Gastrointestinal Imaging Original Research

Gollub
Features of Colonic Intussusception

Gastrointestinal Imaging
Original Research
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Colonic Intussusception: Clinical

and Radiographic Features
Marc J. Gollub1 OBJECTIVE. The purpose of this article is to comprehensively survey all CT-detected
ileocolic and colocolic intussusceptions at a cancer institute.
Gollub MJ MATERIALS AND METHODS. Using the free-text string intus, the radiology infor-
mation database of Memorial Sloan-Kettering Cancer Center was searched over a 13.5-year
period for abdominopelvic CT scan reports. Images were rereviewed by an attending radiolo-
gist for the presence of a bowel-within-bowel appearance involving the colon. The reference
standard for a lead point was histopathologic examination or, if the tumor was not resected,
an identifiable mass persisting on follow-up CT scans. Transient intussusception was defined
as intussusception that resolved on follow-up CT scan without surgical removal or as intus-
susception with an intermittent presence on serial CT scans. Idiopathic intussusception was
defined as the absence of mass or mural thickening at CT or surgery.
RESULTS. Four hundred sixty-one CT scan reports were retrieved, 138 of which mentioned
intussusception as a pertinent negative. From the remaining 323 scan reports, after all exclu-
sions (small bowelsmall bowel intussusception, incomplete imaging, pediatric patients, and
misinterpretations on rereview), 33 patients were shown to have 34 intussusceptions, including
ileocolic (n = 11) and colocolic (n = 23) intussusceptions, on 34 CT scans. Seven intussuscep-
tions were transient (i.e., intermittent). No patient had idiopathic intussusception. Histopatho-
logic results were available for 22 of 34 intussusceptions. Intussusceptions were caused by co
lorectal cancer (n = 12), lymphoma (n = 5), metastases to the colon (n = 8), colon polyps (n =
4), and nonneoplastic causes, including lipoma (n = 3), hematoma (n = 1), and edema (n = 1).
CONCLUSION. In patients with cancer, intussusceptions involving the colon are never
idiopathic. Most are due to primary colon cancer or metastatic disease and most require surgi-
cal removal. Although seven intussusceptions were transient, six were caused by neoplasia.

I
ntussusception can involve any
part of the gastrointestinal tract.
It most frequently involves the
Keywords: colon, CT, ileum, intussusception, neoplasm
small intestine and is often en-
DOI:10.2214/AJR.10.5112 countered incidentally on routine CT scans.
Much has been written recently about the
Received June 4, 2010; accepted after revision transient and idiopathic nature of this entity;
November 10, 2010.
small-intestinal intussusception has been
1
Department of Radiology, Memorial Sloan-Kettering found to be much more common than previ-
Cancer Center, 1275 York Ave, New York, NY 10065. ously thought before the availability of cross-
Address correspondence to M. J. Gollub sectional imaging [1]. Colonic intussuscep-
(gollubm@mskcc.org).
tion is less common and may either be
WEB ileocolic or colocolic. Reports in the litera-
This is a Web exclusive article. ture are confined to series of combined
small- and large-bowel intussusceptions.
AJR 2011; 196:W580W585
However, colonic intussusceptions are usual-
0361803X/11/1965W580 ly malignant and have clinically important
differences from their small-bowel counter-
American Roentgen Ray Society parts, such as a more frequent need for sur-
gery. They are rarely transient or idiopathic.
Because intussusceptions involving the co-
lon are of greater clinical importance, I
aimed to comprehensively investigate all
cases of colonic intussusception to better un-
derstand the clinical presentation and course.
Here, I review reports in the literature con-
taining more than single cases and present a
large single-institution case series from my
tertiary care facility.
Materials and Methods
Patient Selection
This retrospective study was approved by the in-
stitutional review board with a waiver for patient
consent. Eligible patients were selected by perform-
ing a five-letter free-text search of the Memorial
Sloan-Kettering Cancer Center radiology informa-
tion system using the search string intus from the

