A 58-year-old woman has recurrent colicky central abdominal pain for 3 months. CT shows ileocolic intussusception with a 3 cm submucosal fat-density lesion as the lead point. There is no free fluid or free air. What is the most appropriate management?
- A Laparotomy or laparoscopy with en bloc resection of the involved segment without attempted manual reduction ✓
- B Air or contrast enema reduction followed by surveillance
- C Manual reduction of the intussusception alone, reserving resection for recurrence
- D CT-guided biopsy of the lead point before any intervention
Correct answer: A. Laparotomy or laparoscopy with en bloc resection of the involved segment without attempted manual reduction
Explanation
In adults, intussusception almost always has a pathological lead point, and up to two thirds harbour a malignant lesion such as carcinoma, lymphoma, or metastasis. Reduction, whether radiological or manual, risks tumour dissemination and venous embolisation, so the standard is en bloc resection with appropriate lymphadenectomy. Enema reduction is reserved for children with idiopathic ileocolic intussusception.
Reference: Sabiston Textbook of Surgery, 21st ed.
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