Review

Duodenoduodenal and duodenojejunal intussusceptions in adults: A systematic review with a focus on demographics, diagnosis, and etiology

  • Received: 06 July 2020 Accepted: 24 August 2020 Published: 10 September 2020
  • Background and Objectives Diagnosis and management of Duodenal Intussusception (DI) in adults present several clinical challenges. Available literature specific to the DI in adults is scant, mainly due to the rarity and emergency associated with DI. The objective of this study is to conduct a systematic review of the literature and elucidate key factors related to DI in adults. Methods and Materials PubMed, Scopus, Web of Science, and Cochrane databases were searched. Data on demographics, etiology, symptoms, physical examination, and diagnosis was extracted and analyzed for pooled incidence of adult DI (ADI; adult duodenal intussusception) and its specific subclasses i.e. duodenoduodenal (ADDI) and duodenojejunal (ADJI) intussusceptions. Results The database search yielded 234 results. A total of 51 studies, involving 54 patients with ADI, were included in the final analysis. The median (Interquartile, IQR) age of patients was 44.5 (26) years and 66.7% of patients were women. Among 54 ADI patients, 40.7% had ADDI and 59.3% had ADJI. The duration of symptoms varied widely with a median (IQR) of 60 (357) days. Abdominal pain and vomiting were the common reported symptoms. Physical examination and laboratory tests were inconclusive in several patients. CT scan was the most commonly used diagnostic modality. Only one case of ADI was idiopathic. Adenomas were the most frequent etiology, observed in about 50% of ADI patients. Peutz–Jeghers Syndrome was seen in 8 patients and all of them had ADJI. Out of the 12.5% cases that were malignant, only one had ADDI. Conclusion This study is probably the first attempt to systematically review ADI and its subclasses with the intention to provide key information specific to patient characteristics, diagnosis, and etiology of ADI. The findings of this review will possibly augment research in the area of the management and epidemiology of ADI.

    Citation: Nasser A. N. Alzerwi. Duodenoduodenal and duodenojejunal intussusceptions in adults: A systematic review with a focus on demographics, diagnosis, and etiology[J]. AIMS Medical Science, 2020, 7(3): 204-222. doi: 10.3934/medsci.2020012

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  • Background and Objectives Diagnosis and management of Duodenal Intussusception (DI) in adults present several clinical challenges. Available literature specific to the DI in adults is scant, mainly due to the rarity and emergency associated with DI. The objective of this study is to conduct a systematic review of the literature and elucidate key factors related to DI in adults. Methods and Materials PubMed, Scopus, Web of Science, and Cochrane databases were searched. Data on demographics, etiology, symptoms, physical examination, and diagnosis was extracted and analyzed for pooled incidence of adult DI (ADI; adult duodenal intussusception) and its specific subclasses i.e. duodenoduodenal (ADDI) and duodenojejunal (ADJI) intussusceptions. Results The database search yielded 234 results. A total of 51 studies, involving 54 patients with ADI, were included in the final analysis. The median (Interquartile, IQR) age of patients was 44.5 (26) years and 66.7% of patients were women. Among 54 ADI patients, 40.7% had ADDI and 59.3% had ADJI. The duration of symptoms varied widely with a median (IQR) of 60 (357) days. Abdominal pain and vomiting were the common reported symptoms. Physical examination and laboratory tests were inconclusive in several patients. CT scan was the most commonly used diagnostic modality. Only one case of ADI was idiopathic. Adenomas were the most frequent etiology, observed in about 50% of ADI patients. Peutz–Jeghers Syndrome was seen in 8 patients and all of them had ADJI. Out of the 12.5% cases that were malignant, only one had ADDI. Conclusion This study is probably the first attempt to systematically review ADI and its subclasses with the intention to provide key information specific to patient characteristics, diagnosis, and etiology of ADI. The findings of this review will possibly augment research in the area of the management and epidemiology of ADI.