W580 AJR:196, May 2011

 Features of Colonic Intussusception

radiology reports of CT scans available as analog
or digital images on the PACS. The scan had to in-
clude the abdomen and pelvis and had to have been
performed over a 13.5-year period (July 1, 1996,
through January 1, 2010) since the institution ac-
quired PACS. The inclusion criteria were intussus-
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sualized in their entirety and measuring a minimum
length of 10 mm in axial or craniocaudal plane.
Imaging Criteria
A colonic intussusception was defined as a
colon-within-colon or small bowelwithin-colon
termined on axial CT (only axial images were con-
sistently available). The appearance had to include
mesenteric fat and vessels in the lumen of the in-
tussuscipiens, or an obvious intestinal invagination
seen in longitudinal perspective if there was a pau-
city of mesentery or if the mesentery was edematous

ceptions involving the colon present on the CT, vi- appearance over a length of at least 10 mm, as de- and no longer of fat density. Obstruction was defined

TABLE 1: Clinical Characteristics of Patients With Colonic Intussusception

Primary Transient or
Age (y), Sex Segment Primary Tumor Symptoms Treatment Nontransient Cause
39, Male Left Colona Pain and diarrhea Surgery Nontransient Colon (T3N0)
69, Female Rectum Cholangioma Asymptomatic Medical Transient Edema due to portal hypertension
58, Female Right (ileocolic) Mantle cell Asymptomatic Medical Nontransient Lymphoma
72, Male Transverse None Asymptomatic Surgery Nontransient Tubulovillous adenoma
80, Male Left Prostate Asymptomatic None Nontransient Lipoma
46, Female Right (ileocolic) Ovarian Asymptomatic None Transient Lipoma
67, Male Rectosigmoid Tongue Asymptomatic Surgery Nontransient Colon (T3N1)
72, Male Right (ileocolic) Lymphoma Diarrhea Medical Nontransient Lymphoma
39, Female Left Colona Asymptomatic Surgery Nontransient Colon (T2N2)
58, Female Rectosigmoid Colona Asymptomatic Surgery Nontransient Colon (T4N2)
73, Male Left Lymphoma Asymptomatic Surgery Nontransient Lymphoma
65, Male Transverse Melanoma Asymptomatic None (ill) Nontransient Melanoma
77, Male Transverse (ileocolic) Pancreas Asymptomatic Surgeryb Nontransient Colon (T3N0)
54, Male Right (ileocolic) Mantle cell Abdominal pain None (ill) Nontransient Lymphoma
65, Female Transverse (ileocolic) Urachal Asymptomatic Surgeryb Nontransient Colon (T3N0)
68, Female Right Lung Asymptomatic Surgeryb Nontransient Lung metastasis
83, Female Right Spindle melanoma Asymptomatic Surgeryb Nontransient Spindle melanoma
86, Female Transverse (ileocolic) Colon Asymptomatic Surgery Transientc Colon (T4N0)
49, Male Right Cholangioma Asymptomatic Surgery Nontransient Colon (T2N0)
61, Female Transverse Pancreas Twisting pain None (ill) Transient Tubulovillous adenoma
62, Female Transverse Melanoma Asymptomatic None (ill) Nontransient Presumed melanoma
71, Female Right (ileocolic) Melanoma Pain and blood Surgery Nontransient Melanoma
66, Male Right (ileocolic) Colona Bloating Surgery Nontransient Colon (T3N0)
43, Female Rectum Colona Asymptomatic Medicald Nontransient Colon (T3N0)
73, Female Right Lymphoma Asymptomatic Surgeryc Transiente Lipoma
73, Male Left Lymphoma Asymptomatic Surgery Nontransient Lymphoma
59, Male Right Pancreas Asymptomatic Surgery Nontransient Tubulovillous adenoma
66, Female Transverse Myeloma Pain and hematochezia Surgery Nontransient Hematoma
26, Female Right Leiomyosarcoma Asymptomatic Medical Transient Presumed sarcoma
85, Female Right Colona Nausea, vomiting, and weight loss Surgery Nontransient Colon (T3N0)
57, Female Transverse Carcinoid Asymptomatic Medical Transient Presumed carcinoid
45, Male Transverse Colona Asymptomatic Medicald Nontransient Colon (T0N0)
59, Male Right (ileocolic) Melanoma Nausea, vomiting, and pain Surgery Nontransient Melanoma
86, Female Right Endometrial Vomiting Surgery Nontransient Villous adenoma
aIntussuscepting mass was presenting feature of unknown colon cancer.
bIntussusception was still present at surgery.
cInfarction, inflammation, and abscess were present at surgery.
dIntussusception resolved before surgery as a result of chemotherapy.
eIntussusception became nontransient for one CT scan 17 months later.

