Intussusception in adults Moamen Salameh 1

Intussusception Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment 2

3

A rare condition in adults, accounting 5% of all cases of intussusception and 1-5% of bowel obstructions Symptoms are often chronic, with intermittent abdominal pain as the main symptom Types: enteroenteric, enterocolic, colocolic Arises in the small bowl in two-thirds of cases 4

Pathophysiology Idiopathic % Secondary 90% 5

Secondary intuss. Initiates from any pathologic lesion of the bowel wall or irritant within the lumen 6

Aetiology - Small bowl Benign lesions - neoplasm (lipoma, leiomyoma, haemangioma, neurofibroma) Adhesions IBD Meckel’s diverticulum Coeliac disease Henich-schonlein purpura Iatrogenic Malignant - most often metastatic 15% Idiopathic 20% 7

Aetiology - Large bowl malignant 65% Benign: neoplasm (lipoma, leiomyoma, adenomatous polyps) IBD Endometriosis Idiopathic 10% 8

Clinical presentation The classic paediatric presentation of acute intussusception is rare in adults The majority of cases in adults are presented as chronic non-specific symptoms Physical examination may demonstrate diffuse or localised abdominal tenderness, but is often unremarkable 9

Symptoms Nausea Vomiting Gastrointestinal bleeding Changes in bowl habits Constipation Diarrhoea Abdominal distention 10

Diagnosis AXR US CT Endoscopy 11

US Target sign 12

CT Sausage-shaped mass 13

CT Target sign 14

Treatment Air enema surgical intervention 15

Q?