Malignancy predictors and treatment strategies for adult intestinal intussusception

Abstract

Purpose

Intussusception in adult patients is a rare medical finding, which is accompanied by an underlying tumor in some cases. However, no accepted method has been established to identify patients at risk for tumor-related intussusception. This study aimed to identify imaging features as predictors for tumor-related intussusception.

Methods

CT images of patients with confirmed intussusception were retrospectively acquired between 01/2008 and 12/2022. Available follow-up images and medical health records were evaluated to identify various imaging features, the cause of intussusception, and treatment strategies. Imaging interpretation was conducted by two blinded radiologists. A third radiologist was consulted in cases of disagreement.

Results

A total of 71 consecutive patients were included in this study (42 males, 29 females) with a median age of 56 years (interquartile range: 40.5–73.8 years). Enteroenteric intussusceptions in the small bowel were the most common type observed in adult patients. In contrast, colocolic intussusception was more frequently associated with malignancy, and this association was statistically significant (p < 0.05). Among the malignant tumors, adenocarcinoma was the most common, followed by metastases and lymphoma. Additionally, bowel obstruction and wall thickening were significantly correlated with malignancy (p < 0.05). The high negative predictive values (NPVs) and high specificities for ileus (NPV 88.5%, specificity 82.1%), bowel wall thickening (NPV 90.9%, specificity 71.4%), and acute abdomen (NPV 84.6%, specificity 78.8%) suggest that the absence of these features strongly predicts a low probability of malignancy in cases of adult intussusception.

Conclusion

Active surveillance with follow-up exams is suitable for asymptomatic and transient intussusception when imaging features suggest a low likelihood of a neoplasm. Additionally, malignancy predictors such as ileus and thickening of the bowel wall in the affected segment could guide tailored treatment. Surgical interventions are essential for symptomatic cases, with adenocarcinoma being the most common malignancy found in colocolic intussusceptions.

Key Points

Intussusception in adults is rare and is often associated with underlying tumors, particularly in colocolic intussusceptions. Key imaging predictors for malignancy include bowel obstruction, wall thickening in the affected segment, and the presence of acute abdomen, with high NPVs and specificities indicating low malignancy risk when these features are absent. Active surveillance is recommended for asymptomatic cases with low neoplasm probability, while surgical intervention is the method of choice for symptomatic patients.

Citation Format

• Reschke P, Le Hong QA, Gruenewald LD et al. Malignancy predictors and treatment strategies for adult intestinal intussusception. Rofo 2025; 197: 953–961

 

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Zusammenfassung

Ziel

Eine Invagination bei Erwachsenen kommt selten vor und ist in manchen Fällen mit zugrunde liegenden malignen Tumoren verbunden. Derzeit gibt es keine Standardmethode zur Identifizierung von Patienten, bei denen das Risiko einer tumorbedingten Invagination besteht. Ziel dieser Studie war es, bildgebende Merkmale zu identifizieren, die eine tumorbedingte Invagination bei erwachsenen Patienten vorhersagen.

Materialien und Methoden

CT-Bilder von Patienten mit bestätigter Invagination wurden retrospektiv zwischen 01/2008 und 12/2022 in die Studie aufgenommen. Verfügbare Folgebilder und medizinische Gesundheitsakten wurden ausgewertet, um verschiedene Bildgebungsmerkmale, die Ursache der Invagination und Behandlungsstrategien zu identifizieren.

Ergebnisse

Insgesamt wurden 71 Patienten in diese Studie einbezogen (42 Männer und 29 Frauen, Durchschnittsalter 56 Jahre). Invaginationen, die auf den Dünndarm beschränkt waren, kamen am häufigsten bei erwachsenen Patienten vor. Invaginationen im Dickdarm waren signifikant mit Malignität assoziiert (p<0,05). Das Adenokarzinom war der häufigste bösartige Tumor, gefolgt von Metastasen. Ileus und Darmwandverdickung waren signifikant mit einer höheren Wahrscheinlichkeit einer Malignität verbunden (p<0,05). Die hohen negativen Vorhersagewerte (NPVs) und die hohen Spezifitäten für Ileus (NPV 88,5%, Spezifität 82,1%), Wandverdickung des Darms (NPV 90,9%, Spezifität 71,4%) und akutes Abdomen (NPV 84,6%, Spezifität 78,8%) deuten darauf hin, dass das Fehlen dieser Merkmale auf eine niedrige Wahrscheinlichkeit für eine Malignität bei Erwachsenen mit Invaginationen hinweist.

