OBSTRUCTION & ISCHEMIA • SENIOR RESIDENT / SURGEON

Adult Intussusception

In an adult with obstruction and a CT target sign, the key question is the pathologic lead point and whether bowel is threatened.

PROTOTYPE REVIEW REQUIRED

The Call

64-year-old man with intermittent abdominal pain

Three days of episodic abdominal pain that becomes constant, with distention, nausea and bilious emesis. CT shows small-bowel dilation and a target sign at the transition point.

T 37.8 C • HR 108 • BP 118/70

Adult intussusception is different from pediatric disease: look for a structural lead point.

Read the Image • Clinical DataACS VISUAL

Target sign associated with intussusception from the ACS image archive.

Make the Decision • Commit to a Plan

Adult Intussusception

64-year-old man with intermittent abdominal pain

An adult has intermittent obstruction and CT shows ileocolic intussusception with a discrete lead-point mass. Best next strategy?

The involved colon is viable but a firm cecal mass is palpable. Best principle?

Final pathology reveals malignancy with high-risk features not anticipated intraoperatively. Best next step?

Find the lead point and assess bowel viability.

The pathology result often determines the next chapter.

Surgical Pearls

Pitfalls

At exploration, a small-bowel intussusception contains a firm intraluminal mass and the segment is ischemic. What is the priority?