Diagnosis
Intussusception
Invagination (telescoping) of one portion of the bowel into itself.
Also known as: Enteroenteric invagination
Etiology
Causes [1an][we3][owf]
Idiopathic (75%)
Infection --> Hypertrophia of Peyer patches
Viral enteritis: Enterovirus, Rotavirus
Bacterial enteritis: Salmonella, Escherichia coli, Shigella, Campylobacter
Meckels diverticulum
Appendicitis
Polyp
Lymphoma
Henoch-Schonlein purpura
Cystic fibrosis
Crohn disease
Celiac disease
Cancer
Endometriosis
Fibroids
Gastrostomy/Jejunostomy tube
Pathophysiology [we3]
Peristalsis pulls the proximal segment into the distal segment
Usually, the ileum enters the cecum
GI obstruction --> mechanical ileus --> abdominal pain
The trapped section of the bowel may cause ischemia
Necrotic mucosa sloughing off into the GI --> "red currant jelly" stool
Risk [we3]
Infections
Cystic fibrosis
Intestinal polyps
Endometriosis
Bowel adhesions
Intestinal tumors
Complications [we3][owf]
Bowel obstruction
Perforation/Peritonitis
Bowel necrosis
Sepsis
Short bowel syndrome
Epidemiology
Incidence per 100.000 [wgq][kth][e7q][ehr][bco][vcm]
Symptoms & findings
Symptoms
Apnea, Constipation, Dance's sign, Decreased consciousness, Diarrhea, Fever, Hematochezia, Hypoactive bowel sounds, Hypotension, Jelly stool, Lethargy, Pallor, Seizure, Tachycardia, Tachypnea, Vomiting
Clinical findings
Donut sign, Gastrointestinal dilatation, Pseudo-kidney sign, Target sign
Anamneses
None listed.
Localized findings
Approach
Blood gas [1an]
Barium enema
Stool guaiac test
Abdominal x-ray
Abdominal ultrasound
Abdominal CT
Treatment
Supportive: [owf]
Pain control
Antiemetics
IV hydration
Nasogastric tube
Antibiotics
Non-operative reduction: normal vital signs, and no bowel perforation [1an][we3]
Hydrostatic enema: Barium, water-soluble
Pneumatic enema: Air-contrast enema
Surgical intervention: Acutely ill, perforation, suspicion of malignancy (adults)
Manual reduction without resection
Reduction with resection
Differential diagnoses
Acute mesenteric ischemia, Acute pancreatitis, Appendicitis, Cholecystitis, Choledocholithiasis, Cholelithiasis, Constipation, Crohn disease, Diabetes mellitus, Diabetic gastroparesis, Diverticulitis, Encephalitis, Gastric volvulus, Gastritis, Gastroenteritis, Gastrointestinal obstruction, Henoch-Schönlein purpura, Infectious colitis, Inguinal hernia, Intestinal atresia, Intestinal malrotation, Intoxication, Irritable bowel syndrome, Meckels diverticulum, Meningitis, Myoma uteri, Necrotizing enterocolitis, Ogilvie syndrome, Ovarian abscess, Ovarian torsion, Pelvic inflammatory disease, Peritonitis, Postseizure encephalopathy, Pyelonephritis, Ruptured aortic aneurysm, Sepsis, Testicular torsion, Ulcerative colitis, Ulcer disease, Volvulus
References
[1] https://www.uptodate.com/contents/intussusception-in-children
[2] Jain S, Haydel MJ. Child Intussusception: https://www.ncbi.nlm.nih.gov/books/NBK431078/
[3] Brill A, Lopez RA. Intussusception in Adults. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545264/
[4] Liu N, Yen C, Huang T, Cui P, Tate JE, Jiang B, Parashar UD, Duan ZJ. Incidence and epidemiology of intussusception among children under 2 years of age in Chenzhou and Kaifeng, China, 2009-2013. Vaccine. 2018 Dec 14;36(51):7862-7867.
[5] Tiantian Zhang, Liangliang Cui, Xingyi Geng, Xiaolin Yu, Ji Zhang. Epidemiology study of pediatric primary intussusception aged ≤24 months in pre-rotavirus vaccine era of Jinan, China. Vaccine, Volume 37, Issue 11, 2019, Pages 1436-1442, ISSN 0264-410.
[6] Myat TW, Thin Aung NN, Thu HM, Aye A, Win NN, Lwin MM, Lin H, Hom NS, Lin KS, Htun MM. Epidemiology of intussusception among children less than 2 years of age; findings from baseline surveillance before rotavirus vaccine introduction in Myanmar. Heliyon. 2021 Mar 29;7(3):e06601.
[7] Gadroen K, Kemmeren JM, Bruijning-Verhagen PC, Straus SM, Weibel D, de Melker HE, Sturkenboom MC. Baseline incidence of intussusception in early childhood before rotavirus vaccine introduction, the Netherlands, January 2008 to December 2012. Euro Surveill. 2017 Jun 22;22(25):30556.
[8] Clark AD, Hasso-Agopsowicz M, Kraus MW, Stockdale LK, Sanderson CFB, Parashar UD, Tate JE. Update on the global epidemiology of intussusception: a systematic review of incidence rates, age distributions and case-fatality ratios among children aged <5 years, before the introduction of rotavirus vaccination. Int J Epidemiol. 2019 Aug 1;48(4):1316-1326.
[9] Sáez-Llorens X, Velázquez FR, Lopez P, Espinoza F, Linhares AC, Abate H, Nuñez E, Venegas G, Vergara R, Jimenez AL, Rivera M, Aranza C, Richardson V, Macias-Parra M, Palacios GR, Rivera L, Ortega-Barria E, Cervantes Y, Rüttimann R, Rubio P, Acosta CJ, Newbern C, Verstraeten T, Breuer T. A multi-country study of intussusception in children under 2 years of age in Latin America: analysis of prospective surveillance data. BMC Gastroenterol. 2013 May 27;13:95.
[10] http://emedicine.medscape.com/article/937730 (2014-01-02); [Medscape]