Intussusception
Basics
Basics
Basics
Description
Description
- The proximal bowel invaginates into the distal bowel, producing infarction and gangrene of the inner bowel:
- >80% involve the ileocecal region
- Often occurs with a pathologic lead point in children >2 yr:
- Hypertrophied lymphoid patches may be present in infants
- Children >2 yr: 1/3 of patients have pathologic lead point
- Children >6 yr: Lymphoma is the most common lead point
- Adults usually have a pathologic lead point
- The most common cause of intestinal obstruction within the first 2 yr of life
- Epidemiology in the U.S.:
- Most frequently between 5–9 mo of age
- Incidence is 2.4 cases per 1,000 live births
- Male > female predominance of 2:1
- Mortality <1%
- Morbidity increases with delayed diagnosis
ALERT
Patients, particularly those in the pediatric age group, with a picture of potential intestinal obstruction, especially with hematest-positive stool or altered mental status, need to have intussusception considered
Etiology
Etiology
- Most cases (85%) have no apparent underlying pathology
- Predisposing conditions that create a lead point for invagination, esp in children <3 mo, those >5 yr of age and adults:
- Masses/tumors:
- Lymphoma
- Lipoma
- Polyp
- Hypertrophied lymphoid patches
- Meckel diverticulum
- Infection:
- Adenovirus or rotavirus infection
- Parasites
- Foreign body
- Henoch–Schönlein purpura
- Celiac disease and cystic fibrosis (small intestine intussusception)
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