Eisen LK, Cunningham JD, Aufses AH Jr. Intussusception in adults: institutional review. Adult intussusception: a systematic review and meta-analysis. Usually the most common site is the small bowel. West K W, Stephens B, Vane D W, Grosfeld J L. Intussusception: current management in infants and children. When there is clinical suspicion, imaging has a valuable role. Intussusception in adults is a rare clinical entity and is found in less than 1 in 1300 abdominal operations. Abbreviations: Abd, abdominal; constip, constipation; Dx, diagnosis; GI, gastrointestinal; ICV, ileocolic volvulus; LB, large bowel; malig, malignant; N/V, nausea/vomiting; SB, small bowel; sx, symptoms. This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. The choice of using a laparoscopic or open procedure depends on the clinical condition of the patient and especially on the surgeons advanced laparoscopic experience (4043). [1] Intussusception occurs more commonly in children than adults. Anyway, the increased use of cross sectional imaging has increased the early-diagnosis of intussusception, in many cases with a successful nonoperative management; such findings led to some questioning about the optimal management of these conditions. Marina Rizzi, Department of Endoscopy, "Madonna delle Grazie" Hospital, Matera 75100, Italy. In addition, signs of shock such as hypotension and tachycardia may be present. Upper gastrointestinal contrast series may show a stacked coin or coil-spring appearance, while a barium enema examination may be useful in patients with colo-colic or ileo-colic intussusception, during which a cup-shaped filling defect or spiral or coil-spring appearances are sometimes characteristically demonstrated (23). Less commonly, malignant tumors may act as lead points with metastatic disease (i.e., carcinomatosis) being the most common. In addition, minimally invasive tecniques have been used successfully in selected cases. Wang N, Cui XY, Liu Y, Long J, Xu YH, Guo RX, Guo KJ. Alonso V, Targarona EM, Bendahan GE, Kobus C, Moya I, Cherichetti C, Balagu C, Vela S, Garriga J, Trias M. Laparoscopic treatment for intussusception of the small intestine in the adult. Additionally, altered peristalsis in focal areas of the bowel wall leading to aperistaltic segments that feed into peristaltic areas, as in the submucosal hemorrhages in Henoch-Schonelin purpura, allows for the formation of an intussusceptum. 8 Intussusception is the most common cause of intestinal obstruction in babies and young children. It can occur anywhere in the small and large intestine. Other ports are placed as needed depending on the location of the pathology. Department of Radiology, "Madonna delle Grazie" Hospital, Matera 75100, Italy. http://creativecommons.org/Licenses/by-nc/4.0/, Adherences, coeliac disease, Crohns disease, endometriosis, hamartoma, infections, Kaposi sarcoma, lipoma, Meckel diverticulum, neurofibroma, polyps (inflammatory, adenomatous), stromal tumor, tubercolosis, Adenocarcinoma, carcinoid tumors, leiomyosarcoma, lymphoma, malignant gastrointestinal stromal tumor, metastatic carcinoma, neuroendocrine tumor, Adherences, inflammatory pseudopolyp, lipoma, polyps (inflammatory, adenomatous), Adenocarcinoma, metastatic carcinoma, lymphoma, gastrointestinal stromal tumor. Lee EH, Yang HR. The main issues in the management of adult intussusception are: (1) When proceed with surgical exploration; (2) Once the surgical approach is the treatment of choice, whether attempt intraoperatively reduction or proceed direct to resection of the affected segments; and (3) Once the surgical approach is the treatment of choice, it should be performed open or laparoscopically. In the pediatric population, treatment depends on the type of intussusception. The previous version of this article was authored by Susan M. Cera, MD. Ultrasonic diagnosis of adult intussusception. Inflammatory fibroid polyp of the small intestine. When the small bowel intussusception is induced by malignant lesions these are often metastatic disease (i.e., carcinomatosis). An official website of the United States government. Ileocecal valve adenocarcinoma. . (Images courtesy of Dr. Nancy McNulty, MD.). Interestingly, intussusceptions have been classified according to their locations into four categories: (1) entero-enteric (confined to the small bowel), (2) colo-colic (involving the large bowel), (3) ileo-colic (prolapse of the terminal ileum within the ascending colon) and (4) ileo-cecal, (the ileo-cecal valve is the leading point of the intussusception) (18, 19). Adult intestinal intussusception: CT appearances and identification of a causative lead point. 8600 Rockville Pike Ciftci F. Diagnosis and treatment of intestinal intussusception in adults: a rare experience for surgeons. Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Kori T, Kuwano H. The diagnosis and treatment of adult intussusception. Distinguishing features of self-limiting adult small-bowel intussusception identified at CT. Jain P, Heap SW. Intussusception of the small bowel discovered incidentally by computed tomography. It occurs mostly in children but can also occur in adults. The diagnosis and management in this population generally starts with nonoperative reduction of the intussusceptum using air or contrast enemas. A successful patient of abdominal section for intussusception. In: StatPearls [Internet]. As previously mentioned, bowel intussusception afflicts children more than adults with an approximate ratio of 20 to 1. Left panel demonstrates a sausage-shaped filling defect in the right hemi-abdomen; the middle (contrast enhanced) and right (postcontrast) panels demonstrates the invagination. the contents by NLM or the National Institutes of Health. