Intussusception in the adult

Bond, Michael R.; Roberts, Julian

doi:10.1002/bjs.1800511105

Cited by 18 publications

(7 citation statements)

References 30 publications

(5 reference statements)

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“…Prospective data are lacking in the literature because the diagnosis is only reported to occur in one in 20,000 to one in 45,000 hospital admissions annually, and only 4.5 per cent to 36 per cent of all intussusceptions are reported to occur in adults. [3][4][5][6][7][8][9][10][11][12][13] If a tumor of the small or a large bowel tumor is present, the likelihood of development of intussusception may be close to 4 per cent. 10 However, two large series of bowel obstruction traced the etiology to intussusception in only 1 per cent of cases.…”

mentioning

confidence: 99%

Approach to Management of Intussusception in Adults: A New Paradigm in the Computed Tomography Era

Rea

Lockhart

Yarbrough

et al. 2007

The American Surgeon™

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Intussusception has been considered an operative indication in adults as a result of the risk of ischemia and the possibility of a malignant lead point. Computed tomographic (CT) scans can reveal unsuspected intussusception. All CT reports from July 1999 to December 2005 were scanned electronically for letter strings to include the keyword intussusception. Identified CT scans were analyzed to characterize the intussusception and associated findings. Clinical, laboratory, pathological, and follow-up variables were gleaned from medical records. Findings were analyzed by treatment and findings at operation. Review of 380,999 CT reports yielded 170 (0.04%) adult patients (mean age, 41 years) with intussusceptions described as enteroenteric in 149 (87.6%), ileocecal in eight (4.7%), colocolonic in 10 (5.9%), and gastroenteric in three (1.8%). Radiological features included mean length of 4.4 cm (range, 0.8-20.5 cm) and diameter of 3.2 cm (range, 1.6-11.5 cm). Twenty-nine (17.1%) had a lead point, and 12 (7.1%) had bowel obstruction. Clinically, 88 (48.2%) patients reported abdominal pain, 52 (30.6%) had nausea and/or vomiting, and 74 (43.5%) had objective findings on abdominal examination. Thirty of 170 (17.6%) patients underwent operation, but only 15 (8.8%) patients had pathologic findings that correlated with CT findings. Seven had enteroenteric intussusceptions from benign neoplasms (two), adhesions (one), local inflammation (one), previous anastomosis (one), Crohn's disease (one), and idiopathic (one). Three had ileocolic disease, including cecal cancer (one), metastatic melanoma (one) and idiopathic (one; whereas five patients had colocolonic intussusception from colon cancer (three), tubulovillous adenoma (one), and local inflammation (one). Of the 15 without intussusception at exploration, five had pathology related to trauma, four had nonincarcerated internal hernia after Roux-en-Y gastric bypass, four had negative explorations, one had adhesions, and one had appendicitis that did not correlate with CT findings. No patient in the observation group required subsequent operative exploration for intussusception at mean 14.1 months (range, 0.25-67.5 months) follow up. All operative patients demonstrated gastrointestinal symptoms versus 55.3 per cent of the observation group ( P < 0.006). Analysis of CT features demonstrated differences among patients observed without operation, those without intussusception at exploration, and confirmed intussusception with regard to mean intussusception length 3.8 versus 3.8 versus 9.6 cm, diameter 3.0 versus 3.2 versus 4.8 cm, lead point 12.1 per cent versus 30 per cent versus 53.3 per cent, and proximal obstruction 3.8 per cent versus 0 per cent versus 46.7 per cent, respectively. Intussusceptions in adults discovered by CT scanning do not always mandate exploration. Most cases can be treated expectantly despite the presence of gastrointestinal symptoms. Close follow up is recommended with imaging and/or endoscopic surveillance. Length and diameter of the intussusception, presence of a lead point, or bowel obstruction on CT are predictive of findings that warrant exploration.

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mentioning

confidence: 99%

Approach to Management of Intussusception in Adults: A New Paradigm in the Computed Tomography Era

Rea

Lockhart

Yarbrough

et al. 2007

The American Surgeon™

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“…Secondly, the patient harboured a large colonic intussusception which was completely asymptomatic. Intussusception is uncommon in adults and it is thought that only 4% of small and large bowel tumours present this way 3. We decided that early operative intervention in our patient was not warranted because he had no physical signs or CT scan evidence of bowel obstruction.…”

Section: Discussionmentioning

confidence: 91%

Chemotherapy induced carcinoma–adenoma regression in the caecum

et al. 2009

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The case of a male patient with synchronous oesophago-gastric junction (OGJ) and caecal adenocarcinomas is reported. His management is described, particularly the administration of neoadjuvant chemotherapy targeting his upper gastrointestinal cancer. Synchronous gastrectomy and hemicolectomy were performed. Histopathological examination of the surgical specimen confirmed the OGJ cancer but only identified a caecal adenoma. This is believed to be the first description of chemotherapy induced reversal of the adenoma-carcinoma sequence.

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“…Intussusception due to endometriosis [6] and neurofibroma has also been reported in adults. Stubenbord and Thorbjarnarson [7] reported 34 cases of intussusception, 25 affecting the small bowel and 9 affecting the large bowel, 9 had no obvious cause and 16 had benign tumours.…”

Section: Pathological Discussionmentioning

confidence: 95%