Adult intussusception:A retrospective review of 41 cases

AIM:To optimize the preoperative diagnosis and surgical management of adult intussusception (AI).METHODS:A retrospective review of the clinical features,diagnosis,management and pathology 41 adult patients with postoperative diagnoses of intussusception was conducted.RESULTS:Forty-one patients with 44 intussusceptions were operated on,24.4% had acute symptoms,24.4% had subacute symptoms,and 51.2% had chronic symptoms.70.7% of the patients presented with intestinal obstruction.There were 20 enteric,15 ileocolic,eight colocolonic and one sigmoidorectal intussusceptions.65.9% of intussusceptions were diagnosed preoperatively using a computed tomography (CT) scan (90.5% accurate) and ultrasonography (60.0% accurate,rising to 91.7% for patients who had a palpable abdominal mass).Coloscopy located the occupying lesions of the lead point of ileocolic,colocolonic and sigmoidorectal intussusceptions.Four intussusceptions in three patients were simply reduced.Twenty-one patients underwent resection after primary reduction.There was no mortality and anastomosis leakage perioperatively.Except for one patient with multiple small bowel adenomas,which recurred 5 mo after surgery,no patients were recurrent within 6 mo.Pathologically,54.5% of the intussusceptions had a tumor,of which 27.3% were malignant.9.1% comprised nontumorous polyps.Four intussusceptions had a gastrojejunostomy with intestinal intubation,and four intussusceptions had no organic lesion.CONCLUSION:CT is the most effective and accurate diagnostic technique.Colonoscopy can detect most lead point lesions of non-enteric intussusceptions.Intestinal intubation should be avoided.

Adult intussusception:A case series and review

To identify factors differentiating pathologic adult intussusception (AI) from benign causes and the need for an operative intervention. Current evidence available from the literature is discussed. METHODSThis is a case series of eleven patients over the age of 18 and a surgical consultation for “Intussusception” at a single veteran’s hospital over a five-year period (2011-2016). AI was diagnosed on computed tomography (CT) scan and or flexible endoscopy (colonoscopy). Surgical referrals were from the emergency room, endoscopy suites and the radiologists. RESULTSA total of 11 cases, 9 males and 2 females were diagnosed with AI. Median age was 58 years. Abdominal pain and change in bowel habits were most common symptoms. CT scan and or colonoscopy diagnosed AI, in ten/eleven (90%) patients. There were 6 small bowel-small bowel, 4 ileocecal, and 1 sigmoid-rectal AI. 8 patients (72%) needed an operation. Bowel resection was required and definitive pathology was diagnosed in 7 patients (63%). Five patients had malignant and 2 patients had benign etiology. Small bowel enteroscopy excluded pathology in 4 cases (37%) with AI. Younger patients tend to have a benign diagnosis. CONCLUSIONMajority of AI have malignant etiology however idiopathic intussusception is being seen more frequently. Operative intervention remains the mainstay however, certain small bowel intussusception especially in younger patients may be a benign, physiological, transient phenomenon and laparoscopy with reduction or watchful waiting may be an acceptable strategy. These patients should undergo endoscopic or capsule endoscopy to exclude intrinsic luminal lesions.

Adult intussusception caused by cystic lymphangioma of the colon:A rare case report

We experienced a case of intussusception caused by cystic lymphangioma of the colon in a 32 years old female who was admitted to our hospital for the chief complaint of bloody stool. In the colonoscopic examination, cystic mass with stalk which had smooth mucosal surface was noted at the descending colon. Abdominal ultrasonography and computed tomography revealed left colon intussusception with a multilocular cystic tumor as a leading point. Emergent operation was performed. On the histopathologic examination, the cystically dilated spaces lined by endothelium and septated by fibrous septa were present. The pathological diagnosis was cystic lymphangioma of the colon. Although intussusception due to lymphangioma in an adult are rare, it should be taken into consideration that it is possible diagnosis.

Bowel intussusception in adult:Prevalence,diagnostic tools and therapy

Intussusception is defined as invagination of one segment of the bowel into animmediately adjacent segment. The intussusception refers to the proximalsegment that invaginates into the distal segment, or the intussusception (recipientsegment). Intussusception, more common occur in the small bowel and rarelyinvolve only the large bowel. In direct contrast to pediatric etiologies, adultintussusception is associated with an identifiable cause in almost all thesymptomatic cases while the idiopathic causes are extremely rare. As there aremany common causes of acute abdomen, intussusception should be consideredwhen more frequent etiologies have been ruled out. In this review, we discuss thesymptoms, location, etiology, characteristics, diagnostic methods and treatmentstrategies of this rare and enigmatic clinical entity in adult.

