Adult intussusception in the last 25 years of modern imaging: is surgery still indicated?

Because most adult intussusceptions are reportedly due to malignancy, operative treatment is recommended. With current availability of computed tomography, we questioned the role of mandatory operative exploration for all adult intussusceptions. This study is a retrospective review of all adults treated from 1983 to 2008 at a large tertiary referral center for intussusception. One hundred ninety-six patients had intussusception over the 25-year study period. Computed tomography was obtained in 60% of patients. Neoplasms [malignant, (21%); benign, (24%)] were the commonest etiology; 30% cases were idiopathic. One hundred twenty (61%) patients underwent operative treatment for intussusception. Six of the 58 idiopathic or asymptomatic cases were operated on with negative findings in all. Palpable mass (OR 4.56, p < 0.035), obstructive symptoms (OR 9.13, p < 0.001) or obstruction (OR 9.67, p < 0.001), GI bleeding (OR 14.41, p < 0.001), and a lead point on computed tomography (OR 10.08, p < 0.001) were associated with the need for operation. In the current era of computed tomography, idiopathic or asymptomatic intussusception is being seen more commonly; however, the majority of adult intussusceptions still have pathologic lead points. From our experience, all patients with palpable mass, obstructive symptoms or obstruction, gastrointestinal bleeding, or a lead point on computed tomography should undergo operative exploration.