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    Author contributions



    Nasser A. N. Alzerwi: Idea generation and conception, study design, data collection, data analysis, literature review, and manuscript writing.

    Conflict of interest



    There is no conflict of interest to disclose.

    [1] Lu HL, Ding Y, Goyal H, et al. (2019) Association between rotavirus vaccination and risk of intussusception among neonates and infants: A systematic review and meta-analysis. JAMA e1912458.
    [2] Marinis A, Yiallourou A, Samanides L, et al. (2009) Intussusception of the bowel in adults: A review. World J Gastroenterol 15: 407-411. doi: 10.3748/wjg.15.407
    [3] Weilbaecher D, Bolin JA, Hearn D, et al. (1971) Intussusception in adults. Review of 160 cases. Am J Surg 121: 531-5. doi: 10.1016/0002-9610(71)90133-4
    [4] Chen XD, Yu YY, Yang L, et al. (2012) Duodenal intussusception due to a giant neuroendocrine carcinoma in a patient with Peutz-Jeghers syndrome: Case report and systematic review. Eur J Gastroenterol Hepatol 24: 722-726. doi: 10.1097/MEG.0b013e328351c1df
    [5] Hong KD, Kim J, Ji W, et al. (2019) Adult intussusception: a systematic review and meta-analysis. Tech Coloproctol 23: 315-324. doi: 10.1007/s10151-019-01980-5
    [6] Honjo H, Mike M, Kusanagi H, et al. (2015) Adult intussusception: a retrospective review. World J Surg 39: 134-138. doi: 10.1007/s00268-014-2759-9
    [7] Marsicovetere P, Ivatury SJ, White B, et al. (2017) Intestinal intussusception: etiology, diagnosis, and treatment. Clin Colon Rectal Surg 30: 30-39. doi: 10.1055/s-0036-1593429
    [8] Valentini V, Buquicchio GL, Galluzzo M, et al. (2016) Intussusception in adults: the role of MDCT in the identification of the site and cause of obstruction. Gastroenterol Res Pract 2016: 5623718. doi: 10.1155/2016/5623718
    [9] Lianos G, Xeropotamos N, Bali C, et al. (2013) Adult bowel intussusception: presentation, location, etiology, diagnosis and treatment. G Chir 34: 280-283.
    [10] Yalamarthi S, Smith RC (2005) Adult intussusception: case reports and review of literature. Postgrad Med J 81: 174-177. doi: 10.1136/pgmj.2004.022749
    [11] Moher D, Liberati A, Tetzlaff J, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 151: 264-269. doi: 10.7326/0003-4819-151-4-200908180-00135
    [12] Azar T, Berger DL (2009) Adult intussusception. Ann Surg 226: 134-138. doi: 10.1097/00000658-199708000-00003
    [13] Gagnier JJ, Kienle G, Altman DG, et al. (2013) The CARE guidelines: consensus-based clinical case reporting guideline development. J Med Case Rep 7: 223. doi: 10.1186/1752-1947-7-223
    [14] Kellogg EL (1931) Intussusception of the duodenum caused by adenoma originating in Brunner's glands. Med J Rec 134: 440-442.
    [15] Ibrahim H (1959) Duodeno-jejunal intussusception caused by a myoma of third part of duodenum. J Egypt Med Assoc 42: 14-17.
    [16] Lempke R (1959) Intussusception of the duodenum: Report of a case due to Brunner's gland hyperplasia. Ann Surg 150: 160-166. doi: 10.1097/00000658-195907000-00020
    [17] Rieth D, Abbott G, Gray G (1977) Duodenal intussusception secondary to Brunner's gland hamartoma. A case report. Gastrointest Radiol 2: 13-16. doi: 10.1007/BF02256458
