Intussusception
Intussusception is a topic covered in the 5-Minute Emergency Consult.
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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 1st 2 yr of life
- Epidemiology in US:
- Most frequently between 5 and 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 older children 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)
- Masses/tumors:
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Citation
Rosen, Peter, et al., editors. "Intussusception." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307375/all/Intussusception.
Intussusception. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307375/all/Intussusception. Accessed December 5, 2019.
Intussusception. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307375/all/Intussusception
Intussusception [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 December 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307375/all/Intussusception.
* Article titles in AMA citation format should be in sentence-case
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BT - 5-Minute Emergency Consult
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