Korean J Gastroenterol.  2015 May;65(5):291-296. 10.4166/kjg.2015.65.5.291.

Conservative Management of Adult Small Bowel Intussusception Detected at Abdominal Computed Tomography

• Kim JS
• Lim JH
• Jeong JH
• Kim WS

• KMID: 2373225
• DOI: http://doi.org/10.4166/kjg.2015.65.5.291

Abstract

BACKGROUND/AIMS
The incidence of adult small bowel intussusception detected at CT has increased with advanced imaging techniques and universal utilization of CT scan. We aimed to identify factors that could predict the necessity of surgical intervention in adult patients with small bowel intussusception detected at CT during the past decade.
METHODS
There were 39 cases of adult small-bowel intussusception detected at CT from January 2004 to June 2014. The data on clinical factors, radiological factors and outcomes were collected by retrospectively reviewing all available medical records. Patients were classified as surgical group and conservative group according to the outcome. Association between predictive factors and outcome was assessed by Fisher's exact test and logistic regression models.
RESULTS
Among a total of 39 patients, there were 32 patients (82%) in the conservative group and 7 patients (18%) in the surgical group. Spontaneous reduction was confirmed at short-term follow-up studies (abdominal ultrasonography [n=14], single contrast small bowel series [n=14], CT [n=4]) in the conservative group. No recurrence occurred during the median follow-up period of 14.1 months (range, 0-67.5 months). Patients in the surgical group had significantly higher white blood cell (WBC) counts (OR 1.001, p=0.048), more frequent obstruction (n=4 vs. n=4, p=0.022) or leading point (n=5 vs. n=0, p<0.001) and longer intussuception length (OR 1.929, p=0.032).
CONCLUSIONS
Factors associated with the necessity to resort to surgical intervention in adults with small bowel intussusceptions were higher WBC counts, presence of obstruction or leading point, and longer intussuception length. Conservative management can be considered with short-term follow-up for those without these predictive factors.

Keyword

Intussusception; Adult; Intestine, small; Computed tomography

MeSH Terms

Abdomen/diagnostic imaging
Adult
Aged
Aged, 80 and over
Diagnosis, Differential
Female
Follow-Up Studies
Humans
Intestine, Small/*diagnostic imaging
Intussusception/*diagnostic imaging/surgery/therapy
Leukocyte Count
Male
Middle Aged
Odds Ratio
Radiography, Abdominal
Retrospective Studies
Tomography, X-Ray Computed
Ultrasonography

Figure

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  Fig. 1. Adult small bowel intussusception detected at abdominal CT. (A) Small bowel intussusception with ‘target like appearance’ is detected at abdominal CT during surveillance of prostate cancer patient (arrow). (B) After 2 years, previously identified small bowel intussusception in jejunum has completely disappeared without complications.

Reference

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