Transient intussusception of the small bowel has been reported in adults with celiac disease 2 and crohn disease 6 but is most frequently detected incidentally and is presumed to be innocuous. However, neoplasm is the most common cause and is found in. We report on a young patient who presented with an ileoileal intussusception in whom there were no. What is the prognosis of intussusception in adults. Intussusception in adults jama surgery jama network. It has often been stated that intestinal intussusception in adults is frequently caused by serious underlying disease, with 70%90% of cases having a demonstrable cause based on discharge diagnosis or surgical results, 1, 2. For children younger than 2, intussusception is the most common abdominal emergency.
The most common symptoms of intussus ception are abdominal pain, nausea, and vom iting. Although it is frequently associated with neoplastic. A wide range of causes can predispose to intussusception in adults. Nevertheless, intussusception is an important differential to consider because most cases in adults are caused by structural lesions, commonly malignant neoplasms. The growing use of multidetector computed tomography mdct in abdominal imaging has increased the number of radiological diagnoses of intussusception, even in transient and nonobstructing cases. Intussusception in adults most frequently occurs in the small bowel, with 10% of cases occurring in the stomach or at the site of a surgical stoma. The underlying pathologic processes were identified in 23 patients 92%. Most of the cases of this condition are, of course, seen in the infant. Intussusception in adults can be further classified according to the presence of a lead point or not. Age and sex distribution intussusception in adults can occur at any age, but this condition is much more common in infants and young children. Intussusception is a rare cause of intestinal obstruction in adults. Most of the information available on this unusual entity in adults is in the form of case reports. Pdf intussusception in adult population is quite uncommon.
Ileoileal or enteroenteric affecting only the small bowel. Intussusception occurs when one part of the intestine slides into the section next to it. However malignancy is quite often encountered in cases of colonic intussusception. In adults, the intussusception commonly occurs as a result of medical conditions such as tumor, intestinal adhesions, hematoma, inflammatory conditions such as crohns disease and the presence of surgical scars in the small intestine or colon. Barbette of amsterdam described the first case in 1674. An analysis of twentyseven episodes of intussusception in adults treated at charity hospital from 1938 through 1959 is presented. Intussusception is highly uncommon in adults and accounts for only 5% of all reported cases. The clinical index of suspicion for intussusception should be raised for an hivpositive young adult with intermittent. Clinical presentations, diagnosis and treatment of adult.
Intussusception causes, symptoms, diagnosis, treatment. Children are at a higher risk to develop intussusception than adults. Unlike intussusception in children, an acute abdomen is very occasionally present in adults. Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%5% of intestinal obstructions in adults4. We present a single centre experience of this enigmatic entity over a period of 10 years. Only about 1% of bowel obstructions are due to intussusception in adults.
Original article diagnosis and treatment of intestinal. About 90% of intussusceptions in adults are caused by a definite underlying disorder such as a neoplasm or by a postoperative condition. Intussusception causes in infants, in children and in adults. Any information contained in this pdf file is automatically generated from digital material. Intussusception is an emergency requiring rapid treatment. Intussusception seems to occur more often in the spring and fall months.
Intussusception often occurs at the junction of the small and large intestine and most. Once an individual has a blockage, there is always a risk that it might recur. Adult intussusception is an unusual entity, and its etiology differs from that in pediatric patients. In contrast to intussusception in childhood, intussusception in adults usually has a definable lead point and resection of the involved bowel, rather than simple reduction. In 1742, cornelius henrik velse performed the first successful operation on adult intussusception. Intestinal intussusception in adults is a rare entity and there is an ongoing controversy regarding the optimal management of this problem. Intussusception occurs more commonly in children than adults. It is more commonly secondary to an identifiable bowel lesion in 90% of cases, whereas 10% have no discernable cause. Ileoileal intussusception was the most common anatomic variety. This is due to the significant rate of other pathologies associated with bowel intussusception in adults. Ct imaging demonstrated ileocolic intussusception with free air and fluid indicating perforation.
Outcomesresolutions if treated early on and quickly, intussusception in adults can be completely cured. In rare cases, it can affect adults, though its usually. Diagnosis is thus often delayed and results in surgical intervention due to the development of bowel ischaemia. Diagnostic challenge of the nonspecific presentation of. Small bowel intussusception in adults the annals of the. Babies and children with intussusception have intense abdominal pain, which often begins suddenly and causes the child to draw the knees up toward the chest. The purpose of this study was to determine the causes and management of intussusception in adults. The childhood variety is common and success 90%38, barium method 70%38 and. There is usually a lead point which is the cause of the invagination. Cases of intussusception in adults are fairly rare.
Intussusception is defined as invagination of an intestinal segment with its mesentery as a result of peristalsis into the intestinal lumen. In adults, a diagnosis of intussusception is often difficult and not often made before laparotomy. In intussusception part of the gastrointestinal gi tract invaginates or telescopes into another neighbouring portion. The etiology of malignant nature has been reported to be more frequent in this group. This condition is frequent in children and presents with the classic triad of cramping abdominal pain, bloody diarrhea and a palpable tender mass. Adult intussusception is a rare condition wich can occur in any site of gastrointestinal tract from stomach to rectum. Intussusception in adult population is quite uncommon. Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. It usually takes place in a peristaltic direction, that is, the proximal segment invaginates into the distal segment. Dexamethasone may decrease the risk of another episode. Its the most common cause of intestinal obstruction in children under the age of 3. Mdct is well suited to delineate the presence of the.
