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

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.

Intussusception of Heterotopic Gastric Mucosa in the Transverse Colon: A Rare Cause of Perforation and Bleeding

Heterotopic gastric mucosa in the colorectal region is a rare condition and can be found throughout the gastrointestinal tract. Intussusception in adults is mostly associated with adenocarcinoma and requires prompt surgical intervention, especially in cases of intestinal perforation. Our case report demonstrates a cecal perforation caused by the intussusception of heterotopic gastric mucosa within the transverse colon. The patient presented with substantial hematochezia. Despite the challenges of diagnosing this condition preoperatively and in the ICU, accurate pathologic evaluation is important. The consideration of a heterotopic gastric mucosa is crucial in cases of persistent hematochezia, especially in cases of intussusception. The postoperative course of the patient was characterized by hematochezia, which improved with proton pump inhibitors. The consideration of the possibility of heterotopic gastric mucosa may be a guide to appropriate surgical management and optimization of patient outcomes.

Appendiceal mucocele as an exceptional cause of ileocecocolic intussusception in adults: a case report

BACKGROUND

Intussusception is a rare condition in adults, accounting for 5% of intestinal intussusception and being responsible for approximately 1% of all adult bowel obstructions. Neoplastic origin is the most common etiology of intestinal intussusception in adults, unlike pediatric intussusception, which is usually idiopathic. Intussusception due to the appendiceal mucocele is exceptional, and only a few cases have been reported in the medical literature.

CASE PRESENTATION

We report the case of a 25-year-old black African male patient with no medical history. He presented to the emergency department for abdominal pain, nausea, and bilious vomiting. The abdominal examination revealed typical signs of acute bowel obstruction. Enhanced abdominopelvic computed tomography showed an invagination of the last ileal loop, cecum, and ascending colon into the lumen of the transverse colon, with a rounded image with hypodense content and some calcifications compatible with an appendiceal mucocele. An emergency exploratory laparoscopy was performed and confirmed the ileocecocolic intussusception. Right hemicolectomy and ileocolic anastomosis were performed. The patient recovery postoperatively was uneventful, and he was discharged 4 days later. Histological examination of the surgical specimen confirmed the diagnosis of mucinous cystadenoma.

CONCLUSION

The symptoms of bowel intussusception with the appendiceal mucocele as the lead point in adults are similar to any other bowel intussusception. Differential diagnosis is often carried out thanks to the injected abdominal computed tomography scan.

An adult case of small bowel intussusception caused by hemangioma presenting with intestinal obstruction: A case report

INTRODUCTION

Both small bowel intussusception in adults and small bowel hemangioma are rare benign mass lesions. Moreover, a secondary effect of intussusception caused by hemangioma is extremely rare.

PATIENT CONCERNS

A 87-year-old female suffered from intussusception and intestinal obstruction caused by hemangioma located in the small bowel (February 14, 2020), reporting abdominal distention without nausea and vomiting.

DIAGNOSIS

Emergency abdominal and pelvic computed tomography showed an intussusception with the evidence of associated small bowel obstruction. Histological analysis revealed as small intestinal hemangioma accompanied by mesenteric ulcer.

INTERVENTIONS

The patient underwent segmental resection of intussusception of intestine instead of invalid conservative treatment.

OUTCOMES

Although the postoperative pathological results were inconsistent with preoperative imaging examination, the old woman recovered well.

CONCLUSION

The literature on intussusception of small intestine has described several possible causes including hemangioma, which more likely results in gastrointestinal bleeding or abdominal pain. Yet we experienced a rare case presenting as abdominal distention without nausea and vomiting, Therefore, preoperative diagnosis and localization of these lesions is of great importance. We recommend high resolution contrast-enhanced computed tomography and magnetic resonance imaging should be considered in diagnosis while capsule endoscopy is not available owing to the intestinal obstruction, as long as in facilitating surgical excision.

Ileocolic intussusception caused by giant submucosal colonic lipoma: A rare case report

INTRODUCTION

An adult intussusception is associated with a pathological lesion involving a lead point, such as a benign polyp, enlarged mesenteric lymph node, lipoma, Meckel's diverticulum, lymphoma, gastrointestinal stromal tumor, primary, or metastatic adenocarcinoma. A lipoma is usually asymptomatic, however, lipomas >2 cm may cause intussusception by forming a lead point.

PRESENTATION OF CASE

A 46-year-old South Korean man was admitted and presented with a two-week history of intermittent abdominal pain and discomfort. Abdominal pelvic computed tomography scan revealed that about 6.5 cm of fat attenuation mass is present in the ascending colonic loop with about 15 cm of ileal loop pulled into the ascending colonic loop through the ileocecal valve. Mechanical obstruction with ileocolic intussusception was found in distal ileum. The colonoscopy detected a huge mass in the mid-ascending colon blocking the passage of the colonoscope. The patient was diagnosed with an ileocolic intussusception which was suspected to be a huge lipoma. Laparoscopic assisted right hemicolectomy was performed and the follow-up pathologic examination showed that it is a submucosal lipoma.

