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X-ray abdomen. (a) Supine abdominal radiograph shows dilated small bowel loops and absence or paucity of gas in the large bowel due to distal small bowel obstruction. (b) Upright abdominal radiograph shows multiple air-fluid levels in upper and central abdomen that represent dilated proximal and central fluid-filled small bowel due to distal small bowel obstruction (arrows).
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Protrusion of a bowel segment into another (intussusception) produces severe abdominal pain and culminates in intestinal obstruction. In adults, intestinal obstruction due to intussusception is relatively rare phenomenon, as it accounts for minority of intestinal obstructions in this population demographic. Organic lesion is usually identifiable as...
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Intussusception is the telescoping of a segment of the gastrointestinal tract within the lumen of an adjacent segment. Adult intussusceptions are rare, with ileal lipoma responsible for only 6% of cases. Clinically, adult intussusception remains an elusive diagnosis. The triad of abdominal pain, vomiting and passage of bloody stool is not frequentl...
Acute intestinal intussusception (AII) is the telescoping of one segment of the intestine and its mesentery into the lumen of the adjacent intestine. It is the most common abdominal emergency in young children between 3 months and 3 years old but can occur at any age. We report the case of a 4-month-old infant.
Citations
... Cases of adult intussusception usually have a malignant etiology, with the abnormal growth acting as the initiating factor. Peristaltic contractions at this moment relax and contract the lumen, enabling the proximal segment to invaginate into the distal bowel [7]. ...
M. M. (2024). Insights into Complexity: Intussusception with Leiomyoma as a Lead Point in a 67-Year-Old Female. J Nur Healthcare, 9(2), 01-04. Abstract A portion of the colon that telescopes into the colon's length that comes before or after it is known as intussusception. The patient presented with symptoms of anemia, diarrhea, and stomach discomfort; CT imaging was crucial in guiding the successful laparoscopic right hemicolectomy. The patient's condition was promptly recognized. This emphasizes how crucial it is to be vigilant in identifying and treating this illness, particularly in older people. Analgesia and supportive treatment were useful in managing the leukocytosis and fever that characterized the postoperative phase. Potential problems were avoided by careful observation and fast intervention, highlighting the importance of a thorough diagnostic approach and timely surgical treatment in maximizing patient outcomes. In the context of adult presentations, this case emphasizes the need for enhanced clinical awareness and skillful management tactics when addressing intussusception. It also reinforces the significance of customized therapy to guarantee a good prognosis.
... It is the most common cause of intestinal obstruction in children under three years of age [7,8]. It is rare in adults, accounting for only 1%-5% of bowel obstructions [4][5][6][7] with a mean age of 50 years old [9]. Compared to pediatric intussusception, adult intussusception is distinct in that 90% of cases are secondary to a pathological lead point, not limited to polyps, carcinomas, strictures, adhesions, and Meckel diverticulum [4][5][6][7]. ...
... Adult intussusception is a rare clinical entity, accounting for only 1%-5% of all cases of intestinal obstruction [5,11]. Of these, the vast majority (90%) of cases can be attributed to an identifiable neoplasm, and the remainder (10%) are idiopathic [6,9]. While the exact mechanism is still unknown, it is believed that a pathological lead point or lesion within the bowel wall alters normal peristaltic activity [11], leading to the invagination of a proximal segment of the bowel into a distal segment, resulting in obstruction [1][2][3][4][5][6]. ...
... Intussusceptions can also be classified according to etiology (benign, malignant, or idiopathic) [5,9,11]. A majority of identifiable neoplasms causing intussusception are benign (80%), such as adhesions, lymphoid hyperplasia, lipomas, Meckel's diverticulum, Peutz-Jegher adenoma, gastrointestinal stromal tumors, hemangiomas, trauma, or leiomyomas [9]. ...
Intussusception is highly uncommon in adults, with most cases caused by a pathological lead point that requires surgical resection. This case presentation highlights a rare example of idiopathic intussusception in a young male adult. Our patient is a 23-year-old African American male who presented at the Piedmont Macon Medical Center emergency department in February 2023 with acute-onset severe periumbilical pain, nausea, vomiting, and diarrhea. Computed tomography (CT) imaging was inconclusive, and his diagnosis of an ileo-ileal intussusception in the distal ileum was made during an exploratory (diagnostic) laparoscopy. Based on a visual inspection of the bowel demonstrating no evidence of inflammation, adhesions, lesions, ischemia, or a pathological lead point, manual reduction without resection was indicated. While intussusception is rare in adults, it is an important clinical prognosis that should be carefully considered in the differential diagnosis.
