Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Intussusception in children

INTRODUCTION

Intussusception refers to the invagination of a part of the intestine into itself. It is the most common abdominal emergency in early childhood, particularly in children younger than two years of age [1]. Intussusception is unusual in adults, and the diagnosis is commonly overlooked. In the majority of cases in adults, a pathologic cause is identified [2]. In contrast, the majority of cases in children are idiopathic.

Treatment of intussusception by hydrostatic pressure dates back to the days of Hippocrates, who recommended the use of enemas in all forms of ileus. The installation of effervescent powder and the administration of hydrogen sulfide in the colon and the retrograde passage of bougies are examples of ancient methods of intussusception reduction. In 1876 Hirschsprung reported his experience with the treatment of intussusception by enema. The first successful surgical correction of an intussusception in an infant was described in 1871 by Hutchinson. The mortality rates after surgery during the following years were considerably higher than the 35 percent mortality reported by Hirschsprung using hydrostatic pressure.

Reduction of intussusception by barium enema under fluoroscopy was first reported by Pallin and Olsson in Sweden, Retan in the United States, and Pouliquen in France in 1927; the technique was popularized by Ravitch, a surgeon at Johns Hopkins. The technique was soon taken over by radiologists as part of their responsibility.

A discussion of intussusception in adults is discussed separately. (See "Overview of management of mechanical small bowel obstruction in adults".)

EPIDEMIOLOGY

Intussusception is the most common cause of intestinal obstruction in infants between 6 and 36 months of age. Approximately 60 percent of children are younger than one year old, and 80 to 90 percent are younger than two years [3]. Intussusception is less common before three months and after six years of age. In a population-wide survey in Switzerland, the yearly mean incidence of intussusception was 38, 31, and 26 cases per 100,000 live births in the first, second, and third year of life, respectively, and was less than half that rate in older age groups [4].

                          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Aug 2014. | This topic last updated: Jul 30, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Lloyd DA, Kenny SE. The surgical abdomen. In: Pediatric Gastrointestinal Disease: Pathopsychology, Diagnosis, Management, 4th, Walker WA, Goulet O, Kleinman RE, et al (Eds), BC Decker, Ontario 2004. p.604.
  2. Erkan N, Haciyanli M, Yildirim M, et al. Intussusception in adults: an unusual and challenging condition for surgeons. Int J Colorectal Dis 2005; 20:452.
  3. Mandeville K, Chien M, Willyerd FA, et al. Intussusception: clinical presentations and imaging characteristics. Pediatr Emerg Care 2012; 28:842.
  4. Buettcher M, Baer G, Bonhoeffer J, et al. Three-year surveillance of intussusception in children in Switzerland. Pediatrics 2007; 120:473.
  5. West KW, Grosfeld JL. Intussusception. In: Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management, Wyllie R, Hyams JS (Eds), WB Saunders, Philadelphia 1999. p.427.
  6. Bhisitkul DM, Todd KM, Listernick R. Adenovirus infection and childhood intussusception. Am J Dis Child 1992; 146:1331.
  7. Guarner J, de Leon-Bojorge B, Lopez-Corella E, et al. Intestinal intussusception associated with adenovirus infection in Mexican children. Am J Clin Pathol 2003; 120:845.
  8. Hsu HY, Kao CL, Huang LM, et al. Viral etiology of intussusception in Taiwanese childhood. Pediatr Infect Dis J 1998; 17:893.
  9. Montgomery EA, Popek EJ. Intussusception, adenovirus, and children: a brief reaffirmation. Hum Pathol 1994; 25:169.
  10. Bines JE, Liem NT, Justice FA, et al. Risk factors for intussusception in infants in Vietnam and Australia: adenovirus implicated, but not rotavirus. J Pediatr 2006; 149:452.
  11. Nylund CM, Denson LA, Noel JM. Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study. J Pediatr 2010; 156:761.
  12. Blakelock RT, Beasley SW. The clinical implications of non-idiopathic intussusception. Pediatr Surg Int 1998; 14:163.
