Intussusception

Descriptive text is not available for this imageBASICS

DESCRIPTION

  • The invagination or telescoping of a proximal portion of bowel (the intussusceptum) into a distal segment of bowel (the intussuscipiens)
    • Can be unremitting (80%) or transient (20%)
    • 85% are ileocolic; ileoileal and colocolic types also occur.
    • Telescoping of the bowel occurs over a “lead point”—a lesion or defect in the bowel wall.
  • Telescoping of the bowel causes diminished venous blood flow and bowel wall edema, which can result in ischemia and obstruction.
    • Over time, arterial blood flow is inhibited, and infarction of the bowel wall occurs, which results in hemorrhage or perforation.
    • If untreated, can lead to death
  • Bowel necrosis can occur within 48 to 72 hours after onset.
  • Clinical presentation can vary but usually includes the following:
    • “Paroxysms of pain”: episodes of calmness interspersed with fussiness
    • Persistent vomiting
    • “Currant jelly stools” which represent mucosal sloughing

EPIDEMIOLOGY

  • Worldwide incidence of 74 per 100,000 children <1 year of age
  • Male-to-female ratio: 2:1
  • Generally, occurs in patients 3 months to 3 years of age
  • Peak age: from 5 to 7 months
  • The most frequent cause of bowel obstruction in infancy and second most common cause of abdominal pain (next to constipation)
  • Increased incidence after administration of the RotaShield rotavirus vaccine (no longer available); current vaccines (RotaTeq® or Rotarix®) present a small but significant increase in risk 1 to 7 days after first dose of the vaccine. The Centers for Disease Control and Prevention (CDC) recommends the first vaccine dose should be given before the child is 15 weeks of age and the completion of all doses before the child turns 8 months of age.

ETIOLOGY

  • Children aged <3 years: usually idiopathic (95%) or due to an enlarged Peyer patch (from infection)
  • Most common location: ileocolic (90%)
  • Children aged ≥3 years: higher incidence of a pathologic lead point (4%); most common:
    • Meckel diverticulum
    • Polyps
    • Lymphomas
    • Other less common etiologies include Henoch-Schönlein purpura (HSP), Peutz-Jeghers syndrome, intestinal duplications, inflammatory bowel disease, coagulopathies, cystic fibrosis, appendicitis, and tumors.
  • Postoperative (<1%): can occur in children who have had large retroperitoneal tumors removed (usually within 1 week of surgery)

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