Schlussfolgerung

Eine aktive Überwachung mit Folgeuntersuchungen ist bei asymptomatischer und vorübergehender Invagination geeignet, wenn bildgebende Merkmale auf eine geringe Wahrscheinlichkeit für eine Neoplasie hindeuten. Zudem könnten Malignitätsprädiktoren wie Ileus und die Verdickung der Darmwand im betroffenen Segment eine gezielte Behandlung unterstützen. Chirurgische Eingriffe sind für symptomatische Fälle unerlässlich, wobei das Adenokarzinom die häufigste maligne Tumorentität bei Invaginationen im Dickdarm darstellt.

Kernaussagen

Invaginationen bei Erwachsenen sind selten und häufig mit zugrunde liegenden Tumoren assoziiert, insbesondere bei Invaginationen im Dickdarm. Wichtige bildgebende Prädiktoren für Malignität umfassen Ileus, Wandverdickung des betroffenen Segments und das Vorhandensein eines akuten Abdomens, wobei hohe negative prädiktive Werte (NPV) und Spezifitäten auf ein geringes Malignitätsrisiko hinweisen, wenn diese Merkmale fehlen. Eine aktive Überwachung wird für asymptomatische Fälle mit geringer Neoplasie-Wahrscheinlichkeit empfohlen, während chirurgische Intervention die Methode der Wahl für symptomatische Patienten ist.

 

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Keywords

abdomen - intussusception

Introduction

Intestinal intussusception is defined as telescoping of the proximal segment of the bowel (intussusceptum) into the lumen of the distal segment (intussuscipiens). The increasing use of multidetector computed tomography (MDCT) for diagnosing abdominal emergencies has led to a rise in the detection of intestinal intussusception [1] [2]. In CT imaging, the characteristic “bowel-within-bowel configuration” appearance varies depending on the imaging plane. The CT images of an intussusception resemble a “target sign” when the CT beam is positioned perpendicular to the longitudinal axis. When the CT beam is aligned parallel to the longitudinal axis, the “pseudokidney sign” or “sausage sign” is typical [1] [3]. These signs are formed by alternating bowel wall and mesenteric fat [4]. Abdominal CT has been recognized as the most effective diagnostic tool for identifying intestinal intussusception surpassing the diagnostic capabilities of ultrasonography and endoscopy [4] [5]. Intussusception is the most common cause for intestinal obstruction in young children [6]. The majority of previous studies have focused on pediatric patients, thus leaving a gap in knowledge about the management and outcomes of intestinal intussusception in adults. Unlike in their pediatric counterparts, intussusception in adult patients is rare, accounting for only 1% of intestinal obstructions in adults [7] [8]. Patients are usually diagnosed via abdominal multiplanar CT, which is considered the gold standard for distinguishing between intussusception with and without a lead point mass [1]. A meta-analysis conducted by Hong et al. in 2019 showed that adult intussusception typically follows a chronic course. The majority of patients present with non-specific symptoms such as abdominal pain, vomiting, and nausea [9]. Major complications of intussusception include obstruction, ischemia, volvulus, and perforation [10].

Intussusception in adults is a serious medical finding which is accompanied by an underlying tumor in some cases [11]. We shifted our focus to image findings rather than symptoms. The purpose of the study was to identify imaging features as predictors for tumor-related intussusception.

 

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Materials and methods

The institutional review board approved this retrospective study and waived the requirement to obtain written informed consent.

Patient Selection and Study Design

Between 01/2008 and 12/2022 CT images of 93 adult patients with intussusception were retrospectively acquired at XXX through the internal PACS system. The inclusion criteria consisted of patients aged 18 years or older with confirmed intussusception, either identified on initial CT images or during surgery. The exclusion criteria included the unavailability of follow-up CT examinations and the unavailability of health records ([Fig. 1]). Available follow-up imaging and medical records were evaluated up to January 2024 to determine the resolution of intussusception and the outcomes. We classified therapeutic modalities as conservative treatment and surgical intervention. For surgical interventions, we distinguished between manual reduction and bowel resection.

Fig. 1 Flowchart of patient inclusion and exclusion criteria and standards of reporting.

 

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Intussusception location

As previously reported, intussusceptions can be divided into three categories based on their location: [1] enteroenteric, confined to the small bowel; [2] colocolic, restricted to the colon; and [3] iliocolic, which involves the prolapse of the terminal ileum into the colon [12] [13].

