Adult intussusception in Glasgow

Nationwide population-based epidemiologic study of childhood and adulthood intussusception in Taiwan

BACKGROUND

Most studies have evaluated the epidemiology of intussusception only in children. This was the first nationwide population-based study conducted to investigate the epidemiology and associated medical expenses of intussusception for all age groups in Taiwan.

METHODS

Cases of intussusception were identified from the annual hospitalization discharge claims of the National Health Insurance Research Database with corresponding International Classification of Diseases, Ninth Revision (ICD-9) code 560.0, from January 2000 to December 2007.

RESULTS

In total, 7255 incident cases of intussusception were detected. The majority of cases were children younger than 4 years of age. Significant male predominance was observed in the under-10-, 55-59-, and older-than-80-year age groups. The incidence peaked in the 1-2-year age group, reaching as high as 112.84 and 81.96 per 100,000 person-years for males and females, respectively. The incidence of intussusception was very low in adults. However, the medical expenses, number of coexisting neoplasms and malignancies, and hospitalization days were substantially higher in adults than in children. Although coexisting neoplasms developed in 40.8% of adult patients with intussusception, it occurred in only 0.4% of those younger than 3 years.

CONCLUSION

This study is the first to describe detailed age- and sex-specific incidence rates and medical expenses of intussusception for both pediatric and adult groups in Taiwan. There were significant differences between the two groups, with a much higher incidence in young children, but more coexisting neoplasms and malignancies and average medical expenses in adult patients.

Intussusception in adults: institutional review

OBJECTIVE

The objectives were to review adult intussusception (AI), its diagnosis and treatment.

BACKGROUND DATA

Intussusception is a different entity in adults than it is in children. AI represents 1% of all bowel obstructions, 5% of all intussusceptions.

METHODS

The records of all patients, 18 years and older, with the postoperative diagnosis of intussusception at the B.P.K.I.H.S during the years 2003-2009 were reviewed retrospectively.

RESULTS

In six years, there were thirty-eight patients of surgically proven AI. The patients' mean age was 49.6 years, M:F ratio was 1.3:1. Intestinal obstructions of various extents were the commonest presentation in twenty-seven patients (71%). There were 42% enteric, 32% ileocolic and 26% colonic AI. The diagnostic accuracy of the ultrasonography was 78.5%, CT scan was 90% and colonoscopy was 100%. The pathological lesions were found in 94% of AI. Among the pathological lesion, enteric have 62% benign, 38% malignant, ileocolic have 50% benign, 50% malignant, and in colocolic 70% malignant, 30% benign. In enteric AI, 68% were reduced successfully, 25% reduction was not attempted. Of ileocolic AI, 58.3% were reduced successfully, 41.6% had resection without reduction. Of colocolic AI, 30% of them were reduced successfully before resection, 70% had resection without reduction.

CONCLUSIONS

AI is a rare entity and requires a high index of suspicion. CT scanning proved to be the most useful diagnostic radiologic method. Colonoscopy is most accurate in ileocolic and colonic AI. The treatment of adult intussusception is surgical. Our review supports that small-bowel intussusception should be reduced before resection if the underlying etiology is suspected to be benign or if the resection required without reduction is deemed to be massive. Large bowel should generally be resected without reduction because pathology is mostly malignant.

Intussusception of the small bowel discovered incidentally by computed tomography

Three cases of asymptomatic intussusception in adults are reported, discovered incidentally during a CT scan of the abdomen. It is being increasingly observed in adults, possibly aided by the reformatting capabilities of the new multislice CT scanners. It has been documented in children where it is considered to be transient and of no clinical significance.

Emergency medicine bedside ultrasound diagnosis of intussusception in a patient with chronic abdominal pain and unrecognized Peutz-Jeghers syndrome

An adult patient presented to the Emergency Department (ED) with abdominal pain caused by intussusception. The diagnosis had not been made despite several prior evaluations for episodes of similar symptoms. The diagnosis was finally made by bedside ultrasound performed by the treating physicians in the ED. The patient's underlying condition of Peutz-Jeghers Syndrome with intestinal polyps was also previously undiagnosed. The discussion reviews and compares clinical aspects of intussusception in adults and children. Sonographic findings of intussusception and their pathological basis are described, and the accuracy of sonography in the diagnosis of intussusception is reviewed.

Adult intussusception

OBJECTIVE

The objectives were to review adult intussusception, its diagnosis, and its treatment.

SUMMARY BACKGROUND DATA

Adult intussusception represents 1% of all bowel obstructions, 5% of all intussusceptions, and 0.003%-0.02% of all hospital admissions. Intussusception is a different entity in adults than it is in children.

