Intussusception in the adult

1. 1. Intussusception in the adult although a rare condition is more commonly found than heretofore supposed. Types of intussusception in series of 665 cases Gastroduodenal 36 Gastroduodenojejunal 1 Pyloropyloric 1 Gastropyloric 1 Jejunogastric 29 Duodenoduodenal 4 Duodenojejunal 3 Jejunojejunal 53 Jejuno-ileal 4 Ileojejunal 1 Appendico-appendiceal 8 Appendicocecal 20 Appendicocecocolic 4 Appendico-ileo-colic 3 IIeo-appendico-cecal 2 Ileo-appendico-colic 1 Ileocecocolic 1 IIeocecal 95 IIeo-ileal 205 Ileocolic 82 Colocolic 55 Cecocoli 25 Cecal 1 Small intestine 2 Sigmoidosigmoidal 11 Sigmoidorectal 14 Colorectal 5 Epiploicosigmoidal 1 2. 2. In analyzing a large series of cases it is convenient to revise the old classification of intussusception. 3. 3. The most common etiologic factors of intussusception in the adult are tumors, MeckeI's diverticulum, prior gastro-enterostomy and prolapse of gastric mucosa. Other causes as enumerated in Table 1 have been given. 4. 4. The age factor should be considered important in the forming of a diagnosis but bear in mind, as Table 1 shows, any age may be affected. Patients between the ages of fifteen and twenty-five show a predominance. 5. 5. Males are more often affected than are females. 6. 6. Benign tumors were the etiologic factor in 213 cases while malignant tumors occurred in 123 instances. (Tables II and III.) 7. 7. The so-called primary cases show a large number in this series although it is believed that had meticulous care been taken in the discovering of some etiologic factor, many would have been included in the secondary listing. However, many cases following careful examination are primary. 8. 8. The great percentage of primary intussusceptions in the adult are of the ileo-ileal, ileocecal and ileocolic type. (Table IV.) 9. 9. The symptomatology in cases of intussusception in the adult is so undefinable that a definite diagnosis can be made only rarely. 10. 10. In analyzing this series of cases (665) nausea, vomiting, irregular attacks of colicky pain, recurrence of attacks and constipation are present with few exceptions. Abdominal masses were found in about one-half of the cases while abdominal tenderness, rigidity and melena were most infrequent. As complete obstruction develops, the patients present the usual signs and symptoms of obstruction including distention, patterns and an absence of abdominal clicks replacing the lively clicks heard before complete obstruction developed.