Adult intussusception: a systematic review and meta-analysis

Colo-colonic intussusception as a rare complication of colonoscopy with polypectomy: Two case reports

BACKGROUND

Colonoscopy is the most frequently used diagnostic and therapeutic tool for the treatment of colorectal diseases. Although the complication rate is low, it can be potentially serious. Intussusception is a rare and severe complication often associated with polypectomy. Only a handful of post-colonoscopy intussusception cases have been reported, making this study a valuable addition to the medical literature.

CASE SUMMARY

Case 1: A 61-year-old man underwent colonoscopy with polypectomy for chronic abdominal pain. The patient experienced abdominal pain 11 hours later but was still discharged after pain management. He was readmitted due to recurring pain. Computed tomography (CT) showed colo-colonic intussusception. Initial conservative management and attempts at endoscopic reduction failed; therefore, laparoscopic right hemicolectomy was performed. Histopathological examination revealed tubular adenomas in the polyps and inflammation in the resected specimens. Case 2: A 59-year-old woman underwent colonoscopy with polypectomy for a polyp in the transverse colon. She experienced upper abdominal pain, fever, nausea, and vomiting 9 hours after the procedure. Emergency CT and blood tests revealed a colo-colonic intussusception near the hepatic flexure and an elevated white blood cell count. Initial attempts at endoscopic reduction failed and conservative treatment showed no improvement. She underwent successful laparoscopic reduction and recovered uneventfully. Histopathological examination of the resected polyp revealed hyperplasia.

CONCLUSION

Post-colonoscopy intussusception in adults is rare, and polypectomy may contribute to its occurrence. Early diagnosis is crucial, with prompt CT examination serving as key. After excluding malignancies, conservative management and reduction of intussusception should be considered before surgical bowel resection.

Rare etiology of colonic intussusception involving an adult with emphysematous cystic enteropathy: A case report and review of literature

BACKGROUND

Pneumatosis cystoides intestinalis (PCI), characterized by a collection of gas-filled cysts in the intestinal wall, is an uncommon but well-known condition in gastroenterology. Abdominal pain is the most frequent symptom associated with PCI. Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation. However, the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood.

CASE SUMMARY

A 52-year-old male, known with idiopathic PCI, presented seventeen months after initial diagnosis with a new right upper quadrant pain. A computed tomography-scan demonstrated a colonic intussusception at the hepatic flexure. PCI did not progress compared with initial investigation. The patient underwent an emergency right hemicolectomy.

CONCLUSION

Resection was recommended in this case because PCI proved to be persisting with no identified curable cause. Surgery allowed to address the underlying pathology, the potential relapse of intussusception, and the likely cause of recurrent abdominal pain, either invagination or PCI itself.

Colonic intussusception after endoscopic mucosal resection successfully managed by endoscopic procedure

Adult-onset intussusception, particularly associated with colonoscopy, is extremely rare. A 78-year-old man, referred to our hospital for colonic endoscopic mucosal resection (EMR), experienced subsequent dull abdominal pain, as well as elevated peripheral blood leukocytosis and C-reactive protein levels. Abdominal computed tomography (CT) revealed a colocolonic intussusception at the hepatic flexure. Emergency colonoscopy revealed ball-like swollen mucosa distal to the EMR site of the ascending colon. The mucosa was intact without necrosis. The endoscopic approach was able to temporarily release the intussusception. A transanal drainage tube was inserted through the endoscope to prevent relapse. Both CT and colonoscopy showed release of the intussusception. Our case underscores the importance of considering colocolonic intussusception in post-colonoscopy abdominal pain, advocating for endoscopic management after excluding mucosal necrosis.

A Case of Colonic Intussusception Caused by Cecal Lymphangioma and Requiring Emergency Surgery

Lymphangiomas are benign tumors of dilated lymphatic vessels often found in the head, neck, and axilla of children. Lymphangiomas rarely occur in the abdomen, much less in the colon of adults. Colonic lymphangioma can cause symptoms and signs such as abdominal pain and abdominal distension and complications of gastrointestinal bleeding and intussusception. Intussusceptions are rarer in adults than in children. Most cases of intussusception in adults have a distinct cause, and a substantial number are related to malignant tumors. Herein, we report a rare case of ileocecal intussusception caused by cecal lymphangioma that required emergency surgery. A 40-year-old woman presented with severe abdominal pain of a two-day duration. Her abdomen was tender and showed muscle rigidity in the right lower quadrant. Contrast-enhanced CT of the abdomen revealed ileocecal intussusception and a cystic mass, which was the leading point, with no evidence of bowel strangulation. The patient underwent emergency laparoscopic surgery because she had severe abdominal pain and showed peritoneal irritation signs. During surgery, the cecum was found to have invaginated into the ascending colon, almost to the hepatic flexure. Laparoscopic ileocecal resection with central vascular ligation was performed without intraoperative reduction of the intussusception because the cystic lesion could have a malignant component. Upon inspection, the lesion was a 60 mm × 50 mm submucosal mass located in the cecum. It was filled with clear serous fluid and thin walls. Pathology revealed the cystic mass to be a cecal lymphangioma with no evidence of malignancy. The patient was discharged seven days after emergency surgery with no complications. Our case adds to evidence that cecal lymphangiomas can cause colonic intussusception in adults. Although rare, the risk of colonic intussusception must be considered in the management of colonic lymphangiomas.

Adult ileocecal intussusception as an unusual presentation of ascending colon adenocarcinoma: a case report from Sudan

Adult colonic intussusception, is a rare entity that is typically associated with underlying organic pathologies, notably colorectal tumors, unlike pediatric cases, which are mostly idiopathic. We present a unique case of a 42-year-old female with ascending colon adenocarcinoma, where ileocecal intussusception served as the initial clinical manifestation. The patient's non-specific symptoms, familial history of colon cancer and subsequent diagnostic evaluations underscore the importance of considering malignancy in such presentations. Successful laparoscopic right hemicolectomy resolved the intussusception. This case, which is the first case to be reported in Sudan, highlights the clinical complexities of adult colonic intussusception, emphasizing the need for a heightened index of suspicion for underlying malignancy and the significance of timely surgical intervention. Furthermore, the challenges encountered in resource-limited settings underscore the necessity for genetic testing to guide familial screenings and identify hereditary factors contributing to colon cancer, providing valuable insights for clinicians managing similar cases.

