Pediatric intussusception is a serious condition that carries with it a high risk of morbidity and mortality.

This review highlights the pearls and pitfalls of pediatric intussusception, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

Intussusception is one of the most common pediatric abdominal emergencies. This is associated with one part of the intestine telescoping into another, resulting in bowel edema. If the intussusception remains untreated, obstruction, ischemia, necrosis, and perforation may result. Most cases are idiopathic, with 10-25 % associated with a pathologic mass or lead point. The most common age group affected includes those between 3 months to 5 years. The triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon, though most patients will present with intermittent abdominal pain. Nonbilious emesis and bloody stools (gross blood or guaiac positive) are also common. Younger patients can present atypically, including altered mental status or lethargy. Thus, intussusception should be considered in pediatric patients with abdominal pain, emesis, and a sausage-shaped mass, as well as those with atypical presentations such as altered mental status or lethargy if there is no other etiology found on testing. The diagnostic modality of choice is ultrasound. Plain radiography may assist in evaluating for obstruction and perforation. Treatment includes prompt reduction of the intussusception. In patients who are stable and have no evidence of perforation, non-operative reduction with hydrostatic or pneumatic reduction should be attempted. Operative intervention is necessary in those who are unstable, peritonitic, or have a focal lead point. Discharge may be appropriate for patients following successful non-operative reduction if the patient is able to tolerate clear fluids, is asymptomatic, and can return for any recurrence of symptoms.

An understanding of pediatric intussusception and its many potential mimics can assist emergency clinicians in diagnosing and managing this high risk disease.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely utilized for managing diabetes and obesity due to their efficacy in improving glycemic control and promoting weight loss. However, their gastrointestinal effects, such as slowed motility, may lead to adverse outcomes, including small bowel obstruction. Intussusception, a rare complication in adults, has been sparsely reported with GLP-1RA use. We present a 32-year-old woman with iron deficiency anemia who was incidentally diagnosed with transient small bowel intussusception on computed tomography enterography while on semaglutide therapy. No evidence of obstruction or pathological lead point was identified, and follow-up imaging showed resolution without intervention. This case suggests a possible link between GLP-1RA therapy and intussusception, likely secondary to altered gastrointestinal motility. Clinicians should remain vigilant for rare complications associated with GLP-1RAs, particularly in patients presenting with gastrointestinal symptoms. Further studies are warranted to elucidate this association.

Intussusception is a rare condition in adults, accounting for approximately 5% of all cases. Unlike pediatric intussusception, which is typically idiopathic, the adult cases are usually associated with an underlying pathology, most commonly malignancies. The surgical intervention is often required, but in small bowel cases, where malignancy is less frequent than in colonic intussusception, the decision regarding resection requires careful consideration. There are no prior reports on the use of intraoperative enteroscopy for small bowel intussusception evaluation. We report the case of a 78-year-old woman who presented with acute abdominal pain, nausea, and bilious vomiting. She had a history of distal gastrectomy with gastroduodenostomy (Billroth-I) and total gastrectomy with Roux-en-Y for gastric ulcer and residual stomach cancer, respectively. Abdominal computed tomography (CT) revealed small bowel intussusception without clear evidence of a lead point lesion. The emergency laparotomy confirmed intussusception 15 cm distal to the Roux-en-Y anastomosis, which was manually reduced. The intraoperative enteroscopy revealed inflammatory changes but no malignancy or structural abnormalities. Given the absence of a lead point lesion and the viability of the bowel, resection was avoided. The patient had an uneventful postoperative course and was discharged without complications. Adult intussusception is frequently associated with malignancy, yet cases without a lead point lesion pose a diagnostic and therapeutic challenge. The surgical history, including prior anastomotic procedures, may contribute to the pathogenesis through disrupted intestinal pacemaker activity and retrograde contractions. While second-look surgery can aid in bowel viability assessment, it carries a high complication rate. This case highlights the potential role of intraoperative enteroscopy in evaluating small bowel viability, minimizing unnecessary resection, and improving surgical decision-making. Although further studies are needed to assess its role in optimizing surgical outcomes, intraoperative enteroscopy may be a valuable adjunct in cases of adult small bowel intussusception without an apparent lead point.

Intussusception in adults is rare, comprising 5% of cases, and is often associated with pathological lesions like polyps or tumors. This report highlights a case of ileocolic intussusception due to a giant terminal ileal lipoma incidentally found during a colonoscopy.

A 53-year-old male presented with chronic constipation, mild abdominal pain, and rectal bleeding for 2 years. The patient used laxatives in the past for constipation but it did not improve. A colonoscopy revealed protrusion of the small intestine through the ileocecal valve into the cecum with a 3 cm lipoma as the leading point. A CT scan of the abdomen was performed, revealing findings suggestive of intussusception. The patient underwent laparotomy, the lipoma was excised, and the intussusception was resolved.

Symptoms of intestinal lipoma vary widely, from acute obstruction to incidental imaging findings. Surgical intervention is typically necessary to address the underlying cause, such as gastrointestinal lipomas found predominantly in the right colon. The causes of intussusception in patients, such as lipoma, tumor, or polyp, can be found accidentally during routine colonoscopy.

Intussusception in adults can present with chronic constipation and mild abdominal discomfort.

Point of care ultrasound (POCUS) is useful in diagnosing intussusception. In this case file, we describe a 69-year-old man presenting with nausea, vomiting, left upper quadrant abdominal pain and recent weight loss who had findings concerning for intussusception on POCUS. This led the emergency provider to order computed tomography (CT) which confirmed the diagnosis.

