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Sciberras N, Zammit SC, Sidhu R. Small bowel intussusception - aetiology & management. Curr Opin Gastroenterol 2024; 40:175-182. [PMID: 38190421 DOI: 10.1097/mog.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Adult small bowel intussusception (SBI) differs in incidence, symptomatology and management from the more commonly encountered paediatric intussusception. This review spans across the multitude of causes of adult SBI, and summarises the diagnostic work-up and management options according to recent literature. RECENT FINDINGS There has been an increase in use of small bowel capsule endoscopy and point-of-care ultrasound for the diagnosis of acute adult SBI. SUMMARY A high degree of suspicion of a malignant cause of SBI is required in the adult population. Alarm clinical features include weight loss, history of malignancy, and iron deficiency anaemia. CT remains the gold standard imaging technique as it may identify the lead point and thus aid in endoscopic or surgical management. If malignancy is excluded and no lead point is identified, serology and histology may be helpful to look for inflammatory, infective and autoimmune aetiology.
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Affiliation(s)
| | | | - Reena Sidhu
- Department of Gastroenterology, Sheffield Teaching Hospital NHS Foundation Trust, Department of Infection, Immunity & Cardiovascular Diseases, University of Sheffield, UK
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Eschlböck SM, Weixler B, Weidinger C, Pozios I. Postoperative intussusception: a rare but critical complication in adult patients with Crohn's disease - case report and literature review. Innov Surg Sci 2023; 8:3-8. [PMID: 37842197 PMCID: PMC10576550 DOI: 10.1515/iss-2023-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/10/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives Postoperative entero-enteric intussusception is a rare complication in adult patients with Crohn's disease (CD). The knowledge of this distinct complication and its timely diagnosis and therapy are of utmost importance to prevent fatal intestinal necrosis. There is no consensus about the optimal management of postoperative entero-enteric intussusception, although surgical exploration is widely advised. Case presentation In this report we describe an unusual case of postoperative jejuno-jejunal intussusception following small bowel resection in a patient with stricturing CD. Furthermore, this report offers an overview of the available literature and summarizes the best approach and management strategies for adult intussusception associated with CD. Conclusions Delay in diagnosis and therapy can lead to life-threatening complications. Early diagnosis and emergent surgical treatment prevent intestinal necrosis and reduce the risk of short bowel syndrome.
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Affiliation(s)
- Sophie M. Eschlböck
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Campus Benjamin Franklin, Hindenburgdamm 30, 12203Berlin, Germany
| | - Benjamin Weixler
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Campus Benjamin Franklin, Hindenburgdamm 30, 12203Berlin, Germany
| | - Carl Weidinger
- Department of Gastroenterology, Rheumatology and Infectiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203Berlin, Germany
| | - Ioannis Pozios
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Campus Benjamin Franklin, Hindenburgdamm 30, 12203Berlin, Germany
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Silva V, Khalil K, Zaidi SR, Highsmith S, Tucker JI. Intussusception and Chronic Marijuana Use in a Young Adult. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932479. [PMID: 34388145 PMCID: PMC8370136 DOI: 10.12659/ajcr.932479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient: Female, 26-year-old
Final Diagnosis: Intussusception
Symptoms: Abdominal pain • nausea
Medication: —
Clinical Procedure: CT scan • surgery
Specialty: Gastroenterology and Hepatology • General and Internal Medicine • Surgery
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Affiliation(s)
- Vixey Silva
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Krystina Khalil
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
| | - Syeda Ramsha Zaidi
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
| | - Shanequa Highsmith
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
| | - Jared I Tucker
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
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Boyack I, Vu D, Patel P, Opsha O. Colocolic intussusception secondary to submucosal lipoma. Am J Emerg Med 2020; 38:1697.e1-1697.e3. [DOI: 10.1016/j.ajem.2020.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022] Open
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Mazzotta E, Lauricella S, Carannante F, Mascianà G, Caricato M, Capolupo GT. Ileo-ileal intussusception caused by small bowel leiomyosarcoma: A rare case report. Int J Surg Case Rep 2020; 72:52-55. [PMID: 32506030 PMCID: PMC7283087 DOI: 10.1016/j.ijscr.2020.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Intussusception is the telescoping of one segment of the bowel into an adjacent bowel segment, causing venous congestion, edema, and blood supply reduction. We present a case of ileo-ileal intussusception in an adult patient with intestinal obstruction caused by a rare mesenchymal malignant lesion of the distal ileum: Leiomyosarcoma (LMS). PRESENTATION OF CASE A 90-year-old Caucasian man presented to the hospital with a two-day history of abdominal pain, nausea, and bowel occlusion. Preoperative Computer Tomography (CT) showed a solid mass with stratified walls in the lumen of the cecum with the classics "bulls-eye" appearance with concentric rings, suggestive of intussusception. The patient underwent emergency laparotomy with evidence of a small bowel wall tumor driving ileo-ileal intussusception with ischemic damage. Ileocecal resection was performed without postoperative complications. Histopathological examination showed a tumor on the muscular layer of the small bowel. The definitive diagnosis was LMS. DISCUSSION Adult intussusception is a rare condition, with an incidence of 2/1 000 000 cases per year worldwide. About 60% of patients suffering from this disease require surgery. Clinical presentation can be non-specific because of its no characteristic signs and symptoms. The most common presenting symptom is abdominal pain with bowel obstruction sings. Intussusception can occur anywhere along the small and large intestine and it is typically associated with a Lead Point (LP). The LP may be benign or malignant conditions. Infrequent malignant causes include LMS. CONCLUSION Diagnosis of intussusception is relatively challenging because of its non-specific symptoms. CT scan is the examimation of choice for the diagnosis because of its peculiar images. In adults, surgical treatment is recommended with laparoscopic or open approach according to surgeon expertise, sometimes in an emergency setting.
