Community teaching hospital surgical experience with adult intussusception: Study of nine cases and literature review

Abstract

Introduction: Although more commonly thought of as a surgical problem affecting children, surgeons evaluating the adult acute abdomen should remain vigilante in diagnosing intussusception. In this case series, we reviewed 6 years of medical records at a community teaching hospital in order to analyze the etiology, presentation, and management of nine cases of adult intussusception.

Presentation of cases: Most of the patients in our series shared symptoms of nausea, vomiting, and abdominal pain. Computed tomography scan was crucial in distinguishing adult intussusception from other causes of acute abdomen. Eight patients underwent operative exploration, five of whom underwent bowel resection. One patient's symptoms resolved with no surgical intervention. All nine patients had excellent outcomes.

Discussion: Although detailed history and physical examination are essential in all cases of acute abdomen, CT scan findings of "target" signs are pathognomonic of intussusception. Laparoscopy should be strongly considered in select cases. Current literature suggests that reduction may be performed before resection if the lesion meets certain stringent parameters. The primary concern with regards to reduction before resection is potential embolization of malignant cells. Colonic intussusception is almost always treated with resection without reduction, while small intestinal intussusception could be treated by reduction before resection, if the small bowel lead points are less likely to be malignant.

Conclusion: Intussusception is a rare but serious etiology of the acute abdomen in adults. Each case should be evaluated independently according to the specific type of lead-point lesion. Excellent outcomes may be anticipated with prompt diagnosis and surgical treatment.

Keywords: Embolize; Intussusception; Reduction; Resection.

Fig. 1

Ileocecal anatomy showing intussusception.

Fig. 2

Classic “target” sign indicating intussusception from case #1.

Fig. 3

Abdominal CT indicating intussusception from case #2.

Fig. 4

Axial CT showing intussusception from case #9.

Fig. 5

Coronal CT showing intussusception from case #9.

Fig. 6

Gross morphology of the spindle cell tumor from case #9.

Fig. 7

Intussusception of the small bowel segment from case #9.