Highlights & Basics
- Intussusception most commonly occurs in infants between the ages of 3 and 12 months, with a peak at the age of approximately 9 months.
- Presentation often includes colicky abdominal pain, flexing of the legs, fever, lethargy, and vomiting, with blood in the stool in some cases.
- When there is clinical suspicion, imaging has a valuable role. Plain abdominal x-ray may reveal an intestinal obstruction and paucity of wind in the right lower quadrant. The presence or absence of free gas will influence subsequent management; abdominal ultrasound undertaken by an experienced radiologist will usually establish the diagnosis; contrast enema (most often air but may be liquid contrast) is the most specific and sensitive test for diagnosis. As well as being used therapeutically, it can also be used diagnostically where doubt remains.
- The pathologic location is typically ileocecal.
- Treatment involves reduction by contrast enema. Air is likely to be more effective and safer than liquid; in cases where this is unsuccessful or where peritonitis exits, surgery is required. Open reduction is then performed in uncomplicated cases, and intestinal resection for cases complicated by bowel necrosis and perforation.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Intussusception: blood vessels become trapped between layers of intestine, leading to reduced blood supply, edema, strangulation of bowel and gangrene. Sepsis, shock, and death may eventually occur.
Transverse sonogram of the abdomen showing the donut sign (concentric rings within the lumen of a distended loop of bowel)
Abdominal x-ray showing impaired passage of barium at site of obstruction due to intussusception
Ultrasound image showing invagination of a segment of bowel into the adjacent segment
Site of intussusception as revealed by abdominal x-ray, showing the meniscus
Citations
American College of Radiology. ACR Appropriateness Criteria: Vomiting in Infants. 2020 [internet publication].[Full Text]
Navarro O, Dugougeat F, Kornecki A, et al. The impact of imaging in the management of intussusception owing to pathologic lead points in children. A review of 43 cases. Pediatr Radiol. 2000 Sep;30(9):594-603.[Abstract]
American College of Radiology. ACR-SPR practice parameter for the performance of pediatric fluoroscopic contrast enema examinations. 2021 [internet publication].[Full Text]
Daneman A, Navarro O. Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol. 2004 Feb;34(2):97-108.[Abstract]
Daneman A, Navarro O. Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol. 2004 Feb;34(2):97-108.[Abstract]
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21. O'Ryan M, Lucero Y, Pena A, et al. Two year review of intestinal intussusception in six large hospitals of Santiago, Chile. Pediatr Infect Dis J. 2003;22:717-721.[Abstract]
22. American College of Radiology. ACR Appropriateness Criteria: Vomiting in Infants. 2020 [internet publication].[Full Text]
23. del-Pozo G, Albillos JC, Tejedor D, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics. 1999 Mar-Apr;19(2):299-319.[Abstract][Full Text]
24. Gluckman S, Karpelowsky J, Webster AC, et al. Management for intussusception in children. Cochrane Database Syst Rev. 2017 Jun 1;6:CD006476.[Abstract]
25. Navarro O, Dugougeat F, Kornecki A, et al. The impact of imaging in the management of intussusception owing to pathologic lead points in children. A review of 43 cases. Pediatr Radiol. 2000 Sep;30(9):594-603.[Abstract]
26. Daneman A, Navarro O. Intussusception. Part 1: a review of diagnostic approaches. Pediatr Radiol. 2003 Feb;33(2):79-85.[Abstract]
27. American College of Radiology. ACR-SPR practice parameter for the performance of pediatric fluoroscopic contrast enema examinations. 2021 [internet publication].[Full Text]
28. Byrne AT, Goeghegan T, Govender P, et al. The imaging of intussusception. Clin Radiol. 2005 Jan;60(1):39-46.[Abstract]
29. Kim JH. US features of transient small bowel intussusception in pediatric patients. Korean J Radiol. 2004 Jul-Sep;5(3):178-84.[Abstract][Full Text]
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32. Ko HS, Schenk JP, Tröger J, et al. Current radiological management of intussusception in children. Eur Radiol. 2007 Sep;17(9):2411-21.[Abstract]
33. Daneman A, Navarro O. Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol. 2004 Feb;34(2):97-108.[Abstract]
34. Xie X, Wu Y, Wang Q, et al. A randomized trial of pneumatic reduction versus hydrostatic reduction for intussusception in pediatric patients. J Pediatr Surg. 2018 Aug;53(8):1464-1468.[Abstract][Full Text]
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36. Kia KF, Mony VK, Drongowski RA, et al. Laparoscopic vs open surgical approach for intussusception requiring operative intervention. J Pediatr Surg. 2005 Jan;40(1):281-4.[Abstract]
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Key Articles
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