Analysis of the Diagnostic Maneuver and Timing of Operation in Adult Intussusception

ABSTRACT

PURPOSE: Intestinal intussusception in adults is a rare entity and its clinical course and etiology differ from pediatric counterpart. About 90% have a primary pathologic lesion, especially malignancy consists of etiology as 30% in small bowel and 66% in large bowel. The purpose of this study is to investigate of accurate diagnosis, treatment, and timing of operation by review of clinical symptom, physical examination, laboratory finding, pathologic finding, and operation finding of adult intussusception patients. METHODS: We studied 20 adult patients who were diagnosed as intussusception between July 1993 and September 2005. Intussusception by operation and rectal prolapse were excluded. Clinicopatholgic findings were analyzed retrospectively through the medical record. RESULTS: There was 15 males and 5 females in all 20 patients, and mean age was 52.3 years with a range of 29 to 78 years. Preoperative diagnosis was suspected in 14 of 20 patients (70%). We performed emergency operation in 8 cases (40%) and elective operation in 12 cases (60%). Two cases of them which preoperative diagnosis were strangulation and peritonitis accompanied with small bowel necrosis and leukocytosis. There were 12 small bowel lesions (60%) and 6 colonic lesions (30%). In two cases, there were no primary lesions. Of the cases with a defined cause, 12 cases were malignant (60%) and 6 cases were benign (30%). CONCLUSION: The most useful diagnostic method is computed tomography to reveal adult intussusception. Two cases of all were strangulated and also had a leukocytosis. In adult intussusception, most common cause is malignancy. If there is no evidence of strangulation such as leukocytosis, we recommend that elective surgery is adequate.