  13. Navarro O, Daneman A. Intussusception. Part 3: Diagnosis and management of those with an identifiable or predisposing cause and those that reduce spontaneously. Pediatr Radiol 2004; 34:305.
  14. St-Vil D, Brandt ML, Panic S, et al. Meckel's diverticulum in children: a 20-year review. J Pediatr Surg 1991; 26:1289.
  15. Hwang CS, Chu CC, Chen KC, Chen A. Duodenojejunal intussusception secondary to hamartomatous polyps of duodenum surrounding the ampulla of Vater. J Pediatr Surg 2001; 36:1073.
  16. Abbasoğlu L, Gün F, Salman FT, et al. The role of surgery in intraabdominal Burkitt's lymphoma in children. Eur J Pediatr Surg 2003; 13:236.
  17. Brichon P, Bertrand Y, Plantaz D. [Burkitt's lymphoma revealed by acute intussusception in children]. Ann Chir 2001; 126:649.
  18. Gupta H, Davidoff AM, Pui CH, et al. Clinical implications and surgical management of intussusception in pediatric patients with Burkitt lymphoma. J Pediatr Surg 2007; 42:998.
  19. Chen Y, Ni YH, Chen CC. Neonatal intussusception due to a cecal duplication cyst. J Formos Med Assoc 2000; 99:352.
  20. Rizalar R, Somuncu S, Sözübir S, et al. Cecal duplications: a rare cause for secondary intussusception. Indian J Pediatr 1996; 63:563.
  21. Morgan DR, Mylankal K, el Barghouti N, Dixon MF. Small bowel haemangioma with local lymph node involvement presenting as intussusception. J Clin Pathol 2000; 53:552.
  22. Tatekawa Y, Muraji T, Nishijima E, et al. Postoperative intussusception after surgery for malrotation and appendicectomy in a newborn. Pediatr Surg Int 1998; 14:171.
  23. Hamada Y, Fukunaga S, Takada K, et al. Postoperative intussusception after incidental appendicectomy. Pediatr Surg Int 2002; 18:284.
  24. Chikamori F, Kuniyoshi N, Takase Y. Intussusception due to intestinal anisakiasis: a case report. Abdom Imaging 2004; 29:39.
  25. Khuroo MS. Ascariasis. Gastroenterol Clin North Am 1996; 25:553.
  26. Choong CK, Beasley SW. Intra-abdominal manifestations of Henoch-Schönlein purpura. J Paediatr Child Health 1998; 34:405.
  27. Holmes M, Murphy V, Taylor M, Denham B. Intussusception in cystic fibrosis. Arch Dis Child 1991; 66:726.
  28. Grodinsky S, Telmesani A, Robson WL, et al. Gastrointestinal manifestations of hemolytic uremic syndrome: recognition of pancreatitis. J Pediatr Gastroenterol Nutr 1990; 11:518.
  29. Martinez G, Israel NR, White JJ. Celiac disease presenting as entero-enteral intussusception. Pediatr Surg Int 2001; 17:68.
  30. Mushtaq N, Marven S, Walker J, et al. Small bowel intussusception in celiac disease. J Pediatr Surg 1999; 34:1833.
  31. Reilly NR, Aguilar KM, Green PH. Should intussusception in children prompt screening for celiac disease? J Pediatr Gastroenterol Nutr 2013; 56:56.
  32. Cohen DM, Conard FU, Treem WR, Hyams JS. Jejunojejunal intussusception in Crohn's disease. J Pediatr Gastroenterol Nutr 1992; 14:101.
