Adult Intussusception

Adult intussusception differs from the predominantly idiopathic pediatric condition because a pathological lead point is common. In a systematic review of 2,330 adults, 58% had a pathological lead point, 39% were classified as idiopathic, and 25% had underlying malignancy. The evidence base was largely retrospective case series, so these estimates should guide suspicion rather than function as patient-level prediction rules. Wolters KluwerWolters KluwerIntestinal Intussusception in Adults: A... : World Journal of Surgery

Anatomical location materially changes the pretest probability of malignancy. In the same review, malignancy was reported in 68% of colocolic, 46% of ileocolic, and 9% of small-bowel intussusceptions. This gradient supports a lower threshold for definitive oncologic operative management when colon is involved and more selective management of enteric disease. Wolters KluwerWolters KluwerIntestinal Intussusception in Adults: A... : World Journal of Surgery

For suspected adult intussusception, contrast-enhanced abdominal CT is preferred because it can identify the location and extent of intussusception, a potential primary cause, and associated complications. CT is also described as the most sensitive diagnostic approach in adult case literature. Wiley+1WileySpontaneous resolution of a gastro‐gastric intussusception in a dog: Diagnostic approach and clinical implicationsWileyIntussusception of the bowel in a young woman: A case ...

Interpret CT in clinical context rather than treating a target-shaped configuration as an automatic indication for laparotomy. Increasing CT use has identified more idiopathic and asymptomatic intussusceptions, while management remains dependent on the clinical presentation and evidence for a lead point. facs+1facsIleocolic Intussusception Secondary to a Large Tubulovillous Polyp | ACSpubs rsnaAdult Intussusception Detected at CT or MR Imaging

Operative management was performed in 49% of adults in a systematic review, predominantly through an open approach (72% of operations). Reporting of operative details and selection criteria was heterogeneous, and the review identified continuing controversy regarding conservative versus operative management. Wolters Kluwer+1Wolters KluwerIntestinal Intussusception in Adults: A... : World Journal of SurgeryWileyIntestinal Intussusception in Adults: A Systematic Review

For colocolic intussusception, the systematic review recommends oncologic surgical resection without reduction because of the high probability of underlying malignancy. Attempted reduction could compromise oncologic principles if a malignant lesion is present; however, the supplied evidence does not provide comparative trial data for this approach. Wolters KluwerWolters KluwerIntestinal Intussusception in Adults: A... : World Journal of Surgery

For enteric small-bowel intussusception, management should be individualized according to length, clinical presentation, and intraoperative evidence of a lead point. This approach accommodates the lower reported small-bowel malignancy frequency and the recognition that some CT-detected cases are idiopathic or asymptomatic. Wolters Kluwer+2Wolters KluwerIntestinal Intussusception in Adults: A... : World Journal of Surgerypubs rsnaAdult Intussusception Detected at CT or MR ImagingfacsIleocolic Intussusception Secondary to a Large Tubulovillous Polyp | ACS

Adult intussusception is often caused by an intraluminal or other structural lead point, which can be benign or malignant. Case literature documents lead points including Meckel diverticulum, inflammatory fibroid polyp, and large tubulovillous polyp. Wolters Kluwer+2Wolters KluwerSynchronous ileo-ileal and ileocolic intussusception caused by ...Oxford AcademicAdult ileo-ileal intussusception caused by inflammatory fibroid ...facsIleocolic Intussusception Secondary to a Large Tubulovillous Polyp | ACS

If operative management is undertaken, establish a pathologic diagnosis of the lead point and align further oncologic staging or surveillance with the final diagnosis. The supplied evidence does not provide disease-specific surveillance schedules after resection for adult intussusception itself.