Adult intussusception: still a challenging diagnosis for the surgeon

Álvarez-Bautista, F.E.; Moctezuma-Velázquez, Paulina; Pimienta-Ibarra, Adriana Simoneta; Vergara-Fernández, Omar; Salgado‐Nesme, Noel

doi:10.1016/j.rgmxen.2022.06.009

Cited by 6 publications

(13 citation statements)

References 14 publications

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“…12 Intussusception has been classified as follows based on its location in the gastrointestinal tract: enteroenteric (jejunojejunal (Figure 1) and ileoileal), colocolic (involving the large bowel), ileocolic (terminal ileum into ascending colon), ileocecal (terminal ileum into ascending colon), and ileocecal (ileocecal valve acts as the lead point). 2,7 Six separate regions of intussusception within the small bowel have been described, and these have become especially clear with the increasing use of CT. 13 In 70% to 90% of cases of intussusception in adults, a pathologic condition functions as the lead point [4][5][6] (Figure 3). The lead points of small bowel intussusception in adults are benign lesions in 60% of cases, malignant lesions in 30%, and idiopathic in 10%.…”

Section: Discussionmentioning

confidence: 99%

“…Among adult patients, intussusception accounts for 5% of all cases of intussusception and 1% of intestinal obstructions. [3][4][5] In 70% to 90% of intussusceptions in adults, there is a demonstrable lead point with a definite pathologic abnormality, and 65% of lead points involve a neoplastic abnormality. 4,6 Intussusception may present with acute, subacute, or chronic nonspecific symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Jejunojejunal intussusception induced by a gastrointestinal stromal tumor: a case report and literature review

Nwagbara,

Ashindoitiang,

Ugbem

et al. 2024

J Int Med Res

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Intussusception is defined as the invagination of a proximal segment of the bowel into the adjoining or distal segment. In most adults with intussusception, there is a demonstrable lead point with a definite pathologic abnormality. The clinical features of intussusception include chronic intermittent abdominal pain, nausea and vomiting, constipation, and a palpable abdominal mass. The present case report describes a 62-year-old woman with a 2-week history of abdominal pain and 9-day history of vomiting. Clinical, imaging, and histologic evaluations revealed a jejunojejunal intussusception with a gastrointestinal stromal tumor as the lead point. A gastrointestinal stromal tumor should be considered as a possible lead point in adult patients with intussusception. The implication of reducing the intussusception prior to tumor resection requires further evaluation in view of the risk of venous embolism, including direct spread of malignant cells, in cases involving a large polypoid mass with a necrotic surface that extends to the serosa as shown by intraoperative examination. Accordingly, the rationale for adjuvant therapy with imatinib also requires further evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Jejunojejunal intussusception induced by a gastrointestinal stromal tumor: a case report and literature review

Nwagbara,

Ashindoitiang,

Ugbem

et al. 2024

J Int Med Res

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“…The clinical manifestations include nausea, vomiting, gastrointestinal bleeding, changes in stool pattern, and weight loss. 2 Recent series 3 4 of adult patients with intussusception have reported abdominal pain as the most frequent symptom, occurring in 54.5% to 96.42% of the cases, followed by vomiting in 10% to 71.42%, abdominal distension in 4% to 35.7%, gastrointestinal bleeding in 6% to 28.57%, and changes in the pattern of bowel movements in 8% to 32.14%. The abdominal CT scan is a useful tool with diagnostic accuracy close to 100%, in which sausage-shaped double-ring lesions with target ( bullseye) signs can be observed.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In addition, it should be considered that endoscopic reduction and surgical reduction without resection of the affected segment carries the potential risk of intussusception recurrence and missing a malignant lesion. 4,7 To conclude, although adult intussusceptions are rare, they must be included in the differential diagnosis of acute abdominal pain. The definitive treatment should consider the clinical presentation, the patient's general condition, and the risk of malignancy.…”

Section: Discussionmentioning

confidence: 99%

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Metastatic Clear-Cell Renal Carcinoma: An Exceptional Cause of Ileocolonic Intussusception in Adults

Alvarez-Bautista,

Hoyos-Torres,

Sarre-Lazcano

et al. 2023

Journal of Coloproctology

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Introduction Intussusceptions in adults are rare, representing 1% to 5% of intestinal obstructions in this age group. This condition can be caused by benign and malignant lesions acting as lead points, the latter being the most frequent. Furthermore, the diagnosis is challenging due to the non-specific symptoms with variable duration. Case Presentation A 43-year-old man, with a history of localized clear-cell renal carcinoma (ccRCC) treated 9 years earlier with a right radical nephrectomy, presented with bowel obstruction symptoms. An abdominal computed tomography scan showed an ileocolonic intussusception. Hence, the patient required a right hemicolectomy with ileotransverse anastomosis. The histopathological analysis showed a metastatic ccRC to the terminal ileum causing the intussusception. Discussion Adult intussusceptions are rare. However, they should be considered in the differential diagnosis of patients with abdominal pain and symptoms of bowel obstruction. Metastases of renal cancer to the small bowel are uncommon and even more so in the form of intussusception. Definitive treatment must be tailored to the patient's condition and underlying cause.

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Antegrade long giant ileocolic intussusception via colon–cecum cancer lead points: case report with focus on the sign of the python colon

Pierro,

Apollonio,

Mirco

et al. 2024

Egypt J Radiol Nucl Med

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Background Ileocolic intussusception is a rare condition that is difficult to diagnose. A pathological lead point, usually malignant, is often the cause of adult intussusception. In emergency scenarios, radiologists must be able to identify this entity and its causes and express their opinions on associated complications. Case presentation The hospital's emergency room admitted a 75-year-old woman who was suffering from intermittent abdominal pain and constipation. An abdominal contrast-enhanced computed tomography revealed a long giant ileocolic intussusception. Considering the clinical stability and the absence of signs of complications on CT, the patient did not undergo an urgent surgical procedure but underwent a colonoscopy the following day. Surprisingly, the colonoscopy highlighted the spontaneous resolution and revealed the presence of the three tumour lead points in the cecum and ascending colon. A CT was performed after the colonoscopy, confirming the intussusception's resolution. The surgeon performed a right oncological hemicolectomy. The malignant lead points on histological examination were moderate to poorly differentiated adenocarcinomas. Conclusions A giant and long ileocolic intussusception with a long embedded visceral segment (the python colon sign) could suggest pathological lead points in the cecum and ascending colon. Despite the large size, a spontaneous resolution of the python colon is possible. In this scenario, even if, on imaging, it is impossible to macroscopically identify a lead point, in cases of giant and long ileocolic intussusceptions, every effort must be undertaken to search for the cause of the intussusception.

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Adult intussusception: still a challenging diagnosis for the surgeon

Cited by 6 publications

References 14 publications

Jejunojejunal intussusception induced by a gastrointestinal stromal tumor: a case report and literature review

Jejunojejunal intussusception induced by a gastrointestinal stromal tumor: a case report and literature review

Metastatic Clear-Cell Renal Carcinoma: An Exceptional Cause of Ileocolonic Intussusception in Adults

Antegrade long giant ileocolic intussusception via colon–cecum cancer lead points: case report with focus on the sign of the python colon

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