    [18] Van Beers B, Trigaux JP, Pringot J (1983) Duodenojejunal intussusception secondary to duodenal tumors. Gastrointest Radiol 13: 24-26. doi: 10.1007/BF01889017
    [19] Taams J, Huizinga WK, Somers SR (1992) The wandering ampulla--duodenal-jejunal intussusception of a carcinoid tumour with displacement of the bile duct to the left iliac fossa. A case report. S Afr J Surg 30: 153-155.
    [20] Vinnicombe S, Grundy A (1992) Case report: obstructive jaundice secondary to an intussuscepting duodenal villous adenoma. Clin Radiol 46: 63-65. doi: 10.1016/S0009-9260(05)80040-6
    [21] Schnedl WJ, Reisinger EC, Lipp RW, et al. (1996) Biliary obstruction due to duodenojejunal intussusception in Peutz-Jeghers syndrome. J Clin Gastroenterol 23: 220-223. doi: 10.1097/00004836-199610000-00014
    [22] Uggowitzer M, Kugler C, Aschauer M, et al. (1996) Duodenojejunal intussusception with biliary obstruction and atrophy of the pancreas. Abdom Imaging 21: 240-242. doi: 10.1007/s002619900055
    [23] O'Connor PA, McGrath FP, Lane BE (1999) Duodenal intussusception secondary to an internal duodenal duplication. Clin Radiol 4: 69-70. doi: 10.1016/S0009-9260(99)91243-6
    [24] Blanchet MC, Arnal E, Paparel P, et al. (2003) Obstructive duodenal lipoma successfully treated by endoscopic polypectomy. Gastrointest Endosc 58: 938-939. doi: 10.1016/S0016-5107(03)02232-6
    [25] Ijichi H, Kawabe T, Isayama H, et al. (2003) Duodenal intussusception due to adenoma of the papilla of Vater. Hepatogastroenterology 50: 1399-1402.
    [26] Gardner-Thorpe J, Hardwick RH, Carroll NR, et al. (2007) Adult duodenal intussusception associated with congenital malrotation. World J Gastroenterol 13: 3892-3894. doi: 10.3748/wjg.v13.i28.3892
    [27] Jeon SJ, Yoon SE, Lee YH, et al. (2007) Acute pancreatitis secondary to duodenojejunal intussusception in Peutz-Jegher syndrome. Clin Radiol 62: 88-91. doi: 10.1016/j.crad.2006.08.011
    [28] Madanur MA, Mula VR, Patel D, et al. (2008) Periampullary carcinoma presenting as duodenojejunal intussusception: A diagnostic and therapeutic dilemma. Hepatobiliary Pancreat Dis Int 7: 658-660.
    [29] Neogi P, Misra A, Agrawal R (2008) Duodenal adenoma presenting as duodenojejunal intussusception. Acta Biomed 79: 137-139.
    [30] Bayan K, Tuzun Y, Yilmaz S, et al. (2009) Pyloric giant Brunner's gland hamartoma as a cause of both duodenojejunal intussusception and obscure gastrointestinal bleeding. Turk J Gastroenterol 20: 52-56.
    [31] George J, Kadambari D, Jagdish S, et al. (2009) An unusual case of a duodenal adenocarcinoma presenting as duodeno-jejunal intussusception. ANZ J Surg 79: 655-656. doi: 10.1111/j.1445-2197.2009.05023.x
    [32] Mourra N, Chafai N, Lewin M (2009) An unusual cause of duodenojejunal intussusception and melena. Gastroenterology 137: e7. doi: 10.1053/j.gastro.2009.02.012
    [33] Singhal M, Kang M, Narayanan S, et al. (2009) Duodenoduodenal intussusception. J Gastrointest Surg 13: 386-388. doi: 10.1007/s11605-008-0509-8
    [34] Aiyappan SK, Kang M, Yadav TD, et al. (2010) Duodenojejunal intussusception in Peutz-Jeghers syndrome: Report of a case. Surg Today 40: 1179-1182. doi: 10.1007/s00595-009-4199-y
