Intussusception in adults
About: This article is published in Annals of Surgery.The article was published on 1970-08-01 and is currently open access. It has received 157 citations till now. The article focuses on the topics: Intussusception (medical disorder).
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TL;DR: Primary 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.
Abstract: 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.
614 citations
TL;DR: Adult intussusception is an unusual cause of bowel obstruction and the likelihood of neoplasia, particularly in the colon as a cause, is high and Operative management is thus almost always necessary.
Abstract: 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.
598 citations
TL;DR: In the patient with intussusception of the small intestine, an associated primary malignancy is uncommon and initial reduction, followed by limited surgical resection, is the preferred treatment.
Abstract: 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.
372 citations
TL;DR: Although there is considerable overlap of CT findings, when a lead mass is seen at CT as a separate and distinct entity vis-à-vis edematous bowel, it can be considered a reliable indicator of a lead point intussusception.
Abstract: The widespread application of computed tomography (CT) in different clinical situations has increased the detection of intussusception, particularly non-lead point intussusception, which tends to be transient. Consequently, determining the clinical significance of intussusception seen at CT poses a diagnostic challenge. Patients with intussusception may or may not be symptomatic, and symptoms can be acute, intermittent, or chronic, making clinical diagnosis difficult. In most cases, radiologists can readily make the correct diagnosis of intestinal intussusception by noting the typical bowel-within-bowel appearance at abdominal CT. However, the CT findings that help differentiate between lead point and non-lead point intussusception have not been well studied. Nevertheless, although there is considerable overlap of CT findings, when a lead mass is seen at CT as a separate and distinct entity vis-a-vis edematous bowel, it can be considered a reliable indicator of a lead point intussusception. Differentiating between lead point and non-lead point intussusception is important in determining the appropriate treatment and has the potential to reduce the prevalence of unnecessary surgery.
251 citations
TL;DR: Less than one-third of adult intussusceptions demonstrated at CT or MR imaging were caused by a neoplastic lead point, and almost half of adult cases in this series were idiopathic.
Abstract: PURPOSE: To determine the clinical presentation in cases of adult intussusception demonstrated at computed tomography (CT) or magnetic resonance (MR) imaging and to correlate the imaging appearance with clinical diagnosis. MATERIALS AND METHODS: Retrospective review of CT and MR images and clinical records of all patients with an intussusception demonstrated on CT or MR images from January 1, 1991, through April 30, 1998. RESULTS: Thirty-three patients had one or more intussusceptions demonstrated on CT (n = 30) or MR (n = 3) images. Twenty-nine patients had enteroenteric intussusceptions, and four had intussusceptions involving the colon. Ten patients (30%) had a neoplastic lead point, including all four of the intussusceptions involving the colon (benign mass, n = 3; malignant mass, n = 7). In 23 cases (70%), no neoplastic lead point was identified. A variety of causes were implicated in these cases, with 16 cases (48%) classified as idiopathic. Enteric intussusceptions in the nonneoplastic group were s...
229 citations
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TL;DR: What appears to be the rational management of such cases is presented in detail, using the facts regarding locations and causes of intussusception as found in published case reports as a guide.
Abstract: Intussusception in adults is discussed from the standpoint of incidence, location, pathogenesis and diagnosis. What appears to be the rational management of such cases is presented in detail, using the facts regarding locations and causes of intussusception as found in published case reports as a guide. Five cases are reported and discussed which illustrate some of the problems of the surgical treatment of the condition.
209 citations
TL;DR: The most common etiologic factors of intussusception in the adult are tumors, MeckeI's diverticulum, prior gastro-enterostomy and prolapse of gastric mucosa, while malignant tumors occurred in 123 instances.