CONCLUSION

The present case report concerns a 46-year-old male with a long segment ileocolic intussusception due to a giant lipoma arising from the ascending colon and whose intussusception was surgically resected.

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.

A Rare Case of Colo-Colonic Intussusception Caused by Colonic Submucosal Lipoma

Unlike in infancy, where intussusception is an abdominal emergency, diagnosis of intussusception could be tricky in adults as most of these patients present sub-acutely with vague abdominal symptoms. Early diagnosis could impact these patients significantly in decreasing morbidity and mortality along with reduction in healthcare expenses. Colo-colonic intussusception is rare and accounts for less than 20% of adult intussusception. More than 50% of adult intussusception is caused by mass-like lesions. In such cases, this could be an early presentation of malignant intestinal lesions. Abdominal CT is mandatory in all adult patients; when combined with ultrasound, it has 95.5% accuracy of pre-operative diagnosis. Here we report a case of a 42-year-old female who presented with a two-month history of intermittent abdominal pain; a CT abdomen revealed colo-colonic intussusception which was initially missed on prior imaging. We discuss the importance of considering intussusception as a rare differential of abdominal pain, the need for early diagnosis, and the role of colonoscopy and non-surgical management in adults.

Intussusception after reconstruction following gastrectomy for gastric cancer

Background

Gastric cancer is the most prevalent tumor in Chinese men, and surgery is currently the most important treatment. Billroth II and Roux-en-Y are the anastomosis methods used for reconstruction after gastrectomy. Jejunal intussusception is a rare complication after gastric surgery.

Main Body

Intussusception after gastric surgery occurs mostly at the gastrojejunostomy site for Billroth II reconstruction, and the Y-anastomosis site for Roux-en-Y reconstruction. Many studies have reported that postoperative intussusception appears at the anastomosis after bariatric surgery, while a few have reported intussusception at the anastomosis and its distal end after radical gastrectomy.

Conclusion

A review was carried out to analyze intussusception after radical gastrectomy with roux-en-y anastomosis during the current situation. And the relevant mechanisms, diagnosis, treatment methods, etc. are described, hoping to provide better guidance for clinicians

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.

Management of Adult Intussusception-A Case Series Experience from a Tertiary Center

BACKGROUND

The management of intussusception is controversial. Clinical presentation, with the aid of imaging modalities, enables a better selection of patients for the appropriate treatment algorithm. Conservative management versus surgical intervention with bowel resection is considered accordingly.

METHODS

Retrospective review of a computerized database of patients who were admitted with intussusception between January 1, 2010, and December 31, 2020, in a single tertiary center in Israel. Patients who were treated conservatively were compared to those who underwent surgery. Patients who underwent bowel resection were compared to those that had surgery without a resection.

RESULTS

A total of 76 patients were diagnosed with intussusception, and 49 were operated. Bowel resection was performed in 32 cases. 20/76(26%) were successfully managed conservatively. Patients with a lead point (OR = 5.59) and colonic involvement (OR = 13.72) had a higher likelihood for resection. The likelihood of bowel resection was found to be significantly lower with proximal small bowel intussusception (OR = 0.071).

CONCLUSION

Young patients presenting with intussusception may be treated conservatively when adequate criteria are met in order to avoid unnecessary surgical interventions.

Bleeding Edge Therapy: Ileocolic Intussusception Due to Ileocecal Valve Adenocarcinoma and Its Management in an Adult Patient-Case Report and Literature Review

Adenocarcinoma as the primary cause of bowel intussusception is uncommon. We describe the case of a 86-year-old patient admitted for ileocecal intussusception due to the presence of adenocarcinoma, located in the ileocecal valve and right colon. The etiologies of intussusception, its diagnosis, and conservative or surgical treatments are discussed, with attention placed on the indications for reduction of the invagination prior to surgical resection.

Adult Intussusception: An Uncommon Condition and Challenging Management

INTRODUCTION

Intussusception is a rare condition in adults. A pathological lesion is usually found with a significant percentage of malignancy. The optimal treatment is still not universally clear.

METHODS

This is a retrospective review of adult patients with a diagnosis of intestinal intussusception and surgically treated at our institution from January 2009 to December 2018. Clinical, operative, and histological details were collected and analyzed.

RESULTS

A total of 26 cases, 16 males and 10 females, were diagnosed with surgically proven intussusception during the 10-year period. The mean age was 45 years (range 21-70). Using ultrasound and/or computed tomography as imaging study, the preoperative diagnosis was made in 21/26 (81%) patients. Five intussusceptions were discovered only upon exploratory laparotomy for intestinal obstruction. There were 19 (73%) cases of enteric and 7 (27%) cases of colonic intussusceptions. All patients underwent surgical exploration. Intestinal resection with immediate anastomosis was the technique of choice for most patients. A single patient underwent stoma for peritonitis secondary to intestinal perforation. An organic cause has been systematically revealed, and no idiopathic intussusception was detected. Etiology was malignant in 9 (35%) cases.

