Adult intussusception: A 15-year retrospective review

Abstract

Objective: Adult intussusception is an uncommon disease and is usually associated with malignancy. In many cases, diagnosis is made only in the theatre as a result of its non-specific presentation and low index of suspicion. By reporting the present study, we would like to share our experience in managing this condition. Methodology: Patients with the diagnosis of intussusception admitted to Queen Elizabeth Hospital within the period 1996-2010 were included. Demographic data, presenting symptoms, and operative and pathological findings were collected and analysed. Results: There were 37 adult intussusceptions in the study period; 18 of them were female and 19 of them were male. The mean age of the patients was 67years. More than 40% of the patients had subacute onset of the symptoms. Abdominal pain was the most common presenting symptom, present in 83.5% of the patients. Preoperative diagnosis was made in 62.2% of the cases and all of these received either preoperative computed tomography and/or ultrasonography. There were nine enteric and 28 colonic intussusceptions. A pathological lead-point could be identified in 83.8%, and their size ranged from 2cm to 8cm. The malignant lead-point was larger than the benign one lead-point (4.74 vs 3.3, P=0.021). Malignancy was found in 33.3% of the enteric lesions and 60.7% of the colonic lesions. respectively. Age older than 70years was found to be an associated risk factor for malignancy (P=0.022). Conclusion: Intussusception should be considered as one of the differential diagnoses, especially in elderly patients complaining of subacute abdominal pain. Computed tomography scan should be the imaging of choice. Oncological resection should be carried out without attempt of reduction if the patient is older than 70years, having colonic intussusception and containing a large lead-point. © 2011 The Authors. Surgical Practice © 2011 College of Surgeons of Hong Kong.