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Background: Intussusception in adults, unlike in children, is rare and commonly reported to be due to malignancy. Adult colonic intussusception is associated with primary carcinoma in 65-70% of cases while adult small bowel intussusceptions are associated with malignancy in only 30-35% of cases, 70% of these lesions are metastatic. As a result, most authors recommend surgical exploration for diagnosis and therapy. In light of the current availability of CT scans, we questioned the role of mandatory surgical exploration for all adult intussusceptions.Methods: A retrospective review of all records of adults treated at a large tertiary referral center for intussusception from 1983 to 2008 was performed. A comparative analysis of the medical history, imaging, operative and pathological reports was performed.Results: A total of 200 adult patients had intussusception over the 25-year study period. A total of 137 (68.5%) patients had enteric intussusception, 18 (9%) had ileocecal, 15 (7.5%) had ileocolic and 30 (15%) patients had colocolic intussusception. CT scan was the most common imaging modality (58.5%). A discrete pathologic process was present in 134 patients (67%) of all intussusceptions. The remaining 66 patients (33%) were idiopathic. Neoplasms were the most common etiology of intussusception, there were 25 primary (12.5%), 20 metastatic (10%), and 48 (24%) benign neoplasms identified. Adhesions from prior surgery (12), celiac disease (8), inflammatory bowel disease (7), infection (7), Meckel’s diverticulum (6), and a gall stone (1) accounted for the remaining 41 cases. Obstructive symptoms, hematochezia and palpable mass were clinical indicators present in 87% of patients with a neoplastic lead point. One hundred and twenty patients underwent operative treatment for intussusception. Overall, 99 (82.5%) patients underwent primary resection of the intussusception without prior reduction, thirteen (10.8%) patients had reduction of their intussusception followed by resection and eight (6.7%) patients underwent reduction only. There were 7 (5.8%) negative surgical explorations. Of the 66 idiopathic cases, 36 patients had spontaneous reduction of the intussusception. Twenty four of the remaining 30 patients were successfully managed nonoperatively and six had a negative surgical exploration. Conclusion: In the current era of modern imaging the incidence of adult intussusception has increased 4-fold. While idiopathic intussusception has become more common the majority of adult intussusception cases are still associated with a pathologic lead point which in many cases is malignant. Based on our experience all patients with obstructive symptoms, hematochezia or palpable mass associated with intussusception should undergo primary surgical resection without prior reduction to avoid unnecessary manipulation of a potential neoplasm.