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Affiliation(s)
- Erica Mazzotta
- Colorectal Surgery Unit, Università Campus Bio-Medico, Rome, Italy.
| | - Sara Lauricella
- Colorectal Surgery Unit, Università Campus Bio-Medico, Rome, Italy
| | | | | | - Marco Caricato
- Colorectal Surgery Unit, Università Campus Bio-Medico, Rome, Italy
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Transient jejuno-jejunal intussusception in an anabolic steroid user-A case report. Int J Surg Case Rep 2020; 70:126-129. [PMID: 32428711 PMCID: PMC7235922 DOI: 10.1016/j.ijscr.2020.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/22/2020] [Accepted: 04/01/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Adult intussusception (AI) is both a challenging and rare diagnosis, with predisposing factors including malignancy, surgery and infection to name a few. Transient jejunal intussusception is a subset of AI which is usually diagnosed radiologically, with diagnostic laparoscopy utilised to determine whether a malignant cause is identifiable and subsequently treatable. PRESENTING CASE We present the case of a previously healthy 36-year-old male diagnosed with transient jejunal intussusception on computed tomography after presenting with abdominal pain. Blood tests on admission were normal apart from polycythaemia. His only significant history was that of chronic anabolic steroid use. He had a subsequent normal gastroscopy and colonoscopy with diagnostic laparoscopy demonstrating thickening of the small bowel. Histopathological analysis of the intraoperative specimen was normal. The patient improved and was discharged with no further complications. CONCLUSION This case highlights the potential association between anabolic steroid use resulting in polycythaemia, and AI or transient jejunal intussusception, along with further validating a conservative approach in the management of AI in patients deemed to be low risk of malignancy on pre-operative evaluation.
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Tan HL, Koh YX, Taufik M, Lye WK, Goh BKP, Ong HS. A Clinical Scoring System to Predict the Clinical Sequelae of Computed Tomography Diagnosed Intussusception. World J Surg 2018; 42:682-687. [PMID: 28916884 DOI: 10.1007/s00268-017-4196-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intussusception in adults is increasingly diagnosed on cross-sectional imaging with a lack of clear recommendations on management. The presence of an underlying lead point is a key to guiding management as its absence can predict spontaneous resolution. We studied adult patients with computed tomography (CT) diagnosed intussusception formulate a clinical scoring system to predict the risk of an underlying lead point. METHODOLOGY We performed a retrospective review of all adult patients who underwent CT scans of the abdomen and pelvis in our institution between 2001 and 2014. Independent associations of an underlying lead point were derived following multivariable analysis, from which a clinical scoring system was developed. RESULTS We studied 140 patients. In multivariable analysis, six factors were found to be independently associated with the presence of an underlying lead point, namely gender, abdominal pain, CT evidence of colonic involvement, CT evidence of a lead point, distal diameter ≥27 mm and minimum wall thickness ≥3 mm. A nine-point clinical scoring system was developed, with a cutoff score of four or higher yielding a sensitivity and specificity of 0.75 and 0.81, respectively. CONCLUSION Our clinical scoring system provides a quantitative tool to predict the likelihood of an underlying lead point in CT-diagnosed intussusception in adults to help guide management.
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Affiliation(s)
- Hwee Leong Tan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, 20 College Road, Level 5, Singapore, 169856, Singapore
| | - Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Level 5, Singapore, 169856, Singapore.
| | - Mohammad Taufik
- Department of Diagnostic Radiology, Singapore General Hospital, 20 College Road, Level 4, Singapore, 169856, Singapore
| | - Weng Kit Lye
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Level 5, Singapore, 169856, Singapore
| | - Hock Soo Ong
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, 20 College Road, Level 5, Singapore, 169856, Singapore
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Transient Descending Colocolonic Intussusception Due to a Large Fecaloma in an Adult. ACG Case Rep J 2017; 4:e94. [PMID: 28798942 PMCID: PMC5541757 DOI: 10.14309/crj.2017.94] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/25/2017] [Indexed: 12/26/2022] Open
Abstract
Intussusception typically occurs in infants and children, with adults representing 5% of cases. A 53-year-old African American woman presented with lower abdominal pain and tenderness. Computed tomography of the abdomen and pelvis demonstrated a 3.5 cm colocolonic intussusception in the descending colon. Emergent colonoscopy found solid stool in the mid descending colon. Water-soluble rectal enema showed a filling defect in the mid descending colon. Repeat colonoscopy demonstrated presence of a large fecaloma in left colon. Laxatives were initiated, and abdominal pain subsided. To our knowledge, this is the first report of colocolonic intussusception secondary to fecaloma.
