Duodenoduodenal and duodenojejunal intussusceptions in adults: A systematic review with a focus on demographics, diagnosis, and etiology

Background and Objectives: Diagnosis and management of Duodenal Intussusception (DI) in adults present several clinical challenges. Available literature specific to the DI in adults is scant, mainly due to the rarity and emergency associated with DI. The objective of this study is to conduct a systematic review of the literature and elucidate key factors related to DI in adults. Methods and Materials: PubMed, Scopus, Web of Science, and Cochrane databases were searched. Data on demographics, etiology, symptoms, physical examination, and diagnosis was extracted and analyzed for pooled incidence of adult DI (ADI; adult duodenal intussusception) and its specific subclasses i.e. duodenoduodenal (ADDI) and duodenojejunal (ADJI) intussusceptions. Results: The database search yielded 234 results. A total of 51 studies, involving 54 patients with ADI, were included in the final analysis. The median (Interquartile, IQR) age of patients was 44.5 (26) years and 66.7% of patients were women. Among 54 ADI patients, 40.7% had ADDI and 59.3% had ADJI. The duration of symptoms varied widely with a median (IQR) of 60 (357) days. Abdominal pain and vomiting were the common reported symptoms. Physical examination and laboratory tests were inconclusive in several patients. CT scan was the most commonly used diagnostic modality. Only one case of ADI was idiopathic. Adenomas were the most frequent etiology, observed in about 50% of ADI patients. Peutz-Jeghers Syndrome was seen in 8 patients and all of them had ADJI. Out of the 12.5% cases that were malignant, only one had ADDI. Conclusion: This study is probably the first attempt to systematically review ADI and its subclasses with the intention to provide key information specific to patient characteristics, diagnosis, and etiology of ADI. The findings of this review will possibly augment research in the area of the management and epidemiology of ADI.