Adult Intussusception After Screening Colonoscopy: A Case Report

Adult intussusception, a rare condition where one segment of the intestine slides into another, was discovered as an incidental finding during a routine screening colonoscopy in a case reported by Cureus. This condition is significantly more common in children, but in adults, it often occurs due to an underlying “lead point” such as a tumor or polyp that pulls the intestinal wall forward.

According to the case report published in Cureus, the patient was asymptomatic and underwent the colonoscopy for standard screening purposes. The procedure revealed the intussusception without the patient experiencing the typical acute symptoms associated with the condition, such as severe abdominal pain, nausea, or bowel obstruction.

Medical literature indicates that while pediatric intussusception is often idiopathic, adult cases are typically secondary to a pathological lesion. The Cureus report highlights that the incidental nature of this discovery underscores the role of screening in identifying silent gastrointestinal abnormalities before they progress to emergency surgical crises.

Clinical Presentation and Diagnosis of Adult Intussusception

Intussusception occurs when a proximal segment of the bowel telescopes into a distal segment. In adults, this mechanism is usually triggered by a lead point. According to the Cureus report, the diagnosis was made visually during the colonoscopy, which allowed the medical team to identify the displacement of the intestinal wall.

Standard clinical presentations of adult intussusception usually involve a triad of symptoms: intermittent abdominal pain, a palpable abdominal mass, and “currant jelly” stools. However, the Cureus case demonstrates that these symptoms are not always present, particularly when the intussusception is partial or intermittent.

Imaging techniques typically used to diagnose the condition include Computed Tomography (CT) scans, which often show a characteristic “target sign” or “sausage-shaped” mass. In this specific instance, the direct visualization provided by the colonoscopy served as the primary diagnostic tool.

The Role of Lead Points in Adult Cases

The distinction between adult and pediatric intussusception lies largely in the cause. According to the Cureus report, the presence of a lead point is a critical factor in adult cases. These lead points can be benign or malignant.

Common lead points identified in medical research include:

• Malignant tumors: Adenocarcinomas are the most frequent lead points in the colon.
• Benign polyps: Lipomas or adenomas that create a protrusion in the intestinal lining.
• Meckel’s diverticulum: A congenital pouch in the lower part of the small intestine.
• Post-surgical adhesions: Scar tissue from previous abdominal surgeries.

The Cureus report emphasizes that identifying the lead point is essential for determining the surgical approach and the long-term prognosis for the patient.

Treatment and Surgical Implications

Treatment for adult intussusception differs from the non-surgical reduction techniques often used in children. According to the Cureus report and general surgical standards, adult cases typically require surgical intervention because of the high likelihood of an underlying malignancy acting as the lead point.

Surgical options generally involve a resection of the affected bowel segment. This approach allows surgeons to remove both the intussuscepted portion and the lead point lesion, ensuring that any potential cancer is excised with clear margins.

The report notes that the incidental discovery of the condition during a screening colonoscopy allows for a planned surgical intervention. This is a significant advantage over emergency surgeries performed during a complete bowel obstruction, which carry higher risks of complications and morbidity.

Significance of Routine Colorectal Screening

The Cureus case report serves as a clinical example of how routine screening can detect rare but potentially life-threatening conditions. While colonoscopies are primarily used to find and remove precancerous polyps, they can uncover structural anomalies like intussusception.

Because adult intussusception can remain asymptomatic until a total obstruction occurs, the report suggests that the ability to catch these cases incidentally can prevent the need for emergency care. This aligns with broader public health goals of early detection in colorectal health.