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Shenoy S. Adult intussusception: A case series and review. World J Gastrointest Endosc 2017; 9:220-227. [PMID: 28572876 PMCID: PMC5437388 DOI: 10.4253/wjge.v9.i5.220] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/22/2016] [Accepted: 03/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To identify factors differentiating pathologic adult intussusception (AI) from benign causes and the need for an operative intervention. Current evidence available from the literature is discussed.
METHODS This is a case series of eleven patients over the age of 18 and a surgical consultation for “Intussusception” at a single veteran’s hospital over a five-year period (2011-2016). AI was diagnosed on computed tomography (CT) scan and or flexible endoscopy (colonoscopy). Surgical referrals were from the emergency room, endoscopy suites and the radiologists.
RESULTS A total of 11 cases, 9 males and 2 females were diagnosed with AI. Median age was 58 years. Abdominal pain and change in bowel habits were most common symptoms. CT scan and or colonoscopy diagnosed AI, in ten/eleven (90%) patients. There were 6 small bowel-small bowel, 4 ileocecal, and 1 sigmoid-rectal AI. 8 patients (72%) needed an operation. Bowel resection was required and definitive pathology was diagnosed in 7 patients (63%). Five patients had malignant and 2 patients had benign etiology. Small bowel enteroscopy excluded pathology in 4 cases (37%) with AI. Younger patients tend to have a benign diagnosis.
CONCLUSION Majority of AI have malignant etiology however idiopathic intussusception is being seen more frequently. Operative intervention remains the mainstay however, certain small bowel intussusception especially in younger patients may be a benign, physiological, transient phenomenon and laparoscopy with reduction or watchful waiting may be an acceptable strategy. These patients should undergo endoscopic or capsule endoscopy to exclude intrinsic luminal lesions.
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Ileocolic Intussusception in a Leukemic Adult Patient: A Case Report and Review of the Literature. Case Rep Surg 2016; 2016:3972605. [PMID: 27840762 PMCID: PMC5093260 DOI: 10.1155/2016/3972605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/04/2016] [Indexed: 12/26/2022] Open
Abstract
We present a rare case of intussusception in a 41-year-old man with acute myeloid leukemia without an evidence of leukemic infiltration of the bowel. The patient presented to the emergency room with right lower quadrant pain. Initially he was diagnosed with typhlitis. CT scan was done and showed ileocolic intussusception without a definitive lead point identified. Patient underwent hemicolectomy and histopathological study of the specimen did not show any leukemic infiltrate. High suspicion of intussusception should be kept in mind with leukemic patients presenting with abdominal pain.
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Mandaliya R, Aggarwal D, Lim P. Trapped Among the Waves: Massive Jejunojejunal Intussusception After Gastric Bypass. Am J Med 2016; 129:819-22. [PMID: 27154782 DOI: 10.1016/j.amjmed.2016.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/07/2016] [Accepted: 04/07/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Rohan Mandaliya
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pa.
| | - Divya Aggarwal
- Department of Medicine, Abington Hospital-Jefferson Health, Pa
| | - Philip Lim
- Department of Radiology, Abington Hospital-Jefferson Health, Pa
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Aydin N, Roth A, Misra S. Surgical versus conservative management of adult intussusception: Case series and review. Int J Surg Case Rep 2016; 20:142-6. [PMID: 26859872 PMCID: PMC4818310 DOI: 10.1016/j.ijscr.2016.01.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/16/2016] [Indexed: 11/17/2022] Open
Abstract
Adult intussusception has traditionally been considered an indication for surgery. Transient intussusceptions are now detected with increased use of imaging. In patients with low risk for underlying neoplasm, supportive care is sufficient. Smaller intussusceptions are more likely to resolve with conservative treatment.
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.
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Affiliation(s)
- Nail Aydin
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX 79106-1786, USA.
| | - Andrew Roth
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX 79106-1786, USA.
| | - Subhasis Misra
- Department of Surgery, Texas Tech University Health Sciences Center, 1400 South Coulter Street, Amarillo, TX 79106-1786, USA.
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Ileocaecal Intussusception with a Lead Point: Unusual MDCT Findings of Active Crohn's Disease Involving the Appendix. Case Rep Radiol 2015; 2015:856483. [PMID: 26558130 PMCID: PMC4629019 DOI: 10.1155/2015/856483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/07/2015] [Indexed: 01/15/2023] Open
Abstract
Adult intussusception is a rare entity accounting for 1% of all bowel obstructions. Unlike intussusceptions in children, which are idiopathic in 90% of cases, adult intussusceptions have an identifiable cause (lead point) in the majority of cases. Crohn's disease (CD) may affect any part of the gastrointestinal tract, including the appendix. It was shown to be a predisposing factor for intussusception. Here, we report a rare case of adult intussusception with a lead point, emphasizing diagnostic input of multidetector computed tomography (MDCT) in a patient with active CD that involves the appendix.