CONCLUSION

Adult intussusception should be considered in any patient with subacute abdominal pain. Considering the high rate of malignancy, intestinal resection without attempting reduction is highly recommended for colonic intussusceptions. However, a more selective approach can be adopted for enteric intussusceptions.

Most Adult Intussusceptions are Caused by Tumors: A Single-Centre Analysis

Background

Adult intussusception is less common than paediatric intussusception. The aim of this study was to explore the clinical presentation, aetiology, diagnosis and treatment of adult intussusception.

Methods

Adults (>18 years) with intussusception treated by surgical or conservative measures were included from January 2005 to January 2018, and the manifestation, types, diagnosis and treatment of adult intussusception in our centre were reviewed.

Results

A total of 150 patients with adult intussusception were included in this study. The clinical manifestations included 111 cases (74%) of abdominal pain, 38 cases (25.3%) of bloody stool, 37 cases (24.7%) of bowel obstructions, 33 cases (22%) of abdominal distension, 29 cases (19.3%) of nausea and vomiting, 19 cases (12.7%) of an abdominal mass, and 12 cases (8.0%) of diarrhoea. The types of intussusception were classified into 36 cases (24%) of enteric intussusception, 87 cases (58%) of intestine-colon intussusception and 27 cases (18%) of colonic intussusception. Surgical intervention was applied in 139 cases (92.7%), including 115 patients who underwent open surgery, and laparoscopy-assisted surgery was performed in 24 patients. The main pathogenesis of intussusception was malignant tumors in 51 cases (36.7%) and benign tumors and polyps in 49 cases (35.3%).

Conclusion

Malignant and benign tumors are the main causes of adult intussusception. Abdominal CT is the preferred evaluation method for the preoperative diagnosis of this condition. The choice of surgical procedure depends on the location and type of intussusception.

Ileocolic intussusception caused by ileal lipoma: A case report

RATIONALE

Adult intussusception is rarely observed, accounting for about 5% of all cases of intussusception. Most ileal lipomas are asymptomatic and do not need any special treatment. Herein, we describe a case with ileocolic intussusception caused by ileal lipoma.

PATIENT CONCERNS

A 27-year-old woman complaints of intermittent abdominal pain for 10 days.

DIAGNOSIS

Abdominal computed tomography demonstrated ileocolic intussusception. Colonoscopy revealed a spherical polypoid lesion with surface capillary rising from the lateral wall of the ileum. A diagnosis of ileocolic intussusception was made.

INTERVENTIONS

The patient underwent primary resection of the intussuscepted intestine after which an end-to-end anastomosis was performed.

OUTCOMES

Histopathology report confirmed a 4.5 cm × 3.5 cm lipoma in the terminal ileum. The patient was discharged on a postoperative day 9 without complications.

LESSONS

We describe the difficulties in diagnosis and treatment of this rare cause of intussusception and review the literature on adult intussusceptions. The ileal lipoma is a very rare cause of ileocolic intussusception. Abdominal CT and colonoscopy are important for the diagnosis of intussusception and abdominal lipomas. Surgical resection remains the treatment of choice.

Case of Irreducible Ileocecal Intussusception Due to Leiomyoma of the Colon

Intussusception is defined as the telescoping of the proximal segment of the bowel into the distal segment. In most clinical cases, pediatric intussusception is much more common than adult intussusception. Pediatric intussusception is often due to viral or bacterial infections, which lead to the inflammation of lymphoid tissue in the intestine. Adult intussusception is typically secondary to tumors and idiopathic causes. Malignant tumors tend to affect the colon, while benign tumors affect the small intestine. Lipomas are the leading cause of benign tumors which cause intussusception. Conversely, adenocarcinomas are the leading cause of malignant tumors that cause intussusception.  Our case focuses on a young adult who developed intussusception secondary to a leiomyoma present near the ileocecal junction of the intestine. The treatment of intussusception caused by tumors is either surgical reduction or excision of the involved tissue. If excised, the specimens are sent to the pathology department for confirmation of the potential cause. If leiomyomas are suspected, staining is used to differentiate them from gastrointestinal stromal tumors (GISTs). These stromal tumors are unusual causes of intussusception, which require further research to determine their disease course and age at presentation.

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.

A rare cause of adult ileocolic intussusception: ileal leiomyoma

Intussusception is a rare condition in adulthood and, unlike in children, is usually caused by an identifiable underlying lesion, most commonly a gastrointestinal tumour. The clinical presentation is non-specific and often there are intermittent symptoms making the diagnosis difficult based solely on history and examination. Plain radiography may reveal signs of bowel obstruction, however, CT is the gold standard to diagnose and localise an intussusception in adults. We present an unusual case of adult ileocolic intussusception caused by an ileal leiomyoma. This case highlights the important radiological findings of intussusception presenting with a high-grade obstruction and discusses the potential causes which should be considered.

