Barussaud M, Regenet N, Briennon X, de Kerviler B, Pessaux P, Kohneh-Sharhi N, Lehur PA, Hamy A, Leborgne J, le Neel JC, Mirallie E. Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study. Several key clinical conditions and findings on imaging can assist the surgeon faced with adult intussusception to confidently proceed with surgical exploration: (1) intussusception with associated signs or symptoms of clinical obstruction, (2) intussusception with a lead point mass appreciated on cross-sectional imaging studies, and (3) colocolonic or ileocolic intussusception given the high association with malignancy in many of these cases, particularly ileocolic. 33 The site is secure. Abbreviations: Abd, abdominal; constip, constipation; Dx, diagnosis; GI, gastrointestinal; ICV, ileocolic volvulus; LB, large bowel; malig, malignant; N/V, nausea/vomiting; SB, small bowel; sx, symptoms. The compromised blood flow to the affected segment can cause necrosis of the intestinal wall with bacterial translocation, peritonitis, sepsis and even perforation. The most common locations involved in intussusception are at the junctions between mobile and fixed segments of the bowel, such as between the freely-moving ileum and the retroperitoneal cecum[8]. Intussusception in children - UpToDate government site. Onkendi EO, Grotz TE, Murray JA, Donohue JH. Children younger than 2 years classically present with acute onset colicky abdominal pain, knees drawn to chest, with excessive irritability and crying. Hackam DJ, Saibil F, Wilson S, Litwin D. Laparoscopic management of intussusception caused by colonic lipomata: a case report and review of the literature. Blood loss or a palpable mass are present in a minority of cases. However, obesity and the presence of massive air in the distended bowel loops can many times limit the image quality and the diagnostic accuracy of this method (26). Adult intestinal intussusception: CT appearances and identification of a causative lead point. the contents by NLM or the National Institutes of Health. The abdomen X-ray (Figure (Figure1)1) may reveal signs of intestinal obstruction (hydro-air levels, distension of the intestinal tract upstream, unexplained masses) which can occur in different abdominal quadrants depending on the level of obstruction (high or low)[20]. The diagnosis and management in this population generally starts with nonoperative reduction of the intussusceptum using air or contrast enemas. A: Ultrasound scan revealed target sign; B and C: Computed tomography scan confirmed ielo-colic intussusception, with no signs of bowel obstruction [orange arrow, horizontal (B) and coronal (C)]. Cakir M, Tekin A, Kucukkartallar T, Belviranli M, Gundes E, Paksoy Y. Intussusception: as the cause of mechanical bowel obstruction in adults. Brill A, Lopez RA. In direct contrast to pediatric etiologies, adult intussusception is associated with an identifiable cause in almost all the symptomatic cases while the idiopathic causes are extremely rare. The classic feature is the target or doughnut sign caused by the edematous intussuscipiens forming an external ring around the centrally based intussusceptum.25 On the transverse view, the pseudo-kidney appearance is formed by the layers of the intussusception. Eisen LK, Cunningham JD, Aufses AH Jr. Intussusception in adults: institutional review. In the setting of colocolonic or ileocolic intussusception, preoperative colonoscopy can frequently be pursued to confirm the presence of pathology and/or malignancy. The diagnosis and management of adult intussusception. Reijnen HA, Joosten HJ, De Boer HH. To make a correct differential diagnosis with other similar intestinal pathologies, it is therefore useful to use radiodiagnostic instruments: abdomen X-ray, small bowel series with barium, abdominal ultrasound, abdominal CT. Intussusceptions are classified according to location (enteroenteric, ileocolic, ileocecal, or colo-colic) and cause (benign, malignant, or idio-pathic). This was owing to potentially limiting factors such as bowel wall edema and sigmoid volvulus, which appear on ultrasound with the same target and ox eye signs as intussusception. Adult intussusception: case reports and review of literature. Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. The most common locations are at the junctions between freely moving segments and retroperitoneally or adhesionally fixed segments. Munden M M, Bruzzi J F, Coley B D, Munden R F. Sonography of pediatric small-bowel intussusception: differentiating surgical from nonsurgical cases. Ratcliffe J F, Fong S, Cheong I, O'Connell P. Plain film diagnosis of intussusception: prevalence of the target sign. In addition, gastroduodenal intussusception, the least frequent of all intussusceptions, is caused by the prolapse of a benign gastric tumour into the duodenum, with subsequent invagination of a portion of the stomach wall. Interestingly, the imaging features of intussusception include the famous target or doughnut signs on the transverse view and the pseudo-kidney or hay-fork sign in the longitudinal view (25). Wang N, Cui XY, Liu Y, Long J, Xu YH, Guo RX, Guo KJ. Supratherapeutic anticoagulation therapy may cause submucosal hemorrhages that can lead to intussusception. The symptoms in cases of adult intussusception are so non-specific that a clinical diagnosis beyond bowel obstruction is rarely made before surgery. Carlos Alberto Pratic, Digestive Endoscopy Unit, Hopital Prive Armand Brillard, Nogent-sur-Marne 94130, France. Minimal access surgery for adult