... It is predominantly due to the peristaltic contractions constricting and relaxing the lumen at the transition point [1]. Bowel intussusception is commonly seen in children but is rare in adults, accounting for 5% of all cases of intussusception and 1% of all cases of bowel obstruction in adults [4]. The incidence of intussusception varies among age groups. ...
... Although a rare finding, adult intussusception has the potential to cause severe complications if not recognized and treated early, including but not limited to bowel obstruction, necrosis, and perforation [7]. A proposed hypothesis is that as a part of the bowel segment telescopes into an adjacent segment, the mesenteric vasculature supplying the affected bowel can become compressed and thus compromised, resulting in ischemia of the bowel wall [4]. The gold standard for diagnosing intussusception and small bowel obstruction (SBO) is an abdominal computed tomography (CT). ...
Intussusception in adults is a rare finding with a majority of cases occurring in the pediatric population. It occurs infrequently and its presentation, etiology, and treatment differ from childhood intussusception. When discovered in adults, it raises suspicion for a neoplastic process serving as the pathological lead point. Cross-sectional imaging is the primary study of choice for diagnosis, but at times, a more invasive approach involving an exploratory laparotomy is required posing an increased risk for morbidity and mortality. Here we present a 64-year-old male who was found to have jejunal-jejunal intussusception that was surgically removed with pathology revealing metastatic melanoma as the lead point. This case highlights a unique presentation of a melanoma that was previously eradicated with immunotherapy and now had metastasized to the intestine many years later.
... Intussusception is the invagination of a proximal portion of the intestine into its distal aspect [1], often referred to as telescoping [2]. The condition is typical among pediatrics and infants, with a peak incidence occurring in infants of 5-7 months of age with an incidence of 74 per 100,000 [3,4] in children under one year old. ...
... Adult intussusception cases typically have a malignant etiology, from which the abnormal growth serves as the lead point. At the transition point, peristaltic contractions constrict and relax the lumen, allowing for the invagination of the proximal segment into the distal bowel [2]. Adult intussusceptions account for less than 5% of all cases [7], from which 52% localize in the small bowel [15]. ...
Recurrent abdominal pain in the adult population is a complex symptom with a broad spectrum of diagnoses. The diagnosis of intussusception in the elderly is considerably rarer than in the younger population. High clinical suspicion is required, and imaging is needed for confirmation. Here, we present and discuss the clinical course and management of an 82-year-old female who underwent small bowel resection following recurrent intussusception that was confirmed by imaging and at the time of surgery. The patient was known for having a history of polyps, and the pathology report described a large tubulovillous adenoma found on the resected small bowel specimen. The patient was discharged after surgery with complete remission. This case report intends to explore the importance of surgical intervention versus conservative management in a patient with a similar clinic presentation. This report also intends to highlight the importance of surgical intervention to prevent intussusception-related complications and reduce patient mortality further.
... According to its etiology, Agha classified intussusception as tumor related, postoperative, miscellaneous, and idiopathic (9). While large bowel intussusception is secondary to malignant tumors in about 65-70% of cases, small bowel intussusception is associated with malignancy in only 30-35% of cases (10)(11)(12). In our series, 5 patients had malignant tumors, 2 had polypoidal lesions, and 1 patient had a jejunal lipoma. ...
Background and study aims: Intussusception in adults often remains unrecognized. Our aim was to report our experience with this entity to determine the usefulness of CT scan in its preoperative diagnosis.
Patients and Methods: The medical records and imaging studies of all patients ≥16 years of age with intussusception, who were managed at our hospitals, were retrospectively reviewed.
Results: 17 cases of adult intussusception (7 males, 10 females; mean age 35.9 years; age range of 16-78) were identified. The diagnosis was possible in all patients using CT scan. The underlying etiologies were colon cancer (n=2), lymphoma (n=2), small bowel polyps (n=2), jejunal lipoma (n=1), metastatic melanoma (n=1), Meckel’s diverticulum (MD) (n=1) and idiopathic (n=1). In the remaining 7 patients, the intussusceptions were of the transitory form and were treated conservatively and no significant sequela occurred after a follow-up of 2-60 months. CT scan findings in transient cases characteristically showed that the intussusception was localized to the proximal intestine and all of them had a short segment (2-4 cm) of intussusception.
Conclusions: The important role of the CT in the preoperative diagnosis of intussusception and characterizing its causes cannot be overemphasized. All transient cases had a short segment of intussusception.
... Subsequent peristaltic bowel activity produces an area of sequence constriction and relaxation, thus telescoping the leading point through the distal bowel lumen which can cause bowel obstruction and compromise of mesenteric blood flow, with resultant ischaemia of the bowel wall. Intussusceptions can also occur without a lead point which are usually transient [1,2]. ...