Ileoileal intussusception in unspecific recurrent abdominal pain in adult: A case report

Primary small bowel tumours are very uncommon accounting about 1% of all gastrointestinal tumours. Intestinal lipomas are a rare entity of benign tumours with an incidence at autopsy ranging from 0.04% to 4.5%, most being asymptomatic. Complications such as obstruction, haemorrhage, intussusception and perforation might demand invasive management. Among these, intussusception is the most rare complication of intestinal lipomas. Here, we present a case of intussusception in a 52-year-old female with a large intramural lipoma of the ileum.

Gastrointestinal hemorrhage caused by adult intussusception secondary to small intestinal tumors: Two case reports

RATIONALE

Adult intussusception is rarely observed, and the clinical manifestations are very atypical. The most common symptom is abdominal pain, while the incidence of hematochezia is relatively low. We report two cases of adult intussusception secondary to small intestinal tumors with gastrointestinal hemorrhage as the main symptom.

PATIENT CONCERNS

Two men aged 19 and 54 years were successively referred to our department due to intermittent hematochezia. The hemoglobin levels of the two patients declined progressively, and conservative treatment was ineffective.

DIAGNOSES

The first patient underwent an abdominal computed tomography angiography examination, which showed that the intestine and its mesentery were tortuous, suggesting an intra-abdominal hernia or intussusception. The second patient underwent an abdominal computed tomography examination, which suggested a high possibility of an intussusception. The two patients were diagnosed as adult intussusception caused by small intestinal tumors.

INTERVENTIONS

Emergency laparoscopic explorations were performed. Enteroenteric intussusceptions caused by ileal tumors were found during surgery. Reduction of the intussusceptions and resection of the ileal tumors were performed.

OUTCOMES

The patients recovered well after surgery, and postoperative pathology showed that the tumors were a vascular hamartoma polyp and a lipoma.

LESSONS

Adult intussusception is very rare, particularly with gastrointestinal hemorrhage as the main symptom. Isolated hamartoma polyp is a rare cause of intussusception in adults. The clinical manifestations of adult intussusception are very atypical, and thus, making a preoperative diagnosis is difficult. Abdominal CT or CTA is an effective diagnostic method for adult intussusception. For adult patients with gastrointestinal hemorrhage caused by intussusceptions, active surgery should be performed when conservative treatment is not effective. Laparoscopic surgery is a safe and effective treatment for adult intussusceptions caused by benign diseases.

How Do Adult and Paediatric Intussusceptions Differ? a 10-Year Retrospective Study

Introduction

Intussusception in adult is considered to be an uncommon surgical condition. Our study aims to gather the epidemiology data of intussusception in local population and to compare the clinical characteristics, investigation and management between adult and paediatric intussusceptions.

Methods

This is a retrospective study of patients who were diagnosed intussusception from January 2001 to June 2011 in the study centre. Demographic data, clinical presentation, investigation and management were compared between adult and paediatric patients.

Results

There were 79 patients included in the study period. Twenty-two of them (27.8%) were adults (aged at least 18 years) while 57 (72.2%) of them were paediatrics patients (age <18 years). Forty-three (54.4%) of them were male and 36 (45.6%) of them were female. Mean age of intussusception in adult and paediatric groups were 56.1 years and 23.9 months respectively. The median duration of onset of the presentation of adult patient was 3.5 days which is longer than that of paediatrics group (1 day) (p<0.001), per-rectal bleeding occurred in 18.2% (4/22) of adult patients while 47.4% (27/57) of paediatric intussusception had per-rectal bleeding (p=0.017). There was also significantly more vomiting (78.9%, 45/57) in paediatric intussusception compared with 31.8% in adults (p<0.001). A total of 72.7% (16/22) of adult intussusception were diagnosed by CT scan while 94.7% (54/57) of paediatrics was diagnosed by ultrasound by radiology department. 77.3% (17/22) of the adult intussusceptions had a neoplastic leading point. All the adult intussusception required surgical management while only 21.1% (12/57) of the paediatrics group required surgical reduction with or without bowel resection. The median length of stay (LOS) of adult group was 9 days which is longer than that of the paediatrics group (4 days) (p<0.001).

Conclusions

Intussusception in adult patients lacks classical presentation of per-rectal bleeding and vomiting and the onset is commonly sub-acute when compared with paediatrics cases. Most of the adult intussusceptions have pathological leading points that warrant surgical management.

Ileocolic intussusception caused by a lipoma in an adult

Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.

Factors predicting malignancy in adult intussusception: An experience in university-affiliated hospitals

BACKGROUND

Intussusception is one of the common causes of intestinal obstruction in children but is uncommon in adults. Unlike pediatric intussusception, most adult cases have a demonstrable etiology. The purpose of this study was to review our experience of adult intussusception and to identify the predictive factors for malignancy in this disease.

METHODS

We retrospectively reviewed the medical records of patients who were diagnosed with intussusception and admitted to the six Hallym University-affiliated hospitals between January 2005 and July 2016.

