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Proximal small bowel intussusceptions in adults: CT appearance and clinical significance

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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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Sandrasegaran, K., Kopecky, K., Rajesh, A. et al. Proximal small bowel intussusceptions in adults: CT appearance and clinical significance. Abdom Imaging 29, 653–657 (2004).

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