Intussusception in adults: Review of 160 cases

doi:10.1016/0002-9610(71)90133-4

The American Journal of Surgery

Volume 121, Issue 5, May 1971, Pages 531-535

https://doi.org/10.1016/0002-9610(71)90133-4 Get rights and content

Abstract

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.

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Cited by (301)

Adult intussusception: still a challenging diagnosis for the surgeon
2023, Revista de Gastroenterologia de Mexico
La intususcepción es infrecuente en adultos y puede ocurrir en intestino delgado y colon. Su presentación atípica hace complejo el diagnóstico. El objetivo de este estudio fue evaluar las causas, características clínicas, desenlaces del tratamiento y determinar si existe asociación entre etiología y presentación clínica.
Estudio retrospectivo en un centro de tercer nivel, en pacientes mayores de 18 años con intususcepción tratados entre 2000 y 2020. Se utilizó estadística descriptiva e inferencial para resumir los hallazgos.
Se identificaron 28 casos, con una mediana de edad de 46 años (18-80) y duración de síntomas de 18 días. El dolor abdominal fue el síntoma más frecuente (96.42%). Se registraron 14 intususcepciones entero-entéricas, 4 ileocecales, 4 ileocolónicas, 5 colo-colónicas y una colorrectal. Quince de las intususcepciones fueron de etiología benigna, 9 asociadas a malignidad y 4 idiopáticas. Se realizó cirugía en 11 pacientes con intususcepción entero-entérica y en todos los casos de intususcepción ileocecal, ileocolónica, colo-colónica y colorrectal. Se presentaron 2 eventos de mortalidad perioperatoria (8%) y 8 de morbilidad postoperatoria (32%). No hubo diferencia significativa en la duración de los síntomas, ni en estancia hospitalaria al comparar los grupos etiológicos.
La intususcepción es rara en adultos. El diagnóstico es un reto debido a los signos y síntomas inespecíficos. Para el tratamiento definitivo, se debe considerar la resección quirúrgica, individualizando de acuerdo a las comorbilidades del paciente, presentación clínica y riesgo de malignidad.
Intussusception is rare in adults and can occur in the small bowel and colon. Its atypical presentation makes the diagnosis difficult. The aim of the present study was to evaluate the causes, clinical characteristics, and treatment outcomes of adult intussusception and to determine whether there was an association between etiology and clinical presentation.
A retrospective study was carried out on patients above 18 years of age that were treated for intussusception at a tertiary care hospital, between 2000 and 2020. The findings were summarized utilizing descriptive and inferential statistics.
Twenty-eight cases were identified. Median patient age was 46 years (18-80) and median symptom duration was 18 days. Abdominal pain was the most frequent symptom (96.42%). The intussusceptions registered were enteroenteric (14), ileocecal (4), ileocolonic (4), colocolonic (5), and colorrectal (1). Intussusception etiology was benign in 15 cases, 9 were associated with malignancy, and 4 were idiopathic. Surgery was performed on 11 patients with enteroenteric intussusception and on all the cases of ileocecal, ileocolonic, colocolonic, and colorectal intussusception. There were 2 events of perioperative mortality (8%) and 8 of postoperative morbidity (32%). No significant differences were found regarding symptom duration or length of hospital stay, when the etiologic groups were compared.
Intussusception is rare in adults. Diagnosis is a challenge because of the nonspecific signs and symptoms. Surgical resection should be considered in the definitive treatment and management should be individualized according to the patient's comorbidities, clinical presentation, and risk of malignancy.
Adenocarcinoma of the sigmoid colon causing sigmoido-rectal intussusception: A rare entity in adults
2023, International Journal of Surgery Case Reports
Intussusception occurs when a more proximal portion of the bowel (intussusceptum) invaginates into the more distal bowel (intussuscipiens). The pathomechanism is thought to involve altered bowel peristalsis at the intraluminal lesion, which is then a lead point for the intussusceptum. Intestinal intussusception is rare in adults, accounting for approximately 1 % of all bowel obstructions. We report a unique case in which a partially obstructing sigmoid cancer caused full thickness rectal prolapse requiring surgical intervention.
A 75-year-old male presented in the emergency department due to anal haemorrhage for 5 days. On clinical examination his abdomen was distended with signs of peritoneal irritation in the right quadrants. The CT scan showed sigmoid-rectal intussusception with an sigmoid colonic tumour. The patient underwent emergency anterior resection of the rectum without reduction of the intussusception. Histological examination revealed a sigmoid adenocarcinoma.
Intussusception is the most common urgent situation among the pediatric population but its incidence in adults is very rare. The diagnosis is difficult to establish with history and physical exam findings alone. Since in adults, unlike children, in most cases a malignant pathology acts as a lead point, the treatment of this pathology still reserves doubts. Recognizing and understanding pertinent signs, symptoms, and imaging findings is essential to the early diagnosis and appropriate management of adult intussusception.