RESULTS

The 77 patients had a mean age of 50.5 years (range, 18-91 years). Enteric intussusception is the most common type of adult intussusception (33.7%), and 11 patients (14.2%) had no definite lesion at operation. The most common symptom was abdominal pain (90.9%), and 18 (23.3%) presented with chronic symptoms. Computed tomography was the most common diagnostic modality used, with a diagnostic accuracy of 96.9%. The leading point was identified in 62 (80.5%) patients. Malignancy was more frequently present in the colonic type than in the other two types (61.5% vs. 10%, 37.9%). In a multivariate analysis, chronic symptom >14 days (p = 0.031) and colonic intussusception (p = 0.026) were independent predictors for malignancy.

CONCLUSIONS

Enteric intussusception is the most common type of adult intussusception, and the most common test is computed tomography. Because chronic symptoms and colonic-type intussusception were predictive factors for malignancy, en bloc resection should be considered in patients with chronic or colonic intussusception.

Adult intussusception: An 8 years institutional review

BACKGROUND

Intussusception is a rare cause of intestinal obstruction in adults. Its diagnosis could be elusive based solely on clinical features because of protean presentation. Supplementary imaging allows for preoperative diagnosis, early institution of definitive management, and a better clinical outcome.

PATIENTS AND METHODS

Records of adults managed for intestinal obstruction by laparotomy in a surgical unit of a tertiary health facility were retrospectively examined. The subgroup having an intraoperative diagnosis of intussusception was extracted and analyzed. Data obtained included age, sex, and primary symptom at presentation. Presence of intestinal perforation, the histology of the lead point of resected tissues, and the final disposition of the patients were documented.

RESULTS

Four hundred and three patients underwent surgical management of intestinal obstruction. Eight patients (2%) had an intraoperative diagnosis of intussusception at laparotomy; four males and four females (male: female = 1:1). Abdominal pain was the presentation in 7 (87.5%) and anal protrusion in 1 (12.5%). Four patients (50%) had bowel perforation with peritonitis. Seven of the resected intestines had lead points which were benign. Two patients (25%) died from sepsis. Resection and anastomosis were done for all the patients.

CONCLUSION

Intussusception in adults is uncommon but carries a high morbidity and mortality which can be reduced with a good clinical assessment, appropriate imaging, and early laparotomy.

Transient small bowel intussusception in an adult: case report with intraoperative video and literature review

Background

The term intussusception refers to invagination of a segment of the gastrointestinal tract into the lumen of an adjacent segment. This is a rare entity and it is more prevalent in children and less common in adults. The diagnosis of intussusception in adults is difficult as a result of the nonspecific signs and symptoms. As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. The laparoscopic approach offers both a diagnostic option and a therapeutic one for intussusception in adults.

Case presentation

We report a forty-one year old male patient, who presented to our Emergency Department complaining of peri-umbilical pain associated with nausea and vomiting for 1 day. Diagnosed with transient small bowel intussusception without any obvious underlying pathology. This report is the first to present an intra-operative video showing the small bowel intussuscepting and reducing spontaneously. Furthermore, the authors present a review about this rare condition, including previously reported similar cases in literature.

Conclusion

Transient intussusception is extremely rare and is a challenging condition. Imaging techniques, especially CT scan, are helpful in the diagnosis of intussusception. However, laparoscopy offers the advantage of distinguishing transient intussusception from persistent intussusception.

Electronic supplementary material

The online version of this article (doi:10.1186/s12893-015-0020-6) contains supplementary material, which is available to authorized users.

Recurrent intussusception as initial manifestation of primary intestinal melanoma: Case report and literature review

Enteric intussusception caused by primary intestinal malignant melanoma is a very rare cause of intestinal obstruction. We herein present a case of a 42-year-old female patient with no prior medical history of malignant melanoma, who was admitted with persistent abdominal pain, nausea, and vomiting. A computed tomography scan revealed an intestinal obstruction due to ileocolic intussusception. An emergency laparoscopy and subsequent laparotomy revealed multiple small solid tumors across the whole small bowel. An oncologic resection was not feasible due to the insufficient length of the remaining small bowel. Only a small segment of ileum, which included the largest tumors causing the intussusception, was resected. The pathologic examination revealed two intestinal malignant melanoma lesions. A systematic clinical examination, endoscopic procedures, and fluorodeoxyglucose positron emission tomography-computed tomography scan all failed to reveal any indication of cutaneous, anal, or retinal melanoma. Hence, the tumor was classified as a primary intestinal malignant melanoma with multiple intestinal metastases. Since a complete oncologic resection of tumors was not possible, in order to prevent future intestinal obstruction, a surgical resection of the largest lesions was performed with palliative intention. The epidemiology, clinical manifestations, diagnosis and management of primary intestinal malignant melanoma, and intestinal intussusception in adults are discussed along with a review of the current literature.