AJR:196, May 2011 W581

 Gollub
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A B
Fig. 158-year-old asymptomatic woman with mantle cell lymphoma. Pancreatic head enlargement and mesenteric root adenopathy are also seen.
A, Axial CT scan shows ileocolic intussusception (asterisk) with abnormal lymphomatous infiltration of intussusceptum wall.
B, On cephalad section, solid lymphomatous mass of colon (arrow) acted as lead point. This intussusception resolved with chemotherapy.

as dilatation of small or large bowel proximal to the
intussusception and relative collapse of the large
bowel distal. A transient intussusception was de-
fined as one that was not present on the next CT scan
performed (including CT scans performed else-
where and digitized into the PACS system). If the
intussusception reappeared on subsequent CT scans,
it was still classified as transient and the reappear-
ance was noted (Table 1). Nontransient intussuscep-
tion was defined as one that either did not undergo
further imaging (e.g., patient was lost to follow-up,
died, or proceeded to surgery without further imag-
ing) or that persisted on the next CT scan or scans. In
this instance, the duration of the nontransient intus-
susception was considered from the date of the first
CT visualization to the last CT visualization only,
thus representing a minimum interval. Idiopathic in-
tussusception was defined as one in which no caus-
ative lead point was seen at CT or one in which no
pathologic abnormality was found at surgery.
patients history before and after the CT scan up
to the time of manuscript preparation. All avail-
able follow-up imaging was also reviewed.
CT and Radiographic Data
Images were reviewed by a gastrointestinal ra-
diologist with 16 years of experience. For each pa-
tient, the following data were collected: presence
or absence of intussusception, segment of colon,
length of intussusceptum, width of large-bowel in-
tussuscipiens involved, and presence or absence of
large- or small-bowel obstruction. Measurements
were made on the baseline scans only.
The studies retrieved were performed over a
13.5-year period (July 1996 through January 2010).
Four hundred sixty-one scans were retrieved with
the mention of intus. An ileocolic or colocolic in-
tussusception was mentioned in 47 CT reports.
The remaining reports were of patients with
small-intestinal intussusception and patients with
incomplete imaging. One pediatric patient was ex-
cluded. Thirteen additional scans were excluded
because of misinterpretation. The actual diagnosis
in these 13 cases was mass on ileocecal valve (n =
2), ileal mass (n = 2), lipoma (n = 1), prominent il-
eocecal valve (n = 6), annular right colon cancer (n =
1), and bezoar (n = 1).The final patient population
consisted of 34 cases (index CT scans) in 33 pa-
tients. One patient had two separate pathologic in-
tussusceptions. Thirty index CT scans were per-
formed with 150 mL of either iohexol (Omnipaque
150, GE Healthcare) or iodixanol (Visipaque 320,
GE Healthcare). Thirty-three of 34 index CT scans
were performed with 900 mL of oral contrast agent
(either barium sulfate or dilute diatrizoate meglu-
mine; Gastrografin, Covidien). CT scans were per-
formed on MDCT scanners (4-MDCT Hilite,
8-MDCT LightSpeed, and 16-MDCT LightSpeed
16, all from GE Healthcare). Slice thickness
ranged from 5 to 10 mm, depending on the year of