Telescoping into Adulthood: A Case Report of Intussusception in an Adult Patient

Intussusception is a familiar diagnosis among the pediatric population; however, it is rarely considered among the adult population due to a myriad of life-threatening pathologies within the abdomen. We present an adult female who presented to the emergency department (ED) with abdominal pain and constipation. Laboratory testing and a computed tomography (CT) scan of the abdomen were ordered. Laboratory test results were notable for an elevated lymphocyte count as well as leukocyte esterase, white blood cells (WBC), and bacteria seen on urinalysis. The computed tomography scan detected a colo-colic intussusception secondary to a benign mass within the bowel lumen. The mass was surgically resected and the patient had an uneventful postoperative course. This unique case represents the occurrence of a pathology to which the adult population is not immune, and therefore should not be overlooked when evaluating a non-specific case of abdominal pain.

Topics

Intussusception, colo-colic, obstruction, abdominal pain, constipation, female, mass, bowel, lymphocyte, ultrasound, computed tomography.

Malignant Ileocolocolic Intussusception in a 19-Year-Old Male

Adult intussusception is an infrequent occurrence typically resulting from an identifiable lead point of a benign or malignant etiology. Here, we present a case of a 19-year-old male who presented to the emergency department with complaints of abdominal pain, intractable nausea, and fluctuations between bloody diarrhea and constipation. These symptoms had begun two months prior and had increased in severity, resulting in significant appetite changes. An abdominal and pelvic computed tomography scan without contrast was obtained, which showed evidence of intussusception of the ileocecum into the transverse colon with resultant small bowel obstruction. The patient underwent an exploratory laparotomy, which resulted in a partial ileocolectomy due to the presence of a 6.8 cm cecal mass with palpable mesenteric lymphadenopathy. The pathologic specimen was identified as Burkitt lymphoma based on a combination of histologic, immunohistochemical, and fluorescence in situ hybridization findings. Currently, the patient is undergoing three cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (R-CODOX-M/IVAC) per Magrath protocol for low-risk Burkitt lymphoma.

Adult colorectal intussusception caused by giant lipoma-A case report

Key Clinical Message

Adult intussusception commonly has a leading point. In the colon, malignancy is a prevalent etiology for the leading point; however, benign tumors should also be considered. We present a case of colorectal intussusception caused by a giant lipoma.

Abstract

Intussusception in adults is comparatively infrequent in contrast to children, and in adult colonic intussusception, malignancy is the predominant cause of the leading point. Lipoma, an uncommon tumor in the gastrointestinal tract, rarely induces colonic intussusception in adults. We present the case of a 55-year-old Cambodian man experiencing cramping abdominal pain. He presented with mild abdominal distension with tenderness in the lower abdomen. On the rectal examination a large palpable mass was detected three to four centimeters from the anal verge. Abdominal computerized tomography revealed a collapsed sigmoid colon with mesenteric fat invaginated into the lumen of the upper rectum. Emergency laparotomy was performed and during the surgery the sigmoid intussusception spontaneously reduced. A mass was identified in the mid-sigmoid colon, leading to the decision for segmental resection of the sigmoid colon with the mass and subsequent end-to-end anastomosis. Histological examination results confirmed the mass as a lipoma. Colorectal intussusception in adults due to a lipoma is a relatively rare, with only a few reported cases in the literature.

Enteroenteric intussusception caused by a small bowel metastatic cutaneous melanoma

Unlike in children, intussusception is very rare in adults and accounts for only 1% of ileus in that population. While intussusception in children is most often idiopathic, in adults the cause of intussusception in most cases is tumor and most often metastatic adenocarcinoma. It is an extremely rare phenomenon for intestinal melanoma metastasis to be the cause of intussusception and has been described in the literature so far only in a limited number of case reports. 41-year-old female patient was admitted to the emergency department with a clinical picture of ileus. The patient had a melanoma excision on her back five years ago, for which chemotherapy and radiotherapy were carried out. An MSCT of the abdomen was performed, which indicated an obstructive ileus of the small intestine with a typical sign of intussusception (target sign). Upon explorative laparotomy enteroenteric intussusception was found with an invaginated segment of the ileum in a length of about 20 cm. When the intussuscepted segment was reduced, a black tumor the size of a plum was verified as a leading point. Histological analysis indicated metastatic cutaneous melanoma with foci of melanocytes underneath normal intestinal epithelium.

Adenocarcinoma-Induced Sigmoid Colon Intussusception and Postoperative Parastomal Evisceration in an Elderly Patient: A Case Report and Literature Review

Intussusception in adults is less frequent than in children, and it is less commonly seen in the colon than in the intestines. This may be explained by the fixation of the colon to the retroperitoneum. We herein describe a case of sigmoid colon intussusception caused by a sigmoid colon adenocarcinoma. An 81-year-old man presented with abdominal pain and signs and symptoms of gastrointestinal obstruction. CT revealed a "target sign" with a mass in the sigmoid colon. We diagnosed the patient with colonic obstruction secondary to intussusception of the sigmoid colon and performed an emergency transverse colostomy. On the first postoperative day, the patient had a parastomal evisceration. Oncologic resection of the sigmoid colon without reduction of the intussusception was performed. The tumor was pathologically diagnosed as well-differentiated adenocarcinoma and classified as pT3N0. The patient was discharged on the ninth postoperative day with an uneventful postoperative course. The surveillance was validated for this patient.

