Abstract
Background and aims: Adult intussusception is a rare clinical presentation and often not considered clinically in patients with vague abdominal complaints. Even if the diagnosis is established, the optimal management of this problem remains controversial.
Materials and Methods: The clinical, diagnostic, operative and pathological data of 25 patients of adult intussusception was collected prospectively between June 2007 to June 2017 at two tertiary health centers of North India and was analyzed for varied clinical spectrum, diagnostic techniques and surgical treatment.
Results: Twenty five patients of adult intussusception aged between 18-82 years were included in this study. Most common presenting complaint was pain abdomen in 21/25 patients (84%) followed by nausea and vomiting. CT scan established preoperative diagnosis in 87.5% cases. All patients underwent surgical treatment and there was no mortality in our series. Pathological lead point was detected in 21/25 patients, in one patient it was due to feeding tube and etiology was not detected in three patients. No case with malignant lead point was detected in enteric intussusception group as compared to four cases in colonic intussusception group.
Conclusion: CT scan the most sensitive investigation for preoperative diagnosis. Enteric intussusception should be reduced when the underlying etiology is suspected to be benign or the resection is massive without reduction. But not the colonic intussusception as etiology is malignant in most cases.
Keywords: Adult intussusception, intussusceptum, computed tomography, reduction, surgery.
References
- Haas EM, Etter EL, Ellis S, Taylor TV. Adult intussusception. Am J Surg 2003; 186:75–76
- Barussaud M, Regenet N, Briennon X, et al. Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study. Int J Colorectal Dis 2006; 21:834–839
- Azar T, Berger DL. Adult intussusception. Ann Surg 1997; 226: 134-138
- Begos DG, Sandor A, Modlin IM. The diagnosis and management of adult intussusception. Am J Surg 1997; 173: 88-94
- Weilbaecher D, Bolin JA, Hearn D, Ogden W 2nd. Intussusception in adults. Review of 160 cases. Am J Surg 1971; 121: 531-535
- Zubaidi A, Al-Saif F, Silverman R. Adult intussusception: a retrospective review. Dis Colon Rectum 2006; 49: 1546-1551
- Tan KY, Tan SM, Tan AG, et al. Adult intussusception: experience in Singapore. ANZ J Surg. 2003; 73:1044–47
- Wang LT, Wu CC, Yu JC, Hsiao CW, Hsu CC, Jao SW. Clinical entity and treatment strategies for adult intussusceptions: 20 years' experience. Dis Colon Rectum 2007; 50: 1941-1949
- Eisen LK, Cunningham JD, Aufses AH Jr. Intussusception in adults: institutional review. J Am Coll Surg 1999; 188: 390-395
- Hurwitz LM, Gertler SL. Colonoscopic diagnosis of ileocolic intussusception. Gastrointest Endosc 1986; 32: 217-218
- Thomas AW, Mitre R, Brodmerkel GJ Jr. Sigmoidorectal intussusception from a sigmoid lipoma. J Clin Gastroenterol 1995; 21: 257
- Wang N, Cui X Y, Liu Y, Long J, Xu Y H, Guo R X, Guo K J. Adult intussusception: A retrospective review of 41 cases. World J Gastroenterol 2009 July 14; 15(26): 3303-3308
- Chang FY, Cheng JT, Lai KH. Colonoscopic diagnosis of ileocolic intussusception in an adult. A case report. S Afr Med J 1990; 77: 313-314
- Fujii Y, Taniguchi N, Itoh K. Intussusception induced by villous tumor of the colon: sonographic findings. J Clin Ultrasound 2002; 30: 48-51
- Boyle MJ, Arkell LJ, Williams JT. Ultrasonic diagnosis of adult intussusception. Am J Gastroenterol 1993; 88: 617-618
- Weissberg DL, Scheible W, Leopold GR. Ultrasonographic appearance of adult intussusception. Radiology 1977; 124: 791-792
- Goh BK, Quah HM, Chow PK, Tan KY, Tay KH, Eu KW, Ooi LL, Wong WK. Predictive factors of malignancy in adults with intussusception. World J Surg 2006; 30: 1300-1304
- Gayer G, Zissin R, Apter S, Papa M, Hertz M. Pictorial review: adult intussusception--a CT diagnosis. Br J Radiol 2002; 75: 185-190
- Chang C C, Chen YY, Chen Y F, Lin C N, Yen H H, Lou HY. Adult intussusception in Asians: Clinical presentations, diagnosis, and treatment Journal of Gastroenterology and Hepatology 22 (2007) 1767–1771
- Marinis A, Yiallourou A, Samanides L , Dafnios N, Anastasopoulos G, Vassiliou I, Theodosopoulos T. Intussusception of the bowel in adults: A review World J Gastroenterol 2009 January 28; 15(4): 407-411
- Reijnen HA, Joosten HJ, de Boer HH. Diagnosis and treatment of adult intussusception. Am J Surg 1989; 158:25–28
- Karahasanoglu T, Memisoglu K, Korman U, Tunckale A, Curgunlu A, Karter Y. Adult intussusception due to inverted Meckel's diverticulum: laparoscopic approach. Surg Laparosc Endosc Percutan Tech 2003; 13: 39-41
- Zanoni EC, Averbach M, Borges JL, Corrêa PA, Cutait R. Laparoscopic treatment of intestinal intussusception in the Peutz-Jeghers syndrome: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2003; 13: 280-282
- Alonso V, Targarona EM, Bendahan GE, et al. Laparoscopic treatment for intussusception of the small intestine in the adult. Surg Laparosc Endosc Percutan Tech 2003; 13: 394-396
- Jelenc F, Brencic E. Laparoscopically assisted resection of an ascending colon lipoma causing intermittent intussusc-eption. J Laparoendosc Adv Surg Tech 2005; 15: 173-175.
Corresponding Author
Javid Iqbal
Department of General Surgery,
Government Medical College Jammu, J&K, India 180005
Phone: 9596620409, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.40
