Intussusception

What is it?

• Common abdominal emergency in children.
• Invagination of a portion of the intestine into itself; most common is ileocolic (90%) with the lead point proximal to the ileocecal valve.

Who gets it?

• Males>Females 2:1
• 3-12 month-old age group is most common. (range 3mo-3yr)

Why?

• majority are idiopathic; Can find a lead pt in 5-10% (eg Meckel’s, lymphoma, HSP, polyp (as in Peutz-Jegher syndrome)

Presentation

• Triad of symptoms:
  1. Intermittent colicky, crampy abdominal pain (Child may appear comfortable between episodes).
  2. Emesis .
  3. Passage of bloody, mucousy stools. Bloody mucous ("Currant-Jelly") stool is a late sign resulting from engorgement of the intestine, edema and then bleeding from the mucosa.
• May also present with MS changes, sausage shaped mass

Workup

• X-ray findings:
  1. Target Sign (akaDoughnut, Bull’s Eye): RUQ, just below the liver. Due to layers of peritoneal fat surrounding and within the intussusception alternating with layers of mucosa.
  2. Crescent Sign: Soft-tissue density in LUQ projecting into the colon (leading edge).
  3. Absent Liver Edge Sign: Liver not easily identified.

Treatment: Barium/Air Enema; 10% recurrence after non-operative reduction

CHLA Board Review 2005