Intestinal Intussusception in Adults: A Systematic Review

Management of intestinal intussusception remains controversial with regards to conservative versus operative management, as well as choice of surgical procedure.

A systematic review on PubMed/MEDLINE, Web of Science, Google Scholar, SCOPUS/EMBASE, and the Cochrane Library was performed. Articles published between 2004 and 2024 were collected. Case reports and case series < 20 patients were not considered.

After screening of 2286 articles, 37 studies totaling 2330 patients were included. All studies were retrospective case series except for one prospective case series and one prospective and retrospective case series. There were 20% of colocolic intussusceptions, 21% of ileocolic intussusceptions, and 65% of enteric (small bowel) intussusceptions. A radiological lead point of the intussusception was described in 31% of patients. Intussusceptions were idiopathic in 39%, and caused by a pathological lead point in 58% of cases. Underlying malignancy was present 25% of cases and was more frequent in case of colocolic intussusceptions (68%), versus 9% in small bowel intussusceptions, and 46% of ileocolic intussusceptions. Operative management was performed in 49% of intussusceptions, mainly through open access (72%). Based on these findings, a comprehensive algorithm is provided to guide treatment decisions in adult patients with intussusception.

Data regarding surgical management of the intussusception were heterogenous and poorly reported. In case of colic intussusception, a high degree of suspicion for an underlying malignancy is warranted, and in that regard, an oncological surgical resection without reduction is recommended. Enteric intussusception should be managed according to length, clinical presentation, and interoperative findings of lead points.