Intussusception of the bowel in adults: A review

Abstract

Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. However, bowel intussusception in adults is considered a rare condition, accounting for 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction. Eight to twenty percent of cases are idiopathic, without a lead point lesion. Secondary intussusception is caused by organic lesions, such as inflammatory bowel disease, postoperative adhesions, Meckel's diverticulum, benign and malignant lesions, metastatic neoplasms or even iatrogenically, due to the presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusceptions with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. Formal bowel resection with oncological principles is followed for every case where a malignancy is suspected. Reduction of the intussuscepted bowel is considered safe for benign lesions in order to limit the extent of resection or to avoid the short bowel syndrome in certain circumstances.

Treatment of adult idiopathic ileocolic intussusception with non-operative reduction under fluoroscopic guidance

“…Intestinal intussusception is rare in adults, and is typically due to a pathologic lead point within the bowel, which is often malignant [1,2]. This lead point is pulled forward by peristalsis so that it prolapses the affected segment of intestine (called intussusceptum) into another segment of intestine (called intussuscipiens).…”

“…This lead point is pulled forward by peristalsis so that it prolapses the affected segment of intestine (called intussusceptum) into another segment of intestine (called intussuscipiens). Intussusception is usually classified either according to the etiology (benign lesion, malignant lesion, or idiopathic) or by their location (entero-enteric, ileo-colic, or colo-colic) [2].…”

“…Pathologic lesions that serve as potential lead points include malignant tumors, Meckel's diverticulum, strictures or benign neoplasms. Nevertheless, up to 40% of adult patients may present as idiopathic intussusceptions [2,4].…”

“…Intussusceptions in adults are a rare entity, representing only 1% of all bowel obstructions and 5% of all intussusceptions [1,2]. In children, intussusception is usually idiopathic and benign, with up to 30% of patients coinciding with gastroenteritis [3].…”

Adult Intussusception

“…Although intussusception is the leading cause of intestinal obstruction in children, it is relatively rare after childhood, accounting for less than 5% of bowel obstruction in adults. 1 Adult intussusception occurs most often in the small bowel and is classified on the basis of location. It can be categorized as enteroenteric (small bowel only), colocolic (large bowel only), ileocolic (terminal ileum prolapses within the ascending colon), or ileocecal (ileocecal valve is the lead point).…”