A 48-year-old man has recurrent colicky abdominal pain and a palpable mobile mass in the left iliac fossa. CT shows a target-sign mass consistent with ileocolic intussusception. There is no free fluid or free air. What is the correct surgical principle?
- A Manual reduction followed by observation, as in children
- B En bloc resection without attempted reduction ✓
- C Air or hydrostatic contrast enema reduction under fluoroscopy
- D Reduction, then biopsy of the apex only if it looks abnormal
Correct answer: B. En bloc resection without attempted reduction
Explanation
In adults, intussusception almost always has a pathological lead point, commonly a lipoma, polyp, or carcinoma, so it must be treated as potentially malignant. The accepted approach is en bloc resection with anastomosis, without manual reduction, because reducing the intussusceptum risks venous disruption, tumour embolisation, and dissemination of malignant cells before the specimen is removed. Enema reduction is appropriate only in children, where lead points are usually idiopathic lymphoid hyperplasia.
Reference: Sabiston Textbook of Surgery, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.