Abstract: 1. 1. Intussusception in the adult although a rare condition is more commonly found than heretofore supposed. Types of intussusception in series of 665 cases Gastroduodenal 36 Gastroduodenojejunal 1 Pyloropyloric 1 Gastropyloric 1 Jejunogastric 29 Duodenoduodenal 4 Duodenojejunal 3 Jejunojejunal 53 Jejuno-ileal 4 Ileojejunal 1 Appendico-appendiceal 8 Appendicocecal 20 Appendicocecocolic 4 Appendico-ileo-colic 3 IIeo-appendico-cecal 2 Ileo-appendico-colic 1 Ileocecocolic 1 IIeocecal 95 IIeo-ileal 205 Ileocolic 82 Colocolic 55 Cecocoli 25 Cecal 1 Small intestine 2 Sigmoidosigmoidal 11 Sigmoidorectal 14 Colorectal 5 Epiploicosigmoidal 1 2. 2. In analyzing a large series of cases it is convenient to revise the old classification of intussusception. 3. 3. The most common etiologic factors of intussusception in the adult are tumors, MeckeI's diverticulum, prior gastro-enterostomy and prolapse of gastric mucosa. Other causes as enumerated in Table 1 have been given. 4. 4. The age factor should be considered important in the forming of a diagnosis but bear in mind, as Table 1 shows, any age may be affected. Patients between the ages of fifteen and twenty-five show a predominance. 5. 5. Males are more often affected than are females. 6. 6. Benign tumors were the etiologic factor in 213 cases while malignant tumors occurred in 123 instances. (Tables II and III.) 7. 7. The so-called primary cases show a large number in this series although it is believed that had meticulous care been taken in the discovering of some etiologic factor, many would have been included in the secondary listing. However, many cases following careful examination are primary. 8. 8. The great percentage of primary intussusceptions in the adult are of the ileo-ileal, ileocecal and ileocolic type. (Table IV.) 9. 9. The symptomatology in cases of intussusception in the adult is so undefinable that a definite diagnosis can be made only rarely. 10. 10. In analyzing this series of cases (665) nausea, vomiting, irregular attacks of colicky pain, recurrence of attacks and constipation are present with few exceptions. Abdominal masses were found in about one-half of the cases while abdominal tenderness, rigidity and melena were most infrequent. As complete obstruction develops, the patients present the usual signs and symptoms of obstruction including distention, patterns and an absence of abdominal clicks replacing the lively clicks heard before complete obstruction developed.
130 citations
TL;DR: Most intussusceptions occur in children less than two years of age and, as such, occur in the form of an acute surgical condition.
Abstract: An intussusception is the invagination of a segment of the intestine into a contiguous portion of intestine. It usually takes place in a peristaltic direction, that is, the proximal segment invaginates into the distal segment. In occasional cases, the reverse is true—the so-called retrograde type of intussusception. Most intussusceptions occur in children less than two years of age and, as such, occur in the form of an acute surgical condition. Rarely does an intussusception occur in an adult. When it does occur in an adult, the symptoms are usually less severe and less dramatic in onset. Ninety-six cases of intussusception occurring in adults have been encountered at the Mayo Clinic during the period from January, 1910, to January, 1955. It is the purpose of this paper to draw attention again to the occurrence of this disease in adults and to detail some of its characteristic features. Incidence It has been
76 citations
TL;DR: The clinical picture and x-ray findings associated with intussusception in adults are bizarre and a correct preoperative diagnosis is rarely made, so the surgeon should consider int Mussusception whenever he is confronted with a patient with confusing abdominal symptoms.
Abstract: An analysis of twenty-seven episodes of intussusception in adults treated at Charity Hospital from 1938 through 1959 is presented. Ileo-ileal intussusception was the most common anatomic variety. Only 19 per cent of the cases were due to lesions of the colon. Seventy-four per cent of the patients had a specific underlying lesion as the cause of the intussusception. The lesion was malignant in 22 per cent of the cases. Operative treatment required more extensive procedures in all but four patients, when manual reduction sufficed. Gangrenous bowel in nine of the twenty-seven cases indicates the importance of early operation. In easily reducible cases of intussusception of the small bowel and right colon, an attempt may be made to determine whether the lesion is benign or malignant. If the intussusception is irreducible or difficult to reduce, an adequate operation for cancer should be performed, preferably in one stage. In patients with intussusception of the left colon, a defunctionalizing colostomy should be performed as a first-stage operation so that an adequate resection can safely be performed later. The clinical picture and x-ray findings associated with intussusception in adults are bizarre and a correct preoperative diagnosis is rarely made. The surgeon should consider intussusception whenever he is confronted with a patient with confusing abdominal symptoms.
68 citations
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