Overview
Intussusception describes the invagination or telescoping of the bowel into itself (where the bowel folds into the section immediately ahead of it). It is a common cause of intestinal obstruction in young children and most often occurs in the ileocaecal region.
Epidemiology
- Most commonly seen in children aged 5 months – 3 years old
- Male patients are affected 3 times as often as female patients
Presentation
Intussusception presents with colicky abdominal pain. Associated features are:
- Inconsolable crying
- Progressive and severe pain
- Vomiting which initially is non-bilious and may become bilious
- During episodes of pain, infants draw their knees up and turn pale
- Lethargy/irritability between episodes of pain
- Passing a ‘redcurrant jelly’-like stool – this is a late sign
- Right upper quadrant sausage-shaped mass
Investigations
- Ultrasound scan:
- The investigation of choice
- May show a target-shaped mass
Differential Diagnoses
Infantile colic
- Infant is <5 months of age when symptoms start and stop
- Recurrent and prolonged episodes of crying, fussing, or irritability that can occur without an obvious cause and cannot be prevented or resolved by caregivers
- There is no evidence of faltering growth, fever, or illness
- Episodes occur in the late afternoon or evening
- Drawing the knees up may also occur
Management
Overview
- Most children are treated using pneumatic reduction, which involves passing air under radiological control into the bowel and forcing the bowel back out into its normal position
- If this fails or peritonitis is present, surgery is indicated
Complications
- Ischaemia, necrosis, and perforation which can lead to peritonitis and sepsis
Prognosis
- Early diagnosis and early treatment are associated with a good prognosis
- In some cases, intussusception may spontaneously resolve