METHODS

The records of all patients 18 years and older with the postoperative diagnosis of intussusception at the Massachusetts General Hospital during the years 1964 through 1993 were reviewed retrospectively. The 58 patients were divided into those with benign enteric, malignant enteric, benign colonic, and malignant colonic lesions associated with their intussusception. The diagnosis and treatment of each were reviewed.

RESULTS

In 30 years at the Massachusetts General Hospital, there are 58 cases of surgically proven adult intussusception. The patients' mean age was 54.4 years. Most patients presented with symptoms consistent with bowel obstruction. There were 44 enteric and 14 colonic intussusceptions. Ninety-three percent of the intussusceptions were associated with a pathologic lesion. Forty-eight percent of the enteric lesions were malignant and 52% were benign. Forty-three percent of the colonic lesions were malignant and 57% were benign.

CONCLUSIONS

Intussusception occurs rarely in adults. It presents with a variety of acute, intermittent, and chronic symptoms, thus making its preoperative diagnosis difficult. Computed tomography scanning proved to be the most useful diagnostic radiologic method. The diagnosis and treatment of adult intussusception are surgical. Surgical resection of the intussusception without reduction is the preferred treatment in adults, as almost half of both colonic and enteric intussusceptions are associated with malignancy.

Ileocolic intussusception in large cell lymphoma of the terminal ileum. Report of a case

A case of an adult patient with ileocolic intussusception secondary to a lymphoma of the terminal ileum is reported. On the computed tomograms, a target mass, with the outer rim representing the annular tumour of the terminal ileum and the eccentric rim of low attenuation representing the mesentery, is described. Ultrasound patterns are those of parallel hypoechoic areas separated by hyperechoic stripes seen on longitudinal sections, and of a rounded mass of low echogenicity, exhibiting two hyperechoic concentric ring-like areas within it, on transverse scans. The appearances of the barium examinations are also described. The English literature is reviewed.

Surgical management of intussusception in the adult

Controversy concerning the appropriate surgical management of intussusception in the adult prompted review of the Mayo Clinic's experience with this uncommon entity. During the last 23 years, 48 patients had documented intussusception: 24 instances of intussusception originating in the small intestine and 24 instances of intussusception originating in the colon. Two-thirds of the colonic intussusceptions were associated with primary carcinoma of the colon. Only one-third of the intussusceptions of the small intestine were harbingers of malignancy, and 70% of these lesions were metastatic. Because of these findings, we advocate resection of intussusceptions of the colon without initial surgical reduction, in order to minimize the operative manipulation of a potential malignancy. In the patient with intussusception of the small intestine, an associated primary malignancy is uncommon. Initial reduction, followed by limited surgical resection, is the preferred treatment. Surgical resection without reduction is favored only when an underlying primary malignancy is clinically suspected.

Adult intussusception in Glasgow 1968-74

A further review of adult intussusception in Glasgow between 1968 and 1974 is presented. A higher than expected incidence of idiopathic intussusception has been found both in this and in the earlier Glasgow series of Smith and Gillespie (1968)--44 per cent and 50 per cent respectively.

Recurrent intussusception due to a primary colloid carcinoma of the large bowel in a child

A case of recurrent colo-colic intussusception due to a primary colloid carcinoma of descending colon with widespread lymphatic involvement in a child, is reported. The unusual mode of presentation and lack of awareness were responsible for a delay of 6 months before the final diagnosis was made. Two years after the operation the patient is well and there is no evidence of clinically detectable secondaries.

Tropical intussusception in adults

In contrast with the incidence in Britain and the United States, about 50% of intussusceptions in Sri Lanka occur in adults, the maximum age incidence being in the fourth decade. Seventy-six cases of intussusception in adults are analysed in this paper, 62 of which were of the caecocolic type, which though only rarely described in the West, have also been frequently reported from other tropical countries. The clinical picture was characteristic, and a mass was palpable in 90% of the patients, facilitating diagnosis without ancillary investigations. On the basis of the histological examination of resected specimens it is concluded that amoebic granulomatous formation in the dependent "diverticulum" of the caecum is the predisposing cause of the caecocolic intussusception, accounting for the chronicity of a large number of cases. Irrespective of the duration of the illness, gangrene did not occur in any of the cases if this type, although resection was occasionally required on account of irreducibility. In view of the proliferation of fibrous tissue in the wall of the caecum, complete evagination of the intussusception can only be achieved by surgical exploration and manipulation, the results of which are excellent.