Jejunal intussusception: a rare cause of an acute abdomen in adults

Abdominal pain secondary to intussusception is a common presentation in the paediatric population but rare in adults. Diagnosis is often difficult due to non-specific signs and symptoms. Adult intussusception presents more insidiously with intermittent abdominal pain and signs and symptoms of an acute abdomen are rare. In children, the aetiological factor is usually idiopathic, whereas intussusception in adults is more commonly due to an underlying pathology giving rise to a lead point. Consequently the treatment of choice is different-while it is supportive in children, surgical management is typically indicated in adults. In addition, the causes of a lead point precipitating adult intussusception are different depending on whether they arise from the small or large bowel. This report presents a case of jejunal intussusception in a 30-year-old man with a characteristic CT scan who required exploratory laparotomy and small bowel resection.

Adult intussusceptions: preoperative predictive factors for malignant lead point

Purpose

Adult intussusception is uncommon, but an organic lesion is found to be the lead point in 75% to 90% of the cases. This study was designed to review our experience with adult intussusception and to determine if there are any preoperative predictive factors for a malignant lead point.

Methods

Thirty-three patients over 15 years of age were diagnosed with intussusceptions through operative finding over a period of 20 years. We reviewed the medical records of these patients retrospectively, and preoperative predictive factors of malignant lead points were analyzed.

Results

The preoperative diagnosis of intussusception had been made correctly in 86% of the cases, and computed tomography could find a lead point in 79%. A causative organic lesion was found in 29 patients (88%) pathologically; 16 cases (48%) were due to benign tumors, and 13 (39%) were due to malignant tumors. A malignant lead point was present in four of 21 enteric (20%) versus nine of 13 colonic intussusceptions (75%). The period from symptom appearance to hospital visit showed a more chronic nature in malignant neoplasm than in benign neoplasm (P = 0.006), and the location of causative organic lesion showed significant difference between benign and malignant groups (P = 0.003).

Conclusion

Adult intussusceptions are commonly secondary to a pathologic lead point, and a computed tomography is an effective diagnostic tool for finding a lead point preoperatively. The chronic nature of the disease presentation and colonic location of the lead point may suggest a malignant neoplasm.

Ileocolic intussusception secondary to gastrointestinal stromal tumor in a 61-year-old

Intussusception is a common emergency in patients age of 3 months to 5 years. In adults, the diagnosis is infrequent but must be considered in the clinical setting of abdominal pain and vomiting. We present a case of a 61-year-old woman presenting with epigastric abdominal pain and vomiting, diagnosed with intussusception secondary to gastrointestinal stromal tumor. Serial bedside ultrasound examinations uncovered the diagnosis of intussusception, confirmed by computed tomographic scan during a paroxysm of pain. Intussusception has a much higher predilection for neoplasms in adults, with a high morbidity and mortality, so early recognition is critical in improving patient outcomes.

Intussusception: as the cause of mechanical bowel obstruction in adults

BACKGROUND/AIMS

Intussusception in adults is rarely seen and causes misdiagnosis due to its appearance with various clinical findings. The cause of intussusception in adults is frequently organic lesions. In this study, the underlying etiologic factors, diagnostic methods and alternative methods of treatment are discussed in the light of the literature.

METHODS

In this study, a retrospective evaluation was performed on 47 cases with the diagnoses of intussusception, who were operated on for bowel obstruction between 1990-2011 in Department of Surgery of Necmettin Erbakan University Meram Medical Faculty. Data related to presentation, diagnosis, treatment and pathology were analyzed.

RESULTS

Twenty-four of the patients (51%) were female, and 23 were male (49%). Mean age (year) was 49 (range: 23-78) in female group, and 50 (range: 17-72) in male group. All patients presented mechanical bowel obstruction findings and underwent operation. Intussusception was caused by benign and malignant tumors in 38 patients, and other reasons in 3 cases. No reason could be determined in the other 6 cases. Only small intestine resection was applied in 29 cases, and large intestine resection was also applied in 17 cases. Reduction and fixation surgery was performed in one patient. No postoperative mortality was observed.

CONCLUSIONS

Adult intussusception remains a rare cause of abdominal pain. Diagnosis of intussusception in adults is still difficult. Main treatment was surgical in most cases.

Pedunculated lipoma causing colo-colonic intussusception: a rare case report

Background

Intussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. Colonic lipomas are uncommon nonepithelial neoplasms that are typically sessile, asymptomatic and incidentally found during endoscopy, surgery, or autopsy.

Case presentation

A 55-year old man visited our emergency department with severe abdominal pain, multiple episodes of vomiting, abdominal distension. Abdominal ultrasound sonography and computed tomography showed a sausage-shaped mass presenting as a target sign, suggestive of intussusception. Surgery revealed a hard elongated mass in the right colon wihch telescoped in the transverse colon and caused colo-colonic intussusception. Rhigt hémicolectomy was performed and pathology documented a mature submucosal lipoma of the colon. We describe the difficulties in diagnosis and management of this rare cause of bowel obstruction and review the literature on adult intussusceptions.

