Intussusception

Intussusception is a topic covered in the 5-Minute Emergency Consult.

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Basics

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

  • 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)

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Basics

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

  • 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)

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