first reported in 1674 by barbette of amsterdam , it is the cause of 13% of all cases of intestinal obstructions , . despite in children intussusception is usually idiopathic , in adults an organic etiology is identified in more than 90% of cases , . the preoperative diagnosis of adult intussusceptions remains difficult and surgery is still the recommended treatment . in this study , we try to present our experience of adult intussusceptions in order to analyze the cause , clinical features , diagnosis , and management of this rare pathology . we reviewed data for all patients that had been admitted to our department for intestinal intussusception . we collected :- epidemiologic and clinical characteristics : acute or sub acute presentation , symptoms and signs and the results of radiological investigations if performed - the files were also reviewed for operative and pathology parameters : we compared the preoperative diagnosis to the operative findings and to the conclusion of the pathology of the operative specimen . epidemiologic and clinical characteristics : acute or sub acute presentation , symptoms and signs and the results of radiological investigations if performed the files were also reviewed for operative and pathology parameters : we compared the preoperative diagnosis to the operative findings and to the conclusion of the pathology of the operative specimen . these patients presented with an acute intestinal obstruction that required hospitalization in the intensive care unit for gastric suction . they presented either with pain in the lower right quadrant mimicking an appendicitis or with iterative subocclusion . physical examination was remarkable for abdominal mass in three cases that was located in the right iliac fossa . all patients admitted in our department with acute intestinal occlusion had abdominal x - ray with  air - fluid levels  . in one case , we indicated an intestinal opacification because of the persistent air - fluid levels despite the restoration of the intestinal transit after gastric suction . the underlying lesions discussed after imaging were cecal tumor in 2 cases , cecal polyp in one case , ileal tumor in one case and ileal diverticulum in one other case . the clinical presentation and the preoperative etiologies are summarized in table 1 , table 3 . 5 patients had midline laparotomy and the three others had laparoscopy . in all cases , resection of the intussuscepted intestinal loop was done without intestinal reduction . the choice of procedure was determined by location , size , cause and viability of the bowel : 3 oncologic right colectomies , 4 intestinal resections and one ileo - cecal resection were performed . no anastomotic leak was noticed . in all cases , the pathology examination discovered an underlying lesion . it concluded to 2 cases of ileal lipoma , 2 cases of cecal lipoma , one case of an adenomatous polyp of the ileum , one case of cecal adenocarcinoma , one case of ileal teratoma and one case of jejunal stromal tumor . all cases with clinical presentation , preoperative diagnosis and pathology findings are summarized in table 3 . these patients presented with an acute intestinal obstruction that required hospitalization in the intensive care unit for gastric suction . they presented either with pain in the lower right quadrant mimicking an appendicitis or with iterative subocclusion . physical examination was remarkable for abdominal mass in three cases that was located in the right iliac fossa . all patients admitted in our department with acute intestinal occlusion had abdominal x - ray with  air - fluid levels  . in one case , we indicated an intestinal opacification because of the persistent air - fluid levels despite the restoration of the intestinal transit after gastric suction . the underlying lesions discussed after imaging were cecal tumor in 2 cases , cecal polyp in one case , ileal tumor in one case and ileal diverticulum in one other case . the clinical presentation and the preoperative etiologies are summarized in table 1 , table 3 . 5 patients had midline laparotomy and the three others had laparoscopy . in all cases , resection of the intussuscepted intestinal loop was done without intestinal reduction . the choice of procedure was determined by location , size , cause and viability of the bowel : 3 oncologic right colectomies , 4 intestinal resections and one ileo - cecal resection were performed . it concluded to 2 cases of ileal lipoma , 2 cases of cecal lipoma , one case of an adenomatous polyp of the ileum , one case of cecal adenocarcinoma , one case of ileal teratoma and one case of jejunal stromal tumor . all cases with clinical presentation , preoperative diagnosis and pathology findings are summarized in table 3 . it is defined by the invagination of a segment of bowel and its mesentery ( intussusceptum ) in the downstream lumen of the same loop of bowel ( intussuscipiens ) , leading to intestinal obstruction and ischemia . the mean age at presentation in our study was 48 years old ( range : 2071 ) . it is believed that the causative lead point can be any lesion in the bowel wall or within the lumen that alters normal peristaltic activity . the predominant symptoms are those associated with some form of bowel obstruction . in fact , most series report abdominal pain , nausea , vomiting and bleeding per rectum as the common symptoms . abdominal mass is noted in 1047% of cases , . in our series , an abdominal mass was noted in three cases . the characteristic triad of abdominal pain , palpable abdominal mass and bloody stool often seen in pediatric cases , is rare in adult . intussusception is usually idiopathic , in adults an organic etiology is identified in more than 90% of cases . it can be a benign polyp , a lipoma , a meckel s diverticulum , or a malignant tumor . in our current series , a proven pathological entity the lipoma represent the principal cause in our series . the preoperative diagnosis of intussusception still very difficult due to the variability of the clinical presentation . thus , the use of investigations including , ultrasound , and computed tomography can be helpful to establish the diagnosis . a number of different radiological and endoscopic methods have been described as useful in the diagnosis of intussusceptions . ultrasonography which represent the principal radiological procedure in pediatrics , is also a useful investigation for the diagnosis of adult intussusceptions . doughnut sign in the transverse view and the  pseudo - kidney or  hay - fork sign in the longitudinal view . but the most sensitive radiological method to confirm adult intussusception is abdominal computed tomography ( ct ) . it also can precise the site , level , the cause of intestinal obstructions or demonstrate threatening signs of bowel of non viability . the classic features in ct scan are the signs of target or sausage , mesenteric fat and vessels . in our study , the diagnosis of gastrointestinal intussusception was made preoperatively in 100% of patients . in adults , due to the risk of intestinal ischemia and possible malignancy of the lead point of invagination , the treatment of intussusception is always surgical . the surgical procedure depends upon the location of intussusceptions and viability of the intestine at the time of laparotomy . some authors advocate reducing the intussusception before resection to limit the extent of resection especially when the small bowel is involved . thus , some authors recommend the first resection without reduction the choice of surgical approach will depend on the clinical condition of the patient , the location of intussusception , the nature of the aetiological lesion , the bowel vitality , and the expertise of the surgeon in matters of laparoscopic surgery . several reports have described the laparoscopic as a good approach to diagnose and sometimes treat intussusception of the small and large bowel , , , . but , it requires expertise in laparoscopic surgery due to distension of the bowel loops . therapeutic sanction of intussusception is surgery and there is more emphasis towards resection without reduction . no problem of consent for publication : images are entirely unidentifiable and there are no details on individuals reported within the manuscript ( consent for publication of images may not be required ) . materials described in the manuscript , including all relevant raw data , will be freely available to any scientist wishing to use them for non - commercial purposes .
highlightsthis is a rare entity . its treatment still difficult because of controversy regarding the diagnosis and the optimal management.we tried to present our experience with 8 adult intussusceptions cases followed by a review of the literature in order to analyze the cause , clinical features , diagnosis , and management of this rare pathology.it was a retrospective study , but it is very interesting with clear results and excellent figures which may guide surgeons who encounter this problem.i am hoping that you have received everything as required and that the reviewing process finds the manuscript acceptable for publication in the journal 
 . please accept again dear professor our most humble greetings .