Roux-en-Y gastric bypass (RYGB) is a common elective bariatric operation performed to facilitate weight loss in patients with obesity. Although generally associated with a low rate of late complications, intestinal intussusception can very rarely occur in patients who have undergone RYGB, with significant clinical consequences. This case reinforces the importance of prompt recognition and surgical intervention in cases of intussusception following RYGB, explores the proposed pathophysiology of intussusception, and highlights the options for surgical intervention.

We report a case of a 52-year-old female presenting with a small bowel obstruction secondary to intussusception in the context of a RYGB performed 8-years previously. Computed tomography (CT) and diagnostic laparoscopy confirmed intussusception of a long segment of the biliopancreatic limb into the Roux limb through the jejuno-jejunal anastomosis. Unable to be reduced laparoscopically, the anastomosis was resected en bloc and refashioned. The patient recovered well, and reported no features of recurrence or other surgical complication at post-operative review.

The aetiology of intussusception following RYGB is unclear, although hypotheses include interruption of duodenal pacemaker cells following transection of the small bowel and consequent development of ectopic jejunal pacemaker cells, increased mobility of the mesentery following extreme weight loss, or the jejunojejunal anastomosis functioning as a transition point. In cases of compromised bowel resection is essential, although the approach in cases of non-compromised bowel is less clear.

The recognition of late RYGB complications is becoming increasingly important in the setting of the increasing prevalence of bariatric surgery. Intussusception is an infrequent but significant complication that requires urgent surgical intervention.

We report the case of a woman in her early 60s, who presented with colocolic intussusception, leading to acute large bowel obstruction. The patient presented with colicky abdominal pain, diarrhoea mixed with blood and mucous and raised inflammatory markers. Abdominal examination revealed mild tenderness in the left lower abdomen. The CT scan reported colocolic intussusception extending from proximal to mid-sigmoid colon, with early ischaemic changes. The patient underwent laparoscopy-assisted sigmoid colectomy with an end colostomy and an uneventful postoperative recovery. Histopathological examination identified a benign colonic lipoma, with ischaemic and necrosed intussuscepted colonic segment. Intestinal intussusception is rare in adults and only accounts for 1% of the cases of intestinal obstruction in adults, mostly caused by a pathological lead point like colonic adenocarcinoma or a benign lipoma. Due to the potential risk of malignancy, radiological decompression is not advisable in adults, and en bloc resection of the intussuscepted segment is recommended.

Intussusception in adults is a rare condition often associated with a pathological lead point, which is frequently malignant but can occasionally be benign, such as colonic lipomas. We report the case of a 60-year-old male who presented with colicky abdominal pain, and a computed tomography (CT) revealed a colo-colic intussusception caused by a 6 cm lipoma in the transverse colon, accompanied by ischemic changes in the colonic mucosa. The patient underwent a right hemicolectomy, and histopathology confirmed the benign nature of the lesion. This case highlights the importance of early recognition and surgical intervention to prevent complications and rule out malignancy, especially in rare presentations like intussusception caused by lipomas.

Intussusception is telescoping of a proximal segment of gastrointestinal tract within the lumen of another. Intussusception is a common presentation in pediatric population and present with a classic triad of abdominal pain, bloody diarrhea and a palpable mass. However, intussusception in adults is a rare entity accounting for only 5% of the total cases and is the underlying cause for 1%-5% of all the cases of intestinal obstruction. The adult population caters a varied nonspecific symptoms making diagnosis challenging. We present the case of 32-year-old woman who presented with abdominal pain, altered bowel habits and weight loss. The patient's clinical presentation, familial history of colonic malignancy underscores the importance of considering malignancy as the underlying cause. A contrast enhanced computed tomography (CECT) whole abdomen was done to diagnose the condition. The patient underwent right hemicolectomy and had an uneventful postoperative period. Histopathological findings were consistent with mucinous adenocarcinoma of the caecum.

This is a case of a woman in her late 20s with multiple musculoskeletal congenital anomalies presenting with a 1 week history of right lower quadrant abdominal pain. She was received dehydrated at the emergency department with a soft, non-tender abdomen. After resuscitation, CT imaging showed evidence of retrograde duodenojejunal intussusception. The patient eventually required a jejunal resection as intervention.

Ileum-ileum-colon intussusception constitutes a small proportion of the classification of intussusception. Both adult intussusception and Meckel's diverticulum are rare clinical entities, with few reports documenting Meckel's diverticulum inversion leading to ileum-ileum-colon intussusception in adults.

A 33-year-old Chinese male presented with intermittent abdominal pain persisting for 1 month, that had intensified over the preceding day.

Abdominal computed tomography revealed intussusception, suspected to be secondary to a small intestinal lipoma.

Emergency laparotomy was performed, during which the ileum, located approximately 70 cm from the ileocecal region, was found to be invaginated into the terminal ileum and subsequently into the ascending colon, reaching the hepatic flexure. An inverted Meckel's diverticulum was at the forefront of the intussusception. Surgical resection of the diverticulum, terminal ileum, and cecum was performed, followed by an end-to-side anastomosis of the ileum and colon.

The patient was discharged on postoperative day 7 without complications. During a 1-month follow-up, the patient reported no discomfort and exhibited normal bowel movements.

Adult intussusception of the "ileum-ileum-colon type" resulting from inverted Meckel's diverticulum is exceedingly rare and poses challenges for preoperative diagnosis. Prompt surgical intervention can lead to favorable outcomes in patients. During surgery, the initial step should involve attempting reduction of the intussusception while ensuring that the intestine is preserved as much as possible to maintain intestinal function.

