Intussusception is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

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

Epidemiology

  • 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)

Risk Factors

  • 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.

Pathophysiology

  • 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

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Intussusception ID - 617565 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617565/all/Intussusception PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -