What is Intussusception in Adults?
Intussusception is a condition where one part of the intestine slides into another part, much like a telescope. This can block the intestine and may cause a part of it to die due to lack of blood supply, known as intestinal ischemia. This can lead to severe complications such as a blocked intestine, death of intestine tissues, and even sepsis, an overwhelming infection in the body. This condition is quite common in children but rare in adults. In adults, it generally occurs due to problems like tumors.[1][2]
Diagnosing intussusception in adults can be difficult. It is hard to diagnose because abdominal pain, one of its main symptoms, is a common complaint in the emergency department and can be caused by many conditions. Evaluating and managing abdominal pain mostly depends on how severe the signs and symptoms are during the check-up. The patient’s medical history, physical examination, and lab test results can all contribute to the diagnosis, but usually, it requires imaging tests for confirmation. This condition can be tricky because it can resemble many other diseases.[3] If not properly diagnosed, it could lead to severe complications and affect the patient’s recovery. The definite treatment is surgery, and a successful recovery largely depends on how quickly the condition is diagnosed and treated. An effective healthcare team made up of doctors, nurses, and technicians is crucial in managing this condition. This activity is about understanding this rare but potentially life-threatening emergency more deeply.[1]
What Causes Intussusception in Adults?
In adults, almost 90% of appendicitis cases are triggered by some sort of abnormality, most often a tumor or growth. Different risks can lead to appendicitis, such as:
- A mass (either non-cancerous or cancerous)
- Changes in the structure of your body
- Scar-like tissue that can form following surgery, known as adhesions
- Endometriosis, a condition where tissue similar to the lining of the womb starts to grow in other places, like the appendix
- Unknown causes, referred to as idiopathic
- Fibroids, which are non-cancerous growths in or on the uterus
- A gastrostomy tube, which is a feeding tube inserted into your stomach
- A jejunostomy tube, which is a feeding tube inserted into your small intestine
Risk Factors and Frequency for Intussusception in Adults
Intussusception is a very uncommon condition in adults, appearing in fewer than 1 in 1300 abdominal surgeries. It is 20 times more common in children than in adults. It accounts for 1% of small bowel obstruction cases in adults, often caused by a tumor.
Signs and Symptoms of Intussusception in Adults
It’s important to know that a person’s medical history and physical exams can provide valuable clues for diagnosis and treatment decisions, even if they aren’t always definitive. Abdominal pain is a very common complaint brought up in emergency departments.
People suffering from a condition known as adult intussusception often report symptoms such as:
- Abdominal pain
- Bloating
- Nausea
- Vomiting
The pain might come and go, and the vomit could be greenish-yellow. If the bowel folds in on itself – like telescope parts – it can cut off blood flow, leading to tissue death and bloody diarrhea. If left unchecked, this condition can lead to a hole in the intestine, causing peritonitis (an infection in the abdomen). Sometimes, patients can develop a fever due to sepsis (a severe infection), which usually appears later in the progression of the condition.
A physical examination can reveal either generalized or localized abdominal pain, bloating, and diminished bowel sounds. The level of pain can sometimes exceed what a physical examination might suggest, due to bowel tissue lacking proper blood flow.
Testing for Intussusception in Adults
In diagnosing a condition called adult intussusception, where a part of the intestine slides into another part, abdominal computed tomography (CT) scans are very effective. This is particularly the case for patients experiencing vague stomach pain. CT scans not only help spot this condition, but they can also locate any abnormal growths that may be causing it. They can detect any serious issues with blood flow, and interestingly, in some cases, the scans can even predict the chance of the condition resolving on its own.
On the other hand, an ultrasound of the abdomen isn’t as effective in detecting adult intussusception as a CT scan. Still, it can find a characteristic ‘target sign’ in certain cases, especially in patients with a noticeable stomach lump. In these cases, ultrasounds can be over 90% sensitive. The ultrasound can create different images like ‘target’ and ‘doughnut’ signs seen from a sideways view, or a ‘pseudo-kidney’ sign seen from a lengthwise view. One downside of ultrasounds is that gas filled loops in the bowels can make it harder to see certain features. Additionally, the quality of ultrasound images can depend on who operates the machine.
Other diagnostic tests like plain abdominal X-rays or studies using contrasts, which are substances that help doctors see more detail, play a minor role in diagnosing this condition.
Treatment Options for Intussusception in Adults
If you come into the emergency department suspected of having intussusception, we’ll work to help your discomfort. This means we’ll offer pain relief, medication to stop you feeling sick, rehydrate you with a drip, possibly drain your stomach with a tube through your nose, and depending on your symptoms, give you antibiotics. We’ll also ask you not to eat or drink in case you need surgery.