Chronic gastrointestinal bleeding in patients with Crohn's disease presents diagnostic challenges. Adult intussusception is rare and typically caused by a pathological lead point, such as a tumor or inflammatory lesion. Lipomas, though benign, can lead to obstruction and bleeding, requiring differentiation from inflammatory causes for appropriate management.

A 70-year-old male with Crohn's disease and chronic anemia presented with recurrent obscure gastrointestinal bleeding. Initial endoscopy was unremarkable, but capsule endoscopy identified a bleeding jejunal lesion. Double-balloon enteroscopy and imaging confirmed a jejunal lipoma causing intermittent intussusception. Due to persistent anemia, the patient underwent laparoscopic resection, with pathology confirming an ulcerated lipoma. His anemia resolved postoperatively.

This case underscores the importance of considering structural lesions like lipomas in patients with chronic bleeding and Crohn's disease. A multimodal approach, including advanced imaging and enteroscopy, is crucial for accurate diagnosis and management. Surgical resection remains the preferred treatment for symptomatic small bowel lipomas.

Adult intussusception is an uncommon condition that constitutes a small percentage of cases of bowel obstruction in adults. Unlike its paediatric counterpart, it is often linked to an underlying pathology, necessitating surgical interventions for diagnosis and treatment. This report discusses a case involving a 54-year-old woman who presented with symptoms of small bowel obstruction, including abdominal pain, nausea, and constipation, along with a one-month history of weight loss. Imaging revealed small bowel intussusception and an abnormal pelvic mass. Surgical intervention confirmed an ileo-ileal intussusception with an intraluminal mass as the lead point and a concurrent ovarian mass. The histopathological analysis identified the lead point as a benign small bowel angiomyxoma alongside a benign ovarian cystadenofibroma. The patient recovered well following laparoscopic reduction of the intussusception, bowel resection, and bilateral salpingo-oophorectomy. This case highlights the diagnostic challenges posed by adult intussusception due to its nonspecific presentation and underscores the importance of imaging, surgical management, and multidisciplinary collaboration. The rare finding of a small bowel angiomyxoma as a lead point emphasises the diverse aetiology of this condition.

While intussusception is a well described complication of Roux-en-Y gastric bypass (RYGB), cases of recurrent intussusception after lead point resection and reconstruction are described much less frequently. We present a case of a 28-year-old female with triple recurrent intussusception all of which were treated with surgical resection and reconstruction of her RYGB anastomoses. There is currently limited evidence to direct management in the setting of recurrent intussusception. This case highlights the importance of considering intussusception in the RYGB patient with abdominal pain as well as demonstrates a need for further investigation into pathomechanisms which may lead to recurrence.

Intestinal intussusception is rare in adults and often associated with underlying malignancies. In this case, a colo-colic intussusception involving the descending colon caused acute obstruction, ischemic pain, and carried a high risk for peritonitis, necessitating urgent surgical intervention to prevent severe complications.

We report the case of a 50-year-old male who presented with acute abdominal obtruction and a three-day history of fecal vomiting, left-sided abdominal pain, and recent rectal bleeding. Imaging revealed colo-colic intussusception of the descending colon due to a colonic tumor. Immediate surgical intervention was performed with an oncologic resection of the invaginated segment, including a left hemicolectomy with lymph node dissection. A diversionary left iliac colostomy was conducted, ensuring clear resection margins and reducing the risk of postoperative complications.

Intussusception in adults, while rare, frequently indicates a malignant etiology, and prompt diagnosis and management are essential. In this case, rapid surgical intervention allowed successful removal of the tumor with favorable oncologic outcomes and no recurrence at two-year follow-up. This case highlights the complexity of diagnosing intussusception in adults, where symptoms may mimic other gastrointestinal conditions and are often nonspecific.

This case underscores the critical importance of early detection and intervention for intussusception in adults. Awareness among physicians should be heightened to consider intussusception in adult patients presenting with symptoms such as ischemic pain or a palpable mass with associated pain, as timely intervention can lead to improved outcomes and reduce morbidity.

Meckel's diverticulum (MD) is a common congenital anomaly of the gastrointestinal tract, present in approximately 2% of the population. While typically asymptomatic, MD can lead to complications such as obstruction and intussusception. Here, we present a case report of a man presenting with abdominal pain with an incidental finding of MD complicated by intussusception and our management approach. A 39-year-old man with a history of ulcerative colitis (UC) presented with sudden severe right iliac fossa pain, vomiting, and a background of intermittent dull abdominal pain over three months. Examination revealed a tender abdominal mass in the right iliac fossa. Despite his UC history, imaging revealed ileo-ileal intussusception with an inverted MD serving as the lead point, a rare finding in adults. The patient underwent emergency surgery, including resection of the intussuscepted bowel segment and side-to-side anastomosis. Histopathology confirmed ulceration and granulation tissue within the MD. The patient's postoperative course was uneventful, and he was discharged with follow-up care. This case underscores the diagnostic challenge posed by intussusception in adults, especially when overlapping symptoms suggest more common conditions like a UC flare-up. It highlights the importance of considering less frequent diagnoses, such as MD-induced intussusception, in acute abdominal presentations, and reinforces the utility of CT imaging in identifying atypical causes of bowel obstruction. The case also emphasises the need for surgical intervention in symptomatic MD cases to prevent complications.

