Intussusception

Intussusception most commonly occurs in infants between the ages of 3 and 12 months, with a peak between ages 5 and 9 months.

Presentation often includes colicky abdominal pain, flexing of the legs, fever, lethargy, and vomiting, with blood in the stool in some cases.

When there is clinical suspicion, imaging has a valuable role. Plain abdominal x-ray may reveal an intestinal obstruction and paucity of wind in the right lower quadrant; the presence or absence of free intra-abdominal gas will influence subsequent management, because pneumoperitoneum indicates bowel perforation and requires prompt surgical evaluation. Abdominal ultrasound undertaken by an experienced radiologist will usually establish the diagnosis; contrast enema (most often air but may be liquid contrast) is the most specific and sensitive test for diagnosis. As well as being used therapeutically, it can also be used diagnostically where doubt remains.

The pathologic location is typically ileocecal.

If the patient is clinically stable and perforation is not suspected, treatment involves reduction by contrast enema; air is likely to be more effective and safer than liquid. In cases where this is contraindicated or unsuccessful, or where peritonitis exists, urgent surgery is required. Open reduction is performed in uncomplicated cases and intestinal resection of threatened nonviable bowel is necessary for cases complicated by bowel ischemia, necrosis and perforation.

Intussusception is a common cause of intestinal obstruction in young children and is defined as the prolapse of one part of intestine into the lumen of an adjoining distal part.[1]Marsicovetere P, Ivatury SJ, White B, et al. Intestinal intussusception: etiology, diagnosis, and treatment. Clin Colon Rectal Surg. 2017 Feb;30(1):30-9. https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0036-1593429 http://www.ncbi.nlm.nih.gov/pubmed/28144210?tool=bestpractice.com ​ This condition most often occurs in the ileocecal region. The lead point of the intussusception is most often an enlarged lymph node (Peyer patch) in the terminal ileum. Rarely, the lead point is an anatomic abnormality of the intestine (a “pathologic lead point”). Conditions resulting in pathologic lead points include luminal polyps, malignant tumors (including lymphoma), and benign mass lesions such as lipomata, Meckel diverticulum, Henoch-Schonlein purpura, and enteric duplication cysts.[1]Marsicovetere P, Ivatury SJ, White B, et al. Intestinal intussusception: etiology, diagnosis, and treatment. Clin Colon Rectal Surg. 2017 Feb;30(1):30-9. https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0036-1593429 http://www.ncbi.nlm.nih.gov/pubmed/28144210?tool=bestpractice.com ​

Intussusception results in venous obstruction and bowel-wall edema that can progress to bowel necrosis, perforation, and, rarely, death.[1]Marsicovetere P, Ivatury SJ, White B, et al. Intestinal intussusception: etiology, diagnosis, and treatment. Clin Colon Rectal Surg. 2017 Feb;30(1):30-9. https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0036-1593429 http://www.ncbi.nlm.nih.gov/pubmed/28144210?tool=bestpractice.com ​

This topic covers idiopathic intussusception in infants. Intussusception in older children and adults is rare and is almost always caused by a pathologic lead point.[1]Marsicovetere P, Ivatury SJ, White B, et al. Intestinal intussusception: etiology, diagnosis, and treatment. Clin Colon Rectal Surg. 2017 Feb;30(1):30-9. https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0036-1593429 http://www.ncbi.nlm.nih.gov/pubmed/28144210?tool=bestpractice.com ​