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The invagination or telescoping of a proximal portion of bowel (the intussusceptum) into a distal segment of bowel (the intussuscipiens) which can result in ischemia and obstruction
- Worldwide prevalence 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 9 months
- The most frequent cause of bowel obstruction in infancy and second most common cause of abdominal pain (next to constipation)
- Children <3 years:
- Usually idiopathic (95%) or due to an enlarged Peyer patch (from infection), which is circumferential in distal ileum (common location of condition)
- Children ≥3 years:
- Higher incidence of a pathologic lead point (4%): Meckel diverticulum, polyps, and lymphomas are most common.
- Other common etiologies include Henoch-Schönlein purpura (HSP), Peutz-Jeghers syndrome, intestinal duplications, inflammatory bowel disease, appendix, and tumors.
- Postoperative (<1%):
- Can occur in children who have had large retroperitoneal tumors removed (usually within 1 week of surgery)
- Recent vaccination
- 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 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