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Adult Intussusception—a Contemporary Analysis of Etiology and Management
Stephanie Polites*1, Joy Hughes1, Kristine Thomsen2, Elizabeth B. Habermann2, Martin D. Zielinski1
1Department of Surgery, Mayo Clinic, Rochester, MN; 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN
Introduction: Due to the relative infrequency of adult intussusception when compared to pediatric intussusception, current literature on the etiology and management of intussusception in adults is sparse. Traditionally, adult intussusceptions have been thought to be malignant, requiring surgical exploration for diagnostic purposes. Our aim, therefore, is to describe the current national experience with adult intussusception, suspecting that many are benign in origin.
Methods: The Nationwide Inpatient Sample, a 20% stratified sample of hospitals in the United States, was queried for patients 18 years or older who were hospitalized with a diagnosis of intussusception (ICD-9 560.0) between 2002 and 2010. Only patients with an associated operative or endoscopic procedure were included to ensure accuracy of the cohort. Patients were determined to have a neoplastic or nonneoplastic etiology of intussusception using associated diagnosis codes. Neoplastic intussusceptions were further separated into malignant and benign neoplasms. Differences in demographics and history of cancer, using ICD-9 V codes, were determined for patients with neoplastic versus nonneoplastic intussusceptions using t tests and chi-squared tests.
Results: Over the 9 year period, 5291 adults were identified. Mean (s.d.) age was 51 (19) years and most patients were female (58%). A personal history of cancer was identified in 7%. Endoscopic intervention alone was done in 12% of patients, and the remaining 88% underwent operative intervention—including 67% that underwent bowel resection and 7% that underwent reduction of intussusception without bowel resection. Neoplastic etiologies were identified in 38% of patients, including malignant neoplasms in 22% and benign neoplasms in 16%. The most common malignancy was colorectal cancer (Table). The remaining 62% were identified as nonneoplastic intussusception, including 29% with other benign causes, including adhesions, previous anastomoses, and congenital diverticula, and 33% that were idiopathic or spontaneously reduced, having no associated diagnoses. Patients with a neoplastic intussusception were older (mean age 59 vs 46 years, p<0.001) and more likely to have a personal history of cancer (10% vs 4%, p<0.001) than patients with a nonneoplastic cause. Bowel resection was more frequent in patients with neoplastic intussusception (89%); however was still performed in more than half of patients with nonneoplastic causes (54%).
Discussion: Malignancy is not the most common cause of intussusception in adults, as most cases are idiopathic or benign. Thus, bowel resection due to potential malignancy may not be required in all patients. Further studies are needed to confirm these findings and develop updated management guidelines for adult intussusception. Neoplastic Etiologies of Intussusception in Adults | Malignant Neoplasm (N=1140) | Percent | Benign Neoplasm (N=850) | Percent | | Malignant neoplasm of large bowel or rectum | 46.3 | Lipoma | 40.2 | | Secondary neoplasm of small bowel, large bowel or rectum | 14.6 | Colon and rectal polyps | 33.9 | | Primary or secondary malignant neoplasm of intestine not otherwise specified, of unknown origin, or uncertain behavior | 11.5 | Benign neoplasm of small bowel | 18.2 | | Lymphoma | 10.8 | Multiple benign neoplasms | 4.5 | | Malignant neoplasm of small bowel | 7.0 | Hemangioma or lymphangioma | 1.7 | | Multiple malignant neoplasms | 6.6 | Benign neoplasm of unspecified site | 1.5 | | Primary or secondary malignant neoplasm of peritoneum or retroperitoneum | 1.4 | | | Malignant carcinoid of small or large bowel | 1.1 | | Carcinoma in situ of small or large bowel | 0.7 |
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