Clinical Indicators for Surgical Management about Adult Intussusceptions

Purpose: Intussusception is a rare cause of intestinal obstruction in adults and often poses a diagnostic challenge due to its nonspecific symptoms. This study aimed to identify clinical and radiological predictors that guide the need for surgical intervention in adult intussusception cases. Methods: We retrospectively reviewed adult patients diagnosed with intussusception via abdominal CT or MRI between June 2020 and January 2025. Demographic, clinical, imaging, surgical, and pathological data were analyzed. Statistical comparisons were made between operated and non-operated patients, and ROC curve analysis was performed to assess the predictive value of bowel diameter. Results: A total of 40 adult patients were included (mean age: 43.9 years; 50% female). Surgical intervention was required in 47.5% (n = 19) of cases. Symptom presence (p = 0.032), ileus development (p = 0.0246), and increased bowel diameter (mean 49.3 mm vs. 35.0 mm, p = 0.005) were significantly associated with surgery. The ROC analysis showed that a bowel diameter ≥ 34.0 mm predicted surgical need with 100% sensitivity and 61.9% specificity (AUC = 0.854). Malignant pathology was more common in colonic intussusceptions (70%, p = 0.023), and a bowel diameter ≥ 41.0 mm was associated with malignancy (AUC = 0.678). Conclusion: Clinical presentation, presence of ileus, and bowel diameter are key indicators for surgical decision-making in adult intussusception. A bowel diameter of ≥ 34 mm should prompt consideration for surgical intervention, while ≥ 41 mm suggests a higher probability of malignancy, especially in colonic involvement.