Published online May 16, 2017. doi: 10.4253/wjge.v9.i5.220
Peer-review started: October 9, 2016
First decision: December 13, 2016
Revised: December 22, 2016
Accepted: February 28, 2017
Article in press: March 2, 2017
Published online: May 16, 2017
Processing time: 222 Days and 3.9 Hours
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.
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.
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.
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.
Core tip: In the current era with advances in diagnostic imaging techniques and overutilization of computed tomography, idiopathic or asymptomatic intussusception is being seen more commonly. The majority of adult intussusceptions however, have pathologic etiology. Patients with palpable mass, obstruction, gastrointestinal bleeding, or a lead point on computed tomography should undergo operative exploration. Certain small bowel intussusception may have a benign, physiological cause and laparoscopy with reduction may be an acceptable strategy. However these patients should undergo small bowel enteroscopy or capsule endoscopy if not obstructed to exclude luminal lesions. All colonic intussusceptions should be resected en-bloc without reduction, whereas a more selective approach may be applied for entero-enteric intussusceptions.