Intussusception

Intussusception most commonly occurs in infants aged between 3 and 12 months, with a peak between aged 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 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 pathological location is typically ileocaecal.

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 exists, 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 the 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 ileocaecal 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 'pathological lead point'). Conditions resulting in pathological lead points include luminal polyps, malignant tumours (including lymphoma), and benign mass lesions such as lipomata, Meckel's 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 oedema 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 pathological 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