Intussusception Case Studies

Intussusception is defined by telescoping of one segment of bowel into an adjacent

segment of bowel. The clinical presentation in adult is often nonspecific, making

diagnosis a challenge. Most commonly, patients present with abdominal pain [1, 2,

3]. The less common presentations include complete or partial bowel obstruction,

haem-positive stools, a palpable mass and incidental finding on imaging. [1,2] The

classic triad of abdominal pain, a palpable mass and passage of red current jelly

stools seen in children is rarely seen in adult patients. [2] Multiple diagnostic studies

have been utilized to diagnose intussusception, including computed tomography

(CT), ultrasound scan, small bowel contrast study, and magnetic resonance imaging.
Several recent studies [2,4]

have shown that current CT scanners have a sensitivity of 58 to 100% and specificity

of 57 to 71% in detecting the intussusception.

Most cases of intussusception in children are treated conservatively with non-

operative reduction since this pathological process is usually idiopathic without any

lead point. On the other hand, management of adult intussusception is more

controversial. Firstly, adult intussusception is much less common in comparison to

the incidence of paediatric cases, only accounting for 5% of all intussusceptions.

[5,6] Due to its rarity, there are no large-scale studies or meta-analyses published to

define appropriate guidelines for optimal management of adult intussusception. [1,7]

Secondly, adult intussusceptions are often secondary to presence of a lead point,

including malignancy. Previous studies [6, 8] have shown that the majority of adult

colonic intussusception is associated with primary malignancy, representing 65 to

70% of cases, whereas 30 to 35% of adult small bowel intussusceptions are caused by a malignancy. As a result, most authors [8] have previously
Recent

studies [2, 9, 10] support non-operative management for selected cases of

intussusceptions, recommending against the traditional view of mandatory operative

exploration of all intussusceptions. Furthermore, one of the latest studies [1] has

shown that 40% of patients were managed non-operatively with resolution of

intussusception with acceptable recurrence rates.

Although recent literature has illustrated the increase in the number of idiopathic

cases and advocated conservative management of adult intussusceptions, Onkendi

and his colleagues [2] have recommended surgical resection for colocolonic and

ileocolic intussusceptions. Ileocolic intussusception was one of the least common

subtypes of all intussusceptions among enteroenteric, ileocolic, ileocaecal, and

colocolonic intussusceptions in their study. Lead point associated intussusceptions in

their study demonstrated about half of them were primary malignancies or

metastases and the other half were benign lesions. They have advised resections