Jha Rahul, Ghimire Sabin Kumar, Prasad Rishika, Thapa Kaushal Samsher, Jha Sudhakar, Singh Praveen
Department of General Surgery, National Academy of Medical Sciences, Kathmandu, Nepal.
Nepal Medical College Teaching Hospital, Kathmandu, Nepal.
Ann Med Surg (Lond). 2025 Jun 13;87(8):5222-5228. doi: 10.1097/MS9.0000000000003467. eCollection 2025 Aug.
Adult intussusception is rare, occurring in only 1 out of 1300 (0.08%) abdominal surgeries and accounting <1% of adult intestinal obstruction cases. The overall incidence of adult intussusception is 1-3 cases per 100 000 population and comprises 5% of all intussusception cases. Idiopathic ileocecal colic intussusception in adults is exceptionally rare, making our case a unique and noteworthy contribution to the existing literature.
A 23-year-old male presented with abdominal pain for 2 weeks, associated with vomiting and black-colored stool. On examination, mild tenderness and a palpable mass were noted over the right lumbar region. Ultrasonography and Contrast Enhanced Computed Tomography (CECT) of the abdomen and pelvis revealed features of ileocecal colic intussusception. An emergency exploratory laparotomy was performed, with reduction of the intussusceptum using the Hutchinson maneuver, followed by a limited right hemicolectomy.
Although intussusception is the most common cause of bowel obstruction in children aged ≤5 years, it is rare in adults. When it does occur in adults, >90% of cases are associated with an identifiable lead point, with only a few cases being idiopathic. The most commonly reported types of intussusception in adults are colocolic and enteric, followed by ileocolic and ileocecal types.
Acute intestinal obstruction is not the typical presentation of adult intussusception; rather, the majority of cases present with subacute or chronic symptoms. History of recurrent intermittent partial bowel obstruction over days to years may suggest intussusception. Early diagnosis and timely intervention can significantly reduce patient morbidity and mortality.
成人肠套叠较为罕见，在1300例腹部手术中仅出现1例（0.08%），占成人肠梗阻病例的比例不到1%。成人肠套叠的总体发病率为每10万人中有1 - 3例，占所有肠套叠病例的5%。成人特发性回盲部结肠套叠极为罕见，因此我们的病例对现有文献而言是一项独特且值得关注的贡献。
一名23岁男性因腹痛2周前来就诊，伴有呕吐和黑便。检查发现右腰部有轻度压痛及可触及的肿块。腹部和盆腔的超声检查及增强CT扫描显示回盲部结肠套叠的特征。遂进行急诊剖腹探查术，采用哈钦森手法复位套入部，随后行有限的右半结肠切除术。
虽然肠套叠是5岁及以下儿童肠梗阻最常见的原因，但在成人中却很罕见。当成人发生肠套叠时，超过90%的病例与可识别的引导点有关，只有少数病例是特发性的。成人中最常报告的肠套叠类型是结肠结肠型和肠型，其次是回结肠型和回盲型。
急性肠梗阻并非成人肠套叠的典型表现；相反，大多数病例表现为亚急性或慢性症状。数天至数年反复间歇性部分肠梗阻的病史可能提示肠套叠。早期诊断和及时干预可显著降低患者的发病率和死亡率。
