Intussusception - Revision history

Danbot: Strip excess bold

2026-03-22T09:29:50Z

Strip excess bold

← Older revision		Revision as of 09:29, 22 March 2026
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	==Background==		==Background==
	[[File:Intussusception EN.png\|thumb\|Schematic of intussusception.]]		[[File:Intussusception EN.png\|thumb\|Schematic of intussusception.]]
	*Most common cause of intestinal obstruction in ~~'''~~6 months to 6 years~~'''~~		*Most common cause of intestinal obstruction in 6 months to 6 years
	**Peak incidence at ~~'''~~6-36 months~~'''~~		**Peak incidence at 6-36 months
	*Telescoping of proximal bowel segment (intussusceptum) into distal segment (intussuscipiens)		*Telescoping of proximal bowel segment (intussusceptum) into distal segment (intussuscipiens)
	**~~'''~~Ileocolic~~'''~~ type is most common in children		**Ileocolic type is most common in children
	**Mesenteric involvement leads to venous congestion → ischemia → bloody/mucous stool		**Mesenteric involvement leads to venous congestion → ischemia → bloody/mucous stool

	===Pediatrics===		===Pediatrics===
	*Typically ~~'''~~no pathologic lead point~~'''~~ (idiopathic in ~90% of cases <3 years)		*Typically no pathologic lead point (idiopathic in ~90% of cases <3 years)
	*If ~~'''~~> 6 years old~~'''~~, more likely to have a lead point:		*If > 6 years old, more likely to have a lead point:
	**Meckel diverticulum, duplication cyst, polyp, lymphoma, [[Henoch-Schonlein purpura]] (HSP) hematoma, Peyer patch hypertrophy		**Meckel diverticulum, duplication cyst, polyp, lymphoma, [[Henoch-Schonlein purpura]] (HSP) hematoma, Peyer patch hypertrophy
	*Often preceded by viral URI or [[gastroenteritis]] (lymphoid hyperplasia)		*Often preceded by viral URI or [[gastroenteritis]] (lymphoid hyperplasia)
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	*Rare; accounts for 1-5% of bowel obstruction in adults		*Rare; accounts for 1-5% of bowel obstruction in adults
	*80% involve small bowel		*80% involve small bowel
	*~~'''~~70% associated with pathologic lead point~~'''~~ (malignancy in up to 50% of colonic cases)		*70% associated with pathologic lead point (malignancy in up to 50% of colonic cases)

	==Clinical Features==		==Clinical Features==
	===Pediatrics===		===Pediatrics===
	*~~'''~~Intermittent, colicky abdominal pain~~'''~~ with episodes every 15-20 minutes		*Intermittent, colicky abdominal pain with episodes every 15-20 minutes
	**Child draws knees to chest during episodes		**Child draws knees to chest during episodes
	**~~'''~~Asymptomatic intervals~~'''~~ between episodes (child may appear well and playful)		**Asymptomatic intervals between episodes (child may appear well and playful)
	*[[Vomiting]] (initially non-bilious; bilious in late stages)		*[[Vomiting]] (initially non-bilious; bilious in late stages)
	*~~'''~~Lethargy~~'''~~ may be sole presentation ("neurologic intussusception")		*Lethargy may be sole presentation ("neurologic intussusception")
	**May present with isolated seizure and abdominal pain<ref>Kleizen KJ et al. Acta Paediatr. 2009;98(11):1822-4. PMID 19664012</ref>		**May present with isolated seizure and abdominal pain<ref>Kleizen KJ et al. Acta Paediatr. 2009;98(11):1822-4. PMID 19664012</ref>
	*Classic triad present in ~~'''~~only ~21% of cases~~'''~~<ref>Bruce J, et al. Intussusception: evolution of current management. ''J Pediatr Gastroenterol Nutr''. 1987;6:663-674. PMID 3430268</ref>:		*Classic triad present in only ~21% of cases<ref>Bruce J, et al. Intussusception: evolution of current management. ''J Pediatr Gastroenterol Nutr''. 1987;6:663-674. PMID 3430268</ref>:
	**Sudden colicky abdominal pain		**Sudden colicky abdominal pain
	**Palpable ~~'''~~sausage-shaped mass~~'''~~ (right upper quadrant/epigastric)		**Palpable sausage-shaped mass (right upper quadrant/epigastric)
	**~~'''~~Currant jelly stool~~'''~~ (only ~50%; ~~'''~~late finding~~'''~~ indicating mucosal ischemia)		**Currant jelly stool (only ~50%; late finding indicating mucosal ischemia)
	*~~'''~~Dance sign~~'''~~: emptiness in RLQ (cecum displaced superiorly)		*Dance sign: emptiness in RLQ (cecum displaced superiorly)
	*Late: peritonitis, [[shock]], [[sepsis]]		*Late: peritonitis, [[shock]], [[sepsis]]

