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World Journal of Surgery

, Volume 30, Issue 7, pp 1300–1304 | Cite as

Predictive Factors of Malignancy in Adults with Intussusception

  • Brian K.P. GohEmail author
  • Hak-Mien Quah
  • Pierce K.H. Chow
  • Kok-Yang Tan
  • Khoon-Hean Tay
  • Kong-Weng Eu
  • London L.P.J. Ooi
  • Wai-Keong Wong
Article

Abstract

Introduction

Adult intussusception is an unusual entity, and its etiology differs from that in pediatric patients. The aim of this study was to evaluate our experience of 60 adult patients with intussusception and determine if there are any preoperative factors predictive of malignancy.

Methods

The records of 60 adult patients (> 18 years of age) with a diagnosis of intussusception surgically treated at Singapore General Hospital and Changi General Hospital between 1990 and 2004 were retrospectively reviewed. The intussusceptions were classified as enteric or colonic. Preoperative predictive factors of malignancy were analyzed using univariate and multivariate analyses, and P < 0.05 was considered statistically significant.

Results

There were 60 patients with a median age of 57.5 years (range 21–85 years). Altogether, 34 (56.7%) patients were male, and there were 31 enteric and 29 colonic intussusceptions. A lead point was identified in 54 patients (90%). A total of 22 (36.7%) patients presented with intestinal obstruction, and the correct preoperative diagnosis of intussusception was made in 31 patients (51.7%). Computed tomography was the most useful diagnostic modality, correctly identifying an intussusception in 24 of 30 patients. A malignant pathology was present in 8 of 31 (26%) enteric versus 20 of 29 (69%) colonic intussusceptions. Age (P = 0.009), the presence of anemia (P < 0.001), and the site of the intussusception (P = 0.001) showed significant differences between the benign and malignant groups by univariate analyses. On multivariate analysis, intussusception in the colon (P = 0.004) and the presence of anemia (P = 0.001) were independent predictive factors of malignancy.

Conclusions

Adult intussusception is most commonly secondary to a pathologic lead point. The site of intussusception in the colon and the presence of anemia are independent preoperative predictors of malignancy. All colonic intussusceptions should be resected en bloc without reduction, whereas a more selective approach can be applied for enteric intussusceptions.

Keywords

Intussusception Rectal Prolapse Bloc Resection Lead Point Selective Approach 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Begos DG, Sandor A, Modlin I. The diagnosis and management of adult intussusception. Am J Surg 1997;173:88–94PubMedCrossRefGoogle Scholar
  2. 2.
    Eisen LK, Cunningham JD, Aufses AH. Intussusception in adults: institutional review. J Am Coll Surg 1999;188:390–395PubMedCrossRefGoogle Scholar
  3. 3.
    Nagorney DM, Sarr MG, Mcilrath DC. Surgical management of intussusception in the adult. Ann Surg 1981;193:230–236PubMedGoogle Scholar
  4. 4.
    Weilbaecher D, Bolin JA, Hearn D, et al. Intussusception in adults: review of 160 cases. Am J Surg 1971;121:531–535PubMedCrossRefGoogle Scholar
  5. 5.
    Azar T, Berger DL. Adult intussusception. Ann Surg 1997;226:134–138PubMedCrossRefGoogle Scholar
  6. 6.
    Cole GJ. A review of 436 cases of intestinal obstruction in Ibadan. Gut 1965;6:151PubMedGoogle Scholar
  7. 7.
    Hadley GP, Simpson RL. Adult intussusception in the tropics. Br J Surg 1983;70:281PubMedGoogle Scholar
  8. 8.
    VanderKolk WE, Snyder CA, Figg DM. Cecal-colic adult intussusception as a cause of intestinal obstruction in central Africa. World J Surg 1996;20:341–344PubMedCrossRefGoogle Scholar
  9. 9.
    Tan KY, Tan SM, Tan AG, et al. Adult intussusception: experience in Singapore. ANZ J Surg 2003;73:1044–1047PubMedCrossRefGoogle Scholar
  10. 10.
    Dean DL, Ellis FH, Sauer WG. Intussusception in adults. Arch Surg 1956;73:6–11Google Scholar
  11. 11.
    Sanders GB, Hagan WH, Kinnaird DW. Adult intussusception and carcinoma of the colon. Ann Surg 1958;147:796–803PubMedGoogle Scholar
  12. 12.
    Merine D, Fishman EK, Jones B, et al. Entero-enteric intussusception: CT findings in nine patients. AJR Am J Roentgenol 1987;148:1119–1132Google Scholar
  13. 13.
    Gayer G, Zissin R, Apter S, et al. Adult intussusception: a CT diagnosis. Br J Radiol 2002;75:185–1890PubMedGoogle Scholar
  14. 14.
    Gayer G, Hertz M, Zissin R. CT findings in intussusception in adults. Semin Ultrasound CT MR 2003;24:377–386PubMedCrossRefGoogle Scholar
  15. 15.
    Warshauer DM, Lee JK. Adult intussusception detected at CT or MR imaging: clinical-imaging correlation. Radiology 1999;212:853–860PubMedGoogle Scholar
  16. 16.
    Donhauser JL, Kelly EC. Intussusception in the adult. Am J Surg 1950;79:673–677PubMedCrossRefGoogle Scholar
  17. 17.
    Yalamarthi S, Smith RC. Adult intussusception: case reports and review of literature. Postgrad Med J 2005;81:174–177PubMedCrossRefGoogle Scholar
  18. 18.
    Stubenbord WT, Thorbjarnarson B. Intussuception in adults. Ann Surg 1970;172:306–310PubMedGoogle Scholar
  19. 19.
    Reijnen HA, Joosten HJ, Boer HH. Diagnosis and treatment of adult intussusception. Am J Surg 1989;158:25–27PubMedCrossRefGoogle Scholar
  20. 20.
    Felix EL, Cohen MH, Bernstein AD, et al. Adult intussusception: case report of recurrent intussusception and review of the literature. Am J Surg 1976;131:758–761PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Brian K.P. Goh
    • 1
    Email author
  • Hak-Mien Quah
    • 2
  • Pierce K.H. Chow
    • 1
    • 3
  • Kok-Yang Tan
    • 4
  • Khoon-Hean Tay
    • 4
  • Kong-Weng Eu
    • 2
  • London L.P.J. Ooi
    • 1
    • 3
  • Wai-Keong Wong
    • 1
    • 3
  1. 1.Department of SurgerySingapore General HospitalSingapore
  2. 2.Department of Colorectal SurgerySingapore General HospitalSingapore
  3. 3.Department of Surgical OncologyNational Cancer CentreSingapore
  4. 4.Department of General SurgeryChangi General HospitalSingapore

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