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Intussusception in adults

Intussusception in adults. Moamen Salameh. 1. Intussusception. Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. 2. 3.

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Intussusception in adults

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  1. Intussusception in adults • Moamen Salameh 1

  2. Intussusception • Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment 2

  3. 3

  4. A rare condition in adults, accounting 5% of all cases of intussusception and 1-5% of bowel obstructions • Symptoms are often chronic, with intermittent abdominal pain as the main symptom • Types: enteroenteric, enterocolic, colocolic • Arises in the small bowl in two-thirds of cases 4

  5. Pathophysiology • Idiopathic 10 - 20% • Secondary 90% 5

  6. Secondary intuss. • Initiates from any pathologic lesion of the bowel wall or irritant within the lumen 6

  7. Aetiology - Small bowl • Benign lesions - neoplasm (lipoma, leiomyoma, haemangioma, neurofibroma) • Adhesions • IBD • Meckel’s diverticulum • Coeliac disease • Henich-schonlein purpura • Iatrogenic • Malignant - most often metastatic 15% • Idiopathic 20% 7

  8. Aetiology - Large bowl • malignant 65% • Benign: neoplasm (lipoma, leiomyoma, adenomatous polyps) • IBD • Endometriosis • Idiopathic 10% 8

  9. Clinical presentation • The classic paediatric presentation of acute intussusception is rare in adults • The majority of cases in adults are presented as chronic non-specific symptoms • Physical examination may demonstrate diffuse or localised abdominal tenderness, but is often unremarkable 9

  10. Symptoms • Nausea • Vomiting • Gastrointestinal bleeding • Changes in bowl habits • Constipation • Diarrhoea • Abdominal distention 10

  11. Diagnosis • AXR • US • CT • Endoscopy 11

  12. US • Target sign 12

  13. CT • Sausage-shaped mass 13

  14. CT • Target sign 14

  15. Treatment • Air enema • surgical intervention 15

  16. Q?

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