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	==Evaluation==		==Evaluation==
	*Classic triad not always present — ~~'''~~maintain high index of suspicion~~'''~~		*Classic triad not always present — maintain high index of suspicion
	*Labs are nonspecific; obtain if concerned for complications:		*Labs are nonspecific; obtain if concerned for complications:
	**CBC, BMP, lactate (if concern for bowel ischemia)		**CBC, BMP, lactate (if concern for bowel ischemia)
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	[[File:Ultrasound intussusception.jpg\|thumb\|Ultrasound showing characteristic target sign for intussusception.]]		[[File:Ultrasound intussusception.jpg\|thumb\|Ultrasound showing characteristic target sign for intussusception.]]
	[[File:Intussusception long and short axis.jpg\|thumb\|Intussusception in both short axis and longitudinal view<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]		[[File:Intussusception long and short axis.jpg\|thumb\|Intussusception in both short axis and longitudinal view<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]
	*Sensitivity and specificity approach ~~'''~~100%~~'''~~ (operator dependent)		*Sensitivity and specificity approach 100% (operator dependent)
	*~~'''~~Target/doughnut sign~~'''~~ (short axis): concentric rings of bowel wall		*Target/doughnut sign (short axis): concentric rings of bowel wall
	*~~'''~~Pseudokidney sign~~'''~~ (long axis): layered appearance		*Pseudokidney sign (long axis): layered appearance
	*Can identify ~~'''~~ileo-ileal intussusception~~'''~~ (contrast enema cannot)		*Can identify ileo-ileal intussusception (contrast enema cannot)
	*Successfully implemented as ~~'''~~bedside POCUS~~'''~~ in many EDs		*Successfully implemented as bedside POCUS in many EDs
	**Technique: linear probe, graded compression over all 4 abdominal quadrants		**Technique: linear probe, graded compression over all 4 abdominal quadrants
	*Negative US does not completely exclude intermittent intussusception		*Negative US does not completely exclude intermittent intussusception

	====Other Imaging====		====Other Imaging====
	*~~'''~~Air-contrast enema~~'''~~: both diagnostic and therapeutic (see Management)		*Air-contrast enema: both diagnostic and therapeutic (see Management)
	*~~'''~~CT abdomen~~'''~~: preferred in adults<ref>Marinis A et al. Intussusception of the bowel in adults: A review. ''World J Gastroenterol''. 2009;15(4):407-411. PMID 19152443</ref>		*CT abdomen: preferred in adults<ref>Marinis A et al. Intussusception of the bowel in adults: A review. ''World J Gastroenterol''. 2009;15(4):407-411. PMID 19152443</ref>
	**Target sign, sausage-shaped mass, lead point identification		**Target sign, sausage-shaped mass, lead point identification
	**Up to 20% of adult cases lack identifiable lead point		**Up to 20% of adult cases lack identifiable lead point
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	==Management==		==Management==
	===Pediatric===		===Pediatric===
	*~~'''~~NPO~~'''~~ and IV access		*NPO and IV access
	*~~'''~~IV fluid resuscitation~~'''~~ prior to reduction		*IV fluid resuscitation prior to reduction
	*NG tube if bilious vomiting or significant distension		*NG tube if bilious vomiting or significant distension
	*~~'''~~Surgery consult~~'''~~ prior to attempted reduction		*Surgery consult prior to attempted reduction

	====Nonoperative Reduction (First-line for Stable Patients)====		====Nonoperative Reduction (First-line for Stable Patients)====
	*Indicated if no evidence of ~~'''~~perforation, peritonitis, or hemodynamic instability~~'''~~		*Indicated if no evidence of perforation, peritonitis, or hemodynamic instability
	*~~'''~~Air-contrast enema~~'''~~ (preferred at most centers):		*Air-contrast enema (preferred at most centers):
	**Success rate: ~~'''~~80-95%~~'''~~		**Success rate: 80-95%
	**Performed by radiology with surgery on standby		**Performed by radiology with surgery on standby
	**Contraindicated if perforation, peritonitis, or shock		**Contraindicated if perforation, peritonitis, or shock
	*'''Hydrostatic enema''' (saline or water-soluble contrast): alternative method		*'''Hydrostatic enema''' (saline or water-soluble contrast): alternative method
	*Rule of 3s: maximum ~~'''~~3 attempts~~'''~~ of reduction, each lasting ~~'''~~3 minutes~~'''~~, with ~~'''~~3 minutes~~'''~~ rest between		*Rule of 3s: maximum 3 attempts of reduction, each lasting 3 minutes, with 3 minutes rest between

