Adult intussusception: experience in Singapore

Abstract

Although uncommon, surgeons need to be aware of the epidemiology and treatment options for adult intussusception. The symptoms and signs are often non-specific and the surgeon might be faced with the diagnosis only at laparotomy. Computed tomography is the most useful imaging modality. An identifiable organic lesion is present in most cases, of which more than 50% are malignant (especially in the large bowel). Operative treatment is thus prudent. En bloc resection is recommended for ileo-colonic and colo-colonic intussusception. There is, however, a role of initial reduction in selected patients with ileo-ileal intussusception.

A Clinical Overview of a Retrospective Study About Adult Intussusceptions: Focusing on Discrepancies Among Previous Studies

“…On the other hand, five studies in Asian countries reported that acute abdominal pain was shown in 37.5 (N = 3/8), 44.4 (N = 4/9), 54.1 (N = 13/24), 54.3 (N = 25/49), or 54.5 (N = 6/11) % of patients with intussusception [9][10][11][12][13]. In our series, 27 patients (N = 64.3%) showed acute abdominal pain.…”

“…Adult intussusception occurs more frequently in the small (50-88%) than in the large bowel (12-50%) [1,2,4,6,7,14]. On the other hand, 0% (N = 0/9) [11], 25% (N = 2/8) [13], 41.7% (N = 10/24) [12], and 54.3% (N = 25/46) [9] of cases in the four studies have been reported. Only one in the five studies has reported that 71.4% (N = 5/7) of all cases were enteric intussusception.…”

“…According to the literature, the most common symptom of intussusception is acute abdominal pain [6][7][8]. Five studies reported that both acute and chronic abdominal pain is relatively similar or chronic abdominal pain is even higher in intussusception [9][10][11][12][13]. Surprisingly, all five of the studies were conducted in Asian countries.…”

“…Surprisingly, all five of the studies were conducted in Asian countries. Two series reported that chronic abdominal pain were 55.6 (N = 5/9) and 62.5% (N = 5/8) [11,13] whereas other three series have reported 45.5 (N = 5/11), 45.7 (N = 21/49), and 45.9% (N = 11/24) [9,10,12]. Fifty-three percent (N = 51/97) of all cases in the above five series showed acute abdominal pain.…”

“…Most reports are from Western countries, and only a few reports with a few cases have been published in Asian counties [9][10][11][12][13]15]. Therefore, these discrepancies might have resulted from limited experience with clinical entities of intussusception and low number of cases.…”