Perspectives on intussusception

Intussusception is an uncommon type of bowel obstruction, characterized by the telescoping of one segment of the gastrointestinal tract (intussusceptum) into the lumen of the distal segment (intussuscipiens). This process leads to bowel obstruction and can result in inflammatory changes, varying from thickening to ischemia of the bowel wall. In contrast to children, where it is typically primary and benign, adult intussusception is often secondary to an underlying pathological condition, serving as a lead point in approximately 90% of cases.
The locations prone to intussusception in the gastrointestinal tract include junctions between freely moving segments and segments fixed retroperitoneally or by adhesions. The classic presentation involves a triad of symptoms: cramping abdominal pain, bloody diarrhea, and the presence of a palpable tender mass. However, the clinical presentation and imaging features in adults can vary, making the preoperative diagnosis of intussusception a challenging task. Initially, plain abdominal films are commonly used as a diagnostic tool, especially when obstructive symptoms dominate the clinical presentation. Ultrasonography is considered valuable for diagnosing intussusception in both children and adults, with characteristic imaging features such as the "target" sign on the transverse view. Presently, abdominal computed tomography is regarded as the most sensitive radiologic method to confirm the presence of intussusception. Surgical intervention is generally accepted as the preferred approach for adult intussusception due to the high incidence of structural anomalies and the significant likelihood of associated malignancy.