Differentiation Between Surgical and Nonsurgical Intussusception: A Diagnostic Model Using Multi-Detector Computed Tomography

Abstract

Background: The differentiation of surgical from nonsurgical adult intussusception may enable the appropriate selection of management strategies. Objective: This study aimed to investigate the diagnostic potential of multidetector computed tomography (MCDT) features to differentiate surgical from nonsurgical adult intussusception and develop a diagnostic model. Methods: A retrospective study was performed on 96 patients with intussusceptions at the University Medical Center Hospital between January 2014 and January 2020. Two radiologists reviewed all images, and intussusception characteristics were documented. The location of intussusception, length, diameter, interposed fat thickness, lead point, and complications were evaluated. Based on the results, a diagnostic tree model was developed to differentiate between surgical and nonsurgical adult intussusception. Results: A total of 99 intussusceptions in 96 patients (mean age: 53.0 ± 16.5 years), including 35 (35.3%) enteroenteric, 27 (27.3%) enterocolic, and 37 (37.4%) colocolic lesions, were evaluated. Of the enteroenteric intussusceptions, 22 (62.9%) were surgical, including 19 (79.2%) with lead points. Among colon intussusceptions, 63 (98.4%) were surgical, and 100% had lead points. The characteristics used to predict surgical intussusceptions included lead point presence, length ≥ 5.0 cm, diameter ≥ 3.2 cm, interposed fat thickness ≥ 0.5 cm, and complications (p < 0.001). Based on these features, we established a diagnostic tree model that correctly classified 96 (97%) of 99 lesions. Conclusion: Our study reinforces the importance of MDCT for the diagnosis and guided management of adult intussusceptions. The characteristics that predicted surgical intussusceptions included lead points, length, diameter, interposed fat thickness, and complications. A systematic approach using this diagnostic tree model could be used to distinguish surgical and nonsurgical adult intussusception.

Proposal of a Risk Scoring System to Facilitate the Treatment of Enteroenteric Intussusception in Peutz-Jeghers Syndrome

“…The length of intussusception was reported as a feature to distinguish self-limiting intussusception from these requiring surgery. 11,13,21 Most authors argued that intussusceptions ≥5 cm in length should be treated with surgery. These studies did not consider the enteroscopic treatment as an alternative.…”

Transient intussusception – What the sonographer needs to know

“…8,14 Transient symptomatic intussusception (TSI) Numerous authors have reported the spontaneous resolution of intussusception in children 5,9,14,[21][22][23] and adults. 8,10,12,13,[25][26][27][28][29][30] In some patients, resolution of symptoms may occur before any management decisions are made. 9,14,23 In other patients who are stable and exhibit mild symptoms and encouraging imaging findings, a decision to offer expectant management can be made.…”

“…This is particularly the case if an intussusception is found on CT imaging because the finding may be reported without placing it in the context of the patient's symptomatology and the finding of transient intussusception may be incidental and unrelated to the patient's presenting symptoms. 8,12,13,27 Ultrasound has the distinct advantage of having direct patient contact, allowing the sonographer to perform sonopalpation and correlate the imaging appearance to the patient's symptoms. 23 Ultrasound is also well placed as a surveillance tool for intussusception due to the lack of ionising radiation.…”

“…23 Ultrasound is also well placed as a surveillance tool for intussusception due to the lack of ionising radiation. Several recent publication report patients as young as 18 having received multiple CT scans to monitor the resolution of a benign transient intussusception, 12,26,27 despite the fact that sinister underlying pathology had already been excluded. At least in some of these cases, ultrasound could have provided a safer and more cost-effective modality to monitor the resolution of intussusception.…”

İnvajinasyon Nedeni ile Takip Ettiğimiz Hastalarda Cerrahi Tedavi Endikasyonu ile Ultrasonografi Bulguları Arasındaki İlişkinin Değerlendirilmesi

“…Generalize peritonit, perforasyon, kanlı dışkılama ve yüksek dereceli lökositozun olduğu gecikmiş vakalarda cerrahi tedavi esastır. Bizim hastaların ise 42'sinde (% 26,9) cerrahi tedavi gerekti ve bu oran literatürden daha yüksekti (12). Cerrahi tedavi gereken hastaların çoğu <2 yaş hastalar ve ileoileal invajinasyonu (28 hasta ve %66,7) olan hastalardı.…”