Adult intussusception: a systematic review and meta-analysis

被引:99
作者
Hong, K. D. [1 ]
Kim, J. [1 ]
Ji, W. [1 ]
Wexner, S. D. [2 ]
机构
[1] Korea Univ, Dept Colorectal Surg, Ansan Hosp, Suwon, Gyeonggi Do, South Korea
[2] Cleveland Clin Florida, Dept Colorectal Surg, 2950 Cleveland Clin Blvd, Weston, FL 33331 USA
关键词
Adult intussusception; Enteric type; Colonic type; Ileocolic type; PREDICTIVE FACTORS; DIAGNOSIS; EXPERIENCE; MANAGEMENT; SURGERY;
D O I
10.1007/s10151-019-01980-5
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BackgroundPerhaps partly because intussusception in adults is rare, optimal treatment remains controversial. The aim of this study was to determine the appropriate surgical procedure for adult intussusception.MethodsA systematic search was undertaken using PubMed, Embase, and Web of Science from 1/1980 to 12/2016. Adults (>15years) with intussusception treated by surgical or conservative measures were included.ResultsOne thousand two hundred twenty-nine patients were identified from 40 retrospective case series. Pooled rates of malignant and benign tumors and idiopathic etiologies were 32.9% (95% CI 28.6-37.4), 37.4% (95% CI 32.7-42.3), and 15.1% (95% CI 11.7-19.3), respectively. Pooled rates of enteric, ileocolic, and colonic location types were 49.5% (95% CI 41.8-57.2), 29.1% (95% CI 23.0-36.1), and 19.9% (95% CI 16.3-24.1), respectively. Pooled rates of malignant tumors in enteric, ileocolic, and colonic intussusception were 22.5% (95% CI 18.3-27.3), 36.9% (95% CI 27.3-47.6), and 46.5% (31.1-62.6), respectively. Metastatic carcinoma was the main cause of malignant tumor in enteric intussusception. Conversely, primary adenocarcinoma was the main cause of malignant tumor in ileocolic and colonic intussusception. Considering the high rate of malignancy of colonic intussusception the majority of the studies surveyed recommend en bloc resection without reduction to avoid potential intraluminal seeding or venous tumor dissemination. Pooled rates of postoperative complications and mortality were 22.1% (95% CI 17.5-27.5) and 5.2% (95% CI 3.7-7.4), respectively.ConclusionWhereas enteric intussusception can be managed by reduction followed by resection, colonic intussusception should be resected en bloc. Due to the intermediate forms between enteric and colonic intussusception, a selective approach is recommended. Surgery remains the mainstay in adult intussusception.
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页码:315 / 324
页数:10
相关论文
共 49 条
[1]   INTUSSUSCEPTION IN ADULTS [J].
AGHA, FP .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1986, 146 (03) :527-531
[2]  
[Anonymous], J SURG ASS REPUB CHI
[3]  
[Anonymous], 2018, NEWCASTLE OTTAWA SCA
[4]   Adult intussusception [J].
Azar, T ;
Berger, DL .
ANNALS OF SURGERY, 1997, 226 (02) :134-138
[5]  
Balik AA, 2006, ACTA CHIR BELG, V106, P409
[6]   Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study [J].
Barussaud, M. ;
Regenet, N. ;
Briennon, X. ;
de Kerviler, B. ;
Pessaux, P. ;
Kohneh-Sharhi, N. ;
Lehur, P. A. ;
Hamy, A. ;
Leborgne, J. ;
le Neel, J. C. ;
Mirallie, E. .
INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 2006, 21 (08) :834-839
[7]   The diagnosis and management of adult intussusception [J].
Begos, DG ;
Sandor, A ;
Modlin, IM .
AMERICAN JOURNAL OF SURGERY, 1997, 173 (02) :88-94
[8]  
Cakir Murat, 2013, Korean J Gastroenterol, V61, P17
[9]   Adult intussusception in Asians: Clinical presentations, diagnosis, and treatment [J].
Chang, Chun-Chao ;
Chen, Yang-Yuan ;
Chen, Yung-Fa ;
Lin, Chun-Nan ;
Yen, Hsu-Heng ;
Lou, Horng-Yuan .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2007, 22 (11) :1767-1771
[10]   Intussusception in traditional pediatric, nontraditional pediatric, and adult patients [J].
Cochran, Alexis A. ;
Higgins, George L., III ;
Strout, Tania D. .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2011, 29 (05) :523-527