Intussusception is a rare cause of intestinal obstruction in adults. Intussusception in adult population is quite uncommon. However, neoplasm is the most common cause and is found in. Intussusception often occurs at the junction of the small and large intestine and most. An intussusception is the invagination of a segment of the intestine into a contiguous portion of intestine.
The purpose of this study was to determine the causes and management of intussusception in adults. We described the diagnosis and treatment of intestinal intussusception in adults. Although it is frequently associated with neoplastic. Intussusception is highly uncommon in adults and accounts for only 5% of all reported cases. Intussusception remains a rare condition in adults, representing 1% to 3% of bowel obstructions, and it is a different entity in adults than in children. The clinical index of suspicion for intussusception should be raised for an hivpositive young adult with intermittent. The majority of colon tumors producing intussusception are malignant 64 per cent as reported here. Intussusception occurs primarily in infants boys more often than girls but can also occur in adults and older children. Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%5% of intestinal obstructions in adults. An analysis of twentyseven episodes of intussusception in adults treated at charity hospital from 1938 through 1959 is presented.
Intussusception is the telescoping of one segment of the gastrointestinal tract into an adjacent one. List the causes and clinical manifestations intestinal intussusception. Dexamethasone may decrease the risk of another episode. In adults, the intussusception commonly occurs as a result of medical conditions such as tumor, intestinal adhesions, hematoma, inflammatory conditions such as crohns disease and the presence of surgical scars in the small intestine or colon. Therapeutic enema for intussusception therapeutic enema is used to help identify and diagnose intussusception, a serious disorder in which one part of the intestine slides into another in a telescoping manner and causes inflammation and an obstruction. It is more commonly secondary to an identifiable bowel lesion in 90% of cases, whereas 10% have no discernable cause. Mdct is well suited to delineate the presence of the. Adult intussusception is a rare condition wich can occur in any site of gastrointestinal tract from stomach to rectum. Unlike the paediatric population, reduction of the intussuscepted bowel with barium or air is not indicated in adults. It has often been stated that intestinal intussusception in adults is frequently caused by serious underlying disease, with 70%90% of cases having a demonstrable cause based on discharge diagnosis or surgical results, 1, 2. Once an individual has a blockage, there is always a risk that it might recur.
Diagnostic challenge of the nonspecific presentation of. Intussusception is rare in fully grown individuals and accounts for only 1% of all cases of bowel obstructions. The primary symptoms of intussusception include abdominal pain and vomiting. The underlying pathologic processes were identified in 23 patients 92%. Diagnosis is difficult due to nonspecific symptoms of the disease. The childhood variety is common and success 90%38, barium method 70%38 and. The frequency with which it may occur diminishes with the increasing age of the patient to adult life. The condition is distinct from pediatric intussusception in various aspects. Pdf intussusception in adult population is quite uncommon. Intussusception in adults most frequently occurs in the small bowel, with 10% of cases occurring in the stomach or at the site of a surgical stoma. Intussusception occurs when one part of the intestine slides into the section next to it. Unlike intussusception in children, an acute abdomen is very occasionally present in adults. Ileoileal intussusception was the most common anatomic variety. It can also happen in older children and teenagers.
Intussusception is defined as invagination of an intestinal segment with its mesentery as a result of peristalsis into the intestinal lumen. The etiology of malignant nature has been reported to be more frequent in this group. Children are at a higher risk to develop intussusception than adults. Nevertheless, intussusception is an important differential to consider because most cases in adults are caused by structural lesions, commonly malignant neoplasms. The diagnosis and treatment of adult intussusception. Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. In intussusception part of the gastrointestinal gi tract invaginates or telescopes into another neighbouring portion. Intraluminal tumor is the most frequent cause of intussusception in adults, with small bowel tumors more commonly producing the intussusception. Pdf intussusception in adults fatih alper academia. Intussusception seems to occur more often in the spring and fall months. About 90% of intussusceptions in adults are caused by a definite underlying disorder such as a neoplasm or by a postoperative condition. Most of the information available on this unusual entity in adults is in the form of case reports.
Intussusception occurs more commonly in children than adults. Intussusception in adult cleveland clinic journal of. Cases of intussusception in adults are fairly rare. For children younger than 2, intussusception is the most common abdominal emergency. Idiopathic adult intussusception international journal. Most of the cases of this condition are, of course, seen in the infant. Patients with idiopathic intussusception were treated with simple reduction, while the others underwent segmental resection because of the possibility of malignant tumour. Intussusception is the telescoping of a proximal segment of bowel wall into the lumen of an adjacent, usually distal segment. Although intussusception is a rare cause of abdominal pain in adults, it is an important diagnosis to consider in patients with recurrent abdominal pain because it may be a harbinger of malignancy. Intussusception in children and adults symptoms, causes. Treatment in children is typically by an enema with surgery used if this is not successful. In adults, surgical removal of part of the bowel is more often required.