Ileum intussusception secondary to submucosal liposarcoma in adult：A case report

Intussusception in adults is a rare surgical emergency. Unlike in children, most adult intussusceptions arise from a pathological lead point. Ileal intussusception caused by a submucosal liposarcoma is a particularly rare phenomenon. This report describes the diagnosis and management of adult ileal intussusception secondary to submucosal liposarcoma in adult to provide a reference for future clinical work. A 64-year-old female presented to the emergency department with worsening abdominal pain associated with an 8 h history of intermittent vomiting. Based on physical examination, laboratory investigations, and computed tomography, the most likely diagnosis was ileal intussusception secondary to liposarcoma. Thus, emergency laparotomy was performed. During exploration, an ileal invagination was visualised approximately 30 cm from the ileocecal valve, and a flexible polypoid mass was palpable at the lead point of the intussusception. Subsequently, the patient underwent radical resection of pathological tissues with a primary end-to-end ileal anastomosis. Histopathological examination revealed a well-differentiated submucosal liposarcoma. Postoperatively, the patient recovered uneventfully and was doing well at the 6-month follow-up in the outpatient clinic. Thus, clinicians should consider the origin of submucosal liposarcomas in adult with intussusception. Once ileal intussusception secondary to submucosal liposarcoma is diagnosed, timely radical resection is recommended.

Intussusception of Gastrojejunostomy After Pancreatoduodenectomy With Billroth II Reconstruction

Gastrojejunal anastomosis or gastrojejunostomy (GJ) is a surgical procedure used for allowing gastric emptying, especially in cases where complex reconstructions are needed. One of the less common complications but one of the most relevant in morbidity is the intussusception of the GJ. It requires a high index of suspicion, preoperative optimization of the patient, diagnostic corroboration, and identification of associated complications with the use of contrasted imaging. It was described for the first time by Bozzi in 1914; currently, multiple cases have been described in the literature, being more frequent in bariatric surgeries and reconstructions after distal gastrectomy. In hepatopancreaticobiliary surgery, it is an even uncommon complication. We present the case of a 60-year-old man with intussusception of the efferent loop of the GJ after a pylorus-preserving pancreatoduodenectomy with a Billroth II reconstruction in the setting of malignancy of the extrahepatic bile duct along with our emergency surgical treatment.

Adult intussusception with multiple intestinal adhesions: A case report

Intussusception occurs when a part of the intestine enters another segment of the intestine causing bowel obstruction. It is common in children but not in adults with only <5% of prevalence of all intussusceptions. Most of the cases have an underlying neoplastic pathology. However, we found a case where an adult patient with 2 weeks of ileus obstruction is caused by intussusception with multiple intestinal adhesions. A 59-year-old man complained of being unable to defecate, or vomit and had a tender abdomen for 2 weeks. Contrast abdominal CT showed a dilated and thickened intestinal wall, with ileo-ileal intussusception in the distal terminal ileum, indicating a diagnosis of ileus obstruction due to intussusception. During laparotomy, intussusception was found but released spontaneously followed by ancillary findings were multiple adhesions in the ileum that caused the intussusception and obstruction. In conclusion, transient intussusception in adults with multiple adhesions has never been reported before, and a CT scan is an important clinical tool to diagnose and identify the cause of this condition. Recognizing the imaging abnormalities earlier is important to prevent further complications.

A Case of Long-Tract Ileocolic Intussusception Secondary to Well-Differentiated Cecal Adenocarcinoma

Intussusception denotes the intricate phenomenon wherein one segment of the bowel undergoes invagination or telescoping into its contiguous distal segment. The ensuing invaginated segment may be propelled forward through peristaltic movements, potentially precipitating bowel obstruction or ischemia, culminating in necrosis of the affected bowel segment. Although the precise etiology of intussusception remains elusive, particularly in cases devoid of an identifiable lead point, dysrhythmic contractions and lymphoid hyperplasia have been implicated in the pathophysiology of this condition. We present the case of an 86-year-old African American female with a past medical history of hypertension and asthma who presented to our emergency room with a seven-day history of worsening abdominal. The pain was described as sharp and intermittent, and it would worsen with every meal or drink. A physical exam demonstrated the right lower quadrant with vague abdominal tenderness, especially below the umbilical region. Computed tomography of the abdomen and pelvis revealed a long segment of ileocolic obstructing intussusception in the ascending colon, with a 2.6 cm solid mass serving as a lead point. Swift intervention ensued with an urgent exploratory laparotomy, culminating in a right hemicolectomy to excise the intussuscepted segment of the bowel. The pathological examination identified a well-differentiated adenocarcinoma of the cecum, categorized as T1N0M0, with all 20 resected lymph nodes yielding negative results. This illustrative case presents a unique insight into a patient with ileocolic obstructing intussusception, caused by a well-differentiated adenocarcinoma acting as the lead point, a relatively uncommon occurrence in adults. Diagnosing intussusception in adults is challenging due to its nonspecific symptoms, which are similar to those of various other gastrointestinal disorders. Therefore, it is crucial for medical providers to be acutely aware of the possibility that adenocarcinoma can trigger obstructing intussusception in various parts of the bowel.

Isolated adult ileocecal intussusception in sigmoid colon due to non-specific inflammation

Adult ileocecal intussusception due to non-specific inflammation is a rare condition. Intussusception is the intestinal segment telescoping into the adjacent intestinal lumen. Typically, a pathological lesion is discovered with a high percentage of malignancy. Intussusception of the most common ileocolic kind includes the appendix, but it is uncommon for an appendix to serve as the lead point. The patient was admitted to the emergency department with a complaint of acute intestinal obstruction. After getting a diagnostic workup, an exploratory laparotomy was done, and the ileocecal and ascending colon segment was intussuscepted directly into the sigmoid colon. Transverse and descending colon were normal, and resection of necrosed intussuscepted bowel, primary repair of sigmoid colon with ileostomy with transverse colon as distal mucus fistula done, after the 3-month restoration of bowel continuity done, patient discharged and doing well. After the diagnosis of intussusception, the best surgical choice is in the hands of an experienced surgeon.

