Objective: The finding of intestinal intussusception on radiographic imaging in adults remains a challenging clinical dilemma. The clinical significance of this finding is unknown and determining cases requiring operative therapy is difficult. We present a series of cases of adult intussusception (AI) found on computed tomography (CT) and examine the significant parameters that would guide the management of this condition.
Methods: A retrospective review of records of adult patients found to have intussusception on CT at the Mount Sinai Medical Center from 2001-2007 was performed. Chi-Square and multivariable logistic regression analyses were used to identify factors associated with a true intussusception.
Results: AI was found on CT scan in 80 patients (M=34, F=46) during the study period. The mean age was 45 years. Patients presented with obstructive symptoms in 41% and abdominal pain in 56%. On CT, the intussusceptions were enteroenteric in 87% enterocolic in 4%, and colocolic in 9%. Imaging demonstrated multiple intussusceptions in 6% and obstructive findings in 11% of patients. 53 patients were observed and all of these had no further associated clinical sequelae. 9 patients, found to have an incidental finding of intussusception on CT scan underwent surgery with no intraoperative finding of true intussusception. 18 patients were explored based on CT findings, out of which 12 were found to have a true intussusception. The operative specificity was 67%. A pathologic leadpoint was identified in 9 cases [Crohns enteritis (2), appendiceal mucinous cystadenoma (1), cecal fibroid tumor (1), carcinoid (2), and adenocarcinoma (3), idiopathic (3)]. All patients with negative explorations recovered without complication. Factors associated with a true intussusception on univariate analysis were gastrointestinal symptoms, obstruction on imaging studies, and involvement of the colon (p<0.05). Factors independently associated with a true intussusception on multivariate analysis were obstruction on imaging studies and colonic involvement (p<0.05).
Conclusion: The radiographic finding of AI remains a clinical dilemma. The majority of cases are incidental findings on CT and have no significant clinical sequelae. Factors such as gastrointestinal symptoms, obstruction on imaging studies, colonic involvement are clinically significant and mandate prompt surgical intervention.