  33. Ein SH, Ferguson JM. Intussusception--the forgotten postoperative obstruction. Arch Dis Child 1982; 57:788.
  34. Linke F, Eble F, Berger S. Postoperative intussusception in childhood. Pediatr Surg Int 1998; 14:175.
  35. Kidd J, Jackson R, Wagner CW, Smith SD. Intussusception following the Ladd procedure. Arch Surg 2000; 135:713.
  36. Klein JD, Turner CG, Kamran SC, et al. Pediatric postoperative intussusception in the minimally invasive surgery era: a 13-year, single center experience. J Am Coll Surg 2013; 216:1089.
  37. Lochhead A, Jamjoom R, Ratnapalan S. Intussusception in children presenting to the emergency department. Clin Pediatr (Phila) 2013; 52:1029.
  38. West KW, Stephens B, Vane DW, Grosfeld JL. Intussusception: current management in infants and children. Surgery 1987; 102:704.
  39. Losek JD, Fiete RL. Intussusception and the diagnostic value of testing stool for occult blood. Am J Emerg Med 1991; 9:1.
  40. Yamamoto LG, Morita SY, Boychuk RB, et al. Stool appearance in intussusception: assessing the value of the term "currant jelly". Am J Emerg Med 1997; 15:293.
  41. Pumberger W, Dinhobl I, Dremsek P. Altered consciousness and lethargy from compromised intestinal blood flow in children. Am J Emerg Med 2004; 22:307.
  42. Goetting MG, Tiznado-Garcia E, Bakdash TF. Intussusception encephalopathy: an underrecognized cause of coma in children. Pediatr Neurol 1990; 6:419.
  43. Singer J. Altered consciousness as an early manifestation of intussusception. Pediatrics 1979; 64:93.
  44. Kleizen KJ, Hunck A, Wijnen MH, Draaisma JM. Neurological symptoms in children with intussusception. Acta Paediatr 2009; 98:1822.
  45. Sassower KC, Allister LM, Westra SJ. Case records of the Massachusetts General Hospital. Case 12-2012. A 10-month-old girl with vomiting and episodes of unresponsiveness. N Engl J Med 2012; 366:1527.
  46. Weihmiller SN, Monuteaux MC, Bachur RG. Ability of pediatric physicians to judge the likelihood of intussusception. Pediatr Emerg Care 2012; 28:136.
  47. Ko HS, Schenk JP, Tröger J, Rohrschneider WK. Current radiological management of intussusception in children. Eur Radiol 2007; 17:2411.
  48. Hryhorczuk AL, Strouse PJ. Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception. Pediatr Radiol 2009; 39:1075.
  49. Daneman A, Alton DJ. Intussusception. Issues and controversies related to diagnosis and reduction. Radiol Clin North Am 1996; 34:743.
  50. Lim HK, Bae SH, Lee KH, et al. Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography. Radiology 1994; 191:781.
  51. Harrington L, Connolly B, Hu X, et al. Ultrasonographic and clinical predictors of intussusception. J Pediatr 1998; 132:836.
  52. 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; 30:594.
  53. Ko SF, Tiao MM, Hsieh CS, et al. Pediatric small bowel intussusception disease: feasibility of screening for surgery with early computed tomographic evaluation. Surgery 2010; 147:521.
  54. Morrison J, Lucas N, Gravel J. The role of abdominal radiography in the diagnosis of intussusception when interpreted by pediatric emergency physicians. J Pediatr 2009; 155:556.
  55. Saverino BP, Lava C, Lowe LH, Rivard DC. Radiographic findings in the diagnosis of pediatric ileocolic intussusception: comparison to a control population. Pediatr Emerg Care 2010; 26:281.
  56. Ratcliffe JF, Fong S, Cheong I, O'Connell P. Plain film diagnosis of intussusception: prevalence of the target sign. AJR Am J Roentgenol 1992; 158:619.
  57. Roskind CG, Kamdar G, Ruzal-Shapiro CB, et al. Accuracy of plain radiographs to exclude the diagnosis of intussusception. Pediatr Emerg Care 2012; 28:855.
  58. Weihmiller SN, Buonomo C, Bachur R. Risk stratification of children being evaluated for intussusception. Pediatrics 2011; 127:e296.
