Original Scientific Articles
Intussusception in adults: institutional review1

https://doi.org/10.1016/S1072-7515(98)00331-7Get rights and content

Abstract

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.

Section snippets

Methods

A retrospective review of the records of The Mount Sinai Medical Center from 1986 to 1997 identified 27 patients, 16 years of age or older, with diagnosis of intussusception. Details concerning the presentation, diagnosis, management, and pathology were analyzed. Office records of the primary surgeon were examined if additional information was needed. Followup was limited to the immediate postoperative period. Patients with appendiceal, stomal, and gastroenterostomy intussusceptions were not

Demographics

Of the 27 cases of intussusception identified at The Mount Sinai Medical Center over the past 11 years, there were 13 males and 14 females. The median age at the time of diagnosis was 52 years with a range of 16 to 90 years. Pertinent prior medical history included 7 patients with known prior malignancies, 2 patients with HIV, 1 patient with systemic lupus, and 1 patient with Peutz-Jeghers syndrome.

Clinical presentation

The most common presenting complaint was pain and it was seen in over 80% of the patients.

Discussion

Intussusception is an uncommon cause of intestinal obstruction in adults, but in the pediatric population it is much more common.1, 2, 3, 4, 5 There are significant differences between the two patient populations and therefore discussion should be limited to one group or the other. In this study, we reviewed hospital records from a tertiary hospital center to determine the number of cases of adult intussusception (16 years of age or older) over an 11-year period from 1986 to 1997.

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1

No competing interests declared.

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