Adult intussusception in Asians: clinical presentations, diagnosis, and treatment

A clinical overview of a retrospective study about adult intussusceptions: focusing on discrepancies among previous studies

This study was to determine clinical entity of adult intussusception, focusing on discrepancies among previous studies and to retrospectively investigate the factors associated with malignancy and survival for 10 years. In our study, 3.7% (N=42) of intussusception were adults. The most common symptom was acute abdominal pain (64.3%). Enteric, ileocolic, ileocecal, and colocolic intussusception included 52.4, 9.5, 14.3, and 23.8% of patients, respectively. Two patients (9.1%) with enteric (N=22), no patient with ileocolic (N=4), three patients (50%) with ileocecal (N=6), and five patients (50%) with colocolic (N=10) intussusception were malignant. The factor associated with malignancy was only chronic abdominal pain without acute abdominal pain (P = 0.018) and the absence of fever and ileocecal intussusception were associated with survival (P=0.010, 0.009). In our study, the most common symptom was acute abdominal pain, and enteric intussusception was the most common type. The difference in clinical presentation and location of intussusception might have resulted from small number of cases or selection of cases.

A clinical overview of a retrospective study about adult intussusceptions: focusing on discrepancies among previous studies

This study was to determine clinical entity of adult intussusception, focusing on discrepancies among previous studies and to retrospectively investigate the factors associated with malignancy and survival for 10 years. In our study, 3.7% (N=42) of intussusception were adults. The most common symptom was acute abdominal pain (64.3%). Enteric, ileocolic, ileocecal, and colocolic intussusception included 52.4, 9.5, 14.3, and 23.8% of patients, respectively. Two patients (9.1%) with enteric (N=22), no patient with ileocolic (N=4), three patients (50%) with ileocecal (N=6), and five patients (50%) with colocolic (N=10) intussusception were malignant. The factor associated with malignancy was only chronic abdominal pain without acute abdominal pain (P = 0.018) and the absence of fever and ileocecal intussusception were associated with survival (P=0.010, 0.009). In our study, the most common symptom was acute abdominal pain, and enteric intussusception was the most common type. The difference in clinical presentation and location of intussusception might have resulted from small number of cases or selection of cases.

Can CT features be used to diagnose surgical adult bowel intussusceptions?

OBJECTIVE

The purpose of our study was to identify whether any CT characteristics can be used to diagnose surgical intussusceptions.

MATERIALS AND METHODS

A search of CT reports on adults revealed 118 patients with 136 intussusceptions. Two blinded readers independently reviewed the CT examinations and documented intussusception characteristics. Medical records were reviewed to determine patient outcome. Performance, interobserver agreement (A), and significance of CT characteristics to identify surgical intussusceptions were calculated.

RESULTS

Of 95,223 CT examinations, 0.13% (121/95,223) documented 136 intussusceptions over a 7-year period, of which 88.2% (120/136) were enteroenteric, 3.7% (5/136) were enterocolic, and 4.4% (6/136) were colocolic lesions or in other locations. Eight (5.9%) were surgical and 128 (94.12%) were nonsurgical lesions. Five of eight (63%) surgical lesions involved the colon. Only two of eight surgical lesions had malignant lead points. The mean sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing surgical enteroenteric lesions using a measured lesion length of > 3.5 cm were 100%, 57.3%, 5.7%, and 100% (A = 0.68), respectively. Similar figures using the measured axial diameter > 3 cm were 100%, 32.9%, 3.7% and 100% (A= 0.65), respectively.

CONCLUSION

Surgical intussusceptions in adults are infrequent among the intussusceptions that are detected on CT. Most enteroenteric lesions are nonsurgical lesions, whereas lesions that affect the colon are often surgical. Many nonsurgical enteroenteric intussusceptions are longer than 3.5 cm and thicker than 3 cm, suggesting these CT features may not be useful for diagnosing surgical bowel intussusceptions in adults.

Intussusception in adults: Clinical characteristics, diagnosis and operative strategies

AIM: To evaluate 20 adults with intussusception and to clarify the cause, clinical features, diagnosis, and management of this uncommon entity.

METHODS: A retrospective review of patients aged > 18 years with a diagnosis of intestinal intussusception between 2000 and 2008. Patients with rectal prolapse, prolapse of or around an ostomy and gastroenterostomy intussusception were excluded.

RESULTS: There were 20 cases of adult intussusception. Mean age was 47.7 years. Abdominal pain, nausea, and vomiting were the most common symptoms. The majority of intussusceptions were in the small intestine (85%). There were three (15%) cases of colonic intussusception. Enteric intussusception consisted of five jejunojejunal cases, nine ileoileal, and four cases of ileocecal invagination. Among enteric intussusceptions, 14 were secondary to a benign process, and in one of these, the malignant cause was secondary to metastatic lung adenocarcinoma. All colonic lesions were malignant. All cases were treated surgically.

CONCLUSION: Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. Treatment usually requires resection of the involved bowel segment. Reduction can be attempted in small-bowel intussusception if the segment involved is viable or malignancy is not suspected; however, a more careful approach is recommended in colonic intussusception because of a significantly higher coexistence of malignancy.