  59. Meier DE, Coln CD, Rescorla FJ, et al. Intussusception in children: international perspective. World J Surg 1996; 20:1035.
  60. Al-Tokhais T, Hsieh H, Pemberton J, et al. Antibiotics administration before enema reduction of intussusception: is it necessary? J Pediatr Surg 2012; 47:928.
  61. del-Pozo G, Albillos JC, Tejedor D, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics 1999; 19:299.
  62. Daneman A, Navarro O. Intussusception. Part 2: An update on the evolution of management. Pediatr Radiol 2004; 34:97.
  63. Hadidi AT, El Shal N. Childhood intussusception: a comparative study of nonsurgical management. J Pediatr Surg 1999; 34:304.
  64. Khanna G, Applegate K. Ultrasound guided intussusception reduction: are we there yet? Abdom Imaging 2008; 33:38.
  65. Yoon CH, Kim HJ, Goo HW. Intussusception in children: US-guided pneumatic reduction--initial experience. Radiology 2001; 218:85.
  66. Shehata S, El Kholi N, Sultan A, El Sahwi E. Hydrostatic reduction of intussusception: barium, air, or saline? Pediatr Surg Int 2000; 16:380.
  67. Choi SO, Park WH, Woo SK. Ultrasound-guided water enema: an alternative method of nonoperative treatment for childhood intussusception. J Pediatr Surg 1994; 29:498.
  68. Lee JH, Choi SH, Jeong YK, et al. Intermittent sonographic guidance in air enemas for reduction of childhood intussusception. J Ultrasound Med 2006; 25:1125.
  69. Shekherdimian S, Lee SL, Sydorak RM, Applebaum H. Contrast enema for pediatric intussusception: is reflux into the terminal ileum necessary for complete reduction? J Pediatr Surg 2009; 44:247.
  70. Ein SH, Shandling B, Reilly BJ, Stringer DA. Hydrostatic reduction of intussusceptions caused by lead points. J Pediatr Surg 1986; 21:883.
  71. Dobranowski J. Manual of Procedures in Gastrointestinal Radiology, Springer-Verlag, New York 1990.
  72. Stringer DA, Babyn P. Pediatric gastrointestinal imaging and intervention, 2nd, BC Decker, Philadelphia p.2000.
  73. Ein SH, Stephens CA. Intussusception: 354 cases in 10 years. J Pediatr Surg 1971; 6:16.
  74. Guo JZ, Ma XY, Zhou QH. Results of air pressure enema reduction of intussusception: 6,396 cases in 13 years. J Pediatr Surg 1986; 21:1201.
  75. Stringer DA, Ein SH. Pneumatic reduction: advantages, risks and indications. Pediatr Radiol 1990; 20:475.
  76. Meyer JS, Dangman BC, Buonomo C, Berlin JA. Air and liquid contrast agents in the management of intussusception: a controlled, randomized trial. Radiology 1993; 188:507.
  77. Reijnen JA, Festen C, van Roosmalen RP. Intussusception: factors related to treatment. Arch Dis Child 1990; 65:871.
  78. Maoate K, Beasley SW. Perforation during gas reduction of intussusception. Pediatr Surg Int 1998; 14:168.
  79. Sohoni A, Wang NE, Dannenberg B. Tension pneumoperitoneum after intussusception pneumoreduction. Pediatr Emerg Care 2007; 23:563.
  80. Armstrong EA, Dunbar JS, Graviss ER, et al. Intussusception complicated by distal perforation of the colon. Radiology 1980; 136:77.
  81. Humphry A, Ein SH, Mok PM. Perforation of the intussuscepted colon. AJR Am J Roentgenol 1981; 137:1135.
  82. Daneman A, Alton DJ, Ein S, et al. Perforation during attempted intussusception reduction in children--a comparison of perforation with barium and air. Pediatr Radiol 1995; 25:81.