The Management of Intussusception: A Systematic Review

Intussusception (ISN) is a dangerous condition where a portion of the intestine slides into an adjacent area of the intestine. This telescoping motion frequently prevents liquids or food from flowing through. Developing management guidelines for ileocolic (IC) intussusception was the aim of this systematic study. Data sources were PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, and Embase databases. Our review investigated English-language articles (from 2010 to 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Overall, there were 15 articles. Surveys and analyses of national databases were the most widely used methods (n=15). The search identified 561 studies; 15 were eligible for inclusion in the analysis. Further understanding of the management of intussusception may help improve evaluation and management in the future. The use of preventive antibiotics does not reduce problems following radiologic reduction. When clinically appropriate, repeated attempts at enema reduction may be made. After the enema reduction of ileocolic intussusception, patients can be safely watched in the emergency room (ER), thereby avoiding hospitalization. Success rates for laparoscopic reduction are high. When it comes to intussusception in children who are hemodynamically stable and do not have a serious illness, there is no need for pre-reduction antibiotics. Prioritizing nonoperative outpatient (OP) therapy is recommended as the primary approach, with the utilization of minimally invasive procedures to avoid the necessity for laparotomy. The management of colonic intussusception involves complete removal in one piece, while enteric intussusception can be addressed through reduction followed by resection. A targeted approach is recommended, recognizing the intermediate forms of intussusception that may exist between the colonic and enteric types. It is essential to note that the prevailing treatment for adult intussusception remains to be surgical intervention.

Laparoscopic limited hemicolectomy for descending colo-colic intussusception in an adult

Intussusception in adults represents 1% of bowel obstructions and up to 0.02% of all hospital admissions. Amongst these, colo-colic intussusception of the descending colon forms the rarest of causes due to the fixed nature of the descending colon. Most of adult intussusceptions follow a lead point and are commonly due to colonic malignancy which may get missed on pre-operative evaluation. Surgery is usually warranted as these patients are usually symptomatic and at risk of vascular compromise, leading to perforations and obscure malignancies. We present a case of laparoscopic limited hemicolectomy and primary anastomosis in a middle-aged male who presented with colo-colic intussusception, which appeared to be following a malignant mass on imaging and lipoma on colonoscopic biopsy done twice. Keeping in mind the possibility of a malignant lead point, no attempt was made to reduce the intussusception and a vessel first approach with 5 cm margin on either side was performed.

Ileocecal Intussusception and Obstruction Secondary to Metastatic Melanoma: A Case Report

Intussusception is an uncommon cause of bowel obstruction in adults. Most cases are associated with a pathologic lead point, commonly attributable to benign or malignant tumors. Malignant skin melanoma can metastasize to the gastrointestinal tract and lead to significant morbidity and mortality if left undiagnosed or untreated. In this article, we present the case of a 43-year-old Hispanic female with a history of stage III melanoma on her neck removed four years ago who presented with three weeks of lower abdominal pain, nausea, and vomiting. Abdominal and pelvic imaging showed a high-grade small bowel obstruction with a transition point at the mid-ileum. Diagnostic laparoscopy confirmed an ileocecal intussusception secondary to a 5 cm mass at the lead point. The patient underwent successful resection of the ileum 5 cm from the intussusception and the ascending colon due to the high risk of malignancy. Pathology of the mass was found to be malignant melanoma, but the resected lymph nodes and omentum did not contain any malignancy. The patient tolerated the procedure well and is currently undergoing chemotherapy. This case demonstrates metastatic melanoma as a rare cause of intussusceptions in adults. It emphasizes the importance of considering intussusception when evaluating adult patients with classic lower abdominal pain. Prompt surgical intervention is recommended in suspected cases to address the significant likelihood of malignancy, especially in patients with an oncological history.

Incarcerated Prolapsed Sigmoid Intussusception Presenting as Rectal Prolapse Without a Lead Point

This case series presents two patients with symptoms consistent with acute rectal prolapse. The prolapses were subsequently found to be sigmoid intussusception that had prolapsed through the anus without rectal prolapse and without any intraluminal pathology or lead point. Both were recognised on examination and underwent colonic resection rather than proctectomy.

Transient intussusception - What the sonographer needs to know

Intussusception is typically considered an acute emergency; however, the increased utilisation of medical imaging has revealed that intussusceptions can also be transient, asymptomatic and possibly physiologic. Sonographers should be aware of three categories of intussusceptions: (i) persistent intussusceptions resulting in acute abdomen and requiring urgent intervention, (ii) transient symptomatic intussusceptions which may be amenable to a 'wait-and-see' strategy and (iii) transient asymptomatic intussusceptions which almost always involve the small bowel. In particular, the incidental discovery of enteroenteric intussusceptions in children should not be confused with acute pathology. In adults, sonographers should be mindful of the frequent presence of pathological lead points and further investigations may be warranted. In this literature review, we provide an overview of transient intussusceptions, highlight important differences between children and adults and describe sonographic appearances of various intussusceptions and their mimics.

Intussusception in an elderly female and its management: A case report and literature review

Intussusception is the telescoping or invagination of the proximal part of the gastrointestinal tract into an adjacent section. It is rare in adults, accounting for 1% of adult bowel obstruction. Adult presentation of intussusception is variable, with nonspecific, vague symptoms like abdominal pain, nausea, vomiting, and rectal bleeding. Abdominal computed tomography (CT) scans have the highest sensitivity in the diagnosis of intussusception. The classical findings of intussusception are the target sign and mesenteric vessels lined within the bowel lumen. An abdominal CT scan can reveal a cloverleaf figuration, fluid-filled ileal loops, superior mesenteric venous (SMV) occlusion, and concerns about ongoing sealed perforation or fistulization. Our patient is an 86-year-old female who was diagnosed with a jejunal-jejunal long-segment intussusception, gastro-enteric fistula, and SMV occlusion with distal reconstitution. The patient responded well to conservative treatment and was discharged for follow-up.

