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Intussusception

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  1. Definition
    1. Bowel 'telescopes' onto itself
  2. Epidemiology
    1. Most common cause Intestinal Obstruction age <6 years
    2. Incidence: 1 to 4 in 1000 newborns
    3. Ages affected
      1. Rare before age 3 months
      2. Most common ages 3 to 12 months (66%)
      3. Less common after age 36 months
    4. Gender predominence: Males > Females by 3:1 ratio
  3. Etiology
    1. Idiopathic (90%)
    2. Pathologic lesion at lead point of intussusception
      1. Intestinal polyp
        1. Peutz-Jeghers Syndrome
        2. Juvenile Polyposis
        3. Familial Polyposis Coli
      2. Henoch-Schonlein Purpura
      3. Hemangioma
      4. Meckel Diverticulum
      5. Lymphosarcoma
      6. Abdominal trauma or foreign body
  4. Risk Factors
    1. Cystic Fibrosis
    2. Indwelling gastrointestinal tubes
    3. Recent infection
      1. Upper Respiratory Infection
      2. Acute Gastroenteritis
  5. Symptoms
    1. Child often appears well between episodes of pain
    2. Vomiting
    3. Abdominal Pain
      1. Sudden onset
      2. Colicky with paroxysms of pain in 20 minute intervals
    4. Stool change
      1. Watery stools in first 12 to 24 hours
      2. Red Currant Jelly Stools (bloody mucus) later
  6. Signs
    1. Evolution of abdominal examination
      1. Initial: Benign abdomen
      2. Later: Abdominal distention with peritoneal signs
    2. Right upper quadrant abdominal mass
  7. Differential Diagnosis
    1. Incarcerated Hernia
    2. Acute Gastroenteritis
    3. Testicular Torsion
    4. Acute Appendicitis
    5. Meckel diverticulum
    6. Mesenteric lymphadenitis
    7. Small Bowel Obstruction
    8. Abdominal trauma
    9. Volvulus
  8. Radiology
    1. Ultrasound
      1. May be preferred first screening for intussusception
    2. Contrast Enema
      1. Sensitivity: 95% of intussusception
      2. Curative in most early cases of intussusception
      3. Contraindications
        1. Patient unstable
        2. Surgical abdomen
    3. Abdominal XRay signs of intussusception
      1. Right abdominal mass
      2. Absent bowel gas in right upper quadrant
  9. Management
    1. Immediate contrast enema if no contraindication
    2. Surgical consultation
    3. Admit and observe for recurrence for at least 24 hours
  10. Course and Prognosis
    1. Mortality
      1. Mortality 1 to 3% with early treatment
      2. Fatal if not treated within 2-5 days
    2. Recurrence in 3 to 11% of cases (most in first day)
  11. References
    1. Bisset (1988) Radiology 168(1):141
    2. West (1987) Surgery 102(4):704
    3. Yamamoto (1997) Am J Emerg Med 15(3):293

Intussusception (C0021933)

Definition (MSH)A form of intestinal obstruction caused by the PROLAPSE of a part of the intestine into the adjoining intestinal lumen. There are four types: colic, involving segments of the LARGE INTESTINE; enteric, involving only the SMALL INTESTINE; ileocecal, in which the ILEOCECAL VALVE prolapses into the CECUM, drawing the ILEUM along with it; and ileocolic, in which the ileum prolapses through the ileocecal valve into the COLON.
ConceptsDisease or Syndrome (T047)
ICD9560.0, 560.0
MSHD007443
EnglishIntestinal intussusception, Intestinal Invagination, Intestinal Invaginations, Introsusception, Intussusception, Intussusception of intestine, Intussusception of the intestine, Intussusceptions, Intususception, Intususceptions, Invagination of intestine, Invagination of intestine or colon, ISN - Intussusception
Spanishintrosuscepcion, intususcepcion, intususcepcion del intestino, invaginacion del intestino, invaginacion intestinal
Parent ConceptsIntestinal obstruction without mention of hernia (C0021844), Intestinal Obstruction (C0021843), Intussusception (C0021933), protrusion (C0333056), Mechanical ileus (C0400843), Duplicate concept (C1274013)
SourcesCOSTAR, DXP, ICD9CM, LCH, MSH, MTHICD9, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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