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. 2016:20:142-6.
doi: 10.1016/j.ijscr.2016.01.019. Epub 2016 Jan 22.

Surgical versus conservative management of adult intussusception: Case series and review

Nail Aydin  1 , Andrew Roth  2 , Subhasis Misra  3
Affiliations

Surgical versus conservative management of adult intussusception: Case series and review

Nail Aydin et al. Int J Surg Case Rep. 2016.

Abstract

Introduction: Intussusception is the telescoping of a segment of bowel into its adjacent segment. It is a known cause of abdominal pain in the pediatric population, however, it is rare in the adult. Adults do not always present with the typical symptoms seen in young children, making the clinical diagnosis more difficult. The etiology of adult intussusception can be idiopathic, benign, or malignant. Diagnosis is most accurately made with computed tomography, which is sensitive in detecting intussusception as well as potential lead points.

Presentation of cases: This study presents four adult patients with intussusception. The first three patients are adults with idiopathic intussusception and no evidence of a lead point. The fourth case involves intussusception secondary to a jejunal carcinoid tumor which was treated surgically. Each case has unique features in terms of length and number of intussusceptions, duration of symptoms, and recurrence.

Discussion: Surgical treatment was once argued to be universally appropriate for adult intussusceptions; however, with increased use of advanced imaging, newer literature is demonstrating that this is not true in all cases. Idiopathic intussusception presents with nonspecific symptoms and can be managed with supportive care when the history and clinical picture indicate low probability of a neoplasm.

Conclusion: This study aims to raise awareness to the potential diagnosis and management of intussusceptions, particularly the symptomatic idiopathic type in the young adult.

Keywords: Adult intussusception; Carcinoid; Computed tomography; Idiopathic intussusception.

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Figures

Fig. 1
Fig. 1
Computed tomography (CT) of the abdomen and pelvis with IV contrast showing a small bowel intussusception in the left mid abdomen, extending over a vertical height of about 3 cm. Note the appearance of a “target sign”.
Fig. 2
Fig. 2
CT Abdomen/Pelvis with oral contrast.
Fig. 3
Fig. 3
CT Abdomen/Pelvis without contrast. Note the intussusception in the anterior abdomen at the level of the umbilicus.
Fig. 4
Fig. 4
CT Abdomen/Pelvis with IV and oral contrast.
Fig. 5
Fig. 5
CT abdomen without contrast showing multiple target signs in the small bowel (arrows).
Fig. 6
Fig. 6
Area of intussusception found in proximal jejunum. Affected area of bowel was excised and jejunojejunal anastomosis was created.
See this image and copyright information in PMC

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