In contrast to intussusception in childhood, intussusception in adults usually has a definable lead point and resection of the involved bowel, rather than simple reduction. Diagnostic imaging plays an important role in the diagnosis of the condition. In rare cases, it can affect adults, though its usually. Approximately 90% cases of this condition in adults are the result of a postoperative condition or an underlying ailment such as a neoplasm. Intussusception is one of the infrequent etiologic factors which must be considered in those patients seen with an intestinal obstruction without other apparent cause. In adults, intussusception typically manifests as an acute or chronic obstruction and the presentation of adult intussusception is similar to that of small and large bowel obstruction. Abdominal pain, nausea, and vomiting were the most. Majority of them are benign especially in cases of small bowel intussusception. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. Only about 1% of bowel obstructions are due to intussusception in adults. Approximately 5% of all intussusceptions occur in adults, accounting for 1% of all bowel obstructions, 1. Intussusception causes in infants, in children and in adults. Age and sex distribution intussusception in adults can occur at any age, but this condition is much more common in infants and young children.
Outcomesresolutions if treated early on and quickly, intussusception in adults can be completely cured. Although most of the children who develop the condition are less than 3 years old, intussusception can also occur in older children, teenagers, and adults. In adults, a diagnosis of intussusception is often difficult and not often made before laparotomy. Intussusception causes, symptoms, diagnosis, treatment. Adult, invagination intussusception, diagnosis introduction the prolapse of one segment of the gastrointestinal tract into the lumen of an immediately. It usually takes place in a peristaltic direction, that is, the proximal segment invaginates into the distal segment. It is estimated to account for only 5% of all intussusceptions and causes only 1% of all bowel obstructions and 0. The age range is from intrath decade15, the mean being9 54. Unlike pediatric intussusception, intestinal intussusception is infrequent in adults and it is often secondary to a pathological condition. Intestinal intussusception in adults is a rare entity and there is an ongoing controversy regarding the optimal management of this problem. It represents only about 5% of all intussusceptions agha, 1986 and causes 15% of all cases of intestinal obstru ctions begos et al.
Any information contained in this pdf file is automatically generated from digital material. Ct imaging demonstrated ileocolic intussusception with free air and fluid indicating perforation. This is due to the significant rate of other pathologies associated with bowel intussusception in adults. Ileoileal or enteroenteric affecting only the small bowel. Intussusception is a rare cause of intestinal obstruction in adult patients. We report on a young patient who presented with an ileoileal intussusception in whom there were no. Intussusception has long been discussed in medical literature. The growing use of multidetector computed tomography mdct in abdominal imaging has increased the number of radiological diagnoses of intussusception, even in transient and nonobstructing cases. Small bowel intussusception in adults the annals of the. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Early diagnosis and treatment of intussusception are essential to save the intestine and the patient. Adult intussusception is an unusual entity, and its etiology differs from that in pediatric patients.
We have examined the changing demographics of adult intussusception and implicate human immunodeficiency virus hiv and acquired immune deficiency syndrome aidsassociated gastrointestinal pathology as risk factors for intussusception in young adults. Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%5% of intestinal obstructions in adults4. There is usually a lead point which is the cause of the invagination. The most common symptoms of intussus ception are abdominal pain, nausea, and vom iting. Only 19 per cent of the cases were due to lesions of the colon. However malignancy is quite often encountered in cases of colonic intussusception. The images of the specimen clearly show the ileal tumour within the intussusception.
Original article diagnosis and treatment of intestinal. What is the prognosis of intussusception in adults. The following report will discuss the diagnosis and management of nonspecific abdominal pain in a 77yearold woman who presented to a district general hospital in south london. Intussusception remains a rare condition in adults, representing 1% to 3% of bowel obstructions, 1,2 and it is a different entity in adults than in children. Intussusception is a rare form of bowel obstruction in adults, which is defined as the telescoping of a proximal segment of the gastrointestinal tract, into the lumen of the. Intussusception in adults can be further classified according to the presence of a lead point or not. Intussusception in adults is an uncommon condition.
Transient intussusception of the small bowel has been reported in adults with celiac disease 2 and crohn disease 6 but is most frequently detected incidentally and is presumed to be innocuous. Intestinal intussusception is an uncommon condition in adults which causes 1% to 5% of intestinal obstructions. It is commonly encountered in the small bowel of children, where the aetiology is largely benign and nonoperative treatment usually successful. Intussusception is an emergency requiring rapid treatment.
In 1742, cornelius henrik velse performed the first successful operation on adult intussusception. We present a single centre experience of this enigmatic entity over a period of 10 years. Clinical presentations, diagnosis and treatment of adult. Barbette of amsterdam described the first case in 1674. Its the most common cause of intestinal obstruction in children under the age of 3. Diagnosis is thus often delayed and results in surgical intervention due to the development of bowel ischaemia. Intussusception, first described in 1674, is defined as the invagination of a bowel loop with its mesenteric fold intussusceptum into the lumen of a contiguous portion of bowel intussuscipiens as a result of peristalsis. Intussusception is an uncommon cause of abdominal pain in adults and poses diagnostic challenges for emergency physicians, due to its varied presenting symptoms and time course. Babies and children with intussusception have intense abdominal pain, which often begins suddenly and causes the child to draw the knees up toward the chest. In contrast to pediatric intussusceptions, which are managed nonoperatively with air contrast enemas, treatment in adults is exploratory laparotomy for surgical reduction or resection. Symptoms can be nonspecific, and diagnosis is best made by ct imaging.