Reference Standard
For the existence of a lead point, the reference
standard could be either histopathologic examina-
Fig. 277-year-old man
tion or imaging follow-up. When imaging follow-
with pancreatic carcinoma
up was used, a lead point was defined as a mea- and unsuspected primary
sureable mass present on serial CT scans that was T3N0 colon carcinoma
distinct from the normal colon wall or as abnor- with intussusception
into transverse colon.
mal thickening of the colon wall acting as a mass Intussusception was present
(e.g., lymphoma). at surgery, and there were
two masses originating
from cecum (7 cm) and right
Clinical Data colon 10 cm distal to this
Signs and symptoms attributed to intussuscep- (6 cm). Axial image shows
tion included abdominal pain, vomiting, nausea, typical bowel-within-bowel
mesenteric fat and vessel
bloating, constipation, diarrhea, hematochezia, or
appearance (arrow) with wall
melena. In addition, surgical, clinical, and patho- thickening representing tumor
logic reports were reviewed covering the entire at lead point (arrowhead).

W582 AJR:196, May 2011

 Features of Colonic Intussusception
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A B
Fig. 373-year-old woman with lymphoma and long-standing colonic lipoma. On
index CT scan, intussuscepted lipoma was asymptomatic, as indicated in Table
1. After intervening scans without intussusception, intussusception reoccurred
and was asymptomatic requiring resection. Infarction, inflammation, and abscess
were found at surgery.
A, Axial image reveals mesenteric fat at tail of intussusceptum (arrow).
B, Image shows indurated hyperemic thickened colon wall of intussuscipiens.
C, Image shows lead point lipoma (arrow) with some inflammation of lipoma itself.

acquisition. Routine scans progressed from 10 to
7.5 to 5 mm, in keeping with accepted practice.
Results
Patient Population
There were 33 patients with 34 separate
intussusceptions seen on 34 CT scans; one
patient with lymphoma had two separate in-
utssusceptions caused by two separate lym-
phomatous masses, and each was resected at
separate settings. There were 15 men and 18
women, with a mean age of 63.2 years (range,
2686 years). Thirty-two patients had prima-
ry neoplasms (colon cancer [n = 8], lympho-
ma [n = 5], melanoma [n = 5], pancreaticobil-
iary cancer [n = 5], and endometrial, head and
neck, leiomyosarcoma, lung, myeloma, ura-
chal, prostate, carcinoid, and ovarian cancer
[n = 1 each]). One patient in this series did not
have a final diagnosis of cancer; this patient
had a tubulovillous adenoma (Table 1).
Of eight patients in whom intussusception
was caused by primary colon cancer, only one
had a known primary colon cancer. The oth-
er seven patients were nononcologic patients
who presented with symptoms that led them
to seek medical attention, including bloating
and flatulence (n = 1); diarrhea (n = 1); nausea,
vomiting, and weight loss (n = 1); hematoche-
zia (n = 1); pain and hematochezia (n = 1);
right upper quadrant pain (n = 1); and consti-
pation (n = 1).
Overall, in the patient group, symptoms
attributed to the intussusception occurred in
10 of 33 patients. Abdominal pain was most
common (n = 6), whether alone (n = 2), in
combination with hematochezia (n = 2), with
nausea and vomiting (n = 1), or with diarrhea
(n = 1). Vomiting alone, diarrhea alone, nau-
sea alone, and nausea, vomiting, and bloat-
ing occurred in one patient each. Twenty-
four patients were asymptomatic.
Radiographic Features
Eleven intussusceptions involved the ile-
um and the colon. Twenty-three intussuscep-
tions involved only the colon. Segments of
colon involved were right (n = 15), transverse
(n = 10), left (n = 5), rectosigmoid (n = 2),
and rectum (n = 2) (Figs. 13). There were
three partial small-bowel obstructions, all
due to ileocolic intussusceptions. There were
two partial large-bowel obstructions due to
colocolic intussusceptions.
A mass at the lead point was identified on
index CT scans in 33 of 34 intussusceptions.
Twenty-nine of these 33 patients received IV
contrast agent. The attenuation of the mass at
the lead point in these 29 cases was isoattenu-
ation (n = 10), mixed attenuation (n = 11), hy-
perattenuation (n = 4), and hypoattenuation
(n = 4). The average intussusception length was
8.3 cm (range, 3.015.0 cm). The average in-
tussusception width was 5.6 cm (range, 2.8
9.2 cm). The mean largest diameter of CT lead
points was 4.9 cm (range, 1.58.1 cm). Eleven
patients had no extracolonic metastases. In the
23 patients with extracolonic metastases, ma-
jor sites included the liver (n = 6), lymph nodes

