Highlights & Basics
- Intussusception most commonly occurs in infants between the ages of 3 and 12 months, with a peak between ages 5 and 9 months.
- Presentation often includes colicky abdominal pain, flexing of the legs, fever, lethargy, and vomiting, with blood in the stool in some cases.
- When there is clinical suspicion, imaging has a valuable role. Plain abdominal x-ray may reveal an intestinal obstruction and paucity of wind in the right lower quadrant; the presence or absence of free intra-abdominal gas will influence subsequent management, because pneumoperitoneum indicates bowel perforation and requires prompt surgical evaluation. Abdominal ultrasound undertaken by an experienced radiologist will usually establish the diagnosis; contrast enema (most often air but may be liquid contrast) is the most specific and sensitive test for diagnosis. As well as being used therapeutically, it can also be used diagnostically where doubt remains.
- The pathologic location is typically ileocecal.
- If the patient is clinically stable and perforation is not suspected, treatment involves reduction by contrast enema; air is likely to be more effective and safer than liquid. In cases where this is contraindicated or unsuccessful, or where peritonitis exists, urgent surgery is required. Open reduction is performed in uncomplicated cases and intestinal resection of threatened nonviable bowel is necessary for cases complicated by bowel ischemia, necrosis and perforation.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Transverse sonogram of the abdomen showing the donut sign (concentric rings within the lumen of a distended loop of bowel)
Abdominal x-ray showing impaired passage of barium at site of obstruction due to intussusception
Ultrasound image showing invagination of a segment of bowel into the adjacent segment
Site of intussusception as revealed by abdominal x-ray, showing the meniscus
Citations
American College of Radiology. ACR Appropriateness Criteria: Vomiting in Infants. 2020 [internet publication].[Full Text]
Gluckman S, Karpelowsky J, Webster AC, et al. Management for intussusception in children. Cochrane Database Syst Rev. 2017 Jun 1;6:CD006476.[Abstract]
American College of Radiology. ACR-SPR practice parameter for the performance of pediatric fluoroscopic contrast enema examinations. 2021 [internet publication].[Full Text]
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