TY - JOUR
T1 - Adult Intussusception in the Last 25 Years of Modern Imaging
T2 - Is Surgery Still Indicated?
AU - Onkendi, Edwin Onserio
AU - Grotz, Travis Edward
AU - Murray, Joseph A.
AU - Donohue, John Harrington
PY - 2011/10/1
Y1 - 2011/10/1
N2 - Background: Because most adult intussusceptions are reportedly due to malignancy, operative treatment is recommended. With current availability of computed tomography, we questioned the role of mandatory operative exploration for all adult intussusceptions. Methods: This study is a retrospective review of all adults treated from 1983 to 2008 at a large tertiary referral center for intussusception. Results: One hundred ninety-six patients had intussusception over the 25-year study period. Computed tomography was obtained in 60% of patients. Neoplasms [malignant, (21%); benign, (24%)] were the commonest etiology; 30% cases were idiopathic. One hundred twenty (61%) patients underwent operative treatment for intussusception. Six of the 58 idiopathic or asymptomatic cases were operated on with negative findings in all. Palpable mass (OR 4. 56, p < 0. 035), obstructive symptoms (OR 9. 13, p < 0. 001) or obstruction (OR 9. 67, p < 0. 001), GI bleeding (OR 14. 41, p < 0. 001), and a lead point on computed tomography (OR 10. 08, p < 0. 001) were associated with the need for operation. Conclusion: In the current era of computed tomography, idiopathic or asymptomatic intussusception is being seen more commonly; however, the majority of adult intussusceptions still have pathologic lead points. From our experience, all patients with palpable mass, obstructive symptoms or obstruction, gastrointestinal bleeding, or a lead point on computed tomography should undergo operative exploration.
AB - Background: Because most adult intussusceptions are reportedly due to malignancy, operative treatment is recommended. With current availability of computed tomography, we questioned the role of mandatory operative exploration for all adult intussusceptions. Methods: This study is a retrospective review of all adults treated from 1983 to 2008 at a large tertiary referral center for intussusception. Results: One hundred ninety-six patients had intussusception over the 25-year study period. Computed tomography was obtained in 60% of patients. Neoplasms [malignant, (21%); benign, (24%)] were the commonest etiology; 30% cases were idiopathic. One hundred twenty (61%) patients underwent operative treatment for intussusception. Six of the 58 idiopathic or asymptomatic cases were operated on with negative findings in all. Palpable mass (OR 4. 56, p < 0. 035), obstructive symptoms (OR 9. 13, p < 0. 001) or obstruction (OR 9. 67, p < 0. 001), GI bleeding (OR 14. 41, p < 0. 001), and a lead point on computed tomography (OR 10. 08, p < 0. 001) were associated with the need for operation. Conclusion: In the current era of computed tomography, idiopathic or asymptomatic intussusception is being seen more commonly; however, the majority of adult intussusceptions still have pathologic lead points. From our experience, all patients with palpable mass, obstructive symptoms or obstruction, gastrointestinal bleeding, or a lead point on computed tomography should undergo operative exploration.
KW - Celiac disease
KW - Computed tomography
KW - Gastrointestinal surgical procedure
KW - Intestinal obstruction
KW - Intussusception
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U2 - 10.1007/s11605-011-1609-4
DO - 10.1007/s11605-011-1609-4
M3 - Article
C2 - 21830152
AN - SCOPUS:80053099576
VL - 15
SP - 1699
EP - 1705
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 10
ER -