Intussusception

Intussusception most commonly occurs in infants between the ages of 3 and 12 months, with a peak at the age of approximately 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 gas will influence subsequent management; 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.

Treatment involves reduction by contrast enema. Air is likely to be more effective and safer than liquid; in cases where this is unsuccessful or where peritonitis exits, surgery is required. Open reduction is then performed in uncomplicated cases, and intestinal resection for cases complicated by bowel 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]Whitehouse JS, Gourlay DM, Winthrop AL, et al. Is it safe to discharge intussusception patients after successful hydrostatic reduction? J Pediatr Surg. 2010 Jun;45(6):1182-6. http://www.ncbi.nlm.nih.gov/pubmed/20620317?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 (Peyers patch) in the terminal ileum. Occasionally, 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.[2]Hackam DJ, Newman K, Ford HR. Pediatric surgery: gastrointestinal tract. In: Schwartz's principles of surgery, 8th ed. New York, NY: McGraw-Hill; 2005:1493-4.[3]McCollough M, Sharieff GQ. Abdominal pain in children. Pediatr Clin North Am. 2006 Feb;53(1):107-37. http://www.ncbi.nlm.nih.gov/pubmed/16487787?tool=bestpractice.com [4]Hackam DJ, Saibil F, Wilson S, et al. Laparoscopic management of intussusception caused by colonic lipomata: a case report and review of the literature. Surg Laparosc Endosc. 1996 Apr;6(2):155-9. http://www.ncbi.nlm.nih.gov/pubmed/8680642?tool=bestpractice.com

Intussusception is clinically important. It results in venous obstruction and bowel-wall edema that can progress to bowel necrosis, perforation, and, rarely, death.[2]Hackam DJ, Newman K, Ford HR. Pediatric surgery: gastrointestinal tract. In: Schwartz's principles of surgery, 8th ed. New York, NY: McGraw-Hill; 2005:1493-4.[3]McCollough M, Sharieff GQ. Abdominal pain in children. Pediatr Clin North Am. 2006 Feb;53(1):107-37. http://www.ncbi.nlm.nih.gov/pubmed/16487787?tool=bestpractice.com

This review will focus on idiopathic intussusception in infants. Intussusception in older children and adults is rare and is almost always caused by a pathologic lead point.