Causes of Intussusception in 19-Year-Old Males
In a 19-year-old male, intussusception is almost certainly caused by a pathologic lead point (86-93% of adult cases), most commonly a tumor or structural lesion, and requires surgical intervention rather than enema reduction. 1
Age-Specific Etiology
The etiology of intussusception fundamentally differs between pediatric and adult/adolescent populations:
- Neonates, older children, and adults have pathologic lead points in 86-93% of cases, contrasting sharply with the 75-90% idiopathic rate in typical pediatric cases (ages 5-9 months). 1, 2
- At 19 years old, this patient falls into the category where an underlying anatomic lesion is the expected cause rather than the exception. 1
Common Pathologic Lead Points by Age Category
In Adolescents and Young Adults (>2 years, including 19-year-olds):
The most common causes include:
- Intestinal polyps (including Peutz-Jeghers syndrome polyps) 3
- Meckel's diverticulum 3
- Peutz-Jeghers syndrome (accounts for significant proportion in older children/adolescents) 3
- Lymphosarcomas/lymphomas 4
- Duplication cysts 3, 5, 4
- Benign tumors 3
Evidence from Surgical Series:
- In children older than 2 years, intestinal polyps, Meckel's diverticulum, and Peutz-Jeghers syndrome accounted for 72% of secondary intussusception cases. 3
- The presence of a pathologic lead point is significantly more likely in older children and adolescents compared to infants. 3
Clinical Implications for a 19-Year-Old
Diagnostic Approach:
- CT scan is the preferred imaging modality for adult patients, providing comprehensive information about the entire gastrointestinal tract, 3-D anatomy, and underlying causes. 1
- Ultrasound, while excellent for pediatric cases (98.1% sensitivity), is less commonly the primary modality in adults where CT better characterizes the lead point. 1
Treatment Considerations:
- Hydrostatic/pneumatic enema reduction is unlikely to be successful when a pathologic lead point is present—only 3 of 21 attempts succeeded in one series, and none succeeded in another. 4, 6
- Surgical intervention is almost universally required for intussusception with pathologic lead points. 3
- All patients with identified lead points required operation, with three-fourths requiring bowel resection. 7
Key Clinical Pitfalls
- Duration of symptoms may be prolonged in cases with pathologic lead points, sometimes presenting after weeks to months of intermittent symptoms initially attributed to other causes (e.g., constipation). 5, 7
- The classic triad (abdominal pain, vomiting, bloody stools) is present in only one-third of cases, so absence of these findings does not exclude the diagnosis. 6
- Intermittent or recurrent symptoms should raise suspicion for an underlying structural lesion causing repeated episodes. 5