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Adult intussusception: A case series and review
#MMPMID28572876
Shenoy S
World J Gastrointest Endosc
2017[May]; 9
(5
): 220-227
PMID28572876
show ga
AIM: To identify factors differentiating pathologic adult intussusception (AI)
from benign causes and the need for an operative intervention. Current evidence
available from the literature is discussed. METHODS: This is a case series of
eleven patients over the age of 18 and a surgical consultation for
"Intussusception" at a single veteran's hospital over a five-year period
(2011-2016). AI was diagnosed on computed tomography (CT) scan and or flexible
endoscopy (colonoscopy). Surgical referrals were from the emergency room,
endoscopy suites and the radiologists. RESULTS: A total of 11 cases, 9 males and
2 females were diagnosed with AI. Median age was 58 years. Abdominal pain and
change in bowel habits were most common symptoms. CT scan and or colonoscopy
diagnosed AI, in ten/eleven (90%) patients. There were 6 small bowel-small bowel,
4 ileocecal, and 1 sigmoid-rectal AI. 8 patients (72%) needed an operation. Bowel
resection was required and definitive pathology was diagnosed in 7 patients
(63%). Five patients had malignant and 2 patients had benign etiology. Small
bowel enteroscopy excluded pathology in 4 cases (37%) with AI. Younger patients
tend to have a benign diagnosis. CONCLUSION: Majority of AI have malignant
etiology however idiopathic intussusception is being seen more frequently.
Operative intervention remains the mainstay however, certain small bowel
intussusception especially in younger patients may be a benign, physiological,
transient phenomenon and laparoscopy with reduction or watchful waiting may be an
acceptable strategy. These patients should undergo endoscopic or capsule
endoscopy to exclude intrinsic luminal lesions.
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