Paeds · gastroenterology-hepatology-and-nutrition
Intussusception
Also known as Intussusception · Ileocolic intussusception · Telescoping bowel · Redcurrant jelly stool · Target sign · Pseudokidney sign · Air enema reduction · Pathological lead point · Idiopathic intussusception · Intussusceptum
Fellowship guide to intussusception in children, built around the single rule that a previously well infant with intermittent colicky screaming, vomiting and a sausage-shaped mass has intussusception until proven otherwise. The page covers the idiopathic-versus-pathological-lead-point split, the telescoping mechanism that drags the mesentery and ischaemes the bowel, the bedside ultrasound target sign, the resuscitation that precedes imaging, and the air enema as first-line reduction with surgery reserved for failure, peritonitis and pathological lead points.
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Target exams
Red flags
- A previously well infant with intermittent episodes of colicky screaming and drawing up the knees, with vomiting between episodes, has intussusception until proven otherwise and needs ultrasound the same hour, not next clinic
- Redcurrant-jelly stool is a late sign of mucosal ischaemia and its absence never excludes intussusception; waiting for it costs bowel
- Lethargy between colicky episodes can be the dominant and only finding and is easily dismissed; an intermittently drowsy infant with vomiting still needs a targeted ultrasound
- Abdominal tenderness, guarding, a rigid abdomen, shock or free air signal perforation or ischaemic bowel and are absolute contraindications to enema reduction; that child goes straight to surgery
- An older child or an infant under three months with intussusception is far more likely to harbour a pathological lead point such as a Meckel diverticulum, polyp or lymphoma and changes both the work-up and the operation
Life stages
Care settings
Clinical exam formats
Board mappings
- Intussusception as the common cause of bowel obstruction in infants
- Clinical triad and the target sign on ultrasound
- Principles of resuscitation before reduction
- Air versus contrast enema reduction and their evidence base
- Recognising pathological lead points and indications for surgery
- Recurrence and post-reduction care
- The infant with intermittent colicky pain and vomiting
- Interpreting the abdominal ultrasound
- Fluid resuscitation and analgesia in the obstructed child
- Short case: abdominal examination of the infant with a mass
- Long case: the child with recurrent intussusception
- Gastroenterology and surgery: intussusception in children
- Acute abdominal pain and bowel obstruction
- Intussusception: presentation, imaging and management
- Pathological lead points and rotavirus vaccine association
- Assessment of the infant with colicky abdominal pain and vomiting
- Intussusception
- Bowel obstruction in the infant
- Air enema reduction and indications for surgery
- Patient Care: recognition and stabilisation of intussusception
- Medical Expert: intussusception in children
Overview & Definition
Picture a seven-month-old who was perfectly well, then begins to scream, draw his knees to his chest and go pale, settles into an exhausted sleep, and twenty minutes later does it again. That rhythm is the signature of intussusception. It is the telescoping of one segment of bowel into the next, the proximal intussusceptum invaginating into the distal intussuscipiens, and it is the commonest cause of intestinal obstruction in an infant between three months and three years of age. [1] [2]
The danger is mechanical and vascular at once. As the proximal bowel is driven forward it drags its mesentery with it, and the trapped mesentery is steadily strangulated, so the bowel wall swells, becomes ischaemic and bleeds, producing the blood-and-mucus redcurrant-jelly stool that is a late and ominous sign. The art of the diagnosis is to recognise the colicky pattern and act before that late stage arrives. [2] [6]
The governing principle is therefore speed coupled with a clear decision rule. You resuscitate the child, confirm the diagnosis with ultrasound, and attempt non-operative air enema reduction as first-line treatment, reserving surgery for failure, for signs of peritonitis or ischaemia, and for the older or very young child who is likely to harbour a pathological lead point. Most infants are reduced without an operation and do well, which is exactly why recognising the early pattern matters. [3] [6]
References12ShowHide
- [1]Jiang J; Jiang B; Parashar U Childhood intussusception: a literature review. PLoS One, 2013.PMID 23894308
- [2]Applegate KE Intussusception in children: evidence-based diagnosis and treatment. Pediatr Radiol, 2009.PMID 19308373
- [3]Sadigh G; Zou KH; Razavi SA; et al Meta-analysis of Air Versus Liquid Enema for Intussusception Reduction in Children. AJR Am J Roentgenol, 2015.PMID 26496576
- [4]Ko HS; Schenk JP; Tröger J Current radiological management of intussusception in children. Eur Radiol, 2007.PMID 17308922
- [5]Li XZ; Wang H; Song J; et al Ultrasonographic Diagnosis of Intussusception in Children: A Systematic Review and Meta-Analysis. J Ultrasound Med, 2021.PMID 32936473
- [6]Kaiser AD; Applegate KE; Ladd AP Current success in the treatment of intussusception in children. Surgery, 2007.PMID 17950338
- [7]Fisher JG; Sparks EA; Turner CG; et al Operative indications in recurrent ileocolic intussusception. J Pediatr Surg, 2015.PMID 25598108
- [8]Justice FA; Nguyen LT; Tran SN Recurrent intussusception in infants. J Paediatr Child Health, 2011.PMID 21435072
- [9]Buttery JP; Standish J; Bines JE Intussusception and rotavirus vaccines: consensus on benefits outweighing recognized risk. Pediatr Infect Dis J, 2014.PMID 24732449
- [10]Yen C; Healy K; Tate JE; et al Rotavirus vaccination and intussusception - Science, surveillance, and safety: A review of evidence and recommendations for future research priorities in low and middle income countries. Hum Vaccin Immunother, 2016.PMID 27322835
- [11]Palupi-Baroto R; Lee KJ; Carlin JB Intussusception in Australia: epidemiology prior to the introduction of rotavirus vaccine. Aust N Z J Public Health, 2015.PMID 25558780
- [12]Tesfaye DD; Adem BM; Ketema I; et al Clinical profile and treatment outcome of acute intussusception among children in eastern Ethiopia: A seven years retrospective study. Front Pediatr, 2022.PMID 36518776