    [35] Dhinakar M, Allaya D, Golash V (2010) A rare case of Brunneroma duodenum causing gastric outlet obstraction. Oman Med J 25: 44-46.
    [36] Limi L, Liew NC, Badrul RH, et al. (2010) Duodenal intussusception of Brunner's gland adenoma mimicking a pancreatic tumour. Med J Malaysia 65: 311-312.
    [37] Singla R, Bharti P, Jain R, et al. (2010) Giant Brunner gland adenoma manifesting as iron deficiency anaemia and intussusception. Natl Med J India 23: 376-377.
    [38] He J, Yu LF, Zhang SZ (2011) Jaundice and rectal bleeding in a young man. Gut 60: 892. doi: 10.1136/gut.2009.181149
    [39] Karahan N, Bozkurt KK, Ciris IM, et al. (2011) Duodenojejunal invagination caused by small bowel metastasis of renal cell carcinoma. Turk J Gastroenterol 22: 355-357. doi: 10.4318/tjg.2011.0231
    [40] Abeysekera WYM, de Silva W, Pragatheswaran P, et al. (2012) Brunneroma presenting with radiological features of duodeno-duodenal intussusception. Sri Lanka J Surg 30.
    [41] Li Y, Liu W, Zhou L, et al. (2012) Synchronous presentation of acute pancreatitis and splenomegaly with intussusceptions in Peutz-Jeghers syndrome. Dig Endosc 24: 374-377. doi: 10.1111/j.1443-1661.2012.01308.x
    [42] Rathi V, Jain BK, Garg PK, et al. (2012) An unusual case of duodenal beaking. Br J Radiol 85: 1517-1521. doi: 10.1259/bjr/13193393
    [43] Watanabe F, Noda H, Okamura J, et al. (2012) Acute pancreatitis secondary to duodenoduodenal intussusception in duodenal adenoma. Case Rep Gastroenterol 6: 143-149. doi: 10.1159/000337868
    [44] Ko SY, Ko SH, Ha S, et al. (2013) A case of a duodenal duplication cyst presenting as melena. World J Gastroenterol 19: 6490-6493. doi: 10.3748/wjg.v19.i38.6490
    [45] Pandey A, Chandra A, Wahal A (2013) Brunneroma with duodenojejunal intussusception: A rare cause of gastric outlet obstruction. BMJ Case Rep 2013: bcr2012008119.
    [46] Upadhyay S, Chaudhry N, Mahajan A, et al. (2013) Hamartomatous duodenal polyp leading to duodeno-jejunal intussusception—a rare case report. J Int Med Sci Acad 26: 121-122.
    [47] Ahmad S, Lal N, Fatima U, et al. (2014) Adult duodenojejunal intussusception due to heterotopic pancreas—A rare entity. Bangladesh J Med Sci 13: 340-342. doi: 10.3329/bjms.v13i3.12781
    [48] Kusnierz K, Pilch-Kowalczyk J, Gruszczynska K, et al. (2014) A duodenal duplication cyst manifested by duodenojejunal intussusception and chronic pancreatitis. Surgery 156: 742-744. doi: 10.1016/j.surg.2013.02.013
    [49] Ozer A, Sarkut P, Ozturk E, et al. (2014) Jejunoduodenal intussusception caused by a solitary polyp in a woman with Peutz-Jeghers syndrome: A case report. J Med Case Rep 8: 13. doi: 10.1186/1752-1947-8-13
    [50] Kefeli A, Basyigit S, Yeniova AO, et al. (2015) Retrograde duodenoduodenal intussusception: an uncommon complication of peptic ulcer. Chinese Med J 128: 2981-2982. doi: 10.4103/0366-6999.168085
    [51] Larsen PO, Ellebæk MB, Pless T, et al. (2015) Acute pancreatitis secondary to duodeno-duodenal intussusception caused by a duodenal membrane, in a patient with intestinal malrotation. Int J Surg Case Rep 13: 58-60. doi: 10.1016/j.ijscr.2015.06.013
    [52] Naik B, Arjun N, Kudari A (2015) A case of duodeno-duodenal intussusception. J Evol Med Dent Sci 4: 6138-6142. doi: 10.14260/jemds/2015/893