	====Surgical====		====Surgical====
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	====Special Situations====		====Special Situations====
	*~~'''~~Ileo-ileal intussusception~~'''~~ (small bowel only, often incidental):		*Ileo-ileal intussusception (small bowel only, often incidental):
	**If stable, asymptomatic, and length <2.3 cm → expectant management reasonable (many resolve spontaneously)		**If stable, asymptomatic, and length <2.3 cm → expectant management reasonable (many resolve spontaneously)
	*~~'''~~Post-reduction observation~~'''~~: monitor for recurrence and complications for minimum 12-24 hours		*Post-reduction observation: monitor for recurrence and complications for minimum 12-24 hours

	===Adults===		===Adults===
	*~~'''~~Surgical management~~'''~~ is standard due to ~~'''~~high incidence of malignancy~~'''~~		*Surgical management is standard due to high incidence of malignancy
	*CT for preoperative planning and lead point identification		*CT for preoperative planning and lead point identification

	==Disposition==		==Disposition==
	*~~'''~~Admit~~'''~~ after successful reduction for observation (minimum 12-24 hours)		*Admit after successful reduction for observation (minimum 12-24 hours)
	*Consider discharge only if:		*Consider discharge only if:
	**Successful reduction confirmed		**Successful reduction confirmed
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	**Reliable parents with understanding of recurrence signs		**Reliable parents with understanding of recurrence signs
	**Reasonable distance to hospital		**Reasonable distance to hospital
	*~~'''~~Recurrence rate: 5-12%~~'''~~<ref>Gray MP, et al. Recurrence rates after intussusception enema reduction: a meta-analysis. ''Pediatrics''. 2014;134(1):110-9. PMID 24935999</ref><ref>Beres AL, et al. Comparative outcome analysis of the management of pediatric intussusception with or without surgical admission. ''J Pediatr Surg''. 2014;49(5):750-2. PMID 24851761</ref>		*Recurrence rate: 5-12%<ref>Gray MP, et al. Recurrence rates after intussusception enema reduction: a meta-analysis. ''Pediatrics''. 2014;134(1):110-9. PMID 24935999</ref><ref>Beres AL, et al. Comparative outcome analysis of the management of pediatric intussusception with or without surgical admission. ''J Pediatr Surg''. 2014;49(5):750-2. PMID 24851761</ref>
	**Majority of recurrences do NOT occur within first 24-48 hours		**Majority of recurrences do NOT occur within first 24-48 hours

Danbot: Expanded: POCUS technique details, rule of 3s for reduction, Dance sign, rotavirus vaccine association, ileo-ileal management, updated references with PMIDs

2026-03-21T19:36:38Z

Expanded: POCUS technique details, rule of 3s for reduction, Dance sign, rotavirus vaccine association, ileo-ileal management, updated references with PMIDs

Show changes

Ostermayer: Prepared the page for translation

2026-01-04T23:13:55Z

Prepared the page for translation

← Older revision		Revision as of 23:13, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Intussusception EN.png\|thumb\|Schematic of intussusception.]]		[[File:Intussusception EN.png\|thumb\|Schematic of intussusception.]]
	*Most common cause of intestinal obstruction in 6mo-6yr		*Most common cause of intestinal obstruction in 6mo-6yr
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	*Due to telescoping of one part of intestine into another		*Due to telescoping of one part of intestine into another
	**Mesentery involvement > ischemia, bloody/mucous stool		**Mesentery involvement > ischemia, bloody/mucous stool


	===Pediatrics===		===Pediatrics===

	*Typically no pathological lesions		*Typically no pathological lesions
	**If > 6 years old, more likely to have a lead point		**If > 6 years old, more likely to have a lead point
	***Lead points: Peyer patches, Meckel diverticulum, duplication cyst, polyp, tumor, hematoma, vascular malformation, parasite (eg Ascaris), Henoch-Schonlein purpura		***Lead points: Peyer patches, Meckel diverticulum, duplication cyst, polyp, tumor, hematoma, vascular malformation, parasite (eg Ascaris), Henoch-Schonlein purpura
	*Slight male predominance - 3:2		*Slight male predominance - 3:2


