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 . Intussusception is unusual in adults, and the diagnosis is commonly overlooked. In the majority of cases in adults, a pathologic cause is identified . 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.
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 . 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 .