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Vobořil R, Fanta J, Bačkovský P, Ehrenberger D, Vobořilová J. Transient and Non-Transient Intussusceptions of the Large Bowel in Adults: Two Case Reports. ACTA MEDICA (HRADEC KRÁLOVÉ) 2015; 58:66-8. [PMID: 26455569 DOI: 10.14712/18059694.2015.96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intussusception of the large bowel in adults is a very rare pathological condition. However, it has its clinical importance because intussusception is very often associated with an intraluminal lesion. CASE REPORT We report two cases of the large bowel intussusception, ileocolic and colorectal. Both intussusceptions were associated with a malignant tumor. However, the clinical presentation was different. One of the intussusceptions was of non-transient character, while the second one resolved spontaneously before operation. Both patients underwent surgery and malignant tumors were found and removed. RESULTS The purpose of the article is to draw attention to intussusception and emphasize that intussusception, either transient or non-transient, should be further examined. CONCLUSIONS The intussusception may be the first and the only signal of the existence of a malignant tumor, very often colorectal carcinoma.
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Affiliation(s)
- René Vobořil
- Department of Surgery, First Faculty of Medicine, Charles University in Prague and Na Bulovce Hospital, Prague, Czech Republic.
| | - Jan Fanta
- Department of Surgery, First Faculty of Medicine, Charles University in Prague and Na Bulovce Hospital, Prague, Czech Republic
| | - Petr Bačkovský
- Department of Surgery, Hospital of Merciful Sisters of St. Borromeo, Prague, Czech Republic
| | - Daniel Ehrenberger
- Department of Surgery, Hospital of Merciful Sisters of St. Borromeo, Prague, Czech Republic
| | - Jana Vobořilová
- Department of Biochemistry, Cell and Molecular Biology, Division of Cell and Molecular Biology, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Aref H, Nawawi A, Altaf A, Aljiffry M. Transient small bowel intussusception in an adult: case report with intraoperative video and literature review. BMC Surg 2015; 15:36. [PMID: 25881028 PMCID: PMC4416349 DOI: 10.1186/s12893-015-0020-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/17/2015] [Indexed: 11/25/2022] Open
Abstract
Background The term intussusception refers to invagination of a segment of the gastrointestinal tract into the lumen of an adjacent segment. This is a rare entity and it is more prevalent in children and less common in adults. The diagnosis of intussusception in adults is difficult as a result of the nonspecific signs and symptoms. As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. The laparoscopic approach offers both a diagnostic option and a therapeutic one for intussusception in adults. Case presentation We report a forty-one year old male patient, who presented to our Emergency Department complaining of peri-umbilical pain associated with nausea and vomiting for 1 day. Diagnosed with transient small bowel intussusception without any obvious underlying pathology. This report is the first to present an intra-operative video showing the small bowel intussuscepting and reducing spontaneously. Furthermore, the authors present a review about this rare condition, including previously reported similar cases in literature. Conclusion Transient intussusception is extremely rare and is a challenging condition. Imaging techniques, especially CT scan, are helpful in the diagnosis of intussusception. However, laparoscopy offers the advantage of distinguishing transient intussusception from persistent intussusception. Electronic supplementary material The online version of this article (doi:10.1186/s12893-015-0020-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hager Aref
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abrar Nawawi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulmalik Altaf
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Murad Aljiffry
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Bowel intussusceptions in adults: the role of imaging. Radiol Med 2014; 120:105-17. [DOI: 10.1007/s11547-014-0454-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/14/2014] [Indexed: 02/07/2023]
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Intussusception in adults: what radiologists should know. Emerg Radiol 2011; 19:89-101. [PMID: 22200965 DOI: 10.1007/s10140-011-1006-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 11/22/2011] [Indexed: 12/14/2022]
Abstract
Adult intussusception (AI) is a rare entity with an organic lesion within the intussusception in 70-90% of the cases. Intussusception is classified according to location, etiology, and to the presence or not of a lead point. We illustrate several causes of AI with a variety of radiological findings on plain film, ultrasonography, computed tomography, magnetic resonance, and endoscopy seen at our institution. Imaging plays a major role in their diagnosis and in determining the appropriate treatment.
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Cantarella S, Zisa M, Grasso E, Politi A, Guastella T. The intussusception in patients with Crohn's disease: the role of the surgeon. Updates Surg 2011; 65:77-80. [PMID: 21971920 DOI: 10.1007/s13304-011-0111-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/10/2011] [Indexed: 11/27/2022]
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Loukas M, Pellerin M, Kimball Z, de la Garza-Jordan J, Tubbs RS, Jordan R. Intussusception: An anatomical perspective with review of the literature. Clin Anat 2011; 24:552-61. [DOI: 10.1002/ca.21099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 08/10/2010] [Accepted: 10/25/2010] [Indexed: 12/24/2022]
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Abstract
OBJECTIVE The purpose of our study was to identify whether any CT characteristics can be used to diagnose surgical intussusceptions. MATERIALS AND METHODS A search of CT reports on adults revealed 118 patients with 136 intussusceptions. Two blinded readers independently reviewed the CT examinations and documented intussusception characteristics. Medical records were reviewed to determine patient outcome. Performance, interobserver agreement (A), and significance of CT characteristics to identify surgical intussusceptions were calculated. RESULTS Of 95,223 CT examinations, 0.13% (121/95,223) documented 136 intussusceptions over a 7-year period, of which 88.2% (120/136) were enteroenteric, 3.7% (5/136) were enterocolic, and 4.4% (6/136) were colocolic lesions or in other locations. Eight (5.9%) were surgical and 128 (94.12%) were nonsurgical lesions. Five of eight (63%) surgical lesions involved the colon. Only two of eight surgical lesions had malignant lead points. The mean sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing surgical enteroenteric lesions using a measured lesion length of > 3.5 cm were 100%, 57.3%, 5.7%, and 100% (A = 0.68), respectively. Similar figures using the measured axial diameter > 3 cm were 100%, 32.9%, 3.7% and 100% (A= 0.65), respectively. CONCLUSION Surgical intussusceptions in adults are infrequent among the intussusceptions that are detected on CT. Most enteroenteric lesions are nonsurgical lesions, whereas lesions that affect the colon are often surgical. Many nonsurgical enteroenteric intussusceptions are longer than 3.5 cm and thicker than 3 cm, suggesting these CT features may not be useful for diagnosing surgical bowel intussusceptions in adults.
