Imaging Pearls ❯ Small Bowel ❯ Intussusception
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- Small Bowel Intussuception: Causes in Adults
• Transient and intermittent (idiopathic)
• Small bowel tumors
• Ingested foreign bodies
• Enteric tubes
• Meckel’s diverticulum - “Adult intussusception is thought to be rare, accounting for an estimated 5% of all intussusceptions and only 1% of small-bowel obstructions. Unlike intussusceptions in children, which are idiopathic in 90% of cases, adult intussusceptions were tradition- ally thought to have an identifiable cause in the majority of cases.”
MDCT and 3D Imaging in Transient Enteroenteric Intussusception: Clinical Observations and Review of the Literature Horton KM, Fishman EK AJR 2008; 191:736–742 - “Intussusception occurs when a segment (intussusceptum) of the gastrointestinal tract invaginates (or telescopes) with its mesenter- ic fold into the adjacent segment (intussus- cipiens). This telescoping results from altered peristalsis, which pulls the intussusceptum into the intussuscipiens. A variety of factors can act as a lead point and result in intussus- ception, including tumors, ingested foreign bodies, enteric tubes or suture material, and Meckel’s diverticulum.”
MDCT and 3D Imaging in Transient Enteroenteric Intussusception: Clinical Observations and Review of the Literature Horton KM, Fishman EK AJR 2008; 191:736–742 - “Intussusception can occur anywhere along the gastrointestinal tract. Gastric intussusception is very rare. Enteroenteric intussusceptions are much more common than gastric intussusception and result when one loop of small bowel invaginates into the adjacent small bowel. They can be categorized as du- odenojejunal, jejunojejunal, or jejunoileal. Large-bowel intussusception can be classified as ileocolic or colocolic and has a high report- ed association with underlying tumors.”
MDCT and 3D Imaging in Transient Enteroenteric Intussusception: Clinical Observations and Review of the Literature Horton KM, Fishman EK AJR 2008; 191:736–742 - “Ileocecal intussusceptions, which are typically classified as a colonic intussusception, are reported to be the most common of all the gastrointestinal intussusceptions, although enteroenteric intussusceptions can account for up to 40% of cases.”
MDCT and 3D Imaging in Transient Enteroenteric Intussusception: Clinical Observations and Review of the Literature Horton KM, Fishman EK AJR 2008; 191:736–742 - “Malignant lesions include carcinoid, metastases, leiomyosarcoma, and adenocarcinoma. Benign tumors that have been re- ported to result in intussusception include lipoma, neurofibroma, hemangioma, and inflammatory polyps. Meckel’s diverticulum is also a well-documented cause of small-bowel intussusception, often ileocecal.”
MDCT and 3D Imaging in Transient Enteroenteric Intussusception: Clinical Observations and Review of the Literature Horton KM, Fishman EK AJR 2008; 191:736–742 - “In asymptomatic patients, the CT identification of a proximal (jejunal), short (< 3.5 cm) intussusception with a char- acteristic target sign and without obstruction may indicate a self-limiting process that can be managed conservatively.”
MDCT and 3D Imaging in Transient Enteroenteric Intussusception: Clinical Observations and Review of the Literature Horton KM, Fishman EK AJR 2008; 191:736–742
- “ Unlike in children, intussusception is rare in adults and has a demonstrable cause in 90% of cases. Intussusception occurs when a segment (intussusceptum) of gastrointestinal tract invaginates with its mesenteric fold into an adjacent segment (intussuscipiens).”
Intussusception in adults: what radiologists should know
Baleato-Gonzalez S et al
Emerg Radiol (2012) 19:89-101 - “ Neoplasms account for about 70% of intussusceptions in adults. Adult intussusception of the small intestine is usually caused by benign neoplasms, whereas intussusceptions of the large intestine is usually caused by malignant neoplasms.”
Intussusception in adults: what radiologists should know
Baleato-Gonzalez S et al
Emerg Radiol (2012) 19:89-101 - Intussusception: Etiologies
- Benign causes
- Congenital
- Meckel’s diverticulum
- Cystic fibrosis
- Tumors
- Peutz-Jeghers syndrome
- Inflammatory polyp
- lipoma - Intussusception: Etiologies
- Malignant causes
- Tumors
- Adenocarcinoma
- Lymphoma
- metastases
- Functional Causes
- Celiac disease
- Crohn’s disease - Peutz-Jeghers Syndrome: Facts
- Autosomal dominant disease caused by mutation in the serine threonine kinase gene STK 11/LKB 1 located on short arm of chromosome 19
- Characterized by mucocutaneous pigmentation and hamartomas of the GI tract
- Hamartomas occur anywhere in the GI tract but most common in small intestine(jejunum> ileum > duodenum) - Intussusception: Malignant Tumors
- Malignant tumors cause 30% of intussusceptions in the small bowel and over 50% of intussusceptions in the large bowel
- Adenocarcinoma is the most common pathology of small bowel intussusceptions
- Other malignant causes of intussusception includes lymphoma, sarcomas and metastases
- Metastases to small bowel occur in melanoma as well as lung cancer, breast cancer and renal cell carcinoma
- "Intussuception length is the main factor in distinguishing the majority of small bowel intussuceptions detected at CT that are self limiting from the minority that require surgery. An intussusception that is shorter than 3.5 cm is likely to be self limiting."
Distinguishing features of Self-limiting
Adult Small Bowel Intussusception Identified at CT
Lvoff N et al.
Radiology 2003; 227:68-72