Invaginación intestinal en el adulto: presentación de un caso y revisión de la literatura médica española / Intestinal invagination in adults: Presentation of a case and a review of the Spanish literature

Introducción La invaginación intestinal en el adulto es una entidad infrecuente, a menudo manifestada con síntomas inespecíficos crónicos o subagudos. En la mayoría de las ocasiones asocia una lesión orgánica. Actualmente no hay publicaciones de series amplias de pacientes que ayuden a definir el tratamiento de estos enfermos. Material y método Revisión de series de casos publicados en la literatura médica española. Se diseñó una base de datos de pacientes mayores de 15 años. Los datos se extrajeron de casos clínicos nacionales y se utilizaron recursos de Internet. Se añadió un caso clínico propio reciente. Resultados Se obtuvo una serie de 30 adultos con invaginación intestinal (29 de la revisión de casos y uno propio). La mediana de edad fue de 45 años (de 19 a 84); 17/30 (57%) fueron hombres. Presentaron dolor abdominal 27 pacientes y obstrucción intestinal establecida 8 casos (28%). El diagnóstico preoperatorio de invaginación se hizo en 25/30 pacientes (83%). Las invaginaciones fueron enteroentéricas (61%); colocólicas (12%); enterocólicas (21%), y yeyunogástricas (6%). El 85% de las invaginaciones asoció una lesión proliferativa y el 43% de estas últimas fueron malignas. Conclusiones Habitualmente el diagnóstico de invaginación en el adulto se obtiene preoperatoriamente. No hay datos para apoyar la resección intestinal sin realizar reducción. La resección debe ser la norma, y la presencia de adenopatías no es un argumento para realizar resecciones amplias (AU)

Introduction Intestinal invagination in the adult is an uncommon condition, often manifested by non-specific chronic or sub-acute symptoms. In the majority of occasions there is an organic lesion. There are currently no large patient series published in the literature to help define the management of these patients. Material and method A review of case series published in the Spanish literature. A data base of patients over 15 years old was designed. Data was extracted from national clinical cases using Internet resources. Our own recent clinical case is added. Results A series of 30 adults with intestinal invagination was obtained (29 cases from the review and one own). The median age was 45 years (19–84 years) and 17/30 (57%) were males. A total of 27/30 patients had abdominal pain and 8/30 (28%) cases had established intestinal obstruction. The preoperative diagnosis of invagination was made in 25/30 (83%) of patients. The invaginations were; enteroenteric, 61%; colocolic, 12%; enterocolic, 21%; and gastrojejunal, 6%. A total of 85% of the invaginations were associated with a proliferative lesion and 43% of the latter were malignant. Conclusions The diagnosis of invagination in the adult is usually made preoperatively. There are no data to support intestinal resection without performing a reduction. Resection must be the norm and the presence of lymph nodes is no argument to perform large resections (AU)

[Intestinal invagination in adults: Presentation of a case and a review of the Spanish literature]. / Invaginación intestinal en el adulto: presentación de un caso y revisión de la literatura médica española.

INTRODUCTION: Intestinal invagination in the adult is an uncommon condition, often manifested by non-specific chronic or sub-acute symptoms. In the majority of occasions there is an organic lesion. There are currently no large patient series published in the literature to help define the management of these patients. MATERIAL AND METHOD: A review of case series published in the Spanish literature. A data base of patients over 15 years old was designed. Data was extracted from national clinical cases using Internet resources. Our own recent clinical case is added. RESULTS: A series of 30 adults with intestinal invagination was obtained (29 cases from the review and one own). The median age was 45 years (19-84 years) and 17/30 (57%) were males. A total of 27/30 patients had abdominal pain and 8/30 (28%) cases had established intestinal obstruction. The preoperative diagnosis of invagination was made in 25/30 (83%) of patients. The invaginations were; enteroenteric, 61%; colocolic, 12%; enterocolic, 21%; and gastrojejunal, 6%. A total of 85% of the invaginations were associated with a proliferative lesion and 43% of the latter were malignant. CONCLUSIONS: The diagnosis of invagination in the adult is usually made preoperatively. There are no data to support intestinal resection without performing a reduction. Resection must be the norm and the presence of lymph nodes is no argument to perform large resections.