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Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, Vassiliou I, Theodosopoulos T. Intussusception of the bowel in adults: A review. World J Gastroenterol 2009; 15:407-11. [PMID: 19152443 PMCID: PMC2653360 DOI: 10.3748/wjg.15.407] [Citation(s) in RCA: 452] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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.
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MDCT and 3D Imaging in Transient Enteroenteric Intussusception: Clinical Observations and Review of the Literature. AJR Am J Roentgenol 2008; 191:736-42. [DOI: 10.2214/ajr.07.3741] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Postoperative enteroenteric intussusception in patients with Crohn’s disease: Report of two cases. Surg Today 2008; 38:366-70. [DOI: 10.1007/s00595-007-3624-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 07/11/2007] [Indexed: 10/22/2022]
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Rea JD, Lockhart ME, Yarbrough DE, Leeth RR, Bledsoe SE, Clements RH. Approach to management of intussusception in adults: a new paradigm in the computed tomography era. Am Surg 2008. [PMID: 18092641 DOI: 10.1177/000313480707301104] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Intussusception has been considered an operative indication in adults as a result of the risk of ischemia and the possibility of a malignant lead point. Computed tomographic (CT) scans can reveal unsuspected intussusception. All CT reports from July 1999 to December 2005 were scanned electronically for letter strings to include the keyword intussusception. Identified CT scans were analyzed to characterize the intussusception and associated findings. Clinical, laboratory, pathological, and follow-up variables were gleaned from medical records. Findings were analyzed by treatment and findings at operation. Review of 380,999 CT reports yielded 170 (0.04%) adult patients (mean age, 41 years) with intussusceptions described as enteroenteric in 149 (87.6%), ileocecal in eight (4.7%), colocolonic in 10 (5.9%), and gastroenteric in three (1.8%). Radiological features included mean length of 4.4 cm (range, 0.8-20.5 cm) and diameter of 3.2 cm (range, 1.6-11.5 cm). Twenty-nine (17.1%) had a lead point, and 12 (7.1%) had bowel obstruction. Clinically, 88 (48.2%) patients reported abdominal pain, 52 (30.6%) had nausea and/or vomiting, and 74 (43.5%) had objective findings on abdominal examination. Thirty of 170 (17.6%) patients underwent operation, but only 15 (8.8%) patients had pathologic findings that correlated with CT findings. Seven had,enteroenteric intussusceptions from benign neoplasms (two), adhesions (one), local inflammation (one), previous anastomosis (one), Crohn's disease (one), and idiopathic (one). Three had ileocolic disease, including cecal cancer (one), metastatic melanoma (one) and idiopathic (one; whereas five patients had colocolonic intussusception from colon cancer (three), tubulovillous adenoma (one), and local inflammation (one). Of the 15 without intussusception at exploration, five had pathology related to trauma, four had nonincarcerated internal hernia after Roux-en-Y gastric bypass, four had negative explorations, one had adhesions, and one had appendicitis that did not correlate with CT findings. No patient in the observation group required subsequent operative exploration for intussusception at mean 14.1 months (range, 0.25-67.5 months) follow up. All operative patients demonstrated gastrointestinal symptoms versus 55.3 per cent of the observation group (P < 0.006). Analysis of CT features demonstrated differences among patients observed without operation, those without intussusception at exploration, and confirmed intussusception with regard to mean intussusception length 3.8 versus 3.8 versus 9.6 cm, diameter 3.0 versus 3.2 versus 4.8 cm, lead point 12.1 per cent versus 30 per cent versus 53.3 per cent, and proximal obstruction 3.8 per cent versus 0 per cent versus 46.7 per cent, respectively. Intussusceptions in adults discovered by CT scanning do not always mandate exploration. Most cases can be treated expectantly despite the presence of gastrointestinal symptoms. Close follow up is recommended with imaging and/or endoscopic surveillance. Length and diameter of the intussusception, presence of a lead point, or bowel obstruction on CT are predictive of findings that warrant exploration.
