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.

Figure 1

Abdominal computed tomography in adult intussusception. A: The characteristic “target”-shaped soft-tissue mass with a layering effect of a 29-year old male patient with a diffuse, small B-cell (Burkitt-like) non Hodgkin lymphoma of the ileum who developed an ileo-colic intussusception; B: A “sausage”-shaped soft tissue mass in the ascending colon of the same patient.

Figure 2

Colonoscopy. Revealing the presence of the inverted terminal ileum (intussusceptum) in the ascending colon (intussuscipiens) in a patient with an ileo-cecal intussusception due to an ileal lipoma.

Figure 3

Intraoperative findings. A: Thickened, congested and inflamed terminal ileum with proximal small bowel obstruction in a 75-year old woman with ileo-colonic intussusception; B: The surgical specimen after the en bloc resection of the terminal ileum and the ascending colon in the same patient; C: The cause of the intussusception was a lipoma of the ileo-cecal valve (arrow).