Conclusion

A large submucosal lipoma is a very rare cause of colon intussusception that presents as intestinal obstruction in patients without malignancy. CT and magnetic resonance imaging remain the methods of choice for studying abdominal lipomas, particularly those rising into the layers of the colonic wall. Surgical resection remains the treatment of choice and produces an excellent prognosis.

Laparoscopic colectomy of colonic intussusceptions in adults

Adult intussusception is a rare entity. Most adult intussusceptions require surgical intervention because they have a high rate of pathologic leading point. Mandatory laparotomy and en bloc resection is recommended in colonic intussusceptions due to the possibility of malignancy. We report herein 3 cases of adult colonic intussusceptions. The intussusceptions were located in the sigmoid and rectum, which were managed by laparoscopic colectomy. Case 1 was managed by laparoscopic anterior resection and diverting ileostomy combined with perineal reduction. Perineal approach facilitated laparoscopic reduction. In case 2, intraoperative colonoscopy was performed to determine the distal resection margin. Intraoperative colonoscopy showed edematous bowel mucosa as well as leading point after reduction of intussusceptions. Case 3 showed asymptomatic transient rectorectal colonic intussusceptions.

[A rare cause of recurrent small bowel intussusception. Case report and review of the literature]

Small bowel intussusception is a rare cause of abdominal pain in adult patients. Due to varying symptoms and different underlying causes its diagnosis and treatment is challenging for physicians. This case report describes recurrent intussusception in an adult female patient and celiac disease could only be diagnosed as the cause of these symptoms after surgery. In addition a review of the literature regarding adult intussusception is presented.

Adult intussusception with cecal adenocarcinoma: Successful treatment by laparoscopy-assisted surgery following preoperative reduction

We report a case of adult intussusception caused by cecal adenocarcinoma that was treated by laparoscopy-assisted ileocecal resection following reduction by contrast enema and preoperative colonoscopy. A 68-year-old male with cecal cancer was admitted to our hospital because of colicky abdominal pain after taking a laxative. His abdomen was distended, and a mass was palpable in the right upper quadrant, which appeared as a target- or sausage-shaped lesion by ultrasonograhpy and computed tomography. A contrast enema using water-soluble material showed a cup-shaped filling defect characterized by intussusception in the ascending colon. This round defect with a clear margin was pushed gradually back into the cecum by the enema pressure. Re-occurrence of the intussusception is easily released by colonoscopy. We performed laparoscopy-assisted ileocecal resection of a protruding tumor measuring 6.5 cm × 5.0 cm × 3.5 cm from the cecum, with D3 lymph node dissection. Histological examination revealed a well-differentiated adenocarcinoma that had invaded the serosa without permeating the lymphatic or venous capillaries, as well as lymph node metastasis. The postoperative course was uneventful, and the patient has been well without evidence of disease recurrence for 5 years following the operation. Preliminary reduction of adult colonic intussusception before surgical resection is therefore an option in cases of an early and correct diagnosis of intussusception.

Adult intussusception: diagnostic pitfalls, morbidity and mortality in a developing country

OBJECTIVE

To study diagnostic pitfalls, morbidity and mortality of adult intussusception.

PATIENTS AND METHODS

Retrospective study of adult patients records operated between 1979 and 2007 with the diagnosis of adult intussusception.

RESULTS

We found 41 cases of adult intussusception. The mean age was 35.2 years (standard deviation (SD)=7.1). The delay between onset and medical consultation was 15 days. The diagnosis was made pre-operatively in 11 cases. Abdominal ultrasound showed an abdominal mass in 11 cases. Ileo-ileal intussusception was most frequent (16 cases). Intussusception was secondary in 24 cases. There were seven instances of intestinal necrosis. Intestinal resection was performed in 34 cases. Surgical site infection occurred in four patients, three patients died.

CONCLUSION

The pre-operative diagnosis of acute intestinal intussusception is difficult. Morbidity and mortality rates are high. Improved diagnostic investigations in developing countries could improve the prognosis of this condition.

A rare case of mucinous adenocarcinoma of the colon presenting as ileoileal intussusception in an adult

Intussusception is the cause of around 1% of all bowel obstructions in adults. Unlike in children, where intussusception is most often idiopathic in nature, cases in adults usually have an identifiable etiology, most commonly malignancy. Symptoms are usually non-specific, but timely identification and management is crucial due to high rates of carcinoma as the lead point of intussusception. Here we present a rare case of mucinous adenocarcinoma of the colon that presented as ileoileal intussusception. Diagnostic and treatment issues are also discussed.

Compound double ileoileal and ileocecocolic intussusception caused by lipoma of the ileum in an adult patient: A case report

INTRODUCTION

The initial diagnosis of intussusception in adults very often can be missed and cause delayed treatment and possible serious complications. We report the case of an adult patient with complicated double ileoileal and ileocecocolic intussusception.