A peculiar case of intususception in a pregnant woman: A diagnostic challenge

Adult intussusception presents a diagnostic challenge given its non-specific symptoms. It is not as common as in infants and young children. Traditionally, diagnostic steps are invariably fit for normal adults, but not in pregnancy which faces certain limitations. A 40-year-old pregnant mother, gravida 9 para 8 at 34-week gestation, complained of intermittent epigastric pain for 2 days, requiring hospitalization. She soon developed minimal per rectal bleeding that was ruled out as hemorrhoid. Imaging was limited due to her pregnancy status. She later developed spontaneous delivery to a premature baby. Computed tomography (CT) revealed an ileocolic intussusception, which was confirmed via exploratory laparotomy. Histology was consistent with inflammatory fibroid polyp. Acute abdomen in pregnancy can be due to various causes, thus a high index of suspicion and early CT abdomen might help in early diagnosis and treatment. The benefit of doing CT on the mother and the risk of CT on the fetus is to be weighed as the timely diagnosis can prevent bowel ischemia and reduce maternal morbidity and mortality. Surgery remains the definite management in adult intussusception and an exact diagnosis can be made during the operation.

Ileocecal intussusception as presentation for ascending colon carcinoma. Case report

INTRODUCTION AND IMPORTANCE

Intussusception is described as invagination of a segment of the bowel into the lumen of an adjacent segment. Although it is the most frequent cause of intestine obstruction during childhood, it is unusual in adulthood, where intussusception represents 1% of all intestine obstructions and 5 % of all intussusceptions.

CASE PRESENTATION

A 64-year-old female presented with a history of weight loss, intermittent diarrhea, and occasional transrectal bleeding. An abdominal computed tomography (CT scan) was performed showing a neoproliferative appearance and associated intussusception of the ascending colon. Colonoscopy revealed an ileocecal intussusception and a tumor on the ascending colon. Right hemicolectomy was performed. Histopathological findings were consistent with colon adenocarcinoma.

CLINICAL DISCUSSION

Adults have an organic lesion within the intussusception in up to 70 % of cases. The clinical presentation of intussusception can vary significantly between children and adults, who will often exhibit chronic nonspecific symptoms including nausea, changes in bowel habits, and gastrointestinal bleeding. The imaging diagnosis of intussusception is a difficult subject, the basis for the diagnosis is a high index of clinical suspicion and noninvasive techniques.

CONCLUSION

Intussusception is an extremely rare condition in adults, in this age group, the malignant entity is one of the main etiologies. Intussusception continues to be a rare entity and should be considered as a differential diagnosis of chronic abdominal pain and intestinal motility disorders; the treatment of choice continues to be surgical.

Intussusception after colonoscopic polypectomy: a rare complication

We present a patient who developed an ileocolic intussusception within a few hours of undergoing an endoscopic polypectomy found on screening colonoscopy. She underwent a laparoscopic right hemicolectomy with intracorporeal anastomosis. Final histopathological examination showed no evidence of malignancy. Intussusception after colonoscopy is a rare complication, and only 11 cases have been reported prior to this case. Laparoscopic resection with intracorporeal anastomosis is a safe and feasible option in patients who are not candidates or failed conservative management.

A brief review of diagnostic properties of point-of-care ultrasound for adult bowel intussusception: Making the case for ultrasound

Undifferentiated abdominal pain in adults is a common chief complaint in acute care clinics and emergency departments worldwide, representing up to 10% of visits to emergency departments. Many patients have a non-specific presentation and an initial workup with labwork, urine analysis or X-ray might not reveal a specific diagnosis. Although bowel intussusception is a primarily pediatric disease, adult intussusception is a recognized but rare cause of bowel obstruction often requiring surgical intervention. However, recent data from advanced multi-detector computed tomography imaging shows that milder or recurring cases in adults have been underrecognized. Multi-detector computed tomography is still the imaging gold standard for detecting intussusception in adults, but new data showed that sonographers with basic training using the point-of-care ultrasound approach have a reasonable accuracy in detecting this pathology. As the point-of-care ultrasound for undifferentiated abdominal pain is an emerging core skill in the acute care setting, knowledge of sonographic signs of intestinal intussusception should be included in the skill set of physicians. Sonographic findings in adults mimic pediatric cases, but different location patterns and higher malignancy rates exist in adults. In this manuscript, we will review the current literature on adult intussusception and summarize key knowledge of intestinal intussusception in adults. We will present four adult patients diagnosed with different types of adult acute bowel intussusception using the point-of-care ultrasound and describe a focused scanning approach with typical sonographic findings.

Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management

OBJECTIVE

Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults.

MATERIALS AND METHODS

This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged <16 years. Thus, 21 cases in adults (mean age, 57 years) were analyzed.

RESULTS

The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumours were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant).

CONCLUSIONS

CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its aetiology and therapeutic management.

A Case of Jejuno-Jejunal Intussusception Caused by Underlying Metastatic Melanoma

Intussusception in adults is a rare finding with a majority of cases occurring in the pediatric population. It occurs infrequently and its presentation, etiology, and treatment differ from childhood intussusception. When discovered in adults, it raises suspicion for a neoplastic process serving as the pathological lead point. Cross-sectional imaging is the primary study of choice for diagnosis, but at times, a more invasive approach involving an exploratory laparotomy is required posing an increased risk for morbidity and mortality. Here we present a 64-year-old male who was found to have jejunal-jejunal intussusception that was surgically removed with pathology revealing metastatic melanoma as the lead point. This case highlights a unique presentation of a melanoma that was previously eradicated with immunotherapy and now had metastasized to the intestine many years later.

Proposal of a Risk Scoring System to Facilitate the Treatment of Enteroenteric Intussusception in Peutz-Jeghers Syndrome

Background/Aims

Enteroenteric intussusception in Peutz-Jeghers syndrome (EI-PJS) is traditionally treated by surgery. However, enteroscopic treatment is a minimally invasive approach worth attempting. We aimed to develop a risk scoring system to facilitate decision-making in the treatment of EI-PJS.

Methods

This was a single-center case-control study, including 80 patients diagnosed with PJS and coexisting intussusception between January 2015 and January 2021 in Air Force Medical Center. We performed logistic regression analysis to identify independent risk factors and allocated different points to each subcategory of risk factors; the total score of individuals ranged from 0 to 9 points. Then, we constructed a risk stratification system based on the possibility of requiring surgery: 0-3 points for "low-risk," 4-6 points for "moderate-risk," and 7-9 points for "high-risk."