intussusception with subacute intestinal obstruction: a single centers decadelong experience. Before In the pediatric population, ileocolic intussusception is the most common type. Wang LT, Wu CC, Yu JC, Hsiao CW, Hsu CC, Jao SW. Clinical entity and treatment strategies for adult intussusceptions: 20 years' experience. Part of a proximal segment of the bowel slides into the next distal section. Francesco Panzera, Department of Endoscopy, "Madonna delle Grazie" Hospital, Matera 75100, Italy. Boyle MJ, Arkell LJ, Williams JT. Intussusception (medical disorder) - Wikipedia Hutchinson J. In addition, signs of shock such as hypotension and tachycardia may be present. Therefore, the initial diagnosis is often missed or delayed and may only be established at the operating theater. Gayer G, Zissin R, Apter S, et al. Similarly, Guilln Paredes et al found that despite the fact that ultrasound was used more frequently, it did not guarantee a diagnosis on most occasions and abdominal CT was recommended. Plain abdominal films are the first diagnostic method, since in most cases the symptoms of intestinal obstruction dominate the clinical picture. Intussusception in Adults - PubMed Yalamarthi S, Smith RC. Treatment of gastroduodenal intussusceptions usually entails reduction of the intussusception and surgical excision of the lead point. The reported drawbacks of this method is that malignant cells may be disseminated during the attempt. Other authors suggest that surgical resection without reduction should be the standard treatment in adults, as about 50% of colonic and enteric adult intussusceptions are associated with malignant lesions. In: StatPearls [Internet]. Accessibility In coloanal intussusceptions, the preferred approach is to reduce the intussusception and then proceed with the resection (37). ti.liamtoh@niodraccir. The https:// ensures that you are connecting to the Hutchinson J. Rea J D, Lockhart M E, Yarbrough D E, Leeth R R, Bledsoe S E, Clements R H. Approach to management of intussusception in adults: a new paradigm in the computed tomography era. For the purpose of this article, rectoanal and stomal intussusception will not be discussed as they are better characterized as (extracorporeal) prolapse. Wiot JF, Spitz HB. Laboratory tests usually document increase of leukocytes count and inflammatory markers such as polymerase chain reaction. Intestinal Intussusception: Etiology, Diagnosis, and Treatment. Rarely, this clinical entity may present in adults with the clinical picture of acute intestinal obstruction (17). Laboratory values typically reveal an elevated white blood cell count and nonspecific inflammatory markers/acute phase reactants such as thrombocytosis and elevated C-reactive protein.20 A higher number of lead points is found in young infants and children older than 3 years of age. The classic triad of intussusception including an abdominal mass, tenderness, and haemoglobin-positive stools is rarely found in adults. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. This movement causes the intestine to fold around itself, the way the parts of a telescope fit around. Ileocolic intussusception in adults is a unique variant in which nearly 100% of cases have a malignant lead point, namely, cecal adenocarcinoma involving the ileocecal valve.9. Adult bowel intussusception: presentation, location, etiology All the researchers agree that for adult intussusception laparotomy is the treatment of choice rather than attempts at hydrostatic reduction in view of the high incidence of underlying malignancy (32). Intussusception is a condition in which one segment of intestine "telescopes" inside of another, causing an intestinal obstruction (blockage). Adult intussusception. Small bowel intussuscept ion demonstrated by oral barium. With increasing age, the likelihood of identifiable causes of intussusception increases. Thiago Franchi Nunes, Department of Radiology, Santa Casa de Campo Grande, Campo Grande 79010-050, Brazil. Lvoff N, Breiman R S, Coakley F V, Lu Y, Warren R S. Distinguishing features of self-limiting adult small-bowel intussusception identified at CT. Jain P, Heap S W. Intussusception of the small bowel discovered incidentally by computed tomography. Careers, Unable to load your collection due to an error. The patient present abdominal tenderness and signs of systemic inflammatory response syndrome (i.e., hypothermia or hyperthermia, hypotension, and tachycardia). Malrotation is another etiology of intussusception in a condition called Waugh syndrome.5 Shortly after the onset of pain, vomiting may occur. Ingested food and the subsequent peristaltic activity of the bowel has as result an area of constriction above the stimulus and relaxation below, thus telescoping the lead point through the distal bowel lumen. Ileocecal valve adenocarcinoma. It is associated with lead point pathology in most symptomatic cases presenting as bowel obstruction. A successful case of abdominal section for intussusception. Received 2021 Jan 18; Revised 2021 Feb 15; Accepted 2021 Mar 18. Mrak K. Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception. 2020 Dec 7. Small bowel intussusception, which is uncommon in children, can usually be safely monitored and will reduce spontaneously without surgery.28 Persistent small bowel intussusception, however, has been associated with a lead point or bowel necrosis, and would likely require surgical intervention.29 Regardless of intussusception type, surgery is indicated when enema reduction or close observation is unsuccessful.