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  • • 95% idiopathic, but most commonly involves ileocecal valve

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Epidemiology

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  • • Peak age 6-9 mos old but ranges from 3 months to 3 years of age

    • 1-4/1000 births

    • 3:2 male:female predominance

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Symptoms and Signs

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  • • Abdominal pain (colicky)

    • Vomiting

    • Bloody stool

    • Palpable mass in right abdomen (80-90% cases)

    • Heme positive stool in 80-90%

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Imaging Findings

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  • Abdominal x-ray: Shows paucity of gas in right lower quadrant, later air-fluid levels in small intestine with absence of gas distally

    Contrast enema: 100% sensitive showing lead point of intussusception and is often therapeutic when performed under pressure

    CT and US: Show "bullseye"

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Rule Out

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  • • Peritonitis

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  • • History and physical exam

    • Abdominal x-ray

    • CT or US

    • Barium enema in children should be attempted after adequate resuscitation

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Surgery

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  • • Laparotomy and resection of intussusception if ischemic necrosis present

    • Laparoscopic reduction of intussusception if enema unsuccesful

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Indications

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  • • Failure to reduce with barium enema

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Medications

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  • • Contrast enema to reduce (60-80% successful)

    • -Pneumatic preferred

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Complications

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  • • Recurrence after enema (5%)

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Prognosis

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  • • Spontaneously resolve in 20-30%

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References

DiFiore JW: Intussusception. Semin Pediatr Surg 1999;8:214.  [PubMed: 10573432]

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