Advertisement

Adult Intussusception in the Last 25 Years of Modern Imaging: Is Surgery Still Indicated?

  • Edwin Onserio Onkendi
  • Travis Edward Grotz
  • Joseph A. Murray
  • John Harrington DonohueEmail author
2011 SSAT Quick Shot Presentation

Abstract

Background

Because most adult intussusceptions are reportedly due to malignancy, operative treatment is recommended. With current availability of computed tomography, we questioned the role of mandatory operative exploration for all adult intussusceptions.

Methods

This study is a retrospective review of all adults treated from 1983 to 2008 at a large tertiary referral center for intussusception.

Results

One hundred ninety-six patients had intussusception over the 25-year study period. Computed tomography was obtained in 60% of patients. Neoplasms [malignant, (21%); benign, (24%)] were the commonest etiology; 30% cases were idiopathic. One hundred twenty (61%) patients underwent operative treatment for intussusception. Six of the 58 idiopathic or asymptomatic cases were operated on with negative findings in all. Palpable mass (OR 4.56, p < 0.035), obstructive symptoms (OR 9.13, p < 0.001) or obstruction (OR 9.67, p < 0.001), GI bleeding (OR 14.41, p < 0.001), and a lead point on computed tomography (OR 10.08, p < 0.001) were associated with the need for operation.

Conclusion

In the current era of computed tomography, idiopathic or asymptomatic intussusception is being seen more commonly; however, the majority of adult intussusceptions still have pathologic lead points. From our experience, all patients with palpable mass, obstructive symptoms or obstruction, gastrointestinal bleeding, or a lead point on computed tomography should undergo operative exploration.

Keywords

Intestinal obstruction Intussusception Computed tomography Gastrointestinal surgical procedure Celiac disease 

References

  1. 1.
    Donhauser JL, Kelly EC: Intussusception in the adult. Am J Surg 1950;79:673–677.PubMedCrossRefGoogle Scholar
  2. 2.
    Azar T, Berger DL: Adult intussusception. Ann Surg 1997;226:134–138.PubMedCrossRefGoogle Scholar
  3. 3.
    Begos DG, Sandor A, Modlin IM: The diagnosis and management of adult intussusception. Am J Surg 1997;173:88–94.PubMedCrossRefGoogle Scholar
  4. 4.
    Sanders GB, Hagan WH, Kinnaird DW: Adult intussusception and carcinoma of the colon. Ann Surg 1958;147:796–804.PubMedGoogle Scholar
  5. 5.
    Reijnen HA, Joosten HJ, de Boer HH: Diagnosis and treatment of adult intussusception. Am J Surg 1989;158:25–28.PubMedCrossRefGoogle Scholar
  6. 6.
    Stubenbord WT, Thorbjarnarson B: Intussusception in adults. Ann Surg 1970;172:306–310.PubMedCrossRefGoogle Scholar
  7. 7.
    Nagorney DM, Sarr MG, McIlrath DC: Surgical management of intussusception in the adult. Ann Surg 1981;193:230–236.PubMedCrossRefGoogle Scholar
  8. 8.
    Olasky J, Moazzez A, Barrera K, et al.: In the era of routine use of CT scan for acute abdominal pain, should all adults with small bowel intussusception undergo surgery? The American surgeon 2009;75:958–961.PubMedGoogle Scholar
  9. 9.
    Olasky J, Moazzez A, Barrera K, et al.: In the era of routine use of CT scan for acute abdominal pain, should all adults with small bowel intussusception undergo surgery? Am Surg 2009;75:958–961.PubMedGoogle Scholar
  10. 10.
    Koh JS, Hahm JR, Jung JH, et al.: Intussusception in a young female with Vibrio gastroenteritis and diabetic ketoacidosis. Intern Med 2007;46:171–173.PubMedCrossRefGoogle Scholar
  11. 11.
    Li K, Wu CT, Zhang JH, et al.: [Intestinal mucosal pathology in rats with severe abdominal infection]. Nan Fang Yi Ke Da Xue Xue Bao 2006;26:202–204.PubMedGoogle Scholar
  12. 12.
    Gonda TA, Khan SU, Cheng J, et al (2010) Association of intussusception and celiac disease in adults. Dig Dis Sci 55:2899–2903PubMedCrossRefGoogle Scholar
  13. 13.
    Sundaram B, Miller CN, Cohan RH, et al.: Can CT features be used to diagnose surgical adult bowel intussusceptions? AJR Am J Roentgenol 2009;193:471–478.PubMedCrossRefGoogle Scholar
  14. 14.
    Beall DP, Fortman BJ, Lawler BC, Regan F: Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography. Clin Radiol 2002;57:719–724.PubMedCrossRefGoogle Scholar
  15. 15.
    Barussaud M, Regenet N, Briennon X, et al.: Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study. Int J Colorectal Dis 2006;21:834–839.PubMedCrossRefGoogle Scholar
  16. 16.
    Jain P, Heap SW: Intussusception of the small bowel discovered incidentally by computed tomography. Australas Radiol 2006;50:171–174.PubMedCrossRefGoogle Scholar
  17. 17.
    Strouse PJ, DiPietro MA, Saez F: Transient small-bowel intussusception in children on CT. Pediatr Radiol 2003;33:316–320.PubMedGoogle Scholar
  18. 18.
    Marinis A, Yiallourou A, Samanides L, et al.: Intussusception of the bowel in adults: a review. World J Gastroenterol 2009;15:407–411.PubMedCrossRefGoogle Scholar
  19. 19.
    Weilbaecher D, Bolin JA, Hearn D, Ogden W, 2nd: Intussusception in adults. Review of 160 cases. Am J Surg 1971;121:531–535.PubMedCrossRefGoogle Scholar
  20. 20.
    Warshauer DM, Lee JK: Adult intussusception detected at CT or MR imaging: clinical-imaging correlation. Radiology 1999;212:853–860.PubMedGoogle Scholar
  21. 21.
    Sheth A, Jordan PA: Does small bowel intussusception in adults always require surgery? Digestive Diseases and Sciences 2007;52:1764–1766.CrossRefGoogle Scholar
  22. 22.
    Rea JD, Lockhart ME, Yarbrough DE, et al.: Approach to management of intussusception in adults: a new paradigm in the computed tomography era. The American Surgeon 2007;73:1098–1105.PubMedGoogle Scholar
  23. 23.
    Lvoff N, Breiman RS, Coakley FV, et al.: Distinguishing features of self-limiting adult small-bowel intussusception identified at CT. Radiology 2003;227:68–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Ruoff M, Lindner AE, Marshak RH: Intussusception in sprue. The American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine 1968;104:525–528.PubMedGoogle Scholar
  25. 25.
    Shah A, Roberts J, Lipsky H, et al.: Enteroenteric intussusception: an unusual presentation of Crohn’s disease in an adult patient. The American Journal of Gastroenterology 1995;90:2231–2232.PubMedGoogle Scholar
  26. 26.
    Draganic B, Williamson M, Stewart P: Colonic intussusception in Crohn’s disease. The Australian and New Zealand Journal of Surgery 1999;69:683–684.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Edwin Onserio Onkendi
    • 1
  • Travis Edward Grotz
    • 1
  • Joseph A. Murray
    • 2
  • John Harrington Donohue
    • 1
    Email author
  1. 1.Department of SurgeryMayo Clinic RochesterRochesterUSA
  2. 2.Division of Gastroenterology and HepatologyMayo Clinic RochesterRochesterUSA

Personalised recommendations