Physiologic Intussusception
Physiologic intussusception refers to transient, self-resolving telescoping of bowel segments that occurs asymptomatically in adults and is increasingly detected incidentally on cross-sectional imaging (CT/MRI) without requiring intervention. 1
Key Distinguishing Features
Physiologic (transient) intussusception differs fundamentally from pathologic intussusception:
No symptoms present - Unlike pathologic intussusception which causes cramping abdominal pain, bowel obstruction, and bloody stools, physiologic intussusception is discovered incidentally without clinical manifestations 2, 1
No lead point pathology - Physiologic intussusception occurs without an underlying structural lesion, whereas 86-93% of symptomatic adult intussusceptions have identifiable pathologic lead points (malignancy, polyps, adhesions, inflammatory lesions) 3, 4
Self-resolving nature - These transient invaginations resolve spontaneously without intervention, representing normal peristaltic variations rather than true pathology 1
Clinical Context and Management
The increasing frequency of abdominal CT/MRI in modern practice has led to more frequent detection of these incidental, asymptomatic intussusceptions that may be appropriately observed without intervention. 1
When to Observe vs. Intervene
Observation is appropriate when:
- Patient remains completely asymptomatic 1
- No signs of bowel obstruction (distension, vomiting, obstipation) 2
- No evidence of bowel compromise (ischemia, perforation) 3, 5
- Imaging shows no lead point lesion 1
Intervention is required when:
- Symptoms develop (abdominal pain, obstruction, bleeding) 2, 6
- Lead point pathology identified on imaging 4, 1
- Signs of peritonitis, hemodynamic instability, or bowel ischemia present 3, 5
Important Caveats
Do not confuse physiologic intussusception with the rare idiopathic symptomatic intussusception in adults (8-20% of adult cases), which still requires surgical intervention despite lacking a lead point. 6 The key distinction is symptomatology—physiologic intussusception is by definition asymptomatic and transient, while idiopathic symptomatic intussusception presents with obstruction requiring surgery. 1, 6
In children, idiopathic ileocolic intussusception is the most common form and represents a different entity entirely, typically managed with pneumatic or hydrostatic enema reduction rather than observation. 1