Intussusception, Pediatric

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

Epidemiology

• • 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

Symptoms and Signs

• • Abdominal pain (colicky)

  • Vomiting

  • Bloody stool

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

  • Heme positive stool in 80-90%

Imaging Findings

• • 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"

Rule Out

• • Peritonitis

• • History and physical exam

  • Abdominal x-ray

  • CT or US

  • Barium enema in children should be attempted after adequate resuscitation

Surgery

• • Laparotomy and resection of intussusception if ischemic necrosis present

  • Laparoscopic reduction of intussusception if enema unsuccesful

Indications

• • Failure to reduce with barium enema

Medications

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

  • -Pneumatic preferred

Complications

• • Recurrence after enema (5%)

Prognosis

• • Spontaneously resolve in 20-30%

References