Skip to Main Content

++

Key Points

++

  1. Ninety percent of intussusceptions in children are idiopathic with peak incidence occurring between 5 and 9 months.

  2. Meckel diverticulum is most common “pathologic” lead point.

  3. Triad of abdominal pain, palpable abdominal mass, and currant jelly stool is present in fewer than 50% of cases.

  4. Ultrasound is excellent for confirming diagnosis.

  5. Eighty-five percent successfully reduced nonoperatively with the use of fluoroscopically guided air enema.

  6. Laparoscopic approach to operative reduction is effective and shortens length of stay.

++

Etiology and Pathophysiology

++

Intussusception occurs when a segment of intestine invaginates or “telescopes” into the adjacent distal bowel. Although the process can occur anywhere in the intestine, 90% of the cases in children are ileocolic (Fig. 45-1) in location. The invaginating proximal bowel is termed the intussusceptum and the receiving distal bowel segment the intussuscipiens. Intussusception can occur at any age; however, it is unusual in children younger than 3 months or older than 3 years. The peak incidence occurs between 5 and 9 months.

++
Figure 45-1

Ileocolic intussusception showing how the mesenteric vessels are compressed and squeezed between the layers of the intussusceptum. Resultant edema exacerbates venous congestion leading to ischemia in the intussusceptum. Untreated, tissue pressure will exceed arterial pressure and result in necrosis.

Graphic Jump Location
++

The majority of cases (90%) of intussusception in children are idiopathic. In these patients, viral-induced lymphoid hyperplasia has been hypothesized to account for the “lead point.” Adenovirus, rotavirus, and human herpes virus 6 have all been implicated as potential causative agents.

++

Ten percent of children with intussusception will have an identifiable cause or “pathologic” lead point, most commonly a Meckel diverticulum. Other identifiable lead points include lymphoma and intestinal polyps (Fig. 45-2), conditions most frequently seen in older children. Certain systemic conditions can also predispose children to develop intussusception. For example, intussusception is the most common surgical complication seen in patients with Henoch–Schonlein purpura. Patients with cystic fibrosis, familial polyposis, nephrotic syndrome, and Peutz–Jeghers syndrome are also predisposed to developing intussusception.

++
Figure 45-2

Small bowel intussusception caused by polyp (the second commonest pathogenic lead point).

Graphic Jump Location
++

Aggressive diagnostic workup to identify a pathologic lead point should be initiated when an intussusception is not ileocolic in location or when an intussusception occurs at an age outside the typical infant idiopathic range.

++

Clinical Presentation

++

Severe intermittent cramping abdominal pain occurring at intervals every 15 to 20 minutes in an infant or toddler is a hallmark of intussusception and is noted in up to 95% of children with this diagnosis. The child's abdomen is generally soft and the child may seem relatively playful and well between episodes of colic. Abdominal colic is so prevalent with ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.