The appropriate management of adult intussusception is not always clear cut. There is controversy about the reduction before resection in cases of sigmoidorectal intussusception.
Colo-colic intussusception secondary to colon lipoma: A case report
2021, International Journal of Surgery Case Reports
Citation Excerpt :
Second only to hyperplastic and adenomatous polyps occurring in the large bowel, lipoma is the third most common benign tumor with an incidence of 4.4% [5–7]. A lead point is common and can be found in 70–90% of adult intussusceptions, contrary to pediatric intussusception, which is idiopathic in 90% of cases [8–10]. The lead point is malignant in approximately 30 percent of the cases [9,11].
Intestinal intussusception is rare in adults and it is associated with lead points affecting the colon in around 17% of patients. Lipomas are very rare benign tumors which may act as lead points for intestinal intussusception. Indeed, the incidence of intestinal intussusception is much rare when caused by lipomas.
Our patient is a 29-year-old male, previously healthy and admitted for severe right lower quadrant abdominal pain of 2-day duration. Computed tomography (CT) scan of the abdomen and pelvis showed large mass of fat consistency containing colon structure.
Urgent laparotomy was opted during which colo-colic intussusception was diagnosed and right hemicolectomy with primary ileocolic anastomosis was performed. Pathology report showed that intussusception was induced by a colon lipoma. Patient had an uneventful hospital stay and was discharged on post-operative day 5.
Thus we recommend that colo-colic intussusception caused by lipoma be considered in the differential when diagnosing adults with right lower quadrant pain.
Ileo-caecal intussusception secondary to lipoma in an adult: A rare cause for intestinal obstruction
2020, Radiology Case Reports
Intussusception in adults is a rare condition. Unlike in children, it is often associated with a pathologic lesion that serves as a lead point. We report an unusual case of ileo-caecal intussusception due to lipoma. A 51-year-old male presented with symptoms and signs of intestinal obstruction. CT scan revealed bowel obstruction, resulting from ileo-caecal intussusception with the lead point being a lipoma of the terminal ileum. Ileocaecal resection with primary anastamosis was performed with histology confirming lipoma. Intussusception is not a common cause for intestinal obstruction in adults and is best diagnosed with CT scan. Surgical resection remains the definitive treatment in adult intussusception.
A Unique Case of Massive Colonic Distention
2020, Gastroenterology
Recurrent intussusception of small bowel in a young patient due to metastases from cardiac undifferentiated pleomorphic sarcoma: A first ever case report
2020, International Journal of Surgery Case Reports
Citation Excerpt :
The metastatic tumors that cause intussusception represent another rare clinical conditions in adult patients. Generally, causes of intussusception in adult are benign lesions (lipomas, adenomas, Meckel’s diverticula and fibromas) [13–15]. More than 60% of patients with intussusception have a tumor with 50% being malignant.
Undifferentiated metastatic pleomorphic sarcoma (Malignant Fibrous Histiocytoma) is a rare entity in the small intestine, especially when the primary tumor is of cardiac origin.
We report a case of metastatic intestinal undifferentiated pleomorphic sarcoma in a young patient with a history of primary cardiac tumor in the left atrium and recurrent small bowel intussusception. He was admitted for abdominal pain and constipation. A segmental resection of the small intestine was performed with side-to-side entero-enteroic anastomosis.
Intussusception of the small bowel is rare in adults and it represents about 1–3% of intestinal obstructions. It mainly affects the fifth decade with a male/female ratio of 1:5 More than 60% of patients with intussusception have a tumor with 50% being malignant. This type of intussusception can be diagnosed on the CT abdominalscan. Radiological features include a typical “target” sign with overdistention of the proximal intestine and air-fluid levels, but the diagnosis of certainty is made by exploratory laparotomy.
The metastatic tumors that cause intussusception represent a rare clinical condition in adult patients, but much more common than primary ones. Metastasis to the small intestine are part of differential diagnosis in patient with a history of tumor who present with intussusception.

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¹: From the Department of Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana.

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Scientific paperIntussusception in adults: Review of 160 cases

Abstract

Amer J Surg

Amer J Surg

Amer J Surg

Intussusception in the adult with emphasis on retrograde type

Arch Surg

Intussusception in adults

Arch Surg

Scientific paper
Intussusception in adults: Review of 160 cases