Adult Intussusception: Clinical Experience from a Single Center

Small bowel intussusception - aetiology & management

PURPOSE OF REVIEW

Adult small bowel intussusception (SBI) differs in incidence, symptomatology and management from the more commonly encountered paediatric intussusception. This review spans across the multitude of causes of adult SBI, and summarises the diagnostic work-up and management options according to recent literature.

RECENT FINDINGS

There has been an increase in use of small bowel capsule endoscopy and point-of-care ultrasound for the diagnosis of acute adult SBI.

SUMMARY

A high degree of suspicion of a malignant cause of SBI is required in the adult population. Alarm clinical features include weight loss, history of malignancy, and iron deficiency anaemia. CT remains the gold standard imaging technique as it may identify the lead point and thus aid in endoscopic or surgical management. If malignancy is excluded and no lead point is identified, serology and histology may be helpful to look for inflammatory, infective and autoimmune aetiology.

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.

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.

Colonic Lipoma Causing Bowel Intussusception: An Up-to-Date Systematic Review

Background: Colonic lipomas are rare and can sometimes cause intussusception. The aim of this review was to define the presentation and possible management for colocolic intussusception caused by colonic lipomas. Methods: A systematic search for patients with colocolic intussusception caused by colonic lipoma, including all available reports up to 2021. Epidemiological, clinical, laboratory, and instrumental data and details about the treatments performed were gathered. Results: Colocolic intussusception caused by lipoma is more frequent in women (57%), occurring between 40 and 70 years of age. Up to 83% of patients report abdominal pain, followed by constipation (18%), rectal bleeding (16%), and diarrhea (12%), with abdominal tenderness (37%), and distension in 16%, whereas 24% have a negative exploration. CT (72%) and colonoscopy (62%) are more commonly able to diagnose the entity. The most common location of intussusception is the transverse colon (28%). The surgical operation varies according to the site. The average dimensions of the lipoma are 59.81 × 47.84 × 38.9 mm³. Conclusions: A correct preoperative diagnosis of colonic lipoma causing intussusception might not be easy. Despite nonspecific clinical and laboratory presentation, cross-sectional imaging can help differential diagnosis. Surgical treatment depends on the localization.

Use of Ultrasound in the Diagnostic Work-Up of Adult Intussusception - A Multicenter Retrospective Analysis

PURPOSE

 To evaluate the use of ultrasound (US) in the diagnostic work-up of adult intussusception (AI).

METHODS

 This multicenter study includes 26 consecutive patients diagnosed with AI between January 2010 and November 2017. A retrospective chart analysis was conducted with a focus on abdominal US findings and diagnostic accuracy of different imaging modalities (ultrasound, computed tomography (CT), magnetic resonance imaging). If available, surgical and pathological findings served as the gold standard (76.9 %). US examiners certified according to DEGUM grade 2 or 3 were classified as experts. Otherwise, they were regarded to have basic skills.

RESULTS

 During diagnostic work-up, 92.3 % underwent abdominal US. US was the first-line imaging modality in 88.5 % of cases. The accuracy regarding the detection of AI (85 %), correct localization (95 %) and detection of complications (100 %) was excellent and comparable with CT (81 %, 90.5 %, and 91.7 %) when performed by experts. 72.7 % of tumorous lead points were detected by experienced examiners. In contrast, AI was detected in only 45.5 % of cases by examiners with basic skills. AI was diagnosed prior to surgery in all patients.

CONCLUSION

 US is reliable in the diagnostic work-up of AI when performed by experienced examiners with high-quality equipment. US, CT and MRI should be used in a complementary fashion since combination provides excellent sensitivity regarding the detection and correct localization of AI as well as the detection of complications. The impact of real-time imaging is illustrated by supplementary videos.

Adult intussusception: a systematic review and meta-analysis

BACKGROUND

Perhaps partly because intussusception in adults is rare, optimal treatment remains controversial. The aim of this study was to determine the appropriate surgical procedure for adult intussusception.

METHODS

A systematic search was undertaken using PubMed, Embase, and Web of Science from 1/1980 to 12/2016. Adults (> 15 years) with intussusception treated by surgical or conservative measures were included.

RESULTS

One thousand two hundred twenty-nine patients were identified from 40 retrospective case series. Pooled rates of malignant and benign tumors and idiopathic etiologies were 32.9% (95% CI 28.6-37.4), 37.4% (95% CI 32.7-42.3), and 15.1% (95% CI 11.7-19.3), respectively. Pooled rates of enteric, ileocolic, and colonic location types were 49.5% (95% CI 41.8-57.2), 29.1% (95% CI 23.0-36.1), and 19.9% (95% CI 16.3-24.1), respectively. Pooled rates of malignant tumors in enteric, ileocolic, and colonic intussusception were 22.5% (95% CI 18.3-27.3), 36.9% (95% CI 27.3-47.6), and 46.5% (31.1-62.6), respectively. Metastatic carcinoma was the main cause of malignant tumor in enteric intussusception. Conversely, primary adenocarcinoma was the main cause of malignant tumor in ileocolic and colonic intussusception. Considering the high rate of malignancy of colonic intussusception the majority of the studies surveyed recommend en bloc resection without reduction to avoid potential intraluminal seeding or venous tumor dissemination. Pooled rates of postoperative complications and mortality were 22.1% (95% CI 17.5-27.5) and 5.2% (95% CI 3.7-7.4), respectively.

CONCLUSION

Whereas enteric intussusception can be managed by reduction followed by resection, colonic intussusception should be resected en bloc. Due to the intermediate forms between enteric and colonic intussusception, a selective approach is recommended. Surgery remains the mainstay in adult intussusception.

Intussusception: a rare complication in a patient with acute leukaemia after consolidation chemotherapy

Intussusception is telescoping of one segment of the gastrointestinal tract into an adjacent one. It is more common in children than adults. When it occurs in adults, it is usually associated with a lead point. Intussusception is very rare in acute leukaemia and has only been reported in few cases. We present a case of an adult woman who presented with intussusception after a cycle of consolidation chemotherapy with high-dose cytarabine for acute myeloid leukaemia. Other causes of acute abdominal pain were excluded, and the diagnosis was established by CT scan of the abdomen and barium enema. No pathological lead points were found intraoperatively. She underwent a right-sided hemicolectomy with complete recovery. To the best of our knowledge, this is only the fourth case of intussusception that has been reported in an adult patient with acute myeloid leukaemia.