Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. However, bowel intussusception in adults is considered a rare condition, accounting for 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction. Eight to twenty percent of cases are idiopathic, without a lead point lesion. Secondary intussusception is caused by organic lesions, such as inflammatory bowel disease, postoperative adhesions, Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasms or even iatrogenically, due to the presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusceptions with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected. Reduction of the intussuscepted bowel is considered safe for benign lesions in order to limit the extent of resection or to avoid the short bowel syndrome in certain circumstances.

Intussusception of the bowel in adults: a review.

Background While intussusception is relatively common in children, it is a rare clinical entity in adults, where the condition is almost always secondary to a definable lesion. Data sources Thirteen cases of intussusception occurring in individuals older than 16 were encountered at our institute between 1981 and 1994. Results Presenting signs/symptoms included recurrent bowel obstruction, intermittent pain, and red blood per rectum. Correct preoperative diagnosis was made in six patients using colonoscopy, flexible sigmoidoscopy, upper gastrointestinal (GI) series and computed tomography (CT). At surgery the lead point was identified in the small intestine in eight cases, in the colon in four cases, and one small intestinal intussusception was considered idiopathic. Twelve patients underwent laparotomy and one patient was both diagnosed and treated by colonoscopy alone. Conclusions Adult intussusception is an unusual cause of bowel obstruction. The likelihood of neoplasia, particularly in the colon as a cause, is high. Operative management is thus almost always necessary.

The diagnosis and management of adult intussusception.

The gnotobiotic animal as a tool in the study of host microbial relationships.

Background: Intestinal intussusception in the adult is a rare entity that differs greatly in etiology from its pediatric counterpart. Controversy remains regarding the optimal management of this problem in the adult patient. The purpose of this study was to determine the cause(s) of intussusception and to determine the role of intestinal reduction in the management of intussusception in adults. Study Design: A retrospective review performed at The Mount Sinai Medical Center identified 27 patients, 16 years and older, with a diagnosis of intestinal intussusception. Data related to presentation, diagnosis, treatment, and pathology were analyzed. Results: There were 13 males and 14 females. The median age of the group was 52 years with a range of 16 to 90 years. Abdominal pain was the most common presenting complaint. A preoperative diagnosis was suspected in 11 of 27 patients (40%). There were 22 small bowel lesions and 5 colonic lesions. A pathologic cause was identified in 85% of patients with 8 of 22 (36%) small bowel and 4 of 5 (80%) of large bowel lesions being malignant. All small bowel cancers represented metastatic disease and all large bowel malignancies were primary adenocarcinomas. The median age of patients with malignant disease was 60 years; it was 44 years for those with benign disease. Operative treatment consisted of resection alone in 58% of patients and resection after reduction in 42%. Three patients were treated nonoperatively. Conclusions: Our data support a selective approach to the operative treatment of intussusception in adults. Colonic lesions should not be reduced before resection because they most likely represent a primary adenocarcinoma. Small bowel intussusception should be reduced only in patients in whom a benign diagnosis has been made preoperatively or in patients in whom resection may result in short gut syndrome.

Intussusception in adults: institutional review.

Controversy concerning the appropriate surgical management of intussusception in the adult prompted review of the Mayo Clinic's experience with this uncommon entity. During the last 23 years, 48 patients had documented intussusception: 24 instances of intussusception originating in the small intestine and 24 instances of intussusception originating in the colon. Two-thirds of the colonic intussusceptions were associated with primary carcinoma of the colon. Only one-third of the intussusceptions of the small intestine were harbingers of malignancy, and 70% of these lesions were metastatic. Because of these findings, we advocate resection of intussusceptions of the colon without initial surgical reduction, in order to minimize the operative manipulation of a potential malignancy. In the patient with intussusception of the small intestine, an associated primary malignancy is uncommon. Initial reduction, followed by limited surgical resection, is the preferred treatment. Surgical resection without reduction is favored only when an underlying primary malignancy is clinically suspected.

Surgical management of intussusception in the adult.

Two important points should be remembered in treating intussusception in adults: 1. 1. Malignancy is associated with intussusception much more frequently than was appreciated in earlier literature. It was associated with 24 per cent of cases of enteric intussusception and 54 per cent of all colonic intussusception in this report. 2. 2. With this in mind, the treatment of choice for all types of intussusception in adults is resection without reduction whenever possible.

Intussusception in adults. Review of 160 cases.

1. 1. Experience in the dog with nonsuture intestinal anastomosis utilizing a plastic adhesive (Eastman 910 adhesive) is presented. This method results in an everting rather than an inverting anastomosis. 2. 2. Of 101 intestinal anastomoses, sixty-seven were satisfactory anastomoses and thirty-four were failures. 3. 3. Gross and histologic findings are discussed as are the possible causes of some of the failures. 4. 4. At the present time the nonsuture technic offers no real advantage over conventional suture methods for intestinal anastomosis.

Nonsuture intestinal anastomosis.

Strangulation obstruction in germfree dogs.

BACTERIA exert an inhibitory effect on the growth of tumors of the colon. Vink 1 first demonstrated this experimentally in 1954. He reported that control of the bacterial flora of the colon by intestinal antisepsis increased the incidence of tumor growth at an anastomotic site in the colon. Cohn and Atik 2 found an increase in growth of the Brown-Pearce carcinoma at the anastomotic site in rabbits when the intestinal flora was reduced and trauma increased. Christensen and Kjems 3,4 demonstrated that rabbits with Brown-Pearce tumor growing in the testicle had a diminished incidence of metastases following massive streptococcal infection or therapy with lysates of streptococci. Miller and Ketcham 5 showed a decrease in the implantation and growth of tumor cells in experimental, infected, operative wounds in mice and reported that an intimate contact between bacteria and tumor cells was necessary for inhibition of tumor growth, since infection at a

David A. Weilbaecher

Papers

Intussusception in adults. Review of 160 cases.

Nonsuture intestinal anastomosis.

Strangulation obstruction in germfree dogs.

Growth of Brown-Pearce Carcinoma in the Presence of Bacteria

The influence of iodine on peritoneal implantation of tumors.