What is the management of adult intussusception without intestinal obstruction?

From the Guidelines

Surgical exploration via laparoscopy or laparotomy is the recommended management approach for adult intussusception without intestinal obstruction, with resection of the pathological lead point to prevent recurrence and address potential underlying malignancy. The management of adult intussusception without intestinal obstruction is a complex issue that requires careful consideration of the potential underlying causes and the risk of complications.

Key Considerations

• Adult intussusception is often associated with underlying pathology, such as tumors or polyps, which necessitates surgical management 1.
• The use of laparoscopy or laparotomy for surgical exploration allows for the reduction of the intussusception and resection of the affected bowel segment, if necessary 1.
• Preoperative evaluation with CT imaging can help identify the location and possible cause of the intussusception, guiding surgical decision-making 1.
• During surgery, gentle reduction of the intussusception may be attempted for small bowel intussusceptions without signs of ischemia or malignancy, but resection without reduction is recommended if malignancy is suspected, particularly in colonic intussusceptions 1.

Surgical Techniques

• Resection of the invaginated segment is considered the treatment of choice for avoiding recurrences, with laparoscopy or open surgery used depending on the experience of the surgeon and the setting 1.
• Other described surgical techniques include anchoring of the efferent limb to surrounding structures and the Noble enteropexy, but these may have a higher risk of recurrence 1.
• Reversal of the gastric bypass and conversion to another procedure, such as sleeve gastrectomy, may be an option in some cases, but requires evaluation by an experienced bariatric surgeon in a multidisciplinary approach 1.

Postoperative Care

• Patients require monitoring for complications such as anastomotic leaks, wound infections, and recurrence after surgical management of adult intussusception without intestinal obstruction 1.
• The underlying cause of the intussusception determines long-term prognosis and follow-up needs, with regular surveillance recommended for patients with a history of malignancy or other underlying conditions 1.

From the Research

Management of Adult Intussusception without Intestinal Obstruction

• The management of adult intussusception without intestinal obstruction is a complex issue, with various treatment options available 2, 3, 4, 5, 6.
• Air enema reduction under fluoroscopic guidance can be an effective treatment for idiopathic intussusception in young, previously healthy adult patients, as seen in a case report where a 21-year-old woman was successfully treated with this method 2.
• However, surgery remains the mainstay of treatment for adult intussusception, with a systematic review and meta-analysis recommending en bloc resection without reduction to avoid potential intraluminal seeding or venous tumor dissemination, especially in cases of colonic intussusception 3.
• A retrospective descriptive study found that all patients with adult intussusception had an organic lesion, and resection of the intussuscepted intestinal loop without intestinal reduction was performed in all cases 4.
• Another retrospective review found that intestinal resection with immediate anastomosis was the technique of choice for most patients, with a high rate of malignancy detected in colonic intussusceptions 5.
• Endoscopic resection can be a safe and effective treatment option for adult intussusception caused by benign etiologies, such as lipoma, as seen in a case report where a 58-year-old male was treated with endoscopic pneumatic reduction and colonoscopic resection of an ileal lipoma 6.

Treatment Options

• Air enema reduction under fluoroscopic guidance 2
• Surgery, including en bloc resection without reduction 3, 4, 5
• Endoscopic resection, including pneumatic reduction and colonoscopic resection 6
• Intestinal resection with immediate anastomosis 5

Key Considerations

• High rate of malignancy in adult intussusception, especially in colonic intussusceptions 3, 5
• Importance of preoperative diagnosis and etiologic diagnosis based on CT scans 4, 5
• Need for a selective approach in managing adult intussusception, taking into account the location and etiology of the intussusception 3, 5