• Most cases are idiopathic.
• Lead point: found in 75% of children over 5 years of age; found in 10% of children less than 2 years of age: polyp, duplication cyst, lymphoma, intestinal parasites, Meckel diverticulum, hematoma secondary to Henoch-Schönlein purpura, hypertrophied Peyer’s patches, duplication cysts, intramural hematoma (hemophilia), ventriculoperitoneal shunt, hemangioma proximal to the ileocecal valve is the most common site for the lead point.
• Telescoping of the bowel causes diminished venous blood flow due to compression of the veins. This results in edema and hemorrhage, leading to decreased arterial flow and ischemia and infarction.
• Ileocolic accounts for 90% of intussusceptions.
• Ileoileal and colocolic types do occur.
• Ischemia of the bowel often does not occur in the first 24 hours of intussusception.

• Male:female ratio: 2:1
• Most common from 6 to 12 months

• Bowel necrosis secondary to local ischemia
• Gastrointestinal bleeding
• Bowel perforation
• Sepsis, shock

• Timely diagnosis results in a highly favorable prognosis.
• Hydrostatic reduction by barium enema is therapeutic in 50% to 90%.
• Risk of recurrence is approximately 10% after reduction, 1% after manual reduction, and not reported after intestinal resection.

• Infection: parasites (Enterobius)
• Tumors: The association of lymphoma and intussusception is known.
• A series of 1,200 intussusceptions reported eleven lymphomas; all patients were over 3 years of age. Only one lymphoma was reduced, and a filling defect was noted in the cecum.
• Congenital: Hirschsprung disease
• Immunologic: Henoch-Schönlein purpura: often found at the same time
• Miscellaneous:
  • Meckel diverticulum: usually painless rectal bleeding
  • Incarcerated hernia
  • Incarcerated malrotation
  • Obstruction: adhesions, hernia, volvulus, stricture, bezoar, foreign body, fecal impaction, polyp

• Intermittent abdominal pain with emesis and blood and mucous stools is considered the classic presentation.
• A complete classic presentation is only found in 20% of cases.
• Colicky pain is the major symptom.
• “Currant-jelly” stools appear in about 50% of cases.

• A mass effect in the right upper quadrant may be noted.
• Absence of bowel contents in right lower quadrant (Dance sign)
• Occasionally, the intussusception can be felt on rectal examination.
• A bowel sound may be absent.

• CBC, electrolytes
• Plain abdominal films: obstruction, air-fluid levels, paucity of distal gas, soft tissue mass; may result in false-negative reading
• Barium enema: “cervix-like mass” or “coiled spring” on evacuation film

• Some of the classic symptoms may be absent on presentation, and suspicion must be sufficient to act upon.
• Hypovolemic patients will be worsened with high osmotic contrast agents.

• The bowel should be decompressed by use of an NG tube.
• An intravenous line should be placed, and fluid and electrolyte losses should be corrected.
• Contraindications to reduction by BE include peritonitis, shock, and perforation.
• Caution should be used when symptoms have been present more than 5 days and when radiologic evidence of obstruction, fever, or leukocytosis are present
• A barium enema may miss a lead point.
• A surgical consultation should be obtained before the reduction attempt, because reduction may cause perforation, and failed reduction requires surgical correction.
• Perforation during reduction occurs in 1% of cases, mostly in the transverse colon.

Q: Can my child have a recurrent intussusception?
A: Yes, the risk, though, is very low, probable below the 10% chance if the child has had a nonsurgical reduction or removal of the lead point.

Q: Can my child with constipation get this problem?
A: This is doubtful, although, in severe cases, it might be possible.

Q: What are the common ages for presentation?
A: Six months to 3 years is the age range associated with the greatest risk of intussusception, but it can occur at any age. The prevalence of pathologic conditions rises with the age of a child diagnosed with intussusception.

Ein SH, Stephens CA, Shandling B, Filler RM. Intussusception due to lymphoma. J Pediatr Surg 1986;21:786–788.

Pokorny WJ. Intussusception. In: Oski F, ed. Principles and practice of pediatrics, 2nd ed. Philadelphia: JB Lippincott, 1994:1856–1857.

Wesson D. Acute intestinal obstruction. In: Walker WA, Durie PR, Hamilton JR, et al., eds. Pediatric gastrointestinal disease. Philadelphia: BC Decker, 1991:491–492.