AJR:196, May 2011 W583

 Gollub

(n = 6), lung (n = 3), peritoneum (n = 2), and on CT scans at the lead point. As a result of
miscellaneous sites (n = 6). The intussuscep- widespread metastases, surgical resection of
Colocolic Cases
(% Malignant)

Unknown tion was present on only one CT scan in 21 of these nonobstructing lesions was not clini-

Unknown
34 patients, on two CT scans in seven patients, cally indicated and chemotherapy was used.

62.5

62.5
100

33

33
75
four CT scans in one patient, six CT scans in The final seven patients underwent no treat-
four patients, and nine CT scans in one patient. ment. In four patients who were too ill for
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Intussusception was transient in seven patients further treatment, intussusceptions were

(lipoma [n = 2], metastases responding to che- caused by presumed melanoma (n = 2), lym-
motherapy [n = 2], portal hypertension with phoma (n = 1), and a large tubulovillous ad-
Ileocolic Cases

edema [n = 1], tubulovillous adenoma not re- enoma (n = 1). In two patients, lipomas were
Not applicable
(% Malignant)

Unknown

Unknown

sected because the patient was too ill [n = 1], not removed. The final patient underwent no
90
14
0

0
7

and colorectal cancer that reappeared on five
subsequent CT scans for 175 days until surgery
[n = 1]). Therefore, the cause of transient in-
tussusception in six of seven patients was neo-
plasia (three benign and three malignant). In
Ileocolic and Colocolic Cases
Total No. (%) of Malignant
specific treatment for rectal intussusception,
which was thought to be caused by edema re-
sulting from portal hypertension. This rectal
intussusception resolved spontaneously. The
longest interval on which the intussusception

patients with ileocolic intussusception, sev- was noted on multiple CT scans [2] was 345
en involved the right colon and four involved days in a patient with lymphoma who was at
the transverse colon. In nine of 11 ileocolic in- the end stage and then was lost to follow-up.
11 (100)

24 (70)
4 (100)
10 (91)

6 (43)
5 (28)
4 (17)
2 (18)

tussusceptions, the colon was the source of a

pathologic lead point, including colorectal can-
cer (n = 4), lymphoma (n = 3), and melano-
ma (n = 2). The remaining two cases with ileal
lead points were lipoma and melanoma.
Treatment and Follow-Up
No. of Colocolic Cases
No. of Ileocolic Cases/
Discussion
Adult intussusception is uncommon and
accounts for 5% of all intussusceptions and
1% of all bowel obstructions. Before the first
comprehensive CT report by Warshauer and
Lee in 1999 [1], it was thought that most

SurgeryTwenty-three intussusceptions adult intussusceptions were due to neoplasm.