We described the diagnosis and treatment of intestinal intussusception in adults. The following report will discuss the diagnosis and management of nonspecific abdominal pain in a 77yearold woman who presented to a district general hospital in south london. Intussusception in adults is an uncommon condition. Intussusception is rare in fully grown individuals and accounts for only 1% of all cases of bowel obstructions. Although intussusception is a rare cause of abdominal pain in adults, it is an important diagnosis to consider in patients with recurrent abdominal pain because it may be a harbinger of malignancy.
Intussusception is the telescoping of one segment of the gastrointestinal tract into an adjacent one. Early diagnosis and treatment of intussusception are essential to save the intestine and the patient. The majority of colon tumors producing intussusception are malignant 64 per cent as reported here. Intussusception in adult cleveland clinic journal of. Pdf intussusception in adults fatih alper academia. The condition is distinct from pediatric intussusception in various aspects. Although most of the children who develop the condition are less than 3 years old, intussusception can also occur in older children, teenagers, and adults. The primary symptoms of intussusception include abdominal pain and vomiting. Treatment in children is typically by an enema with surgery used if this is not successful.
Diagnostic imaging plays an important role in the diagnosis of the condition. Symptoms can be nonspecific, and diagnosis is best made by ct imaging. The frequency with which it may occur diminishes with the increasing age of the patient to adult life. We have examined the changing demographics of adult intussusception and implicate human immunodeficiency virus hiv and acquired immune deficiency syndrome aidsassociated gastrointestinal pathology as risk factors for intussusception in young adults. Unlike the paediatric population, reduction of the intussuscepted bowel with barium or air is not indicated in adults. Intraluminal tumor is the most frequent cause of intussusception in adults, with small bowel tumors more commonly producing the intussusception. Intussusception in adults occurs less frequently in the colon than in the small bowel zubaidi et al.
List the causes and clinical manifestations intestinal intussusception. It is commonly encountered in the small bowel of children, where the aetiology is largely benign and nonoperative treatment usually successful. Patients with idiopathic intussusception were treated with simple reduction, while the others underwent segmental resection because of the possibility of malignant tumour. Intussusception is a rare form of bowel obstruction in adults, which is defined as the telescoping of a proximal segment of the gastrointestinal tract, into the lumen of the. Unlike pediatric intussusception, intestinal intussusception is infrequent in adults and it is often secondary to a pathological condition. Intussusception occurs primarily in infants boys more often than girls but can also occur in adults and older children. Only 19 per cent of the cases were due to lesions of the colon. In adults, surgical removal of part of the bowel is more often required. Approximately 5% of all intussusceptions occur in adults, accounting for 1% of all bowel obstructions, 1. It represents only about 5% of all intussusceptions agha, 1986 and causes 15% of all cases of intestinal obstru ctions begos et al. Diagnosis is difficult due to nonspecific symptoms of the disease. It is estimated to account for only 5% of all intussusceptions and causes only 1% of all bowel obstructions and 0.
Adult, invagination intussusception, diagnosis introduction the prolapse of one segment of the gastrointestinal tract into the lumen of an immediately. Intussusception is an uncommon cause of abdominal pain in adults and poses diagnostic challenges for emergency physicians, due to its varied presenting symptoms and time course. Abdominal pain, nausea, and vomiting were the most. Intussusception is one of the infrequent etiologic factors which must be considered in those patients seen with an intestinal obstruction without other apparent cause. Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%5% of intestinal obstructions in adults. Majority of them are benign especially in cases of small bowel intussusception. Idiopathic adult intussusception international journal.
Intestinal intussusception is an uncommon condition in adults which causes 1% to 5% of intestinal obstructions. In contrast to pediatric intussusceptions, which are managed nonoperatively with air contrast enemas, treatment in adults is exploratory laparotomy for surgical reduction or resection. Intussusception has long been discussed in medical literature. The diagnosis and treatment of adult intussusception. Intussusception remains a rare condition in adults, representing 1% to 3% of bowel obstructions, 1,2 and it is a different entity in adults than in children. Intussusception is the telescoping of a proximal segment of bowel wall into the lumen of an adjacent, usually distal segment.
Therapeutic enema for intussusception therapeutic enema is used to help identify and diagnose intussusception, a serious disorder in which one part of the intestine slides into another in a telescoping manner and causes inflammation and an obstruction. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. The images of the specimen clearly show the ileal tumour within the intussusception. Intussusception remains a rare condition in adults, representing 1% to 3% of bowel obstructions, and it is a different entity in adults than in children. Approximately 90% cases of this condition in adults are the result of a postoperative condition or an underlying ailment such as a neoplasm. The age range is from intrath decade15, the mean being9 54. An intussusception is the invagination of a segment of the intestine into a contiguous portion of intestine.
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