Intussusception in adults

Moamen Salameh

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Intussusception

Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment

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• A rare condition in adults, accounting 5% of all cases of intussusception and 1-5% of bowel obstructions

• Symptoms are often chronic, with intermittent abdominal pain as the main symptom

• Types: enteroenteric, enterocolic, colocolic

• Arises in the small bowl in two-thirds of cases

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Pathophysiology

• Idiopathic 10 - 20%

• Secondary 90%

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Secondary intuss.

• Initiates from any pathologic lesion of the bowel wall or irritant within the lumen

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Aetiology - Small bowl

• Benign lesions - neoplasm (lipoma, leiomyoma, haemangioma, neurofibroma)

• Adhesions

• IBD

• Meckel’s diverticulum

• Coeliac disease

• Henich-schonlein purpura

• Iatrogenic

• Malignant - most often metastatic 15%

• Idiopathic 20%

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Aetiology - Large bowl

• malignant 65%

• Benign: neoplasm (lipoma, leiomyoma, adenomatous polyps)

• IBD

• Endometriosis

• Idiopathic 10%

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Clinical presentation• The classic paediatric presentation of acute

intussusception is rare in adults

• The majority of cases in adults are presented as chronic non-specific symptoms

• Physical examination may demonstrate diffuse or localised abdominal tenderness, but is often unremarkable

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Symptoms• Nausea

• Vomiting

• Gastrointestinal bleeding

• Changes in bowl habits

• Constipation

• Diarrhoea

• Abdominal distention

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Diagnosis

• AXR

• US

• CT

• Endoscopy

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US

• Target sign

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CT

• Sausage-shaped mass

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CT

• Target sign

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Treatment

• Air enema

• surgical intervention

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