 

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Imaging features and interpretation

Various imaging features, such as volvulus, ischemia, ascites, perforation, enlarged locoregional lymph nodes, wall thickening, a mass, adjacent fat tissue stranding, and enhancement patterns, were evaluated. According to two blinded radiologists, all CT images confirmed the diagnosis of intussusception and the imaging features mentioned above. The radiologists were blinded to the initial clinical symptoms and pathological results. In cases where no consensus was reached, a third radiologist was consulted to reach a majority decision. The width of the “target sign” and the length of the “sausage sign” were measured for each intussusception. A volvulus was confirmed by the “whirl sign”, which describes torsion of the mesentery around the bowel [14]. In CT images, different signs of ischemia such as mesenteric edema, diminished or absent mural enhancement, pneumatosis intestinalis, and mesenteric venous gas were evaluated [15]. Diminished mural enhancement was defined as a decrease of more than 30% in bowel wall enhancement in the ischemic bowel segment compared to the adjacent nonischemic bowel. Other potential causes of ischemia, such as vascular occlusions, thrombosis, or emboli, were excluded. Locoregional lymph nodes with a short-axis diameter exceeding 1 cm were considered enlarged [16]. Abnormal fluid within the abdominal cavity was documented. Physiological ascites in the Douglas space in young females was not taken into account [17]. When free intraperitoneal air was found, health records were evaluated to avoid pitfalls like postoperative pneumoperitoneum. The thickness of the bowel wall adjacent to the intussusception was assessed. In alignment with the findings of previous studies, we defined >3 mm as a cut-off value for small bowel thickening and >5 mm for large bowel thickening [18] [19]. The nearby bowel segment was examined for the presence of an intraluminal lead point mass as a potential cause of intussusception. We assessed fat tissue stranding adjacent to the location of the intussusception. Additional imaging findings related to the adjacent bowel segment such as enhancement patterns, including the water halo sign and fat halo sign, were documented on CT images [20].

 

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Statistics

The statistical analysis was performed with Python 3.11. The data are presented as median with 25% and 75% quantiles for age, intussusception diameter, and length, respectively. The Kolmogorov-Smirnov test was used to test for normal distributions. The chi-squared test was conducted to evaluate the association between the location enteric/colocolic intussusception and malignant tumors. We conducted an odds ratio analysis to investigate the association between different imaging features (volvulus, ischemia, ascites, perforation, enlarged lymph nodes, wall thickening, a mass, adjacent fat tissue stranding, fat-halo and water-halo enhancement patterns, such as the fat-halo) and the presence of malignancy.

 

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Results

Patient characteristics

After excluding 23 patients, the final study population consisted of 71 patients (median age 56 years, IQR 40.5–73.8). 13 patients were excluded due to unavailable follow-up CT examinations and 10 patients due to unavailable health records. The sex ratio was 1.4 (42 males and 29 females) ([Fig. 1]). We assessed CT images of 71 patients: 48 patients had enteroenteric, 18 had colocolic, and 5 had iliocolic intussusception ([Table 1]).

Table 1 Patient characteristics

Patients	Total (n=71)	Colocolic (n=18)	Enteric (n=48)	Ileocoecal (n=5)
Abbreviations: enteric intussusceptions, confined to the small bowel.
Age [years] | median (±25%-Q.)	56.0 (40.5–73.8)	50.5 (42.5–73.8)	51.6 (39.5–64.2)	75.0 (62.0–76)
Male/female	42/29	10/8	29/19	3/2
Intussusception
Width [cm] | median (±25%-Q.)	3.0 (2.3–3.8)	4.5 (3.7–5.2)	3.0 (2.1–3.5)	2.6 (2.0–3.3)
Length [cm] | median (±25%-Q.)	3.5 (2.0–5.0)	4.9 (3.0–7.9)	3.5 (2.0–5.0)	2.0 (2.0–3.0)
Indication
Abdominal pain	45 (63.4%)	12 (66.7%)	30 (62.5%)	3 (60.00%)
Infection, focus search	12 (16.9%)	0	10 (20.8%)	2 (40.00%)
Tumor staging	11 (15.5%)	5 (27.8%)	6 (12.50%)	0
Trauma	2 ( 2.8%)	0	2 ( 4.16%)	0
Pre-surgery planning	1 ( 1.4%)	1 ( 5.55%)	0	0
Therapy
Conservative treatment	43 (60.56%)	11 (61.11%)	29 (60.42%)	3 (60 %)
Surgery: Undetected	7 ( 9.86%)	0	6 (12.50%)	1 (20%)
Surgery: Reduction	3 ( 4.23%)	0	3 ( 6.25%)	0
Surgery: Resection	18 (25.35%)	7 (38.90%)	10 (20.83%)	1 (20%)