Results

Sixty-one patients (76.25%) were successfully treated with enteroscopy. Sixteen patients (20.0%) failed enteroscopic treatment and subsequently underwent surgery, and three patients (3.75%) received surgery directly. Abdominal pain, the diameter of the responsible polyp, and the length of intussusception were independent risk factors for predicting the possibility of requiring surgery. According to the risk scoring system, the incidence rates of surgery were 4.44% in the low-risk tier, 30.43% in the moderate-risk tier, and 83.33% in the high-risk tier. From low- to high-risk tiers, the trend of increasing risk was significant (p<0.001).

Conclusions

We developed a risk scoring system based on abdominal pain, diameter of the responsible polyps, and length of intussusception. It can preoperatively stratify patients according to the risk of requiring surgery for EI-PJS to facilitate treatment decision-making.

Predictors of malignant intussusception in adults using clinical manifestations and multidetector computed tomographic findings

PURPOSE

To investigate the diagnostic performance of clinical manifestations and multidetector computed tomographic (MDCT) features in detecting predictors of malignant intussusception in adults.

MATERIAL AND METHODS

We retrospectively reviewed 88 adults with 91 intussusceptions who were diagnosed by MDCT. Their clinical manifestations and MDCT features were reviewed and compared between the malignant and benign groups. Uni- and multivariate logistic regression analyses were used to identify independent predictors of malignant intussusception.

RESULTS

There were 61 patients in the malignant group and 27 patients in the benign group. The malignant group had older age (mean, 62.61 vs 54.22 years, P = 0.014), more colon-related intussusception (89.06% vs 55.56%, P < 0.001), shorter intussusception length (median, 6.53 vs 9.73 cm, P = 0.009), higher maximum short axis diameter (mean, 4.85 vs 4.10 cm, P = 0.001), more enlarged lymph nodes (40.63% vs 11.11%, P = 0.006) than the benign group. Lead points were mainly presented as masses, which were irregular (44.74%) and lobular (28.95%) in the malignant group, and round or oval (92.00%) in the benign group. On the unenhanced MDCT, 90.62% of them in the malignant group showed non-hypodense. Multivariate analysis showed that intussusception length (P = 0.013), maximum short axis diameter (P = 0.007), non-round/oval lead point (P < 0.001) and non-hypodense lead point (P = 0.030) were independent factors of malignant intussusception.

CONCLUSION

Malignant intussusception can be identified using independent predictors such as intussusception length, maximum short axis diameter, non-round/oval and non-hypodense lead point. When integrating these four factors, radiologists can make qualitative diagnoses withhigher sensitivity and specificity, allowing clinicians to develop more appropriate treatments.

Ileocolic neoplastic intussusception-Imaging role and surgical management: A case report

Intussusception refers to invagination of bowel loops into a neighboring, adjacent bowel segment. While it is not an uncommon entity in paediatrics-about 95% of intussusceptions occur in childhood, merely 5% of them affect the adult population. When affecting the later typically the small intestine is engaged rather than the colon. The diagnosis often represents with unspecific symptoms and is rarely considered a possibility in adults. In the past the diagnosis was typically made intraoperatively. As the Multi-Detector Computed Tomography (MDCT) of the abdomen became a referral diagnostic method, recognizing the signs of the condition is very important since some of the cases are transient, while others have an underlying malignant cause and more aggressive treatment is required. Surgical treatment planning is mandatory in those neoplastic complicated cases. The presented case report describes the role of radiology and the surgical treatment of a malignant ileocolic intussusception.

Case Report: A Closed Loop Obstruction Secondary to Idiopathic Small Bowel Intussusception in an Elderly Woman

Intussusception is primarily a disease of children and is the primary cause of intestinal obstruction in the pediatric age group. It accounts for around 5-16% of cases of intestinal obstruction in adults of the western population. Most cases of adult intussusception (up to 90%) are secondary to an identified structural lesion or a lead point contrary to pediatric intussusception. Adults with intussusception present with subacute or chronic symptoms of partial obstruction. CT is the best imaging to make a preoperative diagnosis of adult intussusception. The standard treatment for adult intussusception is surgery, and non-operative reduction should not be attempted. Here, we present a rare case of idiopathic small bowel intussusception in a 50-year-old woman. She presented with crampy abdominal pain for one-week duration. It was associated with frequent vomiting of bilious matter. She claimed to have had similar symptoms for the past 2 months and had repeatedly visited nearby health facilities. She had an abdominal CT, which suggested a complicated small bowel intussusception. Exploratory laparotomy was done, and there was a small bowel intussusception and an inflammatory stricture at the end of the intussusceptum, which is believed to form a closed-loop like obstruction. The intussusceptum was resected en-bloc then end-to-end jejuno-jejunal anastomosis was performed. This case report makes physicians aware of this rare condition in adults. So that they have a high index of suspicion when a patient presents with symptoms of subacute or chronic intestinal obstruction and inform that abdominal CT should be done in these circumstances and surgery is the mainstay of treatment. Our case is unique, and there is no report in the literature similar to ours.

Case report and literature review: Small bowel intussusception due to solitary metachronous metastasis from renal cell carcinoma

Introduction

Solitary metachronous small bowel metastasis from renal cell carcinoma (RCC) is rare. In contrast to idiopathic intussusception frequently occurring in children, adult intussusception is fairly uncommon and usually indicates a malignancy.

Case presentation

We presented an 84-year-old man with small bowel intussusception and obstruction due to a solitary metachronous metastasis from RCC. Computed tomography with intravenous contrast revealed small bowel obstruction and a 4 × 4 cm intraluminal soft-tissue mass with moderate enhancement. During urgent exploratory laparotomy, a pedunculated tumor of the distal ileum was found to be the lead point of intussusception. Hence, reduction of the intestinal invagination and segmental resection of the ileum with functional end-to-end anastomosis were performed. Histological examination finally confirmed the diagnosis. The postoperative recovery was uneventful. The patient was discharged without any complications on postoperative day 6.