Intussusception in adults usually requires surgery as there’s often a high chance of a tumour being present. During surgery, special techniques are used to minimise the risk of cancer cells spreading. Knowing where the intussusception is, how big it is, why it occurred, and whether the bowel is still healthy, will influence the exact type of surgery you get. This could either be open surgery (a large abdominal cut) or laparoscopic surgery (small cuts), depending on how serious the condition is and the surgeon’s expertise in minimally invasive surgery.
Your treatment could be influenced by the location of the blockage:
– “Colo-Colic intussusception”: This type of intussusception happens in the colon. When this occurs, health professionals often lean towards open surgery because an underlying issue, like a tumour, is typically the cause. The debate usually involves whether the issue should be tackled directly or if it should be reduced first. Some studies suggest that tackling it directly can prevent unnecessary removal of the bowel. This can save the patient from further complications. Other studies, however, suggest reducing the problem before removal is better. But this has the risk of spreading malignant cells.
– “Gastroduodenal intussusception”: For this type of intussusception, which happens between the stomach and the small intestine, the blockage is typically reduced and then removed.
– “Coloanal intussusception”: This type of intussusception occurs near the end of the colon. Most health professionals agree that the blockage should be reduced and then removed. While it may be challenging and there is a risk of spreading cancer cells, this method can preserve the patient’s future quality of life due to it being less invasive. The procedure can take place either through the abdomen, or more recently, through the anus. Innovations in surgical equipment have made the latter approach simpler for doctors to perform.
During the surgical approach, care is always taken to delicately untangle the area of intussusception without causing damage. Deciding between laparoscopic and open surgery depends on the surgeon’s skill level and the overall condition of the patient.
What else can Intussusception in Adults be?
Abdominal pain is one of the most common reasons why people visit the emergency room. The way doctors evaluate and handle these cases heavily relies upon how serious the symptoms come across during the check-up.
When a patient complains about abdominal pain, there are a lot of possible conditions that need to be considered. These include:
- Gastritis
- Volvulus (twisting of the stomach or intestine)
- Obstruction in the small or large bowel
- Cholecystitis (inflammation of the gallbladder)
- Choledocholithiasis (stones in the common bile duct)
- Cholelithiasis (gallstones)
- Peptic ulcer disease
- Mesenteric ischemia (insufficient blood supply to the intestines)
- Gastroparesis (delayed gastric emptying)
- Constipation
- Inflammatory bowel disease
- Irritable bowel syndrome
- Diverticulitis (swollen or infected pouches in the colon)
- Diverticulosis (development of small pouches in the colon)
- Pancreatitis (inflamed pancreas)
- Abdominal aortic aneurysm (an enlarged part in the lower part of the main artery that carries blood)
- Ovarian torsion (twisting of the ovary)
- Tubo-ovarian abscess (pus-filled pocket involving a fallopian tube and an ovary)
- Fibroids (abnormal growths in the uterus)
- Pelvic inflammatory disease (infection of the female reproductive organs)
- Pyelonephritis (kidney infection)
- Ileus (disruption of the normal propulsive ability of the intestine)
What to expect with Intussusception in Adults
The outlook for patients diagnosed with this rare disease is usually not very good because it often involves cancer. It’s also common for the diagnosis and proper treatment to be delayed because the disease behaves in an unusual way.
Your doctor is typically only able to confirm the diagnosis once you are in the operating room for surgery. Any delay in treatment can lead to serious complications that can increase the risk of death.
Possible Complications When Diagnosed with Intussusception in Adults
Because the symptoms can be unclear and there are numerous possible conditions to consider, a delay in diagnosing intussusception is quite common. This has the potential to lead to serious and possibly life-threatening complications.
Possible Complications include:
- Peritonitis (Infection in the abdomen)
- Bowel ischemia (Reduced blood flow to the intestines)
- Bowel necrosis (Death of bowel tissue)
- Bowel perforation (Rupture in the wall of the intestine)
- Sepsis (Bodywide infection)
- Tumor seeding (Spread of cancer cells, a risk associated with surgical treatment)
Preventing Intussusception in Adults
Patients should be educated on several key points after their procedure:
– Changes in daily habits: This could include things like adopting more active behaviors or quitting smoking.
– Caring for their wound: Patients must learn how to clean and dress their wound properly to avoid infection and promote healing.
– Changes in diet: A patient might need to adjust their eating habits to support recovery.
– If a resection (removal of part or all of an organ) was not done, it’s crucial that they continue to have check-ups for the lesion (an area of damaged tissue) to monitor any changes.
– Patients should also be aware that there’s a 5% chance their condition could come back. Knowing this can help them be vigilant of any recurring symptoms, and seek medical help promptly if necessary.