  83. Fallon SC, Kim ES, Naik-Mathuria BJ, et al. Needle decompression to avoid tension pneumoperitoneum and hemodynamic compromise after pneumatic reduction of pediatric intussusception. Pediatr Radiol 2013; 43:662.
  84. DiFiore JW. Intussusception. Semin Pediatr Surg 1999; 8:214.
  85. van den Ende ED, Allema JH, Hazebroek FW, Breslau PJ. Success with hydrostatic reduction of intussusception in relation to duration of symptoms. Arch Dis Child 2005; 90:1071.
  86. Fragoso AC, Campos M, Tavares C, et al. Pneumatic reduction of childhood intussusception. Is prediction of failure important? J Pediatr Surg 2007; 42:1504.
  87. Franken EA Jr, Smith WL, Chernish SM, et al. The use of glucagon in hydrostatic reduction of intussusception: a double-blind study of 30 patients. Radiology 1983; 146:687.
  88. Fallon SC, Lopez ME, Zhang W, et al. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg 2013; 45:1032.
  89. Davis CF, McCabe AJ, Raine PA. The ins and outs of intussusception: history and management over the past fifty years. J Pediatr Surg 2003; 38:60.
  90. Gorenstein A, Raucher A, Serour F, et al. Intussusception in children: reduction with repeated, delayed air enema. Radiology 1998; 206:721.
  91. Navarro OM, Daneman A, Chae A. Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients. AJR Am J Roentgenol 2004; 182:1169.
  92. Pazo A, Hill J, Losek JD. Delayed repeat enema in the management of intussusception. Pediatr Emerg Care 2010; 26:640.
  93. Yang CM, Hsu HY, Tsao PN, et al. Recurrence of intussusception in childhood. Acta Paediatr Taiwan 2001; 42:158.
  94. Stein M, Alton DJ, Daneman A. Pneumatic reduction of intussusception: 5-year experience. Radiology 1992; 183:681.
  95. Daneman A, Alton DJ, Lobo E, et al. Patterns of recurrence of intussusception in children: a 17-year review. Pediatr Radiol 1998; 28:913.
  96. Gray MP, Li SH, Hoffmann RG, Gorelick MH. Recurrence rates after intussusception enema reduction: a meta-analysis. Pediatrics 2014; 134:110.
  97. Pierro A, Donnell SC, Paraskevopoulou C, et al. Indications for laparotomy after hydrostatic reduction for intussusception. J Pediatr Surg 1993; 28:1154.
  98. Lin SL, Kong MS, Houng DS. Decreasing early recurrence rate of acute intussusception by the use of dexamethasone. Eur J Pediatr 2000; 159:551.
  99. Shteyer E, Koplewitz BZ, Gross E, Granot E. Medical treatment of recurrent intussusception associated with intestinal lymphoid hyperplasia. Pediatrics 2003; 111:682.
  100. Madonna MB, Boswell WC, Arensman RM. Acute abdomen. Outcomes. Semin Pediatr Surg 1997; 6:105.
  101. Koh EP, Chua JH, Chui CH, Jacobsen AS. A report of 6 children with small bowel intussusception that required surgical intervention. J Pediatr Surg 2006; 41:817.
  102. Ko SF, Lee TY, Ng SH, et al. Small bowel intussusception in symptomatic pediatric patients: experiences with 19 surgically proven cases. World J Surg 2002; 26:438.
  103. Kornecki A, Daneman A, Navarro O, et al. Spontaneous reduction of intussusception: clinical spectrum, management and outcome. Pediatr Radiol 2000; 30:58.
  104. Munden MM, Bruzzi JF, Coley BD, Munden RF. Sonography of pediatric small-bowel intussusception: differentiating surgical from nonsurgical cases. AJR Am J Roentgenol 2007; 188:275.
  105. Lvoff N, Breiman RS, Coakley FV, et al. Distinguishing features of self-limiting adult small-bowel intussusception identified at CT. Radiology 2003; 227:68.