Intussusception in adult patients is a rare medical finding, which is accompanied by an underlying tumor in some cases. However, no accepted method has been established to identify patients at risk for tumor-related intussusception. This study aimed to identify imaging features as predictors for tumor-related intussusception.CT images of patients with confirmed intussusception were retrospectively acquired between 01/2008 and 12/2022. Available follow-up images and medical health records were evaluated to identify various imaging features, the cause of intussusception, and treatment strategies. Imaging interpretation was conducted by two blinded radiologists. A third radiologist was consulted in cases of disagreement.A total of 71 consecutive patients were included in this study (42 males, 29 females) with a median age of 56 years (interquartile range: 40.5-73.8 years). Enteroenteric intussusceptions in the small bowel were the most common type observed in adult patients. In contrast, colocolic intussusception was more frequently associated with malignancy, and this association was statistically significant (p < 0.05). Among the malignant tumors, adenocarcinoma was the most common, followed by metastases and lymphoma. Additionally, bowel obstruction and wall thickening were significantly correlated with malignancy (p < 0.05). The high negative predictive values (NPVs) and high specificities for ileus (NPV 88.5%, specificity 82.1%), bowel wall thickening (NPV 90.9%, specificity 71.4%), and acute abdomen (NPV 84.6%, specificity 78.8%) suggest that the absence of these features strongly predicts a low probability of malignancy in cases of adult intussusception.Active surveillance with follow-up exams is suitable for asymptomatic and transient intussusception when imaging features suggest a low likelihood of a neoplasm. Additionally, malignancy predictors such as ileus and thickening of the bowel wall in the affected segment could guide tailored treatment. Surgical interventions are essential for symptomatic cases, with adenocarcinoma being the most common malignancy found in colocolic intussusceptions.Intussusception in adults is rare and is often associated with underlying tumors, particularly in colocolic intussusceptions. Key imaging predictors for malignancy include bowel obstruction, wall thickening in the affected segment, and the presence of acute abdomen, with high NPVs and specificities indicating low malignancy risk when these features are absent. Active surveillance is recommended for asymptomatic cases with low neoplasm probability, while surgical intervention is the method of choice for symptomatic patients. · Reschke P, Le Hong QA, Gruenewald LD et al. Malignancy predictors and treatment strategies for adult intestinal intussusception. Fortschr Röntgenstr 2024; DOI 10.1055/a-2434-7932.

BACKGROUND Adult colonic intussusceptions are relatively rare and are mostly caused by organic structures that serve as lead points. However, the pathogenesis of adult intussusception is not fully understood, and no cases of retrograde colonic intussusception without pathological abnormalities or associations with colonoscopy have been reported. CASE REPORT A 74-year-old woman presented with abdominal distension and constipation. Abdominal computed tomography (CT) revealed marked dilatation of the right and sigmoid colon, initially suggesting volvulus of the sigmoid colon. Observation of the left colon revealed no abnormal findings on the colonoscopy. Due to the persistence of abdominal symptoms from right colon dilatation, another colonoscopy was performed, and a transanal drainage tube was inserted into the transverse colon. Enterography showed a steep contrast interruption in the descending colon, which was missed at this time. The patient's abdominal pain worsened 3 days after removal of the drainage tube. Retrograde intussusception of the sigmoid colon was discovered on abdominal CT, and a laparoscopic left hemicolectomy was performed. Pathological examination revealed multiple ulcers in the superimposed area, but no abnormal organic findings that could be considered as a lead point were found. In this case, the stretching technique and/or shear stress on the sigmoid colon by a second colonoscopy may have contributed to the development of this condition. CONCLUSIONS This is the first report of colonoscopy-associated retrograde colonic intussusception without organic abnormalities. Although much is unknown about the pathogenesis in this case, it may provide new insights into the pathogenesis of intussusception.

Intussusception in adults is rare, constituting a miniscule number of bowel obstruction pathologies. Clinical practice often considers it a last-resort diagnosis, as other causes of mechanical small bowel obstruction are more common. The diagnosis is a challenging one to make, as the "telescoping" motion of the intestines fluctuates in a waxing-and-waning nature. In adults, the etiology is predominantly a pathological lead point being either benign or malignant. When encountering an obscure cause of abdominal pain, intussusception caused by a small bowel lipoma may be the culprit.

In this unique case, we present the journey of a 55-year-old Emirati male who presented with severe abdominal pain, nausea and vomiting. The patient underwent various imaging modalities, initially an "incidental" lipoma finding in the terminal ileum until a diagnosis of ileo-ileal intussusception emerged in later imaging, given its unusual and fluctuating nature. Ultimately, a resection of the bowel segment with side-to-side anastomosis was done.

This case report aims to illuminate the diverse clues and incidental findings encountered during our patient's path to a diagnosis. By exploring the elements of this patient's journey to a diagnosis, we aspire to aid future clinicians in navigating the challenges of identifying obstructive pathologies and considering intussusception as a rare yet crucial differential diagnosis.

This case highlights the importance of a comprehensive approach to diagnosis and management of patients presenting with obstructive symptoms, incorporating both clinical insight and imaging modalities such as CT to ensure optimal patient outcomes. When confronting such an obscure cause of abdominal pain, intussusception caused by a small bowel lipoma may be the culprit.

Feeding jejunostomy is a rare cause of jejuno-jejunal intussusception, with presentations ranging from mild bowel obstruction to severe ischemia or perforation.

