Adult intussusception. An overlooked diagnosis in the emergency department

ABSTRACT

To study the appropriate method of diagnosis and management in adult intussusception [AI] focusing on the clinical manifestations, diagnostic tools, and management of this rare disease. This retrospective study reviewed and analyzed the demographic data, clinical features, diagnosis, management, and pathology reports of all adult patients [18 years of age and older] with a diagnosis of intussusception admitted to Sohag University Hospital, Sohag, Egypt, and Najran Armed Forces Hospital, Najran, Kingdom of Saudi Arabia [KSA] from January 2004 to August 2012. From 2004-2012, 14 patients with AI were diagnosed and treated. Ages ranged from 22-63 years. Ten patients [71.4%] were males. Thirteen patients [92.9%] presented with abdominal pain. All patients were diagnosed after a CT scan, and confirmed at laparotomy. The lead point was found in all, except for 2 patients. Ileo-ileal and jejuno-jejunal intussusceptions represented most of our cases [64.3%], followed by ileocolic [28.5%], and colocolic [7.1%]. The most common causes were Peutz-Jeghers polyps [5 cases], submucosal lipoma [2], and malignancy [2]. Surgery was the treatment option in all except one patient. Postoperative complications occurred in 3 cases [21.4%]. One patient died 28 days postoperatively due to septic shock and multiorgan failure. Owing to its rarity, AI needs a high index of suspicion especially in patients attending ERs with recurrent abdominal pain. A CT scan is of prime importance in the diagnosis, and surgical treatment is the preferred method of management