Intussusception in adults and the role of evolving computed tomography technology

Amr, Mahmoud A.; Polites, Stephanie F.; Alzghari, Mohammad; Onkendi, Edwin; Grotz, Travis E.; Zielinski, Martin D.

doi:10.1016/j.amjsurg.2014.10.019

Cited by 26 publications

(45 citation statements)

References 10 publications

(13 reference statements)

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“…Interestingly, more recent studies have shown a pathologic lead point has become increasingly less common in adult intussusception [1,3,9]. Amr et al [1] have attributed this increase in identification of idiopathic cases partly due to widespread use of CT scans enabling the diagnosis of intussusception in patients without a lead point.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, adult intussusception is much less common in comparison to the incidence of pediatric cases, only accounting for 5% of all intussusceptions [5,6]. Due to its rarity, there are no large-scale studies or meta-analyses published to define appropriate guidelines for optimal management of adult intussusception [1,7]. Secondly, adult intussusceptions are often secondary to presence of a lead point, including malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple diagnostic studies have been utilized to diagnose intussusception, including computed tomography (CT), ultrasound scan, small bowel contrast study, and magnetic resonance imaging. Due to the rapid advancement in CT technology and widespread availability of CT in recent years, its utilization has increased over time [1]. Several recent studies have shown that current CT scanners have a sensitivity of 58-100% and specificity of 57-71% in detecting the intussusception [2,4].…”

Section: Discussionmentioning

confidence: 99%

“…Most commonly, patients present with abdominal pain [1][2][3]. The less common presentations include complete or partial bowel obstruction, heme-positive stools, a palpable mass and incidental finding on imaging [1,2]. The classic triad of abdominal pain, a palpable mass and passage of red currant jelly stools seen in children is rarely seen in adult patients [2].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical presentation in adult is often nonspecific, making diagnosis a challenge. Most commonly, patients present with abdominal pain [1][2][3]. The less common presentations include complete or partial bowel obstruction, heme-positive stools, a palpable mass and incidental finding on imaging [1,2].…”

Section: Discussionmentioning

confidence: 99%

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Adult idiopathic ileocolic intussusception: A case report

Bannai¹,

Pais²

2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.com Adult idiopathic ileocolic intussusception: A case reportMasaki Bannai, Antonio Pais ABSTRACT Introduction: Intussusception is a rare cause of acute abdomen in adults. Traditionally, management of adult intussusception has mandated surgical interventions due to a high incidence of malignant lesion resulting in intussusception. However, recent literature challenges the traditional view of mandatory surgical interventions for all adult intussusceptions due to an increasing number of benign and idiopathic cases. These benign and idiopathic cases of adult intussusceptions are more readily identified partly due to recent widespread use of computed tomography imaging technique. With the growing number of idiopathic cases, recent literature recommends against the traditional mandatory operative exploration of all adult intussusceptions, only advocating surgical interventions for selected cases. Case Report: A 38-year-old female presented with an acute onset of severe right-sided abdominal pain with associated nausea, vomiting and rectal bleeding to our emergency department. Her computed tomography scan of abdomen and pelvis showed an ileocolic intussusception which had advanced to the level of the hepatic flexure without any mass lesion. The patient underwent an emergency ileocecal resection with side-to-side anastomosis of terminal ileum to ascending colon. Conclusion: This case report adds to literature with evaluation of the rare form of adult intussusception without a lead point. There may be a role for a conservative management approach of subtypes with high incidence of primary malignant lesions in the absence of a lead point on a CT scan especially among young patients without any concerning features.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Adult idiopathic ileocolic intussusception: A case report

Bannai¹,

Pais²

2016

IJCRI

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Management of intussusception in patients with melanoma

Perez

Sun

Farley

et al. 2019

Journal of Surgical Oncology

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Background Increased cross‐sectional imaging for surveillance of metastatic melanoma has led to more diagnoses of asymptomatic intussusception. Methods We performed a multi‐institutional retrospective review of patient records with a history of metastatic melanoma and a diagnosis of intussusception. Patients were divided into three groups: 1) asymptomatic patients without current evidence of melanoma (no evidence of disease [NED]); 2) asymptomatic intussusception and known active metastatic melanoma; 3) symptomatic intussusception and known active metastatic melanoma; the number of patients requiring surgery and intraoperative findings were recorded. Results We reviewed 73 patients diagnosed with intussusception from 2004 to 2017. Among asymptomatic patients with NED (n = 16), 14 spontaneously resolved and 2 underwent pre‐emptive surgery without abnormal intraoperative findings. Of asymptomatic patients with active metastatic disease (n = 32), 25 were initially observed and 7 underwent pre‐emptive surgery and 9 of the 25 initially observed patients required surgery for development of symptoms. In this group, all 16 patients undergoing surgery (50% of the group) had intraoperative findings of intussusception and/or metastatic intestinal melanoma.. All symptomatic patients with metastatic melanoma (n = 25) underwent surgery; all had intraoperative findings of intussusception and/or metastatic melanoma except 1 (Meckel's diverticulum). Conclusion Asymptomatic patients with NED do not require surgery and intussusception will likely resolve spontaneously. Asymptomatic patients with known metastatic melanoma may be initially observed, but a low threshold for surgery should be maintained. Symptomatic patients with known metastases should undergo surgery.

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

et al. 2021

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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.

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Intussusception in adults and the role of evolving computed tomography technology

Cited by 26 publications

References 10 publications

Adult idiopathic ileocolic intussusception: A case report

Adult idiopathic ileocolic intussusception: A case report

Management of intussusception in patients with melanoma

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

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