A 21-year-old male with a recent history of feeding jejunostomy placement presented with acute upper abdominal pain, bilious vomiting, and inability to pass stool or flatus. Ultrasonography confirmed jejuno-jejunal intussusception, necessitating resection of the affected segment and jejuno-jejunal anastomosis. One year postoperatively, the patient remains asymptomatic with no recurrence.

Review of 17 cases of jejuno-jejunal intussusception post-jejunostomy revealed abdominal pain, vomiting, and abdominal distension as common symptoms. Diagnosis relied on imaging modalities like ultrasound or CT, and surgery was the primary treatment.

This case underscores the importance of suspicion and timely intervention to prevent complications in patients with feeding jejunostomy presenting with obstructive symptoms.

Colo-colonic intussusception (CI) in adults is rare, usually caused by malignant conditions. Nonmalignant tumors, like colonic lipomas (CLs), can also be an underlying cause.

We report an unusual case of a 62-year-old man admitted to the emergency department with acute abdominal symptoms. The CT scan confirmed the colonic obstruction, causing significant distention in the transverse and right colon. It also revealed an intraluminal pedunculated colonic mass with fatty density. Peroperatively, a descending colon intussusception was noted. We performed a left colon resection with a double colostomy on the left flank. The postoperative follow-up was uneventful. Pathologic examination of the surgical specimen revealed two lipomas. One of them was pedunculated and protruded into the colonic lumen causing the intussusception.

We conducted a literature review of adult CLs complicated by CI, covering the period from January 1900 to June 2024, including 203 cases. We excluded lipomas exclusive to the small intestine and ileocecal valvula. Our analysis focused on the clinical and pathological characteristics of these cases, as well as the available management options.

Colonic intussusception due to lipomas are uncommon with a challenging preoperative diagnosis despite the evolution of imaging procedures. We aimed by our case to highlight such pathology and to study its features and the possibilities of its management.

Feeding jejunostomy is a simple and common procedure used to provide enteral nutrition. Acute intestinal intussusception on a jejunostomy tube is a rare complication that can have catastrophic consequences and often requires urgent surgical intervention. We report the case of a 45-year-old female patient with a stenosing hypopharyngeal tumor leading to complete aphagia. Due to the severe deterioration of her general condition, the patient underwent surgery, and a Witzel-type feeding jejunostomy was performed. The patient's postoperative course was notable for the development of intussusception around the jejunostomy tube two months later, which required surgical intervention. The recovery was uneventful. Early diagnosis is crucial to improve the prognosis of this particular form of acute intestinal intussusception. Treatment is almost exclusively surgical.

Intussusception is rare in adults, making it a challenging and often delayed diagnosis. Patients may re-present with non-specific and subacute abdominal symptoms. Abdominal CT is the most sensitive imaging modality and is often required to make the diagnosis of intussusception. In contrast to the paediatric population, intussusception in adults is most often associated with a pathological lesion acting as a lead point. In adults, the lead point is often secondary to malignancy, though benign lesions can also be implicated. As such, surgical management with selective resection is the mainstay of treatment in adults. We describe a rare case of ileocaecal intussusception in an adult secondary to a large ileocaecal lipoma, successfully treated with laparotomy and resection in a remote Western Australian hospital. The increasing availability of CT imaging and skilled general surgeons in rural and remote Australia allows for the diagnosis and surgical management of such cases without inter-hospital transfer.

Ileo-ileal intussusception, an infrequent cause of small bowel obstruction in adults, can be initiated by inflammatory fibroid polyps. These are uncommon, benign submucosal lesions of the gastrointestinal tract. This case report explores an adult patient with inflammatory fibroid polyps-induced ileo-ileal intussusception.

Intussusception is a rare presentation in adult population and usually occurs secondary to an underlying pathology. We report an unusual case of a 28-year-old female who developed a colo-colonic intussusception secondary to Burkitt lymphoma which was managed with an extended right hemicolectomy. The case was further complicated by a segment of small bowel with malignant adhesion to a prosthetic mesh requiring resection of the involved segment of small bowel. We have discussed the significance of this case as well as general considerations in the surgical management of adult intussusception.

In this case report, we detail the management of a woman in her late 30s with ileocolic intussusception, emphasizing the high malignancy risk inherent in adult intussusception cases. Given the patient's acute symptoms and significant family history of ovarian and breast cancers, radical oncological resection was pursued. The surgical intervention comprised a right hemicolectomy and right ovarian cystectomy, with histopathological findings revealing a Peutz-Jeghers polyp and benign thyroid tissue, but no malignancy. This case underscores the imperative for a surgical approach that anticipates the potential for malignancy in adult intussusception, advocating for radical resection as a fundamental strategy, even in the absence of confirmed malignant histopathology, to ensure comprehensive management and alignment with oncological best practices.

Intussusception in adults is a rare condition characterized by a low incidence, which complicates the establishment of standardized management protocols unlike those readily available for pediatric cases. This study presents a case series from our institution alongside a systematic review of existing literature. The objective is to delineate effective management strategies for adult intussusception.

A systematic search of databases was conducted covering the period from January 2000 to May 2024. The study focused on adult patients diagnosed with intussusception either pre-operatively or intraoperatively and managed with either surgical intervention or conservative methods. The analysis also included retrospective review of patient records from our institution, specifically targeting individuals over 18 years of age, to determine the predominant types of intussusception and identify any pathological lead points associated with these cases.