 

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Intussusception diameter

Colocolic intussusceptions were the largest (median width 4.5 cm, IQR 3.7–5.2 cm, median length 4.9 cm, IQR 3.0–7.9 cm) compared to enteroenteric intussusceptions (width median 3 cm, IQR 2.1–3.5 cm, length median 3.5 cm, IQR 2.0–5.0 cm) and iliocolic intussusceptions (width 2.6 cm IQR 2.0–3.3 cm, median length 2.0, IQR 2.0–3.0) ([Table 1], [Fig. 2]).

Fig. 2 Intussusception diameter. Notes: enteric intussusceptions: intussusceptions confined to the small bowel.

 

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Indications

Abdominal pain was the most common indication for CT (n=45 patients) and was present at all intussusception locations. On the other hand, for incidental intussusception the most commonly reported indication was the search for infection sites (n=12), followed by tumor staging (n=11). The search for infection sites was the second most common indication for enteroenteric intussusceptions while it was not an indication for colocolic intussusceptions. Tumor staging was a more common indication for colocolic intussusceptions than for enteroenteric intussusceptions in the small bowel (27.8% vs. 12.5%) ([Table 1]).

 

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Imaging features

In this study, the “target sign” was identified as a key imaging feature for diagnosing intussusception and was observed in approximately 90% of cases. Of these, around 55% showed the “target sign” exclusively in the axial plane. In about 25% of the cases, the “target sign” was seen exclusively in the coronal plane, which provided additional diagnostic clarity when the axial view alone was not definitive. Additionally, the “target sign” was observed in both the axial and the coronal planes in 10% of patients, offering a multi-angled perspective that further enhanced diagnostic confidence. These multi-planar imaging findings underscore the importance of using both axial and coronal planes for accurately identifying and characterizing intussusception. It is important to note that in about 10% of the cases, typical imaging signs of intussusception were not observed on the CT scan. In these cases, intussusception was confirmed during same-day surgery.

 

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Treatment pathways

Patients with asymptomatic incidental intussusception were treated conservatively without complications (n=26). During the follow-up clinical stay, the patients’ condition improved quickly and they were subsequently discharged without complications. Subsequent follow-up scans revealed resolution of the intussusceptions.

28 of the symptomatic intussusception patients (total n=45) underwent surgery. Open laparotomy was the primary surgical approach, whereas laparoscopic surgery was successfully performed in 9 patients. 17 patients were treated conservatively. Over the clinical course, there was improvement in the patients’ abdominal pain and vital signs. Resolution of the intussusception was documented on repeat CT. 18 of 28 patients underwent bowel segment resection with anastomosis and biopsy. Six enteroenteric intussusceptions and one ileocecal intussusception resolved spontaneously and were not detectable during surgical intervention. A case report (illustrated in [Fig. 3]) describes a jejunal intussusception that also resolved spontaneously and was not found during surgery. All seven colocolonic intussusceptions were detected during surgical intervention and bowel segment resection was performed. In three cases, manual laparoscopy-assisted intraoperative reduction of the intussusception was performed without taking a biopsy.

Fig. 3 Case report of a patient with self-limiting intussusception. A patient with acute, severe, crampy abdominal pain in the upper left quadrant presented to the emergency department. The pain had developed suddenly without any preceding symptoms. On examination, there was no palpable mass, signs of peritonitis, or other notable findings. The CT scan revealed an 6cm long intussusception in the jejunum. Due to the severity of the patient’s symptoms and radiological findings, a decision was made to proceed with diagnostic laparoscopy on the same day. Surprisingly, no intussusception could be found during the intervention. The patient was discharged four days after admission with complete resolution of his symptoms. He was advised to have close follow-up but he remained asymptomatic during subsequent visits. Imaging features: In both the axial (right) and coronal (left) planes, the “target sign” is clearly visible, marked by red flashes, indicating jejunal intussusception. This sign results from the telescoping of the intussusceptum into the intussuscipiens, forming characteristic concentric rings. The intussusceptum creates the central ring, while the intussuscipiens forms the outer ring, known as “bowel-within-bowel” appearance. In these planes, the imaging beam is perpendicular to the longitudinal axis of the intussusception, allowing the “target sign” to be clearly observed.

