Intussusceptions in Adults

ByDr E Aravind

Intussusceptions occur when one segment of the gastrointestinal tract (intussusceptum) telescopes into the lumen of an adjacent distal segment of the gastrointest-inal tract (intussuscipiens).

Very rare in adults Accounts for 5% of all intussusecptions 1% of bowel obstructions In 90% cases definitive underlying

disorder can be identified Mean average age 54.5 yrs male-to-female ratio is 1:1.3 In 65% of cases – neoplasms Malignant tumors are more common in

colon Bening tumours in small intestine

Diagnostic challenge Patients presents with present with

nonspecific symptoms Has chronic indolent course until bowel

ischemia occurs

Symptoms› Abdominal pain (71-100%)- with guarding

only in 50% cases› Nausea and vomiting (40-60%)› Bleeding per rectum (4-33%)- more in

colonic types› Abdominal masses are palpable (<10%)

Types › ileo-colic,› ileo-ileo-colic, › colo-colic and › small bowel intussusception (jejuno-jejunal

and ileo-ileal)› Gastroduodenal and coloanal

intussusceptions are extremely rare

Common lead points Small intestine

› Benign neoplasms,› Meckel’s diverticuli,› Appendix › Adhesions› Malignant lesions (25%)

large bowel› Malignant lesions (50%)

Investigation Abdominal CT

› complex sausage-shaped soft tissue mass with an eccentric area of fat density contained within, which represents the mesenteric fat.

Plain abdominal x-rays Ultrasound

Treatment Always surgical in adults Resection of involved segment and

anastmosis

Prognosis› Good usually depends on cause

Mortality› 8.7% for the benign lesions to 52.4% for

the malignant variety