INTUSSUSCEPTION

Intussusception treatment is available by laparoscopy.It is one of the causes of intestinal obstruction in all age groups

Abdominal pain is one of the most common reasons patients are seen in emergency departments around the world. Causes range from heart diseases to abdominal issues one of which is intestinal obstruction . Intestinal intussusception in adults accounts for 1% to 5% of the cases of intestinal obstruction. In adults it is most often associated with neoplasms, post-surgical scars and Meckel’s diverticulum, but in about 20% of these cases the cause is unknown.

Intestinal intussusception is an uncommon condition in adults which causes 1% to 5% of intestinal obstructions. Although it is frequently associated with neoplastic pathologies or structural abnormalities of the gastrointestinal tract, up to 10% of cases are idiopathic. In most cases the diagnosis is made after surgery, but with the development of imaging techniques, a diagnosis is possible prior to intervention.

Management of intestinal intussusception depends on the patient’s age group. Reduction of intestinal intussusception in children is most often accomplished with nonsurgical pneumatic or hydrostatic enemas using, but for adults the treatment of choice is surgical resection by laparotomy or laparoscopy. This is because of the frequent discovery of triggering structural anomalies and the high incidence of malignancies .

Nevertheless, surgical options for primary reduction and resection of the intestinal segment remain controversial. Many authors recommend primary resection when it is possible but suggest that you should not carry out reduction when there are signs of intestinal ischemia or inflammation . The theoretical risks of manipulating the intussuscepted segment include seeding and tumor spread, and perforation and bacteremia. For these reasons resection requires appropriate oncologic edges especially in cases in which the underlying etiology of the segment is known and there is high probability of  malignancy .

When intussusception occurs in the small intestine, 57% of the tumors are benign and 30% are malignant. The most frequent malignancy is metastasis of melanoma, so primary reduction of the  compromised segment can be attempted in these cases. Nevertheless,  when the location is in the large intestine the most common cause is malignant neoplasia, adenocarcinomas are most common, followed by leiomyosarcomas and reticulum cell sarcomas. In these cases, surgical resection of the segment for the pathological study is recommended . Laparoscopic management of this condition is limited by several factors including the surgeon’s experience, the clinical condition of the patient and the degree and type of compromise of the intussuscepted intestinal segment.

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