From the Research
Introduction to Intussusception
Intussusception is a rare condition where a proximal segment of the gastrointestinal tract telescopes into the lumen of the adjacent distal segment of the GI tract [ 1 ]. This condition can occur in both children and adults, but its presentation and management differ significantly between the two age groups.
Causes and Risk Factors
The causes of intussusception can be categorized into two main types: idiopathic and secondary. Idiopathic intussusception occurs without a lead point lesion, while secondary intussusception is caused by organic lesions such as:
- Inflammatory bowel disease
- Postoperative adhesions
- Meckel's diverticulum
- Benign and malignant lesions
- Metastatic neoplasms [ 2 ]
- Iatrogenic causes, such as the presence of intestinal tubes or jejunostomy feeding tubes [ 2 ]
Preventive Measures
There are no specific preventive measures for intussusception, as it is often a rare and unpredictable condition. However, maintaining a healthy lifestyle and managing underlying medical conditions may help reduce the risk of developing intussusception.
Signs and Symptoms
The signs and symptoms of intussusception can vary depending on the age of the patient and the location of the intussusception. In adults, the clinical presentation is often chronic or nonspecific, and may include:
Diagnosis
The diagnosis of intussusception is typically made using computed tomography (CT) scans, which are sensitive in detecting intussusception and potential lead points [ 2 ]. Other diagnostic modalities, such as ultrasound and MRI, may also be used in certain cases.
Treatment
The treatment of intussusception depends on the underlying cause and the presence of a lead point lesion. In adults, surgical resection of the affected bowel segment with oncological procedures is often necessary, especially if a malignancy is suspected [ 1 ]. However, in cases of idiopathic intussusception, conservative management with supportive care may be considered [ 3 ]. The goal of treatment is to relieve the obstruction, remove any lead point lesions, and prevent recurrence.
Surgical Management
Surgical management of intussusception typically involves:
- Formal bowel resection with oncological principles
- Reduction of the intussuscepted bowel, if possible
- Lymphadenectomy, if a malignancy is suspected [ 2 ]
- Repair of any underlying lead point lesions, such as Meckel's diverticulum [ 4 ]
Caveats and Differentials
It is essential to consider the following caveats and differentials when managing intussusception:
- Recurrent intussusception may occur, especially in cases with a persistent lead point lesion [ 4 ]
- Idiopathic intussusception may be managed conservatively, but surgical intervention may be necessary if symptoms persist or worsen [ 3 ]
- Intussusception can be a rare cause of an acute surgical abdomen, and a high index of suspicion is necessary to make the diagnosis [ 5 ]