ADULT INTUSSUSCEPTION - A SURGICAL DILEMMA
Abstract
Background: Adult intussusception is rare. It is expected to be found in 1/30,000 of all hospitaladmissions, 1/1300 of all abdominal operations, 1/30-1/100 of all cases operated for intestinal
obstruction and one case of adult intussusception for every 20 childhood ones. Methods: The
authors encountered 4 cases of adult intussusception. M:F ratio was 1:1. Mean age was 47years.
Small bowel obstruction was documented in all. They were investigated by radiographs,
ultrasound exam, barium studies, endoscopy and CT scan. Results: All however were diagnosed
at operation although some pre-operative suspicion was raised in one case. All had a laparotomy.
Two were ileo-ileal and two ileo-caecal intussusceptions. One was chronic intussusceptions and
three sub-acute. One intussusception had a malignancy (lymphoma) as a lead point. Two had a
submucous lipoma at the apex. In an interesting case the suture knot from a recent small bowel
anastomosis (2-3 weeks prior) was forming the lead point of the intussusception! The 2 ileo-ileal
intussusceptions had segmental resection. Right hemicolectomy was done for the 2 ileo-caecal
cases. Target lesion and leumen-within-leumen were the CT hallmarks on review. Retrospective
barium enema review failed to show the intussusception. This may suggest the intussusception
may have been recurrent or chronic. All 4 recovered uneventfully and remained well. One patient
was referred for chemotherapy for intestinal lymphoma. Conclusion: Adult intussusception
remains a rare cause of abdominal pain. The treatment almost always is surgical.
Key words: Adult Intussusception
References
Marcos HB, Smelka RC, Worawattanakul S; Adult
intussusception: demonstration by current MR techniques.
Magnetic Resonance Imaging 1997; 15(9):1095-8.
Catalano O; Transient small bowel intussusception: CT
findings in adults. BJR 1997 Aug; 70(836):805-8.
Azar T, Berger DL; Adult intussusception. Annals of Surgery
Aug ; 226(2):134-8.
Begos DG, Sandor A, Modlin IM; The diagnosis and
management of adult intussusception. Am J Surg 1997
Feb;173(2):88-94.
Ahrar K, Watkins GE, Gardiner G; Colocolic intussusception
caused by pneumatosis cystoides coli. Abdominal Imaging
Jul-Aug; 22(4):392-4.
Ford KL 3rd; Aunt Minnie's corner. Small bowel
intussusception due to metastatic melanoma. Journal of
Computer Assisted Tomography 1997 Jan-Feb; 21(1):170.
Matter I, Assaff Y, Nash E, Kunin J, Cohen O, Eldar S;
Intussusception in adults. South African Journal of Surgery
Nov; 35(4):194-7.
Gonzalez Rodriguez JF, Baki W, Nisa Gutierrez E, Cantero
Cid R, Velasco Suarez M, Ramirez Armengol JA;
Endoscopic diagnosis of an ileocolic intussusception in an
adult. (Spanish) Revista Espanola de Enfermedades
Digestivas 1998 Apr; 90(4):305-6.
Berne JD, Asensio JA, Gomez S, Chahwan H, Falabella A;
Double intussusception in an adult following a laparotomy
for trauma: a case report and review of the literature.
J Ayub Med Coll Abbottabad 2006;18(3)
[Review] [14 refs] American Surgeon 1998 Aug; 64(8):781-
Chan KC, Lin NH, Lien HC, Yu SC; Intermittent
intussusception caused by colonic lipoma. Journal of the
Formosan Medical Association 1998 Jan; 97(1):63-5.
Gayer G, Apter S, Hofmann C, Nass S, Amitai M, Zissin R,
Hertz M; Intussusception in adults: CT diagnosis. Clinical
Radiology 1998 Jan; 53(1):53-7.
Navarro O, Daneman A, Alton DJ, Thorner P; Colo-colic
intussusception associated with pneumatosis cystoides
intestinalis. Paediatric Radiology 1998 Jul; 28(7):515-7.
Wan YL, Lee TY, Hung CF, Ng KK; Ultrasound and CT
findings of a cecal lymphangioma presenting with
intussusception. European J Radiol 1998 Mar; 27(1):77-9.
Pinero Madrona A, Rios Zambudio A, Castellanos Escrig G,
Carrasco Pratt M, Parrilla Paricio P; Intestinal invaginatio in
an adult. [Spanish] Gastroenterologia y Hepatologia 1998
Oct; 21(8):398-400.
Eisen LK, Cunningham JD, Aufses AH Jr.; Intussusception
in adults: institutiona review. [Review][14 refs] J Am Coll
Surg 1999 Apr ; 188(4):3 90-5.
Lorenzi M, IroatulamAJ, VernilloR, Banducci T, Mancini S,
Tiribocchi A, Ferrari FS, Mancini S; Adult colonic
intussusception caused by malignant tumor of the transverse
colon. American Surgeon 1999 Jan; 65(1):11-4.
Sato N, Matoba N, Kameoka N, Fujii T, Sato K, Masuda H,
Inoue T, Tanaka M; Gastroduodenal intussusception
secondary to a gastric carcinoma. Hepato-Gastroenterology
Jan-Feb; 46(25):626-8.
