In a 19‑year‑old male with jejunal intussusception, how common is spontaneous resolution?

Spontaneous Resolution of Jejunal Intussusception in Adults

Spontaneous resolution of jejunal intussusception in adults is uncommon and should not be relied upon for management—surgical exploration remains the standard of care due to high rates of underlying pathology and risk of complications. 1, 2

Evidence for Spontaneous Resolution

The limited data on spontaneous resolution comes primarily from pediatric populations and transient cases:

• In pediatric small bowel intussusception, spontaneous reduction occurred in 64% (18/28) of cases, though this population differs significantly from adults in etiology and pathology. 3

• Transient idiopathic jejunal intussusception has been documented in young adults (ages 19 and 39), representing extremely rare cases where intussusception resolved without intervention. These comprised only 2-23% of all adult intussusceptions diagnosed. 4

• Adult intussusception is fundamentally different from pediatric disease: 86-93% of adult cases have an identifiable pathologic lead point (benign lesions, adhesions, or malignancy), making spontaneous resolution unlikely and observation potentially dangerous. 1, 2

Why Observation is Not Recommended

The high mortality associated with delayed intervention makes expectant management inappropriate:

• Delaying surgical intervention beyond 48 hours significantly increases mortality in adult intussusception. 1

• Adult small bowel intussusception typically presents with bowel obstruction requiring definitive management, not conservative observation. 2

• When lead point pathology is present in adult small bowel intussusception, it is usually benign, but malignancy (particularly metastatic disease) must be excluded surgically. 2

Management Algorithm for a 19-Year-Old Male

For this specific patient, the following approach is recommended:

1. Obtain CT scan immediately to confirm diagnosis, identify complications (ischemia, perforation), and assess for lead points. 1

2. Initiate fluid resuscitation and antimicrobial therapy while arranging surgical consultation. 1

3. Proceed with surgical exploration as primary treatment, given:

   • The patient's age places him in the transitional zone where lead points become more common 5
   • Even "transient" cases in this age group required CT diagnosis and close monitoring 4
   • The risk of incarceration and strangulation is substantial 1

4. Do not attempt pneumatic or hydrostatic reduction in jejunal intussusception, as these techniques are:

   • Primarily effective for pediatric ileocolic intussusception 5, 3
   • Associated with high recurrence risk in adults 1
   • Unsuccessful in jejunojejunal intussusception 3

Special Consideration: Peutz-Jeghers Syndrome

If this patient has a history of Peutz-Jeghers Syndrome (PJS), spontaneous resolution is even less likely:

• PJS patients have a 50-68% cumulative risk of intussusception, with median age of first episode at 10-16 years. 6
• PJS polyps >1.5-2 cm specifically cause intussusception and require elective resection to prevent this complication. 7, 6
• Urgent surgical intervention is mandatory in PJS patients presenting with acute abdominal pain and confirmed intussusception. 6

Clinical Pitfall to Avoid

Do not be misled by transient improvement in symptoms—this does not indicate spontaneous resolution but rather temporary reduction that will likely recur with higher complication rates. The two documented cases of "transient" jejunal intussusception in young adults were diagnosed by CT and monitored closely; they did not present, resolve clinically, and get sent home without imaging. 4