From the Research
Introduction to Intussusception
Intussusception is a rare condition where a part of the intestine telescopes into another part, causing bowel obstruction, strangulation of the mesentery, ischemia, and necrosis 1. This condition can occur in both children and adults, but its presentation and management differ significantly between the two age groups.
Causes and Risk Factors
The causes of intussusception can be categorized into two main types: idiopathic and secondary. Idiopathic intussusception occurs without a known lead point, while secondary intussusception is caused by organic lesions such as inflammatory bowel disease, postoperative adhesions, Meckel's diverticulum, benign and malignant lesions, metastatic neoplasms, or iatrogenic causes 2. In adults, 90% of intussusceptions are secondary to an organic lesion, with the majority being malignant 3.
Preventive Measures
Currently, there are no established preventive measures for intussusception, as the etiology is often unknown 1. However, early diagnosis and treatment are crucial to prevent complications and improve outcomes.
Signs and Symptoms
The clinical presentation of intussusception varies between children and adults. In children, the classic triad of cramping abdominal pain, bloody diarrhea, and a palpable tender mass is often seen 2. In adults, the presentation is often chronic or nonspecific, with acute symptoms occurring in fewer than 20% of patients 3. The signs and symptoms of intussusception may include:
- Abdominal pain
- Nausea and vomiting
- Bloody stools
- Abdominal mass
- Bowel obstruction
Diagnosis
The diagnosis of intussusception is often made using imaging studies such as:
- Abdominal computed tomography (CT) scan, which is the most sensitive radiologic method to confirm intussusception 3, 2
- Ultrasonography, which is the modality of choice for diagnosing intussusception in children 4
- Abdominal radiography, which can detect pneumoperitoneum or high-grade bowel obstruction 4
Treatment
The treatment of intussusception depends on the age of the patient, the presence of a lead point, and the severity of the condition. In children, nonoperative enema reduction is the treatment of choice, with a success rate of 82% 4. In adults, surgical resection of the affected bowel segment with oncological procedures is often necessary, especially if a malignant lead point is suspected 3, 2. The treatment options for intussusception include:
- Nonoperative enema reduction, which can be performed using fluoroscopy or ultrasonography guidance, and liquid or air reduction medium 4
- Surgical resection of the affected bowel segment, which may involve formal bowel resection with oncological principles 3, 2
- Reduction of the intussuscepted bowel, which may be considered safe for benign lesions to limit the extent of resection or avoid short bowel syndrome 2
Differentials and Caveats
Intussusception can mimic other common disease processes, leading to delays in diagnosis and treatment 1. It is essential to consider intussusception as a differential diagnosis, especially in patients with abdominal pain, bowel obstruction, or other nonspecific symptoms. The treatment of intussusception should be individualized based on the patient's age, underlying condition, and the presence of a lead point. In some cases, the diagnosis of intussusception may be made incidentally during surgery or imaging studies, and the treatment should be tailored accordingly.