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Virtual Pediatric Hospital: Paediapaedia: Intussusception Paediapaedia: Gastrointestinal Diseases

Intussusception

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Present early in life with 40% presenting between 3-9 months old and 75% in patients less than 2 years old. It is rare in newborns. The symptoms are colicky abdominal pain causing the infant to cry and draw their legs up onto their abdomen, vomiting, hematochezia with "currant jelly" stools, and a palpable abdominal mass.

Etiology/Pathophysiology:
Due to an invagination of part of the intestine (intussusceptum) into the distal intestine (intussuscipiens). The intussusceptum includes mesentery as well as bowel wall and compression of the mesentery leads to a compromise of venous drainage which over time can lead to arterial perfusion being reduced which can lead to subsequent infarction and necrosis. Seventy-five percent are ileocolic, 15% are ileo-ileocolic, 10% are ileoileal or colocolic. Ninety percent are idiopathic without a distinct pathological lead point, with the probable lead point being Peyer's Patches that are hypertrophied due to antecedent viral infection. The incidence of pathological lead points increases with age. In cases with distinct pathological lead points the most common is a Meckel diverticulum followed by polyps, hematoma, or lymphoma.

Pathology:
Not applicable

Imaging Findings:
The abdominal film can be normal, or it can show a rounded soft tissue mass usually in the right side of the abdomen that can cause the inferior margin of the liver to be lost. The barium or air enema will show the mass as a lobulated intraluminal filling defect that often has a coiled spring appearance.

DDX:

References:

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