Malignancy risk and management outcomes in adult intussusception: a single-institution retrospective study.

PURPOSE: Adult intussusception is rare and frequently caused by a pathological lead point, including malignancy. We assessed malignancy rates by CT-based anatomical subtype/location, identified predictors of malignancy, and summarized management outcomes to support risk-stratified decision-making in the emergency setting. METHODS: We conducted a single-institution retrospective study at Tri-Service General Hospital (Taipei, Taiwan), including consecutive adults with CT-diagnosed intussusception from January 2015 to August 2024. We collected demographics, symptoms, hemoglobin, CT-based type/location, management, and histopathology. Malignancy was defined by index-admission pathology (malignant vs. benign). Anemia was defined as hemoglobin < 13 g/dL in men or < 12 g/dL in women. Predictors of malignancy were evaluated using univariable and multivariable logistic regression. Primary analyses included pathology-confirmed cases; sensitivity analyses additionally included presumed benign cases. RESULTS: Forty-seven patients were identified; 38 had pathology-confirmed outcomes. In the primary cohort (n = 38), 18 (47.4%) were malignant. Lower hemoglobin was associated with malignancy (OR per 1 g/dL increase, 0.709; 95% CI, 0.529–0.950; p = 0.021), and anemia strongly predicted malignancy (OR, 11.667; 95% CI, 2.438–55.830; p = 0.002). In multivariable analysis adjusting for age and colonic location, anemia remained independently associated with malignancy (adjusted OR, 13.540; 95% CI, 2.350–78.000; p = 0.004). Findings were consistent in sensitivity analyses including nine presumed benign cases (symptom resolution within 72 h without intervention and no recurrence for ≥ 2 years). CONCLUSION: Malignancy was common among symptomatic adults with intussusception in this single-institution cohort. Anemia was a strong independent predictor of malignancy and may complement CT-based evaluation for risk stratification and operative planning in the emergency setting.