Adult intussusception

a systematic review and meta-analysis

Kwang Dae Hong, J. Kim, W. Ji, S. D. Wexner

Research output: Contribution to journalReview article

Abstract

Background: Perhaps partly because intussusception in adults is rare, optimal treatment remains controversial. The aim of this study was to determine the appropriate surgical procedure for adult intussusception. Methods: A systematic search was undertaken using PubMed, Embase, and Web of Science from 1/1980 to 12/2016. Adults (> 15 years) with intussusception treated by surgical or conservative measures were included. Results: One thousand two hundred twenty-nine patients were identified from 40 retrospective case series. Pooled rates of malignant and benign tumors and idiopathic etiologies were 32.9% (95% CI 28.6–37.4), 37.4% (95% CI 32.7–42.3), and 15.1% (95% CI 11.7–19.3), respectively. Pooled rates of enteric, ileocolic, and colonic location types were 49.5% (95% CI 41.8–57.2), 29.1% (95% CI 23.0–36.1), and 19.9% (95% CI 16.3–24.1), respectively. Pooled rates of malignant tumors in enteric, ileocolic, and colonic intussusception were 22.5% (95% CI 18.3–27.3), 36.9% (95% CI 27.3–47.6), and 46.5% (31.1–62.6), respectively. Metastatic carcinoma was the main cause of malignant tumor in enteric intussusception. Conversely, primary adenocarcinoma was the main cause of malignant tumor in ileocolic and colonic intussusception. Considering the high rate of malignancy of colonic intussusception the majority of the studies surveyed recommend en bloc resection without reduction to avoid potential intraluminal seeding or venous tumor dissemination. Pooled rates of postoperative complications and mortality were 22.1% (95% CI 17.5–27.5) and 5.2% (95% CI 3.7–7.4), respectively. Conclusion: Whereas enteric intussusception can be managed by reduction followed by resection, colonic intussusception should be resected en bloc. Due to the intermediate forms between enteric and colonic intussusception, a selective approach is recommended. Surgery remains the mainstay in adult intussusception.

Original languageEnglish
JournalTechniques in Coloproctology
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Intussusception
Meta-Analysis
Neoplasms
PubMed
Adenocarcinoma
Carcinoma

Keywords

  • Adult intussusception
  • Colonic type
  • Enteric type
  • Ileocolic type

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Adult intussusception : a systematic review and meta-analysis. / Hong, Kwang Dae; Kim, J.; Ji, W.; Wexner, S. D.

In: Techniques in Coloproctology, 01.01.2019.

Research output: Contribution to journalReview article

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title = "Adult intussusception: a systematic review and meta-analysis",
abstract = "Background: Perhaps partly because intussusception in adults is rare, optimal treatment remains controversial. The aim of this study was to determine the appropriate surgical procedure for adult intussusception. Methods: A systematic search was undertaken using PubMed, Embase, and Web of Science from 1/1980 to 12/2016. Adults (> 15 years) with intussusception treated by surgical or conservative measures were included. Results: One thousand two hundred twenty-nine patients were identified from 40 retrospective case series. Pooled rates of malignant and benign tumors and idiopathic etiologies were 32.9{\%} (95{\%} CI 28.6–37.4), 37.4{\%} (95{\%} CI 32.7–42.3), and 15.1{\%} (95{\%} CI 11.7–19.3), respectively. Pooled rates of enteric, ileocolic, and colonic location types were 49.5{\%} (95{\%} CI 41.8–57.2), 29.1{\%} (95{\%} CI 23.0–36.1), and 19.9{\%} (95{\%} CI 16.3–24.1), respectively. Pooled rates of malignant tumors in enteric, ileocolic, and colonic intussusception were 22.5{\%} (95{\%} CI 18.3–27.3), 36.9{\%} (95{\%} CI 27.3–47.6), and 46.5{\%} (31.1–62.6), respectively. Metastatic carcinoma was the main cause of malignant tumor in enteric intussusception. Conversely, primary adenocarcinoma was the main cause of malignant tumor in ileocolic and colonic intussusception. Considering the high rate of malignancy of colonic intussusception the majority of the studies surveyed recommend en bloc resection without reduction to avoid potential intraluminal seeding or venous tumor dissemination. Pooled rates of postoperative complications and mortality were 22.1{\%} (95{\%} CI 17.5–27.5) and 5.2{\%} (95{\%} CI 3.7–7.4), respectively. Conclusion: Whereas enteric intussusception can be managed by reduction followed by resection, colonic intussusception should be resected en bloc. Due to the intermediate forms between enteric and colonic intussusception, a selective approach is recommended. Surgery remains the mainstay in adult intussusception.",
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