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Intussusception in children

Authors
Nghia "Jack" Vo, MD
Thomas T Sato, MD, FACS, FAAP
Section Editors
Jonathan I Singer, MD
B UK Li, MD
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Intussusception refers to the invagination (telescoping) 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]. The majority of cases in children are idiopathic, and pathologic lead points are identified in only 25 percent of cases involving children [2]. Intussusception is unusual in adults, and the diagnosis is commonly overlooked. In the majority of cases in adults, a pathologic cause is identified [3].

The first successful surgical correction of intussusception in an infant was described in 1871 by Hutchinson. In 1876, Hirschsprung reported his experience with the treatment of intussusception by enema. This technique was associated with approximately 35 percent mortality, considerably better than the mortality rates after surgery. Reduction of intussusception by fluoroscopy-guided enema was described as early as 1927, and was soon incorporated by radiologists as part of their expertise. The technique has further evolved to include ultrasound as an additional imaging option. Reduction was traditionally performed using barium or other liquid contrast agents (hydrostatic enema), but can also be performed using air or carbon dioxide (pneumatic enema) [4].

The clinical manifestations, diagnosis, and management of intussusception in infants and children are discussed below. Intussusception in adults is presented separately. (See "Overview of management of mechanical small bowel obstruction in adults".)

EPIDEMIOLOGY

Intussusception typically presents between 6 and 36 months of age, and is the most common cause of intestinal obstruction in this age group. Approximately 60 percent of children with intussusception are younger than one year old, and 80 to 90 percent are younger than two years [5]. 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 [6]. After the third year of life, the incidence fell to less than one-half of these rates.

Although intussusception is most common in infants and toddlers, it is important to consider this diagnosis in children outside this age range. About 10 percent of cases occur in children over five years; 3 to 4 percent in those over 10 years; and 1 percent in infants younger than 3 months [6,7]. When intussusception does occur outside of the typical age range, it is likely to be associated with a pathological lead point, which may include reactive lymphoid hyperplasia (see 'Lead point' below).  

                                  
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Literature review current through: Nov 2017. | This topic last updated: Nov 10, 2017.
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