Manisegaran M, Agarwal AK, Sachdev AK, Chaudhary A,
Abhijit C, Monica J, Kumar N; Duodenal villo us adenoma.
Tropical Gastroenterol 1999 Jan-Mar; 20(1):40-1.
Conners GP, Weber CE, Emmens RW; Intussusception
following a baby walker injury. J Emerg Med 1999 Mar-Apr;
(2):269-71.
Mittermair RP, Prommegger R, Zelger BG, Bodner E;
Intestinal invagination due to endometriosis of the terminal
ileum. [Review][17 refs][German] Deutsche Medizinische
Wochenshrift 1999; 124(50):1522-4.
Huang WS, Kuo CH, Changchien CS, Hsu KL, Lin CC; Ileal
aberrant pancreas induces intussusception and
gastrointestinal bleeding in an adult woman-case report. Eur J
Gastroent & Hepatol 1999 Oct;11(10):1175-7.
Warshauer DM, Lee JK; Adult intussusception detected at
CT or MR imaging: clinical-imaging correlation. 1999 Sep;
Radiology 212(3):853-60.
Hofflander R, Beckes D, Kapre S, Matolo N, Liu S; A case
of jejunal intussusception with gastrointestinal bleeding
caused by metastatic testicular germ cell cancer. Digestive
Surgery 1999;16(5):439-40.
Mushtaq N, Marven S, Walker J, Puntis JW, Rudolf M,
Stringer MD; Small bowel intussusception in celiac disease. J
Pediatric Surg 1999 Dec; 34(12):1833-5.
Desai N, Wayne MG, Taub PJ, Levitt MA, Spiegel R, Kim
U; Intussusception in adults. Mount Sinai J Med 1999 OctNov; 66(5-6):336-40.
Patankar T, Prasad S, Patankar Z, Chaudhry S; Ileo-ileo-colic
intussusception secondary to an ileal lipoma. J Assoc Phys
India 1999 Sep; 47(9):923-5.
Fujino Y, Fujio Y, Shimada E, Okazaki A; Intussusception
due to vanishing colon cancer with metastases of the regional
lymph nodes: report of a case. Surgery Today 2000;
(2):188-90.
Ohno M, Nakamura T, Hori H, Tabuchi Y, Kuroda Y;
Appendiceal intussusception induced by tubulovillous
adenoma with carcinoma in situ: report of a case. Surgery
Today 2000;30(5):441-4.
Stringer MD, Willetts IE; John Hunter, Fredrick Treves and
intussusception. [Review][46 refs] Ann RCS Eng 82(1):18-
, 2000 Jan
Mirone I, Consoli A, Bonaccorso R, Cimbali P, Lizzio A,
Cavallaro A; Ileal invaginations caused by Peutz-Jeghers
polyposis. [Italian] Minerva Chirurgica 2000 Jan-Feb ; 55(1-
:59063.
Wongwaisayawan S, Pornkul R, Teeraratkul S, Pakakasama
S, Treepongkaruna S, Nithiyanant P; Extramedullary
haematopoietic tumour producing small intestinal
intussusception in a boy with beta thalassemia/hemoglobin E
Thai boy: a case report. J Med Assoc Thailand 83 Suppl 2000
Mar; 1:S17-22.
Sato M, Ishida H, Konno K, Komatsuda T, Naganuma H,
Watanabe S, Kotanagi H, Ishida J; Long-standing painless
intussusception in adults. European Radiology
;10(5):811-3.
Huang WS, Changchien CS, Lu SN; Adult intussusception, a
-year experience with emphasis on etiology and analysis of
risk factors. Chang-Keng i Hsueh Tsa Chih 2000 May;
(5):284-90.
Morgan DR, Mylankal K, el Barghouti N, Dixon MF; Small
bowel haemangioma with local lymph node involvement
presenting as intussusception. J Clin Path 2000 Jul;
(7):552-3.
Ugwu BT, Legbo JN, Dakum NK, Yiltok SJ, Mbah N, Uba
FA; Childhood intussusception: a 9-year review. Ann Trop
Paed 20(2):131-5, 2000 Jan
Khurram Baig M, Hussain S, Wise M, Wexner SD;
Controversy in the treatment of adult long ileocolic
intussusception:case report. American Surgeon 2000 Aug;
(8):742-3.
Yao JL, Zhou H, Roche K, Bangaru BS, Ginsburg H, Greco
MA; Adenomyoma arising in meckel diverticulum: case
report and review of the literature. [Review][10 refs]
Paediatric & Developmental Pathology 2000 Sep-Oct;
(5):497-500.
Hadidi AT, El Shal N; Childhood intussusception: a
comparative study of nonsurgical management. [see
comments] J Paed Surg 1999 Feb ; 34(2):304-7.
Ophoff K, Riesener KP, Buchin P, Truong S, Schumpelik V;
Jejuno-jejunal invagination after Dennis tube insertion for
ileus-a rare complication. [Ger] Chirurg 1999 Jun; 70(6):721-
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