Intussusception due to rectal adenocarcinoma in a young adult:A case report

An intussusception due to colonic adenocarcinoma has sometimes been reported. However, to the best of our knowledge, reports of intussusception due to rectal adenocarcinoma are extremely rare. In this report, the case of a young man with rectal adenocarcinoma causing intussusception is described. A 24-year-old man visited a hospital complaining of abdominal pain, and an upper rectal cancer was diagnosed by colonoscopy. Computed tomography showed intussusception caused by a large tumor in the pelvis and absence of distant metastases. Locally advanced rectal cancer causing intussusception was diagnosed, and a low anterior resection was performed. Intraoperatively, repair of the invagination could not be accomplished easily; therefore, the repair was abandoned. Instead, the tumor was removed en bloc to avoid dissemination of the cancer. Histopathologically, the tumor was diagnosed as a poorly differentiated adenocarcinoma, pStage IIA. The patient has no evidence of recurrence at 10 mo after the operation.

Burkitt Lymphoma Presenting as Ileocolic Intussusception in an Adult

Adult intussusception is rare, highly associated with a malignant lead point, and often requires emergent surgical management. We report the case of a 44-year-old male who presented with generalized abdominal pain and was found to have early ileocolic intussusception secondary to a large ileocecal mass. Biopsies of the mass and an enlarged cardiophrenic lymph node, as well as pleural fluid cytology were all consistent with Burkitt lymphoma (BL). Curiously, the patient’s abdominal exam was reassuring, and the intussusception and malignant bowel obstruction resolved over 36 hours with conservative management alone. With a Burkitt lymphoma international prognostic index (BL-IPI) score of 2, the patient proceeded to treatment with combination chemoimmunotherapy and attained a complete response after four cycles. There was no bowel perforation or recurrent intussusception throughout treatment. Thus, this report marks the first reported case of adult BL-associated intussusception to resolve with non-invasive management and establishes a precedent for conservative management in select patients.

Adult duodenal intussusception with horizontal adenoma: A rare case report

BACKGROUND Adult duodenal intussusception rarely occurs,and the majority of duodenal adenomas are located in the descending part of the duodenum.Therefore,adenomas in the horizontal part of the duodenum presenting as duodenal intussusception in adults are extremely rare.CASE SUMMARY A 36-year-old man complained of abdominal pain for 13 d.Blood analysis showed anemia.Magnetic resonance cholangiopancreatography and computed tomography revealed a tumor in the horizontal part of the duodenum as the main finding,leading to duodeno-duodenal intussusception.No obvious abnormalities were found on endoscopy or upper gastrointestinal radiography.He was diagnosed with duodenal intussusception secondary to duodenal adenoma.Laparotomy showed duodeno-duodenal intussusception and a tumor in the horizontal part of the duodenum near the ascending part.Postoperative pathology revealed tubular-villous adenoma with low-grade glandular intraepithelial neoplasia(local high-grade intraepithelial neoplasia).He was discharged without complications.CONCLUSION This case highlights that rational use of computed tomography,magnetic resonance cholangiopancreatography,endoscopy and upper gastrointestinal radiography for preoperative diagnosis and timely surgery is an effective strategy for the treatment of adult duodenal intussusception with duodenal masses.

Ileocecal intussusception caused by two different tumors - which is the culprit lesion? A case report

BACKGROUND Ileocecal intussusception caused by two different tumors is rare,according to a literature review.We describe a case of a male patient with a cauliflower-like mass in the middle of the transverse colon observed by colonoscopy before surgery.It was considered to be intussusception caused by colon cancer.However,a substantial lipomatous mass was seen in the distal end of the intussusception by computed tomography before surgery,which posed a challenge in the preoperative diagnosis.CASE SUMMARY We report a 72-year-old male patient with intussusception.The patient underwent right hemicolectomy and cholecystectomy in our hospital on April 29,2019.During operation,the ileum was inserted into the ascending colon by about 15 cm,and a tumor with a diameter of approximately 3.0 cm was observed in the distal part of the intestine.An atypical liposarcoma/highly differentiated liposarcoma in the adipose tissue was suspected in the postoperative pathology,and a lipoma was diagnosed after MDM2 gene testing.A 4.0 cm×5.0 cm polypoid mass was seen immediately adjacent to the mass,and the postoperative pathology report suggested a high-level tubular adenoma.The patient was eventually cured and discharged with an uneventful follow-up.CONCLUSION Intussusception caused by two different types of masses is extremely rare.At present,surgery is the best treatment once intussusception is diagnosed.