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Affiliation(s)
- Jennifer D Rea
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
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25
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Multislice CT in adult colocolic intussusception: case report and review of the literature. Emerg Radiol 2007; 15:361-6. [DOI: 10.1007/s10140-007-0682-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 10/22/2007] [Indexed: 10/22/2022]
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26
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Adult intestinal intussusception: can abdominal MDCT distinguish an intussusception caused by a lead point? ACTA ACUST UNITED AC 2007; 33:582-8. [DOI: 10.1007/s00261-007-9328-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Sheth A, Jordan PA. Does small bowel intussusception in adults always require surgery? Dig Dis Sci 2007; 52:1764-6. [PMID: 17420949 DOI: 10.1007/s10620-006-9163-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2005] [Accepted: 12/01/2005] [Indexed: 12/09/2022]
Affiliation(s)
- Ankur Sheth
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71130-3932, USA.
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Maconi G, Radice E, Greco S, Bezzio C, Bianchi Porro G. Transient small-bowel intussusceptions in adults: significance of ultrasonographic detection. Clin Radiol 2007; 62:792-7. [PMID: 17604770 DOI: 10.1016/j.crad.2007.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 02/13/2007] [Accepted: 02/18/2007] [Indexed: 10/23/2022]
Abstract
AIM To investigate the frequency, clinical significance, and outcome of small-bowel intussusceptions in adults detected using ultrasound in an outpatient setting. PATIENTS AND METHODS In two different retrospective (January 2001 to April 2003) and prospective (May 2003 to June 2005) periods, 33 small-bowel intussusceptions were found in 32 patients (13 females; mean age: 38.1 years) with known or suspected intestinal disease. Patients underwent diagnostic work-up to assess any organic disease. Patients with self-limiting intussusception were submitted to clinical and ultrasonographic follow-up. RESULTS Of the 32 patients with small-bowel intussusception, 25 were identified in the prospective series of 4487 examinations (0.53%) and seven in the retrospective series of 5342 examinations (0.15%; p=0.002). Four patients had persistent and 28 self-limiting intussusceptions. Self-limiting intussusceptions were idiopathic in 11 patients (39%) or associated with organic diseases in 17 (Crohn's disease in 11 patients, celiac disease in three, ulcerative colitis in one patient, and previous surgery for cancer in two). Self-limiting intussusceptions were asymptomatic in 25% of patients. CONCLUSION Small-bowel intussusceptions in adults are not rare and are frequently self-limiting, idiopathic, or related to organic diseases, mainly Crohn's disease and coeliac disease.
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Affiliation(s)
- G Maconi
- Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan, Italy. giovanni.maconi@unimi-it
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Kim YH, Blake MA, Harisinghani MG, Archer-Arroyo K, Hahn PF, Pitman MB, Mueller PR. Adult intestinal intussusception: CT appearances and identification of a causative lead point. Radiographics 2006; 26:733-44. [PMID: 16702451 DOI: 10.1148/rg.263055100] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The widespread application of computed tomography (CT) in different clinical situations has increased the detection of intussusception, particularly non-lead point intussusception, which tends to be transient. Consequently, determining the clinical significance of intussusception seen at CT poses a diagnostic challenge. Patients with intussusception may or may not be symptomatic, and symptoms can be acute, intermittent, or chronic, making clinical diagnosis difficult. In most cases, radiologists can readily make the correct diagnosis of intestinal intussusception by noting the typical bowel-within-bowel appearance at abdominal CT. However, the CT findings that help differentiate between lead point and non-lead point intussusception have not been well studied. Nevertheless, although there is considerable overlap of CT findings, when a lead mass is seen at CT as a separate and distinct entity vis-à-vis edematous bowel, it can be considered a reliable indicator of a lead point intussusception. Differentiating between lead point and non-lead point intussusception is important in determining the appropriate treatment and has the potential to reduce the prevalence of unnecessary surgery.
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Affiliation(s)
- Young H Kim
- Department of Radiology, UMass Memorial, University of Massachusetts, 55 Lake Ave North, Worcester, MA 01655, USA.
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Mateen MA, Saleem S, Rao PC, Gangadhar V, Reddy DN. Transient small bowel intussusceptions: ultrasound findings and clinical significance. ACTA ACUST UNITED AC 2006; 31:410-6. [PMID: 16944032 DOI: 10.1007/s00261-006-9078-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 07/13/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the ultrasound (US) findings and clinical significance of transient small bowel intussusceptions (TSBI) in adults and children. METHODS Clinical records and US findings of 108 consecutive patients of intestinal intussusception diagnosed on US between August 1995 and August 2004 were reviewed. In all cases, the length, diameter, wall thickness and color Doppler study of the bowel segment involved in intussusception were evaluated. Subsequent follow-up scans were performed at 30 min, 3 days and 2 weeks. Patients were clinically followed up for 6 months. RESULTS Forty-one patients were diagnosed as TSBI. Thirty-six intussusceptions were incidentally detected during US performed for some unrelated disease or vague abdominal symptom. Five patients presented with signs of obstruction at the time of the initial US diagnosis; however, the intussusceptions resolved without any treatment and were not detected on follow-up scans. Sixty-seven symptomatic patients required surgical intervention. CONCLUSION Incidentally detected, small bowel intussusceptions without an identifiable pathological lead point, with a normal wall thickness, a length of less than 3.5 cm, normal nondilated proximal bowel and normal vascularity on color Doppler reduce spontaneously and are of no clinical significance.