 

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Histopathology results

Biopsies were taken in all surgical interventions with manual reduction (n=3) or resection (n=18). Adenocarcinoma was the most common malignant tumor for colocolonic intussusceptions (n=7). (case report, [Fig. 4], [Fig. 5]). Enteroenteric intussusceptions had a great diversity of underlying tumors, including a triton tumor, a neuroendocrine tumor, NHL (n=2), and melanoma metastases (n=3). Lipomas appeared in all regions but were most common in the colocolonic region. We illustrated a rare case of a triton tumor (n=1) in a case report (case report, [Fig. 6]). Further findings were vascular malformation (n=1) and ischemia (n=1) related to enteroenteric intussusceptions. ([Fig. 7])

Fig. 4 A patient with a four-day history of intermittent abdominal pain, constipation, and rectal bleeding presented at the emergency department. Abdominal palpation revealed tenderness in the upper right quadrant without signs of peritonitis, and digital rectal examination indicated fresh blood. CT imaging identified a significant colocolonic intussusception in the upper right quadrant, measuring approximately 15 cm in length and marked by red flashes. The intussusception showed bowel wall thickening extending to the right hepatic flexure. In the axial plane, the classic “target sign” was visible, while the coronal plane displayed a “sausage” appearance, with the mesentery surrounding the compressed inner bowel. The affected segment of the colon was surgically resected on the same day. Histological examination of the resected tissue confirmed the presence of adenocarcinoma.

Fig. 5 A 62-year-old man presented at the emergency department with severe, cramping abdominal pain that had worsened over the past week. Alongside constipation and nausea, the appearance of fresh blood in his stool raised immediate concern. On examination, his abdomen was distended and tender, especially in the lower left quadrant. A CT scan revealed a rectosigmoidal intussusception, where part of the intestine telescoped into itself, causing a significant obstruction. The telescoped bowel was thickened, creating the classic “target sign” in the axial view and a “sausage” appearance in the coronal plane, with the mesentery entering into the inner ring. This intussusception caused upstream dilation of the small and large bowel, indicative of ileus. Given the severity, urgent surgical resection was performed. The operation exposed the congested and thickened segment of the bowel, which was carefully removed. Histological analysis confirmed a colorectal carcinoma, acting as the lead point for the intussusception.

Fig. 6 A patient with a known malignant peripheral nerve sheath tumor (MPNST) presented at the emergency department with postprandial upper abdominal pain for two weeks. The intussusception is indicated by ⇉ near the ligament of Treitz. No characteristic imaging signs of intussusception were observed on the CT scan. Adjacent to this intussusception, a hypodense, round formation (marked with ⇶) measuring 5 cm in diameter was visible within the jejunum lumen. Additionally, another MPNST manifestation was detected, appearing as a hypodense formation around the celiac trunk (marked with →). On CT imaging, distinguishing an MPNST from its benign counterparts such as schwannomas and neurofibromas is challenging. Larger lesions, irregular borders, and perilesional edema are signs of malignancy. The intussusception was detected during surgery. The patient underwent surgical excision of an intraluminal tumor accompanied by manual intussusception reduction and jejunal closure. The decision to avoid resection with anastomosis was influenced by anatomical considerations. Histology confirmed the diagnosis of an R1-resected Triton tumor (a rare subtype of MPNST). The patient’s recovery was uncomplicated and he was discharged after a week.

Fig. 7 Histology of malignant tumors found in intussusception

 

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Factors predicting malignancy in adult intussusception

A chi-squared test revealed a statistically significant association between colocolic intussusception and malignancy (p<0.05). Bowel obstruction and wall thickening were significantly associated with higher odds of developing malignancies (p<0.05). No significant associations were found for benign findings such as volvulus, signs of ischemia, adjacent fat tissue stranding, or enhancement pattern ([Fig. 8]).

Fig. 8 Association between CT imaging features and tumor-related intussusception

 

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Diagnostic Performance of Imaging Features for Predicting Malignancy in Adult Intussusception

The positive likelihood ratio (LR+) for ileus was 3.4 (95% CI: 1.7 to 6.8), indicating a stronger association with malignancy compared to bowel wall thickening, which had an LR+ of 2.6 (95% CI: 1.5 to 4.3). For the negative likelihood ratio (LR-), bowel wall thickening had the lowest value at 0.4 (95% CI: 0.2 to 0.9), suggesting a better ability to rule out malignancy in its absence. Ileus had an LR- of 0.5 (95% CI: 0.3 to 0.9).