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. Based on the systematic review of Hong et al[12], it is important to remark that the pooled rate of patients that received this type of conservative treatment is less of 5% and is limited to patient with entero-enteric locations. Fever is usually a sign of the onset of intestinal necrosis. In: Cameron JL, editor. A: Ultrasound scan revealed target sign; B and C: Computed tomography scan confirmed ielo-colic intussusception, with no signs of bowel obstruction [orange arrow, horizontal (B) and coronal (C)]. sharing sensitive information, make sure youre on a federal Surgical management of intussusception in the adult. Erbil Y, Eminolu L, Cali A, Berber E. Ileocolic invagination in adult due to caecal carcinoma. Clinicians and surgeons are not supported by designated scoring systems in this challenging diagnosis because of non-specific symptoms, and its preoperative identification is often missed or delayed. 9,10 Who is more likely to get intussusception? As there are many common causes of acute abdomen, intussusception should be considered when more frequent etiologies have been ruled out. In a recent systematic review and meta-analysis from Hong et al[12] 1229 adults with intussusception were identified from 40 retrospective case series: Pooled rates of malignant and benign tumors and idiopathic etiologies were 32.9%, 37.4% and 15.1%, respectively. With continued invagination resulting in edema, eventually the vascular flow to the bowel becomes compromised, resulting in ischemia to the affected segment that, left untreated, can result in necrosis and perforation. The nonspecific nature of these findings, coupled with the rarity of intussusception incidence in adults, can result in a broad differential diagnosis and may not include intussusception. Guest Editor: Jason S. Mizell, MD, FACS, FASCRS, intussusception, intussusceptum, intussuscipiens, bowel obstruction. Adult intussusception: case reports and review of literature. Sarma D, Prabhu R, Rodrigues G. Adult intussusception: a six-year experience at a single center. Diagnostic accuracy of CT has been found to be as high as 58 to 100% in other reports.14 The presenting symptoms in adult patients with intussusception are non-specific and often long standing. This telescoping action often blocks food or fluid from passing through. Simple reduction is reccommended in idiopathic intussusceptions where no pathological underlying lesion is present (36). As previously reported, adults intussusception is frequently cause by a pathologic lead point. The characteristic imaging features of CT include an unhomogeneous target or sausage-shaped soft- tissue mass with a layering effect. Adult intussusception less commonly occurs in the colon than in the small bowel and accounts for only 20 to 25% of all intussusceptions in most reported case series.2 In this review we discuss the symptoms, location, etiology, characteristics, diagnostic methods and treatment strategies of this rare and enigmatic clinical entity in adults. Kim Y H, Blake M A, Harisinghani M G. et al. Although the exact mechanism leading to intussusception is unknown, it is believed that any lesion in the bowel wall or irritant within the lumen that alters normal peristaltic bowel activity is able to initiate the invagination process. The risk of preliminary manipulation includes tumor dissemination. Eisen LK, Cunningham JD, Aufses AH., Jr Intussusception in adults: institutional review. Infectious etiology resulting in mesenteric lymphadenopathy is another common cause of pediatric intussusception. Zubaidi A, Al-Saif F, Silverman R. Adult intussusception: a retrospective review. Intussusception is defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel. Rea J D, Lockhart M E, Yarbrough D E, Leeth R R, Bledsoe S E, Clements R H. Approach to management of intussusception in adults: a new paradigm in the computed tomography era. Honjo H, Mike M, Kusanagi H, Kano N. Adult intussusception: a retrospective review. 1 Hong KD, Kim J, Ji W, Wexner SD. Honjo H, Mike M, Kusanagi H, Kano N. Adult intussusception: a retrospective review. Is widely reported that, for right-sided colonic intussusceptions, resection and primary anastomosis can be carried out safely, while for left-sided cases resection with construction of a colostomy and re-anastomosis at a second stage is considered safer. Lloyd D A, Kenny S E. Ontario, Canada: BC Decker; 2004. Interestingly, coloanal intussusceptions are rare and occur in the setting of a benign . official website and that any information you provide is encrypted The term intussusception refers to the invagination of a segment of the gastrointestinal tract into the lumen of an adjacent segment[1]. In several reports, approximately 50% of malignant lesions causing small bowel intussusception were metastatic (miliary) melanomas.8 Malignant intraluminal causes of small bowel intussusception include primary leiomyosarcomas, adenocarcinoma, GIST tumors, carcinoid tumors, neuroendocrine tumors, and lymphomas.
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