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Adult intussusception: a systematic review and meta-analysis

  • Review Article
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Techniques in Coloproctology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-Do, Republic of Korea

    K. D. Hong, J. Kim & W. Ji

  2. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    S. D. Wexner

Authors
  1. K. D. Hong
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  2. J. Kim
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  3. W. Ji
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  4. S. D. Wexner
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Correspondence to S. D. Wexner.

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Hong, K.D., Kim, J., Ji, W. et al. Adult intussusception: a systematic review and meta-analysis. Tech Coloproctol 23, 315–324 (2019). https://doi.org/10.1007/s10151-019-01980-5

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