Adult Intussusception-A Perspective

Abstract

Taskeen Mannan Sikora and Harshal Rajekar

Intussusception occurs when a segment of the proximal intestine called intussusceptum, telescopes into the lumen of the distal segment, also known as intussuscipiens.

Background: Rare in adults, most intussusceptions are due to a lead point, an identifiable pathological abnormality, mostly a tumor, often malignant where the resectability is difficult to assess. In children there are no identifiable pathological lead points, or and most often is due to lymphoid hyperplasia and no other pathology is found and often managed conservatively.

Case Summary: We had 3 patients, all elderly and frail, who presented with acute abdominal pain and bleeding per rectum. They were found to have large bowel intussusception. Surgical intervention is advised in all adult intussusception patients, as all adult intussusceptions are believed to be secondary. At the surgery it was found that all had operable lesions, had a good prognosis and histology of all was benign. One patient had a villous adenoma, one had lymphoid hyperplasia and the 3rd had a tubule-villous adenoma.

Thus all 3 elderly patients, presenting with intussusception did not have any specific signs or symptoms, were diagnosed by computerized tomography and had completely resectable lesions. Thus, early computerized tomography with timely surgical intervention is recommended in all patients with bleeding per rectum and suspected intussusception. Since intussusception is a mobile tumor the likelihood of resectability is high with a good prognosis.

Conclusion: Colonic intussusception rarely leads to colonic obstruction. Any kind of intussusception, points towards a lesion that is mobile and not invading or adherent to surrounding tissue, hence more likely to be resectable.

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