    [53] Pradhan D, Kaur N, Nagi B (2015) Duodenoduodenal intussusception: Report of three challenging cases with literature review. J Cancer Res The 11: 1031.
    [54] Chai LF, Batista PM, Lavu H (2016) Taking the lead: A case report of a leiomyoma causing duodeno-duodenal intussusception and review of literature. Case Rep Pancreat Cancer 2: 19-22. doi: 10.1089/crpc.2016.0001
    [55] Griffin M, Nolan H, Wengler C, et al. (2016) Duodenal leiomyoma causing duodenojejunal intussusception. Am Surg 82: E164-166. doi: 10.1177/000313481608200714
    [56] McCluney SJ, Balarajah V, Giakoustidis A, et al. (2016) Intussuscepting ampullary adenoma: An unusual cause of gastric outlet obstruction leading to cavitating lung lesions. Case Rep Gastroenterol 10: 545-552. doi: 10.1159/000450540
    [57] Patankar AM, Wadhwa AM, Bajaj A, et al. (2016) Brunneroma: A rare cause of duodeno-duodenal intussusception. Euroasian J Hepatogastroenterol 6: 84-88. doi: 10.5005/jp-journals-10018-1174
    [58] Uda H, Murai T, Shinozuka T, et al. (2016) A case of intussusception into the jejunum caused by a Brunner's gland adenoma. Nihon Fukubu Kyukyu Igakkai Zasshi (J Abdom Emerg Med) 36: 125-127.
    [59] Loo GH, Abu Zeid WMM, Lim SL, et al. (2017) Rare presentation of idiopathic duodenoduodenal intussusception. Ann R Coll Surg Engl 99: e188-e190. doi: 10.1308/rcsann.2017.0104
    [60] Kinoo SM, Naidoo R, Singh B (2018) Duodeno-duodenal intussusception secondary to a Brunner's gland adenoma. South Afr J Surg 56.
    [61] Lingala S, Moore A, Kadire S, et al. (2018) Unusual presentation of duodenal ulcer presenting with duodenal intussusception. ACG Case Rep J 5: e25. doi: 10.14309/crj.2018.25
    [62] Fujimoto G, Osada S (2019) Duodenojejunal intussusception secondary to primary gastrointestinal stromal tumor: A case report. Int J Surg Case Rep 64: 15-19. doi: 10.1016/j.ijscr.2019.09.041
    [63] Hirata M, Shirakata Y, Yamanaka K (2019) Duodenal intussusception secondary to ampullary adenoma: A case report. World J Clin Cases 7: 1857-1864. doi: 10.12998/wjcc.v7.i14.1857
    [64] Begos DG, Sandor A, Modlin IM (1997) The diagnosis and management of adult intussusception. Am J Surg 173: 88-94. doi: 10.1016/S0002-9610(96)00419-9
    [65] Brayton D, Norris WJ (1995) Intussusception in adults. Am J Surg 88: 32-43. doi: 10.1016/0002-9610(54)90328-1
    [66] Gupta V, Doley RP, Bharathy KGS, et al. (2011) Adult intussusception in Northern India. Int J Surg 9: 297-301. doi: 10.1016/j.ijsu.2011.01.004
    [67] Gordon RS, O'Dell KB, Namon AJ, et al. (1991) Intussusception in the adult—a rare disease. J Emerg Med 9: 337-342. doi: 10.1016/0736-4679(91)90377-R
    [68] Bartocci M, Fabrizi G, Valente I, et al. (2014) Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound 18: 205-211. doi: 10.1007/s40477-014-0110-9
    [69] Gluckman S, Karpelowsky J, Webster AC, et al. (2017) Management for intussusception in children. Cochrane Database Syst Rev 6: Cd006476.
    [70] Wolfe D, Kanji S, Yazdi F, et al. (2020) Drug induced pancreatitis: A systematic review of case reports to determine potential drug associations. PLoS One 15: e0231883. doi: 10.1371/journal.pone.0231883
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