In our study, a total of 1,902 patients were included from 59 selected articles, with a mean age of 52.13 ± 14.95 years. Among them, 1,920 intussusceptions were diagnosed, with 98.3% of cases identified preoperatively. Computed tomography (CT) scan was the primary diagnostic modality used in 88.5% of cases. Abdominal pain was the predominant presenting symptom, observed in 86.23% of cases. Only 29 out of 1,920 cases underwent attempted reduction, while the majority required surgical resection due to the high incidence of malignancy in adult cases. The most common type of intussusception identified was colocolic (16.82%), followed by enteric (13.28%), ileocolic (4.89%), and ileocaecal (0.78%) types. A pathological lead point was observed in 302 out of 673 patients (44.84%), with a notably higher frequency of malignancy associated with colocolic intussusception.

Surgical management remains the cornerstone in treating adult intussusception, particularly in cases involving the colocolic type, where there is a significant risk of underlying malignancy. Attempts at reduction are generally avoided due to the potential risk of tumor dissemination, which could adversely impact patient outcomes. Contrast-enhanced computed tomography (CECT) of the abdomen is pivotal for accurately diagnosing intussusceptions and guiding appropriate management strategies. It is imperative to adhere strictly to oncological principles during surgical interventions to ensure optimal patient care and outcomes.

The management of gastrointestinal complications in patients with complex medical history poses significant challenges to healthcare clinicians. A 42-year-old male patient was admitted to the emergency department with excruciating abdominal pain and signs of bowel obstruction. The patient had a previous history of schizophrenia and esophageal stricture, treated 6 years ago with colonic esophageal interposition. From the computed tomography scan, intussusception of the jejunum in the colonic graft was revealed, which resolved spontaneously after a few hours probably due to the oral contrast. Although, colonic esophageal interposition is a life-saving procedure for long-esophageal strictures, there are rare complications that are still not clearly reported. Jejunocolic intussusception should raise awareness of the clinicians, as one of the potential complications of colonic esophageal interposition.

Intussusception is the invagination of one segment of the bowel into the adjacent bowel segment leading to obstruction, intestinal ischemia and, in severe cases, peritonitis and perforation. While the condition is more common in children, adult intussusception does occur and is often attributed to malignancy. In this case report, we discuss an adult man who presented for weight loss and intermittent abdominal pain and was ultimately found to have ileocecal intussusception on CT imaging. A colonoscopy with cold biopsy was performed and pathology reports displayed a well-differentiated neuroendocrine tumor lead point; a rare event with only a few cases reported. Ultimately, the patient was taken to the operating room, and an ileocecectomy was performed with primary anastomosis. Prompt diagnosis and management are crucial in adult intussusception as a missed event can lead to tumor progression, bowel ischemia, bleeding and necrosis.

Intussusception, defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one, is a rare cause of abdominal pain in the adult population due to underlying benign or malignant pathology. With the liberal use of CT in the evaluation of patients with abdominal pain, the diagnosis became more reliable. Resection of the bowel segment is the recommended treatment in most cases. We are presenting the case of a 76-year-old male patient who presented with a three-week history of abdominal pain and diarrhea. The evaluation was consistent with ileocolic intussusception. Robotic resection of the right colon was performed. Pathology revealed poorly differentiated adenocarcinoma of the cecum as the underlying pathology.

Intussusception is a rare occurrence in adults and only 5% being adults. Ileocolic intussusception is the most common type in adults whereas duodenal intussusception (DI) is the rarest subtype due to natural retroperitoneal fixation of the duodenum. There are only a few case-reports available in the literature. Here, we aimed to present our experience of five cases with DI in adults, there operative challenges and strategies to deal with the same. Age of presentation ranged from 18-45 years, and four out of five were females. Most common presentation was partial of recurrent gastric outlet obstruction (GOO) along with weight loss. They were all diagnosed on contract-enhanced-CT scan of abdomen, and all had a lead point in form of a benign polypoidal mass arising from duodenum. Two patients were managed with local excision of polyp and retroperitoneal fixation of redundant duodenum, whereas pancreaticoduodenectomy and segmental duodenal resection was required for the other two patients. One patient was lost to follow-up without definitive treatment as was minimally symptomatic. All four operated patients had uneventful recovery post-operatively and are doing well in follow-up. DI is an infrequent occurrence and a rare etiology of GOO in adults. Most of them having benign lead point, require surgical excision of lead point with fixation of duodenum to retroperitoneum. Anatomical proximity of important structures like CBD and pancreatic duct especially at perivaterian location makes surgical resection challenging. With thorough anatomical knowledge and appropriate management, this condition can be managed well.

Intestinal intussusception is rare in adults, involving telescoping of one intestinal segment into another. Commonly associated with colonic lesions, it presents as acute obstruction. Diagnosis relies on CT. We report a rare case of colorectal intussusception due to a polyp, managed by endoscopic polypectomy.

We present a case of a 74-year-old man with chronic constipation, who presented with acute abdominal pain, vomiting, and cessation of bowel movements. Hemodynamically stable, he had a distended abdomen. We diagnosed acute bowel obstruction secondary to colorectal intussusception via CT scan. Surgery was planned after resuscitation. However, after induction of general anesthesia, the procedure was postponed due to a significant diarrheal episode and resolution of the abdominal distension. A subsequent colonoscopy revealed a 10 mm polyp, which was excised endoscopically. The patient's recovery was smooth, with no recurrence after a one-year follow-up.

Intestinal intussusception, rare in adults, primarily affects the small intestine but may involve the colon, often associated with organic lesions or postoperative adhesions. While colocolonic intussusceptions, mostly malignant, may stem from benign causes occasionally, symptoms are nonspecific, with common pain. Diagnosis relies on CT scans, with surgery typically required, except in select cases.

