300 cases of intussusception in adults, only 20 being definitely due to carcinoma. Christopher (1936) On examination she was' seen to be a thin frail old lady with evidence of recent loss of weight.…”

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Intussusception Due to Carcinoma of Colon

Owen¹

1948

BMJ

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Intussusception in adults from any cause is rare, and cases due to carcinoma of the colon seem to be extremely rare. A search of the literature of the past 10 years reveals only two cases associated with a carcinoma of the colon. Rose (1945) described a case of intussusception of the descending colon due to a polypus with a near-by, but apparently unrelated, carcinoma of the colon. lason (1945) On examination she was' seen to be a thin frail old lady with evidence of recent loss of weight. There was no abnormality detected on abdominal examination. Rectal examination revealed a typical sausage-shaped intussusception which had almost reached the anal orifice, and hence a diagnosis of chronic intussusception of the large bowel was made.Operation.-Spinal analgesia was used. The abdomen was opened by a lower midline incision. An intussusception of the pelvic colon into the rectum was found. Reduction was, from the first, difficult, but was partially achieved with the aid of an assistant exerting pressure on the apex through the anal orifice. An impasse was then reached, as no further reduction seemed possible. On increasing the reducing force, signs of splitting of the bowel appeared. and as no other means was possible the split was enlarged and complete reduction was achieved. It was now found that at the apex of the intussusception, in the middle portion of the pelvic colon, there was a small annular carcinoma. The split in the bowel was below this in the upper part of the rectum. The condition was further dealt with by excising the portion of the bowel containing the carcinoma and the split. Continuity could not be re-established and so the proximal end was brought out of the left inguinal region to form a permanent colostomy and the lower end was closed with two layers of sutures as in Hartmann's (1923) operation for removal of a carcinoma in the rectosigmoid region. The rest of the abdomen was not explored because of the danger of disseminating septic material. The wound was closed without drainage.Recovery was uneventful, and the patient was discharged on the 42nd post-operative day. The delay in her discharge was due to difficulty in obtaining a colostomy belt. The growth was reported as being a mucoid carcinoma. When last seen, almost exactly two years after operation, she was in good health and without any evidence of recurrence of the growth.Case 2 A man aged 68 was admitted with a history of two weeks' constipation, colicky abdominal pain, and the passage of blood per rectum.On examination he was seen to be a well-built man in fairly good general condition. Abdominal examination revealed considerable generalized distension and an increase in peristaltic sounds on auscultation. On rectal examination a typical intussusception with a papilliferous carcinomatous mass at the apex was found. It had reached as far as the lower part of the rectum. A diagnosis of chronic intussusception of the large bowel due to a papilliferous carcinoma was made.Operation.-Spinal analgesia was used, The abdomen was opened thro...

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Intussusception, With Special Reference to Adults

Cited by 50 publications

References 0 publications

Approach to Management of Intussusception in Adults: A New Paradigm in the Computed Tomography Era

Approach to Management of Intussusception in Adults: A New Paradigm in the Computed Tomography Era

Intussusception in adults complicating specific inflammatory diseases of the intestine

Intussusception Due to Carcinoma of Colon

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