The positive predictive value (PPV) was higher for ileus at 47.4% (95% CI: 30.9% to 64.4%) compared to bowel wall thickening at 40.7% (95% CI: 29.1% to 53.5%). In terms of negative predictive value (NPV), bowel wall thickening had a slightly higher NPV at 90.9% (95% CI: 81.0% to 95.9%) than ileus at 88.5% (95% CI: 80.3% to 93.5%).

Ileus had a sensitivity of 60.0% (95% CI: 32.3% to 83.7%) and a specificity of 82.1% (95% CI: 69.6% to 91.1%). In comparison, bowel wall thickening showed a higher sensitivity of 73.3% (95% CI: 44.9% to 92.2%) but a slightly lower specificity of 71.4% (95% CI: 57.8% to 82.7%).

Overall, the accuracy of predicting malignancy was higher for ileus at 77.5% (95% CI: 66.0% to 86.5%), while bowel wall thickening had an accuracy of 71.8% (95% CI: 59.9% to 81.9%).

 

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Association of Acute Abdomen with Malignancy

Acute abdomen had a sensitivity of 46.7% (95% CI: 21.3% to 73.4%) and a specificity of 78.6% (95% CI: 65.6% to 88.4%) for predicting malignancy. The positive likelihood ratio (LR+) was 2.2 (95% CI: 1.0 to 4.6), and the negative likelihood ratio (LR-) was 0.7 (95% CI: 0.4 to 1.1). The positive predictive value (PPV) was 36.8% (95% CI: 21.8% to 54.9%), while the negative predictive value (NPV) was 84.6% (95% CI: 77.1% to 90.0%). Overall accuracy was 71.8% (95% CI: 59.9% to 81.9%).

 

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Discussion

Surgery has traditionally been the recommended treatment for adult intussusception due to the high incidence of malignancy associated with this condition [13]. The increased use of CT scans has led to more frequent incidental findings of transient asymptomatic intussusception without an underlying tumor [20]. This has sparked ongoing debate about the appropriateness of non-surgical management for such cases [22] [23].

To address this issue, our study focused on identifying imaging features that could serve as indicators of malignancy in intussusception cases. In this retrospective analysis, we found that the high negative predictive values of ileus (88.5%, CI: 80.3–93.5%) and bowel wall thickening (90.9%, CI: 81.0–95.9%), along with the absence of acute symptoms (NPV 84.6%, CI: 77.1–90.0%), suggest that the absence of these features can effectively indicate a low likelihood of malignancy in adult intussusception. Supportive care could be an appropriate treatment strategy for patients with asymptomatic intussusception when imaging characteristics indicate a low probability of a neoplasm. In our study population, patients with asymptomatic intussusception were treated conservatively with favorable outcomes in terms of patient recovery and resolution of intussusception on follow-up imaging.

Our study revealed a statistically significant association between the location of colocolonic intussusception and malignancy. We acknowledge that this correlation is influenced by the fact that tumors are more prevalent in the colon than in the small intestine. This correlation might be due to the relative rarity of small intestine cancer compared to colonic cancer. Malignant neoplasms of the small bowel are some of the rarest forms of cancer, comprising only 4% of all gastrointestinal cancers [24] [25].

Colocolic intussusceptions were larger in contrast to enteroenteric intussusceptions, likely attributable to anatomical variations. Consequently, we did not consider intussusception size to be a predictor of malignancy. Colocolonic intussusception was more likely associated with malignancy.

Despite promising insights into the management of adult intussusception, several limitations must be considered. First, our study was conducted at a single medical center, thus limiting the generalizability of our findings. Second, the retrospective study design may be vulnerable to bias. Third, we had a relatively high exclusion rate of 25%, which could introduce a selection bias to our study. However, our relatively large sample size for this rare medical condition might provide a foundation for future multicenter investigations with a targeted focus on imaging features. Future research could focus on AI-based analyses to enhance risk stratification for tumor-related intussusception.

In conclusion, the absence of ileus, bowel wall thickening, and acute symptoms can indicate a low risk of malignancy in adult intussusception. This supports a more conservative management approach, which can lead to favorable outcomes, including patient recovery and resolution of the intussusception on follow-up imaging.

 

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Conflict of Interest

C.B. received speaking fees from Siemens Healthineers. I.Y. received a speaking fee from Siemens Healthineers.

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Publication History

Received: 17 August 2024

Accepted after revision: 25 September 2024

Article published online:
22 October 2024