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. 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.
Intussusception is clinically important. It results in venous obstruction and bowel-wall edema that can progress to bowel necrosis, perforation, and, rarely, death.
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.
History and exam
Key diagnostic factors
- presence of risk factors
- male gender
- age 6 to 12 months
- colicky abdominal pain
- lethargy/irritability in between waves of pain
- blood per rectum/redcurrant jelly stool
- hypovolemic shock
Other diagnostic factors
- palpable abdominal mass
- poor feeding
- abdominal distention
- male gender
- age 6 to 12 month
- antecedent viral illness
- seasonal variation
- first-generation rotavirus vaccination
1st investigations to order
- abdominal plain-film x-ray
- diagnostic enema
Investigations to consider
- CT abdomen
clinically stable with no contraindications to contrast enema reduction
with contraindications to contrast enema reduction and/or clinically unstable (e.g., shock, suspected perforation, peritonitis, evidence of bowel wall necrosis)
Jonathan Sutcliffe, MD
Consultant Paediatric Surgeon
Leeds General Infirmary
JRS declares that he has no competing interests.
Dr Jonathan Sutcliffe would like to gratefully acknowledge Dr David Hackam, Dr Steven C. Gribar, and Dr Rahul J. Anand, the previous contributors to this topic. DH, SCG, and RJA declare that they have no competing interests.
Oliver Soldes, MD
Department of Pediatric Surgery
Cleveland Clinic Foundation
OS declares that he has no competing interests.
Lewis Spitz, MBChB, PhD, FRCS, MD, FRCPCH, FAAP, FACS
Emeritus Nuffield Professor of Paediatric Surgery
Institute of Child Health
London and Great Ormond Street Hospital NHS Trust
LS declares that he has no competing interests.
- Appendicitis (uncommon in this age group)
- Urinary tract infection
- ACR-SPR practice parameter for the performance of pediatric fluoroscopic contrast enema examinations
- ACR-SPR practice guideline for the performance of pediatric fluoroscopic contrast enema examinations
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