Gastrointestinal (GI) Unit, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Int J Surg. 2011;9(1):91-5. doi: 10.1016/j.ijsu.2010.10.003. Epub 2010 Oct 15.
The objectives were to review adult intussusception (AI), its diagnosis and treatment.
Intussusception is a different entity in adults than it is in children. AI represents 1% of all bowel obstructions, 5% of all intussusceptions.
The records of all patients, 18 years and older, with the postoperative diagnosis of intussusception at the B.P.K.I.H.S during the years 2003-2009 were reviewed retrospectively.
In six years, there were thirty-eight patients of surgically proven AI. The patients' mean age was 49.6 years, M:F ratio was 1.3:1. Intestinal obstructions of various extents were the commonest presentation in twenty-seven patients (71%). There were 42% enteric, 32% ileocolic and 26% colonic AI. The diagnostic accuracy of the ultrasonography was 78.5%, CT scan was 90% and colonoscopy was 100%. The pathological lesions were found in 94% of AI. Among the pathological lesion, enteric have 62% benign, 38% malignant, ileocolic have 50% benign, 50% malignant, and in colocolic 70% malignant, 30% benign. In enteric AI, 68% were reduced successfully, 25% reduction was not attempted. Of ileocolic AI, 58.3% were reduced successfully, 41.6% had resection without reduction. Of colocolic AI, 30% of them were reduced successfully before resection, 70% had resection without reduction.
AI is a rare entity and requires a high index of suspicion. CT scanning proved to be the most useful diagnostic radiologic method. Colonoscopy is most accurate in ileocolic and colonic AI. The treatment of adult intussusception is surgical. Our review supports that small-bowel intussusception should be reduced before resection if the underlying etiology is suspected to be benign or if the resection required without reduction is deemed to be massive. Large bowel should generally be resected without reduction because pathology is mostly malignant.
回顾成人肠套叠（AI）的诊断和治疗。
成人肠套叠与儿童肠套叠不同。AI 占所有肠阻塞的 1%，占所有肠套叠的 5%。
回顾性分析 2003 年至 2009 年在 B.P.K.I.H.S 接受手术后诊断为肠套叠的所有 18 岁及以上患者的记录。
六年来，有 38 例经手术证实的 AI 患者。患者的平均年龄为 49.6 岁，男女比例为 1.3:1。27 例患者表现为不同程度的肠梗阻（71%）。肠套叠 42%，回结型肠套叠 32%，结肠型肠套叠 26%。超声检查的诊断准确率为 78.5%，CT 扫描为 90%，结肠镜检查为 100%。94%的 AI 发现病理病变。在病理病变中，肠套叠 62%为良性，38%为恶性；回结型肠套叠 50%为良性，50%为恶性；结肠型肠套叠 70%为恶性，30%为良性。肠套叠中，68%可成功复位，25%未尝试复位。回结型肠套叠中，58.3%可成功复位，41.6%未尝试复位而行切除术。结肠型肠套叠中，30%在切除前成功复位，70%未尝试复位而行切除术。
AI 是一种罕见的疾病，需要高度怀疑。CT 扫描被证明是最有用的诊断影像学方法。结肠镜检查对回结型和结肠型肠套叠最准确。成人肠套叠的治疗是手术。我们的回顾支持，如果怀疑潜在病因是良性的，或者认为需要切除的范围很大，则应在切除前尝试复位小肠套叠。如果病理主要为恶性，则一般应切除大肠而不尝试复位。