Conclusion

The case report highlights the rarity of solitary metachronous small bowel metastases from RCC and suggests that life-long follow-up of RCC patients is critical due to its unpredictable behavior and the possibility of a long period of dormancy. Complete surgical resection remains the mainstay treatment for such patients.

Adult intussusception: a challenge to laparoscopic surgery?

Background

Intussusception can occur at any age and is common in children but less common in adults. This study aimed to evaluate our experience of 51 adult intussusception and study the etiology, clinical manifestations, diagnosis, and treatment.

Methods

This analysis assessed the clinical manifestations, etiology, diagnosis, and treatment of adult intussusception in 51 adult patients at the Department of Gastrointestinal Surgery of China-Japan Union Hospital of Jilin University from January 2010 to December 2020.

Results

The mean age of the cohort was 54.43 ± 18.21 years, and 42 patients were diagnosed by abdominal ultrasonography and abdominal computed tomography (CT). Among them, 76.5% (39/51) had abdominal pain, 11.8% (6/51) had blood in stool, and 5.9% (3/51) had a palpable abdominal mass. Of these, 62.7% had tumors: malignant accounted for 39.2% (20/51) and benign accounted for 23.5% (12/51). CT is the preferred imaging method with a sensitivity of 92.2%, while colonoscopy provides a complementary diagnosis in patients involving the colon. All patients underwent surgical treatment, including 21.6% (11/51) laparoscopic surgery, 74.5% (38/51) open surgery, and 5.9% (3/51) intussusception reduction during the operation. The average operation time of the open group was 133.27 ± 43.75 min and the average hospital stay was 16.24 ± 12.55 days, while the average operation time of the laparoscopic group was 140.50 ± 46.15 mins, and the average hospital stay was 16.60 ± 16.98 days (P > 0.05).

Conclusion

Adult intussusception is a rare disease in clinic. Laparoscopic surgery can be useful and safe for adult intussusception.

Intussusception of the cecum due to the acute appendicitis: A case report

Introduction and importance

Intussusception of the cecum due to acute appendicitis is rare condition.

Presentation of case

A 17-year-old male patient presented to our hospital with a chief complaint of right lower abdominal pain, which had lasted for two days. Computed tomography (CT) revealed a “target sign” from the cecum to the ascending colon, leading to a diagnosis of cecocolic intussusception. Colonoscopy revealed an erythematous, edematous, and internally distorted cecum in the ascending colon, which was difficult to repair with air insufflation. Laparoscopic surgery was performed to remove the bowel obstruction. Repositioning of the invaginated cecum was difficult due to the presence of a hard and edematous colic wall. Therefore, laparoscopic ileocecal resection was performed to release the obstruction. The pathological diagnosis was appendicitis and abscess within the cecum wall, with no malignant findings.

Discussion

In our case, intussusception was considered to have caused thickening of the intestinal wall of the cecum due to inflammation of the appendix, and the thickened area became the leading point.

Conclusion

Considering that malignancy is a frequent leading point in adult patients with intussusception, a preoperative endoscopic examination is important for minimizing bowel resection.

•

Most cases of intussusception outside of childhood are caused by tumors, but inflammation of the appendix or cecum can be a cause.

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If malignancy is not the cause of intussusception, bowel resection can be minimized.

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In order to determine the appropriate extent of resection, an accurate preoperative diagnosis is necessary, keeping in mind the possibility that appendicitis or inflammatory changes in the cecum may be the leading point.

Intussusception Caused by Cecal Duplication in an Adult: A Case Report

Cecal duplication is a rare congenital malformation and majority of the cases are discovered in the first years of life. Ileocolic intussusception is also a rare situation encountered in adults. A 19-year-old female presented with acute abdominal pain and bowel occlusion in relation with an ileocecal intussusception. She underwent an emergent laparotomy and ileocecal resection. A cecal duplication cyst was found to be the cause of the intussusception. While duplications and intussusception are very rare situations encountered in the adult life, the presence of both at the same time remains frankly anecdotal. The present case demonstrates that intussusception may likely be involved with any cecal lesion, like duplication.

Case report: Submucosal cavernous lymphangioma causing jejuno-jejunal intussusception in an adult

Cavernous lymphangioma often occurs in the head, neck, trunk, and extremities of infants and children, and it is rare to cause a small intestine intussusception in adults. In this case, a 32-year-old woman presented with abdominal pain, vomiting, and a 5 cm × 5 cm abdominal mass on the left side of the abdomen. Laboratory tests showed anemia and CT showed small intestinal intussusception. After conservative treatments, her symptoms disappeared. However, 18F-FDG PET/CT suggested malignancy and her symptoms reappeared after eating something. Segmental jejunal resection was performed and pathology showed submucosal cavernous lymphangioma. At the 1-year follow-up, the patient was asymptomatic. Then this paper reviewed the literature on small intestinal cavernous lymphangioma in adults and found that this is the first English case report of intussusception caused by a jejunal submucosal cavernous lymphangioma in an adult. Current problem is that adult intussusception and intestinal lymphangioma are difficult to diagnose preoperatively. Imaging techniques such as tomography and PET/CT aid in the diagnosis of these benign lesions. Surgical resection was considered to be the required treatment and seems to have had no recurrence in adults according to the literature.

Case report: An adult intussusception caused by ascending colon cancer

Adults with bowel intussusception caused by malignant tumors are fairly uncommon. We presented a case of a 64-year-old woman whose intussusception was secondary to ascending colon cancer. A color Doppler ultrasonography of the abdomen revealed a low echo mass in the right middle abdomen. Physical examination and digital rectal examination were both unremarkable. Computed tomography (CT) revealed a concentric circle change in the colon, as well as the mesenterium and arteries. Electronic colonoscopy discovered the colonic giant proliferative lesions and stenosis. Adenocarcinoma with moderate differentiation was discovered after a biopsy. Then laparotomy showed intussusception and the tumor was located in the ascending colon. The postoperative pathological test revealed moderately differentiated adenocarcinoma in the right colon invaded the whole layer. After hospitalization, the patient was discharged without any complications. This case highlights that rational use of CT, endoscopy, and timely surgery combines an effective strategy for the treatment of adult intussusception.

