ADULT INTUSSUSCEPTION – A SURGICAL DILEMMA

M A Rathore, S I H Andrabi, M Mansha

Abstract


Background: Adult intussusception is rare. It is expected to be found in 1/30,000 of all hospital
admissions, 1/1300 of all abdominal operations, 1/30–1/100 of all cases operated for intestinal
obstruction and one case of adult intussusception for every 20 childhood ones. Methods: The
authors encountered 4 cases of adult intussusception. M:F ratio was 1:1. Mean age was 47years.
Small bowel obstruction was documented in all. They were investigated by radiographs,
ultrasound exam, barium studies, endoscopy and CT scan. Results: All however were diagnosed
at operation although some pre-operative suspicion was raised in one case. All had a laparotomy.
Two were ileo-ileal and two ileo-caecal intussusceptions. One was chronic intussusceptions and
three sub-acute. One intussusception had a malignancy (lymphoma) as a lead point. Two had a
submucous lipoma at the apex. In an interesting case the suture knot from a recent small bowel
anastomosis (2-3 weeks prior) was forming the lead point of the intussusception! The 2 ileo-ileal
intussusceptions had segmental resection. Right hemicolectomy was done for the 2 ileo-caecal
cases. “Target lesion” and leumen-within-leumen were the CT hallmarks on review. Retrospective
barium enema review failed to show the intussusception. This may suggest the intussusception
may have been recurrent or chronic. All 4 recovered uneventfully and remained well. One patient
was referred for chemotherapy for intestinal lymphoma. Conclusion: Adult intussusception
remains a rare cause of abdominal pain. The treatment almost always is surgical.
Key words: Adult Intussusception

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