Clinical Presentations, MDCT Features, and Treatment of Three Types of Adult Intussusceptions Based on the Location.

ABSTRACT

PURPOSE: This study aimed to explore the similarities and differences in clinical presentations, multidetector computed tomographic (MDCT) features, and treatment of three types of adult intussusceptions based on location. METHODS: We retrospectively reviewed 184 adult patients with 192 intussusceptions. Depending on the location, intussusceptions were classified as enteric, ileocolic, and colonic types. The similarities and differences of clinical presentations, MDCT features, and treatment of three types of adult intussusception were compared. Meanwhile, the three types of intussusceptions were further divided into surgical and conservative groups based on the treatment. Uni- and multivariate logistic analyses were used to identify risk factors for intussusception requiring surgery. RESULTS: Enteric and ileocolic intussusceptions were mainly presented with abdominal pain (78.46% and 85.71%). Hematochezia/melena (64.29%) was the main symptom of colonic intussusception. On MDCT, ileocolic intussusceptions were longer in length and had more signs of intestinal necrosis (hypodense layer, fluid collection and no/poor bowel wall enhancement) than enteric and colonic intussusceptions. Moreover, it was found that 93.88% (46/49) of ileocolic intussusception and 98.59% (70/71) of colonic intussusception belonged to the surgical group, whereas only 43.06% (31/72) of enteric intussusception belonged to the surgical group. Intussusception length (OR=1.171, P=0.028) and discernible lead point on MDCT (OR=21.003, P<0.001) were reliable indicators of enteric intussusception requiring surgery. CONCLUSION: Ileocolic intussusception may be more prone to intestinal necrosis than enteric and colonic intussusceptions, requiring more attention from clinicians. Surgery remains the treatment of choice for most ileocolic and colonic intussusceptions. Less than half of enteric intussusceptions require surgery, and MDCT features are effective in identifying them.