Intussusception

Abstract

Intussusception is a common pathology affecting young children, mostly between 6 and 36 months of age. In most cases, the ileum telescopes into the cecum causing an intestinal obstruction. The child presents with intermittent cramping abdominal pain and emesis, which can progress to bilious emesis, bloody mucous stools and shock if not treated in a timely fashion. Ultrasound is the diagnostic tool of choice. Fluoroscopic reduction should be attempted in all patients without contraindications and is successful in around 90%. If unsuccessful, a second delayed attempt can be made in the otherwise well child. When this too is unsuccessful, or if the child is in shock or has peritonitis, they will need to be taken to the operating room for an operative reduction. In rare cases, especially in older children, the intussusception is not idiopathic but caused by a pathologic lead point, such as a Meckel diverticulum, an enteric duplication cyst or a medical disease such as Burkitt lymphoma or Henoch-Schonlein purpura (IgA vasculitis).