... adhesion, lymphoid hyperplasia, lipoma, leiomyoma, Meckel's diverticulum, gastrointestinal stromal tumor, Peutz-Jegher adenoma) in small bowel intussusception. In contrast, the colon is more likely (60%) to have malignant lesion as the cause of intussusception where adenocarcinoma accounts for two thirds of cases and malignant lymphoma for one third of cases [2,[4][5][6]. ...
... This is particularly important because an underlying malignancy may first present as an intussusception. Abdominal CT is a good modality in distinguishing between lead point and non-lead point intussusception and helps in timely management [1,2,5]. Non-lead point intussusceptions usually don't require surgery. ...
A 55-year-old female patient presented with abdominal discomfort, constipation, weight loss and occasional vomiting for the past 5 months. Imaging Findings Axial CECT abdomen (Fig. 1) showed a sausage-shaped mass with invagination of proximal ascending colon into its distal part. There was thickening of the ascending colon (~ 22mm) which was the lead point causing intussusception. Cross-sectional image of the mid-portion of intussusception (Fig. 2) illustrated typical bowel within bowel appearance or target sign. No hepatic or bone metastasis was noted.
... A few cases of small bowel or colonic intussusceptions in patients with Crohn's disease have been reported; hence CD is considered as a predisposing factor for intussusception [3]. In adults, intestinal obstruction due to intussusception is a relatively rare phenomenon and it accounts for minority of intestinal obstructions [4]. ...
Adult intussusception is a rare entity accounting for 1% of all bowel obstructions. Unlike intussusceptions in children, which are idiopathic in 90% of cases, adult intussusceptions have an identifiable cause (lead point) in the majority of cases. Crohn's disease (CD) may affect any part of the gastrointestinal tract, including the appendix. It was shown to be a predisposing factor for intussusception. Here, we report a rare case of adult intussusception with a lead point, emphasizing diagnostic input of multidetector computed tomography (MDCT) in a patient with active CD that involves the appendix.
... Intussusception is commonly seen in children and has been reported as the second most common abdominal emergency, trailing only appendicitis. Adult intussusceptions, however, account for only 5% of all cases of intussusceptions and only 1% of all cases of bowel obstruction in adults, with the mean age of incidence being 56 years [2]. This entity can be classified into 4 distinct categories: ileocecal enteric, iliocolic, and colocolic [3]. ...
Background: Intestinal intussusceptions represent a rare cause of intestinal obstruction in adults, with the most frequent localization being the ileocecal region. The initial diagnosis is often missed or delayed as the presentation is non-specific.
Case Presentation: A 23 year young female presented to our surgical OPD with 5 days history of colicky pain in the right lower abdominal quadrant, aggravated by food intake and associated with vomiting. Emergency midline laparotomy was performed, and it revealed ileoileal intussusception for which segmental ileal resection was done with end to end anastomosis.
Conclusion: In adults, majority of the intussusceptions are secondary to an underlying pathology, with approximately 65% due to malignant or benign neoplasms. The incidence of malignancy is particularly high with colonic intussusceptions
... Therefore, the presence of intussusception in an adult is a significant finding, as its presence may allude to an underlying malignancy. It follows that resection without reduction is a necessity in most cases in order to abrogate the origin of the intussusception [8]. Fibrosis is a classic feature found in patients with neuroendocrine tumors arising in the ileum and jejunum [9]. ...
A 34-year-old female was admitted to Emergency Department with an abrupt onset of diffuse abdominal pain. A CT scan done prior to her transfer revealed significant dilated loops of bowel as well as multiple target signs with likely torsed bowel. The patient consented to an exploratory laparotomy. During surgery, the proximal jejunum was found to be intussuscepted, a rare finding in an adult. There was evidence of mesenteric foreshortening throughout the small bowel and multiple whitish lesions within the mesentery, both consistent with the desmoplastic response that is characteristic of carcinoid. The interest for this case report comes from the patient's surgical findings of jejunal intussusception as well as her extensive history, which includes a bowel resection with an ileocolic anastomosis for presumed ischemia and a carcinoid tumor in the stomach which had been removed endoscopically.
A 38-year-old woman presented at Orotta National Referral Hospital emergency department in May 2017 with pain in the epigastric region and vomiting. Physical examination revealed no pertinent findings. Blood and urine tests were normal, and erect abdominal x-ray revealed a distended small intestine with multiple layers of “air-fluid levels”. CT scan and MRI were not done due to their temporary unavailability. During laparotomy a large mass of 20x20 cm in size was detected in the mid-jejunum of the small intestine. This leading tumor caused intussusception and coiling of the small intestine. As there are no typical symptoms of intussusception, it is very important to do CT scan for patients with long-standing abdominal pain and vomiting to achieve a definitive diagnosis of intussusception.
