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Published on: March 5, 2018
Intestinal Intussusception: Etiology, Diagnosis, and Treatment
Priscilla Marsicovetere1, S Joga Ivatury2, Brent White1
1Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire.
Insights
Intussusception, bowel telescoping, is common in children but rare in adults. Adult cases often involve a lead point, necessitating surgical resection due to potential malignancy.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Radiology
Background:
- Intussusception involves one bowel segment telescoping into another.
- Ileocolic intussusception is common in children, treated nonoperatively.
- Adult intussusception is rare, often small bowel, and linked to lead points.
Purpose of the Study:
- To differentiate intussusception characteristics in pediatric versus adult populations.
- To analyze the significance of lead point pathology in adult intussusception.
- To review diagnostic and management strategies for adult intussusception.
Main Methods:
- Review of medical literature on intussusception in children and adults.
- Analysis of intussusception etiology, diagnosis, and treatment outcomes.
- Emphasis on cross-sectional imaging (CT/MRI) findings.
Main Results:
- Adult intussusception frequently presents with bowel obstruction due to a lead point.
- Small bowel intussusception lead points are often benign or metastatic (e.g., melanoma).
- Colonic intussusception lead points are frequently primary adenocarcinoma; observation is possible for asymptomatic cases.
Conclusions:
- Adult intussusception management hinges on lead point identification and malignancy risk.
- Surgical resection is often indicated for symptomatic adult intussusception.
- Increasingly frequent imaging detects incidental intussusceptions, allowing for observation.
Abstract:
Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. Idiopathic ileocolic intussusception is the most common form in children and is typically managed with nonoperative reduction via pneumatic and/or hydrostatic enemas. In the adult population, intussusception is uncommon and occurs more often in the small intestine than in the colon. It is associated with lead point pathology in most symptomatic cases presenting as bowel obstruction. When lead point pathology is present in adult small bowel intussusception, it is usually benign, though when malignant it is most frequently due to diffuse metastatic disease, for example, melanoma. In contrast, adult ileocolic and colonic intussusception lead point pathology is most frequently primary adenocarcinoma when malignant. The diagnosis is typically made intraoperatively or by cross-sectional imaging. With increasingly frequent CT/MRI of the adult abdomen in the current era, transient and/or asymptomatic intussusceptions are increasingly found and may often be appropriately observed without intervention. When intervention in the adult population is warranted, usually oncologic bowel resection is performed due to the association with lead point pathology.
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