CASE PRESENTATION

A 46-year-old Caucasian man was transferred from the gastroenterology service to the abdominal surgery service with severe abdominal pain, nausea, and vomiting. An abdominal ultrasound, barium enema, and abdominal computed tomography scan revealed an intraluminal obstruction of his ascending colon. Plain abdominal X-rays showed diffuse air-fluid levels in his small intestine. A double ileoileal and ileocecocolic intussusception was found during an emergent laparotomy. A right hemicolectomy, including resection of a long segment of his ileum, was performed. The postoperative period was complicated by acute renal failure, shock liver, and pulmonary thromboembolism. Our patient was discharged from the hospital after 30 days. An anatomical pathology examination revealed a lipoma of his ileum.

CONCLUSIONS

Intussusception in adults requires early surgical resection regardless of the nature of the initial cause. Delayed treatment can cause very serious complications.

Adult intussusception secondary to an ileum hamartoma

Intussusception is a rare condition in the adult population. However, in contrast to its presentation in children, an identifiable etiology is found in the majority of cases. Clinical manifestations of adult intussusception are non-specific and patients may present with acute, intermittent or chronic symptoms, predominantly those of intestinal obstruction. A 27-year-old male patient with recurrent abdominal pain secondary to intussusception is herein reported. The clinical presentation and ultrasonographic findings led to the diagnosis. At laparotomy, an ileal hamartoma was found as the lead point of the intussusception. Surgical management and histopathologic studies are described. A recurrent intestinal obstruction and classic ultrasound findings may lead to the diagnosis of intussusception but surgical exploration remains essential. The principle of resection without reduction is well established.

Idiopathic adult intussusception

Intussusception is an uncommon cause of abdominal pain in adults and poses diagnostic challenges for emergency physicians, due to its varied presenting symptoms and time course. Diagnosis is thus often delayed and results in surgical intervention due to the development of bowel ischaemia. We report on a young patient who presented with an ileo-ileal intussusception in whom there were no underlying lesions identified as a causal factor.

Adult intussusception in Northern India

BACKGROUND

Adult intussusception is infrequently encountered in Asians. The diagnosis is often late because of the variable presentation. The optimal treatment is not universally agreed upon.

PURPOSE

To determine the causes and management of this uncommon entity in India.

METHODS

A retrospective review of patients with postoperative diagnosis of intussusception between March 2003 and March 2008 was conducted in a tertiary care centre in North India. Data relating to diagnosis, treatment and histopathology was analyzed.

RESULTS

Twenty-seven patients, aged 15-72 years with 28 intussusceptions were studied. Four patients (14.29%) had acute presentation, 16 (57.14%) subacute and 7 (25%) had chronic symptoms. The most common type of intussusception was enteroenteric. A diagnosis of intussusception on contrast enhanced computed tomogram was made in 84% and a lead point was identified in 89%. A causative factor could be identified in 89% (25 out of 28 intussusceptions) which was malignant in 37% and benign in 48%. The most common underlying malignant lesions were adenocarcinoma (50%), and lymphoma (25%). Among benign lesions, small bowel polyps were the most common (57%). All cases underwent surgical intervention. Bowel resection was performed in 89%. There was no mortality.

CONCLUSION

Our series highlights a high frequency of a demonstrable cause of intussusception in a tropical country. Overall our results are similar to those reported from other countries. Resection of the involved bowel is recommended because of high incidence of underlying pathology.

Multiple bowel intussusceptions from metastatic localized malignant pleural mesothelioma: A case report

Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a “target sign” over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small intestine and colon and a segmental resection of metastatic lesions was performed. Unfortunately, the patient died of sepsis despite successful surgical intervention. Though local recurrence is more frequent in LMPM, the possibility of distant metastasis should not be ignored in patients with non-specific abdominal pain.

Clinical presentations, diagnosis and treatment of adult intussusception, a 20 years survey

BACKGROUND

Intussusception is a rare cause of intestinal obstruction in adult patients. The etiology of malignant nature has been reported to be more frequent in this group and the diagnosis is usually made at operation. Few reports are published for this clinical entity from Middle East.

METHODS

The medical records of all adult patients admitted with the diagnosis of intussusception in a tertiary care center between 1989 and 2009 were reviewed.

RESULTS

There were 15 cases of intussusception in this 20 years period. The mean age of patients was 33.6 years, 8 females and 7 males. In 14 cases the leading point of intussusception was in small bowel. Resection and primary anastomosis was the selected procedure in 13 patients; one patient underwent colostomy and one reduction alone. Malignant cause was detected in only 2 cases. 7 Patients were operated on with diagnosis of intussusception according to imaging findings. The diagnosis was made at operation in the remaining 8 cases. Only one anastomotic leakage occurred in patient on systemic steroids.

CONCLUSION

The mean age of our patients is relatively low with more benign etiologies in small bowel. The CT scan may be the most helpful imaging modality in suspected cases but decision for operation in acute presentations should not be deferred for definite diagnosis. Resection of the involved bowel segment and primary anastomosis is associated with a good outcome.