A 58-year-old woman presents with recurrent colicky central abdominal pain and a palpable mobile mass. CT abdomen shows a segment of small bowel invaginating into adjacent bowel with a 'target' or 'doughnut' appearance. Which statement about adult intussusception is most accurate?

• A It is usually idiopathic and best managed by hydrostatic reduction
• B Manual reduction followed by observation is preferred to reduce anastomotic risk
• C A pathological lead point, often a neoplasm, is usually present and en bloc resection is the treatment of choice ✓
• D Air enema reduction is the definitive treatment in all age groups

Explanation

Unlike childhood intussusception, which is usually idiopathic and lymphoid hyperplasia driven, adult intussusception almost always has an anatomical lead point, frequently a benign or malignant tumour. Because manipulation and reduction risk seeding malignant cells and tearing friable bowel, standard practice is en bloc resection with the lead point, without attempted reduction, followed by appropriate oncological management. Enema-based reduction techniques apply to children, not adults.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.