Colorectal intussusception, rare in adults, may necessitate laparotomy. Spontaneous symptom resolution enables conservative management. Clinician awareness is vital to prevent unnecessary and risky surgeries, given its rarity and potential for favorable outcomes sans intervention.

Adult intussusception necessitates early surgical intervention. We emphasis the significance of considering diffuse large B-Cell lymphoma in differential diagnoses for adult intussusception, particularly in the colon, to ensure precise diagnosis and optimal management.

We present an adult patient, a 39-year-old female, with chief complaints of pain in the umbilical region. The patient was further evaluated by radiological investigations and was diagnosed with small bowel intussusception caused by submucosal lipoma as the lead point. She had undergone ileal resection and anastomosis of the affected segment. The postoperative period was uncomplicated, and the patient continued with regular oral intake. The histopathological analysis revealed it to be adipose tissue with no features of atypia. This case shows the rare presentation of small bowel intussusception due to a submucosal lipoma. It emphasizes the significance of diagnostic imaging tools for diagnosis and the need for surgery for proper administration.

Adult intussusception is rare, and an underlying benign or malignant aetiology is often found. Inflammatory fibroid polyp, a benign neoplastic polyp that can arise anywhere in the gastrointestinal tract is a rare cause of intussusception of the small bowel. Clinical presentation differs depending on the location of the lesion in the gastrointestinal tract. Diagnosis may be confirmed on a computed tomography scan or ultrasound. Definite diagnosis is based on histopathology and immunocytochemistry. We present the case of a 58-year-old lady with an inflammatory fibroid polyp who presented with microcytic anaemia and chronic abdominal pain due to recurrent intussusception.

Intussusception is defined as the telescoping of bowel into itself. Intussusception is the leading cause of bowel obstruction in children, but it is rare in adults [1, 2]. It has a pathological intramural or extramural lead point. In adults, it accounts for 1%-5% of cases of bowel obstruction [3, 4]. Unlike presentation in the paediatric population of cramping abdominal pain, bloody mucus, and palpable mass in right iliac fossa, presentation in adults can be more varied and non-specific [1, 4]. Hence, diagnosis of small bowel intussusception (SBI) can be challenging, requiring a higher degree of clinical suspicion [5]. While cases of paediatric intestinal intussusception are often primary, most adult cases are secondary to structural lesions [5]. This case is of a 57-year-old lady who presented with SBI secondary to a small bowel lipoma (SBL), reflecting the importance of considering SBL as a differential in the causes of SBI.

Large intestinal intussusception is rare in adults. Among potential pathologic lead points for intussusception are lipomas, benign tumors very infrequently found in the large bowel. A 30-year-old woman presented to the emergency department with a chief complaint of generalized abdominal pain for two weeks. A computed tomography scan of her abdomen and pelvis showed an ileocolic intussusception with a lead point of 6.7 cm. The lead point appeared to be predominantly fat. A colonoscopy revealed a large, obstructing lesion in the transverse colon. The patient underwent exploratory laparotomy with a right hemicolectomy, and a pathologic diagnosis of a lipoma was made. The patient recovered from surgery without complications and returned to her normal diet three weeks after discharge. This case highlights an unusual and rare presentation of an ileocolic intussusception caused by a cecal lipoma acting as a lead point.

Intussusception involving the colon is unusual in adults and when present is managed with resection due to the risk of malignancy. We present an unusual case where the intussusceptum was impacted stool in a mucosal pouch in the transverse colon. The patient presented with bleeding per rectum and abdominal pain and was found to have a colocolic intussusception on computed tomography. Colonoscopy showed an ulcerated mass in the transverse colon. A laparoscopic right hemicolectomy was performed. Histopathology demonstrated known chronic lymphocytic leukemia, but not solid malignancy. A large fecalith impacted within a mucosal pouch had acted as the lead point. This represents a highly unusual but benign cause of intussusception.

Most adult intussusceptions are secondary to various pathological conditions that serve as a lead point. Because of their serious nature, intussusceptions often require emergency surgery. We report a surgical case of amyloidosis associated with intussusception, probably due to polypoid protrusions and bleeding tendencies. An 80-year-old man with abdominal pain was suspected of having jejunal intussusception on computed tomography. He had been prescribed warfarin for atrial fibrillation, and excessive anticoagulation was observed with a prolonged prothrombin time/international normalized ratio of 5.44 at presentation. After the excessive anticoagulation was resolved, emergency surgery was performed. The intussuscepted jejunum was resected, and a 7 cm long dark-red pedunculated polyp was identified as the lead point, which was accompanied by multiple small pedunculated polyps. Histopathological examination showed that these were all hemorrhagic polyps. Amyloid depositions were observed in the muscularis mucosae, submucosa, and the walls of the blood vessels. Immunohistochemical analysis revealed immunoglobulin light chain amyloidosis. This case is informative to discuss the clinical sequelae of gastrointestinal amyloid deposition.

