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Contemporary Management of Adult Intussusception: Who Needs a Resection?

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Abstract

Background

Surgical resection is often recommended in adults with intestinal intussusception (AI) because of its potential association with malignancy. We provide a contemporary algorithm for managing AI by focusing on the probability of discovering a lead point.

Methods

This is a retrospective study of adult patients with computed tomography (CT)-confirmed intussusception who underwent operative management of AI between 1996 and 2011 at a single academic institution.

Results

Sixty-four patients were diagnosed with AI by CT scan and then managed operatively. The incidence of colonic (CI), small bowel (SBI), and retrograde intussusception (RI) was 14, 55, and 31 %, respectively. All patients with CI had a lead point, whereas none were found among patients with RI. Some 46 % of patients with SBI had a lead point. The probability of discovering a lead point in SBI was increased by past history of malignancy (RR, 3.7, p < 0.001), a mass seen on preoperative CT scan (RR, 2.9, p = 0.005), and age over 60 years (RR, 2.2, p = 0.07).

Conclusions

A pathologic lead point is likely with CI but not with RI. Patients with SBI who are over the age of 60 years and have a history of malignancy or a mass noted on CT scan have a higher likelihood of harboring a pathologic lead point.

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Authors and Affiliations

  1. Department of General Surgery, University of Michigan Health System, 2210 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5343, USA

    Oliver A. Varban

  2. Department of Gastrointestinal and General Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Ali Ardestani, Dan E. Azagury, David C. Brooks & Ali Tavakkoli

  3. Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Bela Kis

Authors
  1. Oliver A. Varban
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  2. Ali Ardestani
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  3. Dan E. Azagury
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  4. Bela Kis
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  5. David C. Brooks
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  6. Ali Tavakkoli
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Correspondence to Oliver A. Varban.

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Varban, O.A., Ardestani, A., Azagury, D.E. et al. Contemporary Management of Adult Intussusception: Who Needs a Resection?. World J Surg 37, 1872–1877 (2013). https://doi.org/10.1007/s00268-013-2036-3

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  • DOI: https://doi.org/10.1007/s00268-013-2036-3

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