Adult intussusception: a retrospective review of 41 cases

Abstract

Aim: To optimize the preoperative diagnosis and surgical management of adult intussusception (AI).

Methods: A retrospective review of the clinical features, diagnosis, management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted.

Results: Forty-one patients with 44 intussusceptions were operated on, 24.4% had acute symptoms, 24.4% had subacute symptoms, and 51.2% had chronic symptoms. 70.7% of the patients presented with intestinal obstruction. There were 20 enteric, 15 ileocolic, eight colocolonic and one sigmoidorectal intussusceptions. 65.9% of intussusceptions were diagnosed preoperatively using a computed tomography (CT) scan (90.5% accurate) and ultrasonography (60.0% accurate, rising to 91.7% for patients who had a palpable abdominal mass). Coloscopy located the occupying lesions of the lead point of ileocolic, colocolonic and sigmoidorectal intussusceptions. Four intussusceptions in three patients were simply reduced. Twenty-one patients underwent resection after primary reduction. There was no mortality and anastomosis leakage perioperatively. Except for one patient with multiple small bowel adenomas, which recurred 5 mo after surgery, no patients were recurrent within 6 mo. Pathologically, 54.5% of the intussusceptions had a tumor, of which 27.3% were malignant. 9.1% comprised nontumorous polyps. Four intussusceptions had a gastrojejunostomy with intestinal intubation, and four intussusceptions had no organic lesion.

Conclusion: CT is the most effective and accurate diagnostic technique. Colonoscopy can detect most lead point lesions of non-enteric intussusceptions. Intestinal intubation should be avoided.

Figure 1

A 44-year-old man with two enteric intussusceptions due to multiple adenoma cancerations. The intussusceptions appear as round target-shaped masses with a hypodense area of fat density close to its centre, the mesenteric fat. The beam is perpendicular to the axis of the intussusceptions.

Figure 2

A 64-year-old man with an ileocolic intussusception due to a ileum B cell malignant lymphoma. A sausage-shaped mass with high density soft tissue above represents the edematous bowel wall of the intussuscipiens and the intussusceptum, with fat density below, representing mesenteric fat. The higher linear density within the mesenteric fat (arrow) is mesenteric blood vessels. This appearance is caused by the axis of the intussusception being parallel with the computed tomography (CT) beam.

Figure 3

Efferent loop intussusception with a tube. A 70-year-old woman underwent Billroth II gastrectomy and efferent loop intubation for enteral nutrition. One month postoperatively, CT at the level of the lower abdomen shows a round, target-shaped mass in the left abdomen. The mass consists of a hyperdense tube (arrow), a “half-moon” shaped hypodense area medial to it, the intussuscepted mesenteric fat and a soft tissue rim representing the opposing walls of the intussuscipiens and the intussusceptum.

Figure 4

An 87-year-old woman with a colocolonic intussusception due to ascending colon carcinoma.