Jejunojejunal intussusception of a sutured enterotomy site after takedown and primary repair of persistent enterocutaneous fistula: a case report

Enterocutaneous fistula (ECF) is a common complication of many abdominal surgeries. Although most ECF resolve spontaneously, there are many factors that can lead to persistence of the fistula. Management of persistent enterocutaneous fistula usually involves surgery with recurrence of fistula being the most common complication. Here we describe a case of 67-year-old female who presented with intussusception following repair of a persistent enterocutaneous. Given the rare finding of intussusception in adults, this case report presents an interesting complication.

A rare case of adult colocolic intussusception secondary to splenosis

Intussusception is the invagination of a segment of bowel (intussusceptum) into the lumen of an adjacent segment (intussuscipiens). Adult intussusception is rare and typically asymptomatic, although bowel obstruction can be a predominant symptom, making it difficult to diagnose. Splenosis is an uncommon and benign disease, arising from the self-implantation of splenic tissue elsewhere in the body after splenectomy or splenic trauma. Colocolic intussusception secondary to splenosis is rare. We report a case of colon intussusception with a mass in the intussusception detected by ultrasound. Abdominal ultrasound identified the intussusception location but failed to distinguish its pathological properties. Colonoscopy revealed the exudation of necrotic and fibrous tissue. Surgery was performed because of suspicions of a malignant tumor.

Jejunojejunal intussusception in an adult due to adenoma: a case report

Intussusception is a rare condition in adults and presents a diagnostic challenge. Clinical presentation tends to be chronic and non-specific. Unlike the pediatric population, most adult intussusceptions have structural lesions as lead points. Here, we present a case of jejunojejunal intussusception in a 27-year female due to adenoma of small bowel.

Invaginación sigmoidea en un adulto. ¿Está indicada la reducción endoscópica preoperatoria?

Introducción. La invaginación intestinal o intususcepción es el deslizamiento de una parte del intestino dentro de otra adyacente. Es la causa más común de obstrucción intestinal en niños entre 3 meses y 6 años de edad, con una baja incidencia en adultos, correspondiente al 1 % del total de los cuadros obstructivos en el adulto. Su localización en colon es poco frecuente, pero conviene prestar especial atención por su asociación a lesiones malignas. Caso clínico. Varón de 39 años que acude a Urgencias con cuadro de obstrucción intestinal secundario a una invaginación en sigmoide. Se intenta reducción endoscópica, sin éxito, por lo que se indicó cirugía urgente, realizando sigmoidectomía y anastomosis colorrectal. El resultado anatomopatológico informó un adenoma de gran tamaño como causante de la invaginación. Conclusión. Existen controversias respecto al manejo endoscópico en invaginación intestinal en los adultos, especialmente en el colon, debido al elevado porcentaje de etiología tumoral maligna, recomendándose actualmente la resección en bloque sin reducción, para minimizar el riesgo de potencial siembra tumoral.

Intestinal Intussusception: A Shocking Diagnosis

Intussusception is a rare condition diagnosed in adults, with few cases reported as idiopathic. It is defined as the invagination of an intestinal segment into another adjacent one, due to the presence of a lead point, or in some cases, without identifiable causative lesions. The presentation is non-specific, even with careful evaluation, and most of the time, the diagnosis is made during surgery. We hereby present the case of a 73-year-old woman with idiopathic intussusception who presented in the emergency room. She was taken to the operating theatre, where intestinal resection was performed. Few cases of true idiopathic intestinal intussusception in adults are seen, and literature on this topic remains scarce. We discuss diagnostic and therapeutic options and do a brief review of the literature.

[Clinical features of intestinal polyps and risk factors for secondary intussusception in children: an analysis of 2 669 cases]

OBJECTIVES

To study the clinical features of intestinal polyps and the risk factors for secondary intussusception in children.

METHODS

A retrospective analysis was performed for the medical data of 2 669 children with intestinal polyps. According to the presence or absence of secondary intussusception, they were divided into two groups: intussusception (n=346) and non-intussusception (n=2 323). Related medical data were compared between the two groups. The multivariate logistic regression analysis was used to identify the risk factors for secondary intussusception.

RESULTS

Among the children with intestinal polyps, 62.42% were preschool children, and the male/female ratio was 2.08∶1; 92.66% had hematochezia as disease onset, and 94.34% had left colonic polyps and rectal polyps. There were 346 cases of secondary intussusception, with an incidence rate of 12.96% (346/2 669). Large polyps (OR=1.644, P<0.001), multiple polyps (≥2) (OR=6.034, P<0.001), and lobulated polyps (OR=93.801, P<0.001) were the risk factors for secondary intussusception.

CONCLUSIONS

Intestinal polyps in children often occur in preschool age, mostly in boys, and most of the children have hematochezia as disease onset, with the predilection sites of the left colon and the rectum. Larger polyps, multiple polyps, and lobulated polyps may increase the risk of secondary intussusception, and endoscopic intervention is needed as early as possible to improve prognosis.

Jejuno-jejunal intussusception secondary to recurrent/metastatic melanoma

Intussusception is uncommon in adults, and usually secondary to a neoplasm. Small bowel obstruction (SBO) is prevalent in adults but rarely due to intussusception. A 55-year-old woman with history of melanoma (four years in remission) presented with abdominal pain and melena. Upper and lower endoscopy was normal. She developed bilious emesis and worsening pain, so she presented to the emergency department. CT abdomen/pelvis identified a SBO with transition point at a small bowel intussusception; she was taken to the operating room. A mid-jejunal intussusception was reduced revealing a mass; resection and primary anastomosis was performed. Final pathology demonstrated a 5.5 cm melanoma, likely metastatic. She required no additional therapy and remains in remission eighteen months later. Intussusception due to metastatic melanoma is rare but should be on the differential for patients with SBO and history of melanoma. Knowledge of this history should prompt consideration for oncologic resection to optimize outcome.