Unknown

Unknown

(in 22 patients) were surgically resected by However, routine CT detected many unsus-
10/24
10/8
15/9
0/11

5/6
7/4

right hemicolectomy (n = 16), left hemico-
lectomy (n = 3), segmental left colectomy
(n = 2), subtotal colectomy (n = 1), and low
anterior resection (n = 1). Surgery was the
means of cure of the intussusception in
Colic Intussusception
pected intussusceptions and revealed that
only 30% of entero-enteric intussusceptions
had a neoplastic lead point [1]. Reports of co-
lonic intussusception are less common in the
literature and have usually been confined to

all but two of these patients. These two pa- series including both small- and large-bowel
(No. of Cases)

tients had colorectal cancer in which preop- types [110] (Table 2).
erative chemotherapy reduced the size of the Colonic intussusception is caused by a
34
24
14
18
11

11
11
4

mass, and the intussusceptions resolved. Re- malignancy more frequently than is small-
section of residual nonintussuscepted mass bowel intussusception, because of the great-
TABLE 2: Colonic Intussusception: Literature Review

occurred later for cancer treatment. In one
of these cases, there was no residual cancer
at surgery. The mean time to surgical exci-
sion in 18 of 23 intussusceptions was 49 days
Total Intussusception
er prevalence of malignant tumors in the
colon (e.g., primary adenocarcinoma, lym-
phoma, and metastatic disease to the colon)
than in the small bowel [3, 4]. Benign co-

(median, 14.5 days; range, 1304 days). In lonic lesions constitute about 30% of colon-
(No. of Cases)

two patients with transient intussusception, ic intussusceptions and include lipoma, be-
136

186
44
33
93

58

34
11

the lesions reappeared after an initial nor-
mal follow-up CT scan, and surgery was
required. In one of these patients, a lipoma
caused severe cramping abdominal pain and
vomiting. Inflammation and infarction were
found at surgery in this symptomatic patient.
Warshauer and Lee, 1999 [1]
nign stromal tumors, adenomatous polyps,
endometriosis, and previous anastomoses.
Ileocecal intussusception can occur from a
lead point in the colon, ileum, or appendix.
Causes may include lipoma, inflammatory fi-
broid polyp, hamartomatous polyp, lympho-

NonsurgicalEleven patients did not ma, adenocarcinoma of the ileum or cecum,

Azar and Berger, 1997 [2]
Sundaram et al., 2009 [8]

undergo surgery. Four patients underwent or even Meckel diverticulum [4]. Inflamma-
Tresoldi et al., 2008 [9]

Wang et al., 2009 [10]

only medical treatment consisting of che- tory appendiceal conditions can also cause
Rea et al., 2007 [5]
Teasdale, 1953 [7]
Study

motherapy. In two patients with lymphoma, intussusception, but the most commonly re-
Present study

intussusceptions resolved with chemother- ported entity is a mucocele.

apy. Two other patients had transient intus- Idiopathic colonic intussusception is rarely
susceptions presumed to be caused by carci- reported [5], as opposed to the more frequent
noid and sarcoma, because masses were seen scenario in the small bowel, where intussus-