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Affiliation(s)
- M A Mateen
- Department of Radiodiagnosis, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500082, India
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Sandrasegaran K, Kopecky KK, Rajesh A, Lappas J. Proximal small bowel intussusceptions in adults: CT appearance and clinical significance. ACTA ACUST UNITED AC 2004; 29:653-7. [PMID: 15185038 DOI: 10.1007/s00261-003-0165-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2003] [Accepted: 11/22/2003] [Indexed: 11/30/2022]
Abstract
BACKGROUND According to the clinical literature, intestinal intussusception in adults is rare, is associated with a pathologic lead point, and is usually treated surgically. Nonobstructing small bowel intussusception has been reported as a transient finding on computed tomographic (CT) studies. METHODS We evaluated the radiographic and clinical findings in 24 patients who were found to have 26 proximal small bowel intussusceptions on abdominal CT scans performed for a variety of indications. RESULTS Twenty patients with intussusceptions had no evidence of small bowel obstruction. The transient and clinically insignificant nature of 22 intussusceptions in these 20 patients was proven radiologically (n = 14), surgically (n = 1), or by clinical follow-up (n = 7). These patients demonstrated a bowel-within-bowel pattern on multiple contiguous images and absence of strangulation or intestinal dilatation. No lead points were demonstrated in these patients. Three other patients had symptoms of low-grade small bowel obstruction and were treated conservatively. Extensive follow-up investigations showed no recurrence of intussusception or a lead point. One patient had high-grade obstructive intussusception with intestinal ischemia and required surgical resection of necrotic bowel. CONCLUSIONS Proximal small bowel intussusceptions are likely to be transient and nonobstructive and unlikely to have a significant lead point.
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Affiliation(s)
- K Sandrasegaran
- Department of Radiology, Indiana University Medical Center, Suite 0279, 550 N. University Bolevard, Indianapolis, IN 46202-5253, USA.
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Abstract
Intussusception is rare in adults, in contrast to its frequent occurrence in infants. The clinical presentation is variable, consisting mainly of abdominal pain that may be chronic, intermittent, or acute. The classic triad of nausea and vomiting, bloody diarrhea, and an abdominal mass typically present in children with intussusception does not usually appear in adults. This diagnosis is, therefore, rarely included in the differential diagnosis of adult patients with vague abdominal complaints. However, with increasing use of CT scanning in the evaluation of patients with abdominal pain, the diagnosis of intussusception can be readily suggested by the radiologist because of its virtually pathognomonic appearance on CT.
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Affiliation(s)
- Gabriela Gayer
- Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zerifin, Israel.
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Abstract
Intussusception is relatively rare in the adult population and differs substantially from pediatric intussusception. Most adult intussusceptions identified at surgery are caused by a definable structural lesion, a substantial proportion of which are malignant, particularly in the colon. Small bowel intussusceptions, however, have a lower prevalence of malignancy. Diagnosis of adult intussusception can be made reliably with noninvasive imaging techniques. CT is now widely regarded as the modality of choice for diagnosing intussusception in adults, but ultrasound and MR imaging have also been used effectively. Determination of the presence of a malignant lead point remains problematic because an edematous or hemorrhagic intussuscipiens may mimic a mass on each modality. Markers for bowel viability have been described but are not precise. Treatment of the persistent symptomatic intussusception in which neoplasia is suspected is surgical, and preoperative reduction is contraindicated. Transient relatively asymptomatic enteric intussusceptions discovered by imaging may not require intervention.
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Affiliation(s)
- Benjamin Y Huang
- Department of Radiology, University of North Carolina School of Medicine, Campus Box 7510, Chapel Hill, NC 27599-7510, USA
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34
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Strouse PJ, DiPietro MA, Saez F. Transient small-bowel intussusception in children on CT. Pediatr Radiol 2003; 33:316-20. [PMID: 12695864 DOI: 10.1007/s00247-003-0870-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2002] [Accepted: 12/12/2002] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the frequency and significance of small-bowel intussusception identified in children on CT. MATERIALS AND METHODS All abdomen CT reports between July 1995 and April 2002 were reviewed to identify patients with small-bowel intussusception. Intussusceptions were identified as an intraluminal mass with a characteristic layered appearance and/or continuity with adjacent mesenteric fat. Ileocolic intussusceptions and intussusceptions related to feeding tubes were excluded. Imaging studies and medical records were reviewed. RESULTS Twenty-five pediatric patients (16 boys, 9 girls; mean age 11.2 years) were identified with small-bowel intussusception on CT. No patient had a persistent intussusception requiring surgery. Fourteen had limited immediate repeat CT images as part of the same examination, ten of which demonstrated resolution of the CT abnormality. Follow-up CT [ n=13 (6 within 24 h)], ultrasound ( n=3), small-bowel follow-through ( n=4) and surgery ( n=3) showed no intussusception. In four patients with persistent symptoms, underlying pathology was identified requiring treatment (giardiasis, 2; small-bowel inflammation/strictures, 1; abscess and partial small-bowel obstruction after perforated appendicitis, 1). In 21 other patients, direct correlation of symptoms to CT abnormality was absent or questionable, no treatment was required, and there was no clinical or imaging evidence of persistence or recurrence. CONCLUSION Most small-bowel intussusceptions identified in children by CT are transient and of no clinical significance.
