From the Guidelines
Intussusception is a serious medical condition where one part of the intestine slides into an adjacent part, causing intestinal obstruction and potentially cutting off blood supply to the affected area, with an estimated incidence of 0.1% to 0.3% after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) 1.
Definition and Classification
Intussusception can be classified into antegrade and retrograde types, with the latter being the most common form after LRYGB, characterized by a featureless entry point beginning a few inches below the intestinal anastomosis, with the intussusceptum traversing the entero-enterostomy into either the biliary or Roux limb 1. The anatomical classification for jejunogastric intussusceptions, proposed by Schackman et al., categorizes the jejunogastric intussusception into three types: Type I—Afferent loop intussusception (antegrade), Type II—Efferent loop intussusception (retrograde), and Type III—combined form of intussusception 1.
Management and Treatment
The management of jejunogastric intussusception could be endoscopic in selected cases, but surgical exploration in laparoscopy or by laparotomy is recommended due to the high risk of incarceration and strangulation, with resection of the invaginated segment being the treatment of choice for avoiding recurrences 1. Delay in surgical intervention is associated with a significant increase in mortality, especially after 48 hours 1. Gentle manual reduction of intussusception could be possible but carries a high risk of recurrence, and if there is intestinal necrosis, the nonviable segment should be resected with the creation of a new anastosis when allowed 1.
Key Points
- Intussusception is a serious medical condition that requires prompt attention
- The incidence of intussusception after LRYGB is estimated to be between 0.1% and 0.3% 1
- Surgical exploration is recommended due to the high risk of incarceration and strangulation
- Resection of the invaginated segment is the treatment of choice for avoiding recurrences 1
- Delay in surgical intervention can lead to increased mortality, especially after 48 hours 1
From the Research
Definition of Intussusception
- Intussusception is a rare condition in adults, representing only 1% of all bowel obstructions 2
- It is a common cause of bowel obstruction in children and typically is treated by reduction via enema 3
- Intussusception is defined as the invagination of a segment of intestine into another, adjacent segment 2, 3, 4, 5, 6
Causes and Symptoms
- The exact cause of intussusception is often unknown, but it can be associated with underlying diseases or conditions 2
- Symptoms of intussusception include colicky abdominal pain, vomiting, and rectal bleeding 3, 4, 5, 6
- In children, intussusception can also cause abdominal colic, rectal prolapse, and small bowel obstruction 6
Treatment Options
- Air enema reduction is a common treatment for intussusception, especially in children 3, 4, 5, 6
- Pneumatic reduction is more likely to successfully reduce intussusception in children without evidence of increased morbidity 3
- General anesthesia can increase the success rate of reduction by air enema 5
- Repeat enemas can be effective in treating intussusception, especially if the initial enema is unsuccessful 4