W584 AJR:196, May 2011


ception is reported to be idiopathic in 70%
of cases [1]. Rectal intussusception, though
rare, has also been reported. It seldom leads
to rectal prolapse. Defecography can be used
to diagnose recurrent rectal intussusception
[4]. Compared with entero-enteric intussus-
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ception, colonic intussusception more of-
ten presents in a subacute manner with pro-
longed abdominal pain and constipation, but
acute presentations do occur [2, 6].
Similar to the findings described in one
of the oldest case series [7], I found that pa-
tients rarely presented with acute intestinal
obstruction or even colicky generalized pain.
In very few cases, as well, was the intestine
gangrenous. For this reason, it has been stat-
ed that there is not the same degree of ur-
gency required in the treatment of a case of
adult colonic intussusception [7].
However, in the opinion of the authors of
one review of intussusceptions at the Massa-
chusetts General Hospital [2], all adult colonic
intussusceptions require surgery. The benign
causes should be removed to prevent reoccur-
rence, and the malignant lesions should be re-
moved for possible cure in addition [2]. It was
further suggested that colonic primary adeno-
carcinomas undergoing intussusception are
likely to be of low stage because larger lesions
with serosal extension may stiffen the mes-
entery and prevent this occurrence. This dif-
fers from my cases, in which nine of 12 cases
were classified as T3 (i.e., extending through
the muscularis propria to the mesenteric fat)
or T4 (i.e., invasion of adjacent organs).
Unlike entero-enteric intussusception, in
which length and width thresholds have been
found to be associated with the presence or like-
lihood of a lead point requiring surgery, others
have noted that this is not helpful for intussus-
ceptions involving the colon [8]. All of my cas-
es had lead points and, therefore, size thresh-
olds would seem to bear less importance.
To my knowledge, I report the largest se-
ries of intussusceptions involving the co-
lon. Many of my findings parallel those de-
scribed in the literature, including the high
frequency of malignancy as the lead point
(25/34 [74%]). The higher rate of malignan-
cy in the present study than that reported in
several other series is most likely explained
AJR:196, May 2011 W585
Features of Colonic Intussusception
by the oncologic population at my institu-
tion. Primary colon cancer was the most
frequent cause, followed by metastases and
lymphoma. Metastases were usually due to
melanoma. I also noted nonneoplastic intus-
susceptions in two patients, one of whom un-
derwent resection for refractory abdominal
pain and diarrhea (hematoma). In this case,
no CT lead point was originally reported on
the unenhanced CT scan. Benign neoplasms
were split between lipomas and colorectal
adenomas. Among my patients, only one
with colonic intussusception ultimately pre-
sented emergently with severe cramping ab-
dominal pain, vomiting, and diarrhea. Most
cases required surgery but not usually emer-
gently. Other malignant intussusceptions
spontaneously resolved after chemotherapy.
As in other series, most cases at my institu-
tion occurred in the proximal colon, either
right or transverse. Possible explanations
include a greater tendency in the proximal
colon for polypoid neoplasms and a longer
colonic mesentery, which allows greater co-
lonic mobility. Obstruction was a rare feature
in this series. Furthermore, two-thirds of my
patients were asymptomatic. Complications
were seen in no patients. Idiopathic colonic
intussusception did not occur in my series.
Two points of interest to me were the ability
of the intussusception to persist without se-
quelae (up to 1 year) and the occasional mis-
diagnosis of intussusception by experienced
radiologists, usually because of the marked
prominence of, or nonintussuscepting mass-
es associated with, the ileocecal valve.
Limitations of this study included its retro-
spective nature. I have a select population of
patients with cancer, and my results may not
be generalizable to other population types.
Specifically, colonic metastases and lym-
phoma would likely be encountered less of-
ten in a nononcologic population. Some cas-
es were presumptively diagnosed because of
the impracticality of surgical proof. Finally,
although there were false-positive diagnoses,
I could not account for missed diagnoses be-
cause my methodology only sought out CT-
reported cases.
In summary, at my cancer center, intussus-
ception involving the colon involved the ileum
in one-third of cases. Lead points were malig-
nant in two-thirds of patients, with benign neo-
plasms accounting for all but two of the re-
maining cases. Presentations were primarily
nonemergent, but two-thirds of cases required
surgery. Although intussusceptions could be
transient and occasionally even be of a benign
cause, no case was idiopathic. In patients with
cancer with colonic intussusception, lead points
were most commonly due to primary colon
cancer, metastatic disease to the colon, and sys-
temic lymphoma with colonic involvement.
Acknowledgments
I thank J. Lewis Fugua, III, and Stuart
Bentley-Hibbert for database asisstance.
References
1. Warshauer DM, Lee JKT. Adult intussusception
detected at CT or MR imaging: clinical-imaging
correlation. Radiology 1999; 212:853860
2. Azar T, Berger D. Adult intussusception. Ann
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