Intussusception - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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 gas will influence subsequent management; 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.
Treatment involves reduction by contrast enema. Air is likely to be more effective and safer than liquid; in cases where this is unsuccessful or where peritonitis exists, surgery is required. Open reduction is then performed in uncomplicated cases, and intestinal resection for cases complicated by bowel necrosis and perforation.

Transverse sonogram of the abdomen showing the donut sign (concentric rings within the lumen of a distended loop of bowel)

Quick Reference

History & Exam
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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

Key Articles

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]

Referenced Articles

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22. Gluckman S, Karpelowsky J, Webster AC, et al. Management for intussusception in children. Cochrane Database Syst Rev. 2017 Jun 1;6:CD006476.[Abstract]
23. Tsou PY, Wang YH, Ma YK, et al. Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: a systematic review and meta-analysis. Am J Emerg Med. 2019 Sep;37(9):1760-9.[Abstract][Full Text]
24. Khasawneh R, El-Heis M, Al-Omari M, et al. The radiological characteristics of childhood intussusception including unusual features and rare pathological lead points. Heliyon. 2021 Jun;7(6):e07231.[Abstract][Full Text]
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27. 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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29. Hwang J, Yoon HM, Kim PH, et al. Current diagnosis and image-guided reduction for intussusception in children. Clin Exp Pediatr. 2023 Jan;66(1):12-21.[Abstract][Full Text]
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31. Beasley SW. The 'ins' and 'outs' of intussusception: Where best practice reduces the need for surgery. J Paediatr Child Health. 2017 Nov;53(11):1118-1122.[Abstract][Full Text]
32. Xie X, Wu Y, Wang Q, et al. A randomized trial of pneumatic reduction versus hydrostatic reduction for intussusception in pediatric patients. J Pediatr Surg. 2018 Aug;53(8):1464-1468.[Abstract][Full Text]
33. Flaum V, Schneider A, Gomes Ferreira C, et al. Twenty years' experience for reduction of ileocolic intussusceptions by saline enema under sonography control. J Pediatr Surg. 2016 Jan;51(1):179-82.[Abstract][Full Text]
34. Kia KF, Mony VK, Drongowski RA, et al. Laparoscopic vs open surgical approach for intussusception requiring operative intervention. J Pediatr Surg. 2005 Jan;40(1):281-4.[Abstract]
35. van der Laan M, Bax NM, van der Zee DC, et al. The role of laparoscopy in the management of childhood intussusception. Surg Endosc. 2001 Apr;15(4):373-6.[Abstract]
36. Daneman A, Navarro O. Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol. 2004 Feb;34(2):97-108.[Abstract]
37. Beres AL, Baird R, Fung E, et al. Comparative outcome analysis of the management of pediatric intussusception with or without surgical admission. J Pediatr Surg. 2014 May;49(5):750-2.[Abstract]
38. Gray MP, Li SH, Hoffmann RG, et al. Recurrence rates after intussusception enema reduction: a meta-analysis. Pediatrics. 2014 Jul;134(1):110-9.[Abstract]
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