Intussusception Case Studies
Intussusception is defined by telescoping of one segment of bowel into an adjacent
segment of bowel. The clinical presentation in adult is often nonspecific, making
diagnosis a challenge. Most commonly, patients present with abdominal pain [1, 2,
3]. The less common presentations include complete or partial bowel obstruction,
haem-positive stools, a palpable mass and incidental finding on imaging. [1,2] The
classic triad of abdominal pain, a palpable mass and passage of red current jelly
stools seen in children is rarely seen in adult patients. [2] Multiple diagnostic studies
have been utilized to diagnose intussusception, including computed tomography
(CT), ultrasound scan, small bowel contrast study, and magnetic resonance imaging. …show more content…
Several recent studies [2,4]
have shown that current CT scanners have a sensitivity of 58 to 100% and specificity
of 57 to 71% in detecting the intussusception.
Most cases of intussusception in children are treated conservatively with non-
operative reduction since this pathological process is usually idiopathic without any
lead point. On the other hand, management of adult intussusception is more
controversial. Firstly, adult intussusception is much less common in comparison to
the incidence of paediatric cases, only accounting for 5% of all intussusceptions.
[5,6] Due to its rarity, there are no large-scale studies or meta-analyses published to
define appropriate guidelines for optimal management of adult intussusception. [1,7]
Secondly, adult intussusceptions are often secondary to presence of a lead point,
including malignancy. Previous studies [6, 8] have shown that the majority of adult
colonic intussusception is associated with primary malignancy, representing 65 to
70% of cases, whereas 30 to 35% of adult small bowel intussusceptions are caused by a malignancy. As a result, most authors [8] have previously …show more content…
Recent
studies [2, 9, 10] support non-operative management for selected cases of
intussusceptions, recommending against the traditional view of mandatory operative
exploration of all intussusceptions. Furthermore, one of the latest studies [1] has
shown that 40% of patients were managed non-operatively with resolution of
intussusception with acceptable recurrence rates.
Although recent literature has illustrated the increase in the number of idiopathic
cases and advocated conservative management of adult intussusceptions, Onkendi
and his colleagues [2] have recommended surgical resection for colocolonic and
ileocolic intussusceptions. Ileocolic intussusception was one of the least common
subtypes of all intussusceptions among enteroenteric, ileocolic, ileocaecal, and
colocolonic intussusceptions in their study. Lead point associated intussusceptions in
their study demonstrated about half of them were primary malignancies or
metastases and the other half were benign lesions. They have advised resections
segment of bowel. The clinical presentation in adult is often nonspecific, making
diagnosis a challenge. Most commonly, patients present with abdominal pain [1, 2,
3]. The less common presentations include complete or partial bowel obstruction,
haem-positive stools, a palpable mass and incidental finding on imaging. [1,2] The
classic triad of abdominal pain, a palpable mass and passage of red current jelly
stools seen in children is rarely seen in adult patients. [2] Multiple diagnostic studies
have been utilized to diagnose intussusception, including computed tomography
(CT), ultrasound scan, small bowel contrast study, and magnetic resonance imaging. …show more content…
Several recent studies [2,4]
have shown that current CT scanners have a sensitivity of 58 to 100% and specificity
of 57 to 71% in detecting the intussusception.
Most cases of intussusception in children are treated conservatively with non-
operative reduction since this pathological process is usually idiopathic without any
lead point. On the other hand, management of adult intussusception is more
controversial. Firstly, adult intussusception is much less common in comparison to
the incidence of paediatric cases, only accounting for 5% of all intussusceptions.
[5,6] Due to its rarity, there are no large-scale studies or meta-analyses published to
define appropriate guidelines for optimal management of adult intussusception. [1,7]
Secondly, adult intussusceptions are often secondary to presence of a lead point,
including malignancy. Previous studies [6, 8] have shown that the majority of adult
colonic intussusception is associated with primary malignancy, representing 65 to
70% of cases, whereas 30 to 35% of adult small bowel intussusceptions are caused by a malignancy. As a result, most authors [8] have previously …show more content…
Recent
studies [2, 9, 10] support non-operative management for selected cases of
intussusceptions, recommending against the traditional view of mandatory operative
exploration of all intussusceptions. Furthermore, one of the latest studies [1] has
shown that 40% of patients were managed non-operatively with resolution of
intussusception with acceptable recurrence rates.
Although recent literature has illustrated the increase in the number of idiopathic
cases and advocated conservative management of adult intussusceptions, Onkendi
and his colleagues [2] have recommended surgical resection for colocolonic and
ileocolic intussusceptions. Ileocolic intussusception was one of the least common
subtypes of all intussusceptions among enteroenteric, ileocolic, ileocaecal, and
colocolonic intussusceptions in their study. Lead point associated intussusceptions in
their study demonstrated about half of them were primary malignancies or
metastases and the other half were benign lesions. They have advised resections