Intestinal Invaginations in Adults

Intestinal invaginations in adults are rare phenomenon . The most critical etiological causes are malignancies. The most common symptoms are abdominal pain, nausea, vomiting, inability to pass flatus and defecation, and distention in the abdomen due to intestinal obstruction. On physical examination, abdominal distention, decreased bowel sounds and sometimes a mass may be palpable on deep palpation. In direct radiography, air-liquid levels can be seen. A mass can be detected in the invagination area on ultrasonography. Definitive diagnosis is usually made by computerized tomography. Treatment of intestinal invaginations in adults is usually surgery. It can be done by laparoscopic or open surgery. As a result, we think that when a definitive diagnosis is made in adults, intestinal invagination should be treated surgically under oncological principles since the etiological factor is mostly malignancy.


Mini-review Article
under one year of age [5]. They are rare in adults and are about 1-5% cause of bowel obstruction [1,3,4].
In a study by Cherni et al., it was reported that nitric oxide (NO) is the major inhibitory neurotransmitter in the enteric nervous system, inflammatory events cause excessive NO release in cases of ileocecal invagination, which results in severe relaxation of the ileocecal valve and ultimately ileocecal invaginations [14]. In a similar study by Kaemmerer et al., it was reported that adenovirus infections cause CD3 positive lymphocyte infiltration, which causes enlargement of Peyer's patches and mesenteric lymph nodes due to inflammatory neuropathy in the mesenteric plexus, which is the cause of ileocecal invaginations [5].
A case of double ilio-caeco-colic invagination due to the tumor was reported in a case report by Saclo et al [29].
Zhang et al. reported an infrequent case of duodeno-duodenal invagination in a 23-year-old male patient [30].

INVAGINATION
In cases of invagination, patients are usually admitted to the hospital with symptoms such as abdominal pain, nausea, vomiting, inability to pass flatus and defecation, and abdominal distention due to intestinal obstruction.
Depending on the obstruction site in the intestines, air-fluid levels may appear on the abdomen x-ray. Enlarged bowel loops and airfluid classes may be revealed on ultrasonography [1,6].  [16], Hong performed laparoscopic resection and anastomosis in a case of lipoma-induced invagination [17]. However, as seen in the literature reviews, there are no cases of laparoscopic ileocecal invagination resection in large series in adults.
In a study conducted by Bahman, the reduction was tried three times with an interval of 2-4 hours in invagination cases, successful results were obtained in 85% of the cases, and 52 patients of unsuccessful intestinal invagination were randomly divided into two groups: Laparoscopic surgery was performed in the first group of 26 people, and open surgery was performed in the other group of 26 people, and the duration of the operation, the transition period to oral nutrition, hospitalization times, wound infection rates were compared. According to the results obtained in the study; operation times were found to be significantly higher in the laparoscopic group than open surgery, and no significant difference was found between the two groups in terms of other criteria [32]. For this reason, it has been reported that reduction should be attempted primarily in cases of intestinal invagination and that laparoscopic surgery is as safe as open surgery.

CONCLUSİON
According to the results of our study, the most common cause of intestinal invaginations in adults is malignancies. CT is the gold standard in diagnosis. However, in many cases, the diagnosis can be made with USG. In invagination cases with suspected malignancy, oncological principles should be followed. Open or endoscopic methods can be used safely in surgical treatment.

CONSENT
It is not applicable.