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Affiliation(s)
- Peter J Strouse
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
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35
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Lvoff N, Breiman RS, Coakley FV, Lu Y, Warren RS. Distinguishing features of self-limiting adult small-bowel intussusception identified at CT. Radiology 2003; 227:68-72. [PMID: 12668740 DOI: 10.1148/radiol.2272020455] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine if clinical or computed tomographic (CT) findings can be used to distinguish self-limiting cases of adult small-bowel intussusception from those requiring surgery. MATERIALS AND METHODS Thirty-seven cases of adult small-bowel intussusception were identified by a retrospective computerized search of 69,040 abdominopelvic CT examinations performed over a 4-year period. Two independent readers recorded CT features. Clinical findings and outcomes were determined by review of all available medical records. Outcome was classified as either surgical or self-limiting. Association between predictive variables and outcome was assessed by the Fisher exact test and logistic regression models. A multivariate, stepwise, logistic regression model was used to determine the best predictors of outcome. RESULTS Six patients (16%) underwent surgery, and all had lead-point tumors. Thirty-one patients were cared for conservatively (84%) and none required surgery at a mean follow-up of 5.2 months (range, 0-46 months). Multivariate, stepwise, logistic regression analysis showed intussusception length was the only variable that was independently predictive of outcome. All 20 patients with an intussusception length of 3.5 cm or less, as measured by either reader, had cases that were self-limiting. Seventeen patients had an intussusception length greater than 3.5 cm, as measured by either reader. Eleven patients had an intussusception that was self-limiting, and six patients had an intussusception that required surgery. CONCLUSION Intussusception length is the main factor in distinguishing the majority of small-bowel intussusceptions detected at CT that are self-limiting from the minority that require surgery. An intussusception that is shorter than 3.5 cm is likely to be self-limiting.
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Affiliation(s)
- Natalya Lvoff
- Department of Radiology, University of California San Francisco, Box 0628, M-372, 505 Parnassus Ave, San Francisco, CA 94143-0628. USA
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Gayer G, Zissin R, Apter S, Papa M, Hertz M. Pictorial review: adult intussusception--a CT diagnosis. Br J Radiol 2002; 75:185-90. [PMID: 11893645 DOI: 10.1259/bjr.75.890.750185] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Intussusception, usually thought of as a childhood condition, may be encountered in adults as well, and is then more often associated with underlying pathology. While the condition is mostly unsuspected clinically, as patients present with non-specific abdominal pain that is often of long duration, CT findings are characteristic. Examples are shown of intussusception both in the small bowel and colon. Awareness of these findings allows the radiologist to make the correct diagnosis.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 52621, Israel
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37
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Abstract
We present the CT findings of a transient colocolic intussusception, related to an underlying colonic tumor, but remote from it. The resolving nature of intussusception was clearly demonstrated on delayed images and may explain the characteristic chronic clinical symptoms of intussusception in adult.
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Affiliation(s)
- R Zissin
- Department of Diagnostic Imaging, Sapir Medical Center, Meir General Hospital, Kfar Saba 44281, Israel
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38
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Draganic B, Williamson M, Stewart P. Colonic intussusception in Crohn's disease. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1999; 69:683-4. [PMID: 10515350 DOI: 10.1046/j.1440-1622.1999.01667.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- B Draganic
- Department of Colon and Rectal Surgery, University of Sydney, Concord Hospital, New South Wales, Australia
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39
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Affiliation(s)
- D Kihiczak
- Department of Radiology, University of Medicine and Dentistry-Robert Wood Johnson Medical School, New Brunswick, NJ 08911, USA
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40
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Marcos HB, Semelka RC, Worawattanakul S. Adult intussusception: demonstration by current MR techniques. Magn Reson Imaging 1997; 15:1095-8. [PMID: 9364957 DOI: 10.1016/s0730-725x(97)00157-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe magnetic resonance findings in three patients with small bowel intussusception from different etiologies including idiopathic, adenomatous polyps, and hamartomatous polyps. Magnetic resonance findings showed a bowel-within-bowel appearance in two patients and a coiled-spring appearance in one patient. These findings were best shown on T2-weighted images, and clear definition was present on breathing independent T2-weighted images using half fourier acquisition snap shot turbo spin echo T2-weighted images.
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Affiliation(s)
- H B Marcos
- Department of Radiology, University of North Carolina, Chapel Hill 27599-7510, USA
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Abstract
Transient non-obstructing intussusception is known to occur in adults. While the CT findings in small bowel intussusception have been described in detail, few reports concerning transient cases have been published. We evaluated five patients with non-obstructive jejuno-jejunal invagination. All CT studies showed a target pattern with an intraluminal soft tissue mass, an eccentric mesentery, and a slightly dilated intussuscipiens. Transient intussusception has typical CT features and should be distinguished from more severe forms requiring prompt surgical treatment.
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Affiliation(s)
- O Catalano
- Department of Radiological Sciences, University Federico II, Naples, Italy
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