Adult intussusception is an infrequent occurrence typically resulting from an identifiable lead point of a benign or malignant etiology. Here, we present a case of a 19-year-old male who presented to the emergency department with complaints of abdominal pain, intractable nausea, and fluctuations between bloody diarrhea and constipation. These symptoms had begun two months prior and had increased in severity, resulting in significant appetite changes. An abdominal and pelvic computed tomography scan without contrast was obtained, which showed evidence of intussusception of the ileocecum into the transverse colon with resultant small bowel obstruction. The patient underwent an exploratory laparotomy, which resulted in a partial ileocolectomy due to the presence of a 6.8 cm cecal mass with palpable mesenteric lymphadenopathy. The pathologic specimen was identified as Burkitt lymphoma based on a combination of histologic, immunohistochemical, and fluorescence in situ hybridization findings. Currently, the patient is undergoing three cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate, ifosfamide, etoposide, and high-dose cytarabine (R-CODOX-M/IVAC) per Magrath protocol for low-risk Burkitt lymphoma.

Intussusception, a condition primarily seen in pediatric populations, involves the telescoping of one segment of the bowel into an adjacent section. In adults, intussusception is rare and presents unique diagnostic and management challenges. This case report highlights a 73-year-old female with ileocecal colonic intussusception complicated by an underlying adenocarcinoma, emphasizing the need for early diagnosis and a multidisciplinary approach.

A 73-year-old female with a history of hypertension and type 2 diabetes presented with right-sided abdominal pain, nausea, and vomiting. Physical examination revealed tenderness in the right upper quadrant, and no palpable mass or rectal bleeding. Lab results, including tumour markers, were normal. Multi-detector computed tomography (MDCT) identified ileocecal colonic intussusception with the "target sign" and low colonic wall enhancement. An emergency laparoscopic right colectomy was performed due to compromised blood supply. Postoperatively, an anastomotic leak was managed with antibiotics, bowel rest, and wound care. Pathological examination revealed cecal adenocarcinoma with one positive lymph node, staged as T3N1aM0, necessitating adjuvant chemotherapy.

Adult intussusception, a rare condition, often has an identifiable organic cause, with clinical symptoms ranging from acute to chronic or asymptomatic. Diagnostic imaging, such as MDCT, plays a crucial role in diagnosis and evaluation. Surgical management varies based on the nature and location of the lead point. In this case, the chronic symptoms, lymph node as the lead point, and low colonic wall enhancement warranted an urgent laparoscopic right colectomy with complete mesocolic excision.

This case underscores the complexity of adult ileocecal colonic intussusception, especially when associated with adenocarcinoma. Timely diagnosis, multidisciplinary collaboration, and meticulous surgical intervention are essential. Effective management of postoperative complications, like the anastomotic leak, is crucial.

Intussusception in adults is rare. There are only a few cases in the literature that report two lead points resulting in double or synchronous intussusception. We present a case of synchronous intussusception in a 45 year old man with neuroendocrine tumour of the ileocaecal valve and lipomatous polyp of the jejunum.

Intussusception is a condition characterized by the invagination of a proximal segment of the intestine into a distal segment. In adults, intussusception is commonly associated with a lead point. The most alarming lead point is an obstructing malignancy. Here, we present the case of a 57-year-old woman with ileocolic intussusception secondary to colonic adenocarcinoma. The patient presented to the emergency department following an incidental finding of bradycardia, with a heart rate of around 40 beats per minute. She presented with several weeks of cramping, right lower quadrant abdominal pain, lightheadedness, fatigue, and palpitations. A computed tomography scan revealed ileocolic intussusception. After the placement of a semi-permanent right subclavian pacer, the patient underwent a right hemicolectomy. Surgical findings were consistent with ileocolic intussusception suspicious of being initiated by a mass in the right cecum involving the appendiceal orifice and ileocecal valve that invaded through the muscularis propria into subserosal tissue. The mass was resected and sent to pathology, where it was classified as stage II colonic adenocarcinoma. This case highlights a nonspecific presentation of intussusception that was only identified due to incidental bradycardia.

Mosaic trisomy 14 is exceptionally rare and was first described in the 1970s with fewer than 100 known liveborn individuals. Information about complications and the natural history of the disease is rare, especially in adult patients. This case illustrates an adult patient with severe functional limitations from mosaic trisomy 14 who presented with abdominal pain and failure to thrive and was subsequently found to have intussusception and severe chronic constipation, which was successfully treated conservatively.

Abdominal pain is a common emergency department complaint, and point-of-care ultrasound (POCUS) of the abdomen is increasingly being utilized to evaluate clinical manifestations. It aids in accurate diagnoses and assists in procedures, particularly in emergency and critical care settings. Imaging is often required to confirm the etiology of abdominal pain. POCUS provides the benefit of avoiding radiation exposure and enables quicker diagnosis compared to computed tomography scans. There is growing evidence of the diagnostic accuracy for numerous abdominal POCUS applications, including appendicitis, intussusception, diverticulitis, gastric ultrasound and contrast-enhanced ultrasound.

Intussusception in adults is less frequent than in children, and it is less commonly seen in the colon than in the intestines. This may be explained by the fixation of the colon to the retroperitoneum. We herein describe a case of sigmoid colon intussusception caused by a sigmoid colon adenocarcinoma. An 81-year-old man presented with abdominal pain and signs and symptoms of gastrointestinal obstruction. CT revealed a "target sign" with a mass in the sigmoid colon. We diagnosed the patient with colonic obstruction secondary to intussusception of the sigmoid colon and performed an emergency transverse colostomy. On the first postoperative day, the patient had a parastomal evisceration. Oncologic resection of the sigmoid colon without reduction of the intussusception was performed. The tumor was pathologically diagnosed as well-differentiated adenocarcinoma and classified as pT3N0. The patient was discharged on the ninth postoperative day with an uneventful postoperative course. The surveillance was validated for this patient.