	===Adults===		===Adults===

	*Rare		*Rare
	*80% involve small bowel		*80% involve small bowel
	*70% risk of malignancy		*70% risk of malignancy


	==Clinical Features==		==Clinical Features==

	Intermittent episodes of pain are often present and may be associated with other symptoms such as:		Intermittent episodes of pain are often present and may be associated with other symptoms such as:
	*[[Vomiting]] (non-bilious, late stages bilious)		*[[Special:MyLanguage/Vomiting\|Vomiting]] (non-bilious, late stages bilious)
	*Child pulls up knees to chest		*Child pulls up knees to chest
	*Asymptomatic periods between episodes where patient has no pain		*Asymptomatic periods between episodes where patient has no pain
	**May be completely benign, smiling, playful		**May be completely benign, smiling, playful
	**Suspect intussusception if there are recurrent brief pain episodes, especially if wake child from sleep		**Suspect intussusception if there are recurrent brief pain episodes, especially if wake child from sleep
	**Later stages may be associated with [[altered mental status (peds)\|lethargy]]		**Later stages may be associated with [[Special:MyLanguage/altered mental status (peds)\|lethargy]]
	*May present as [[altered mental status (peds)\|lethargy]] alone ('''Neurologic intussusception'''), without any of the classic triad		*May present as [[Special:MyLanguage/altered mental status (peds)\|lethargy]] alone ('''Neurologic intussusception'''), without any of the classic triad
	*Neurologic intussusception has also been described as presenting with an isolated [[seizure (peds)\|seizure]] and [[abdominal pain\|abdominal pain]]<ref>Kleizen KJ et al. Acta Paediatr. 2009 Nov;98(11):1822-4</ref>		*Neurologic intussusception has also been described as presenting with an isolated [[Special:MyLanguage/seizure (peds)\|seizure]] and [[Special:MyLanguage/abdominal pain\|abdominal pain]]<ref>Kleizen KJ et al. Acta Paediatr. 2009 Nov;98(11):1822-4</ref>

	===Classic Triad===		===Classic Triad===

	The classic triad may only be present in up to 21% of cases<ref>Bruce J, Huh YS, Cooney DR, et al. Intussusception: evolution of current management. J Pediatr Gastroenterol Nutr 1987;6:663-674. </ref>		The classic triad may only be present in up to 21% of cases<ref>Bruce J, Huh YS, Cooney DR, et al. Intussusception: evolution of current management. J Pediatr Gastroenterol Nutr 1987;6:663-674. </ref>
	#Sudden colicky [[abdominal pain]]		#Sudden colicky [[Special:MyLanguage/abdominal pain\|abdominal pain]]
	#Palpable sausage shaped mass on right		#Palpable sausage shaped mass on right
	#Currant jelly stool (only 50% of cases; late manifestation of the disease)		#Currant jelly stool (only 50% of cases; late manifestation of the disease)


	===Adults===		===Adults===
	*Typically have partial/[[SBO]] symptoms
	*[[Vomiting]], [[rectal bleeding]], [[constipation]]		*Typically have partial/[[Special:MyLanguage/SBO\|SBO]] symptoms
			*[[Special:MyLanguage/Vomiting\|Vomiting]], [[Special:MyLanguage/rectal bleeding\|rectal bleeding]], [[Special:MyLanguage/constipation\|constipation]]
	*Abdominal distension		*Abdominal distension
	*Late Stage: [[sepsis]]		*Late Stage: [[Special:MyLanguage/sepsis\|sepsis]]


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Pediatric abdominal pain DDX}}		{{Pediatric abdominal pain DDX}}
			<translate>


	==Evaluation==		==Evaluation==

	*Classic Triad not always present		*Classic Triad not always present
	**Maintain high index of suspicion		**Maintain high index of suspicion
	*All labs nonspecific		*All labs nonspecific
	*Guaiac-positive stool (~50%)		*Guaiac-positive stool (~50%)


	===Imaging===		===Imaging===

	'''[[Ultrasound: Abdomen\|Ultrasound]]'''		'''[[Ultrasound: Abdomen\|Ultrasound]]'''
	[[File:Invagination Sonografie.jpg\|thumb\|Ultrasound showing characteristic target sign for intussusception.]]		[[File:Invagination Sonografie.jpg\|thumb\|Ultrasound showing characteristic target sign for intussusception.]]
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	*For adults (air contrast or barium enemas not sufficient)<ref>Marinis A et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009 Jan 28; 15(4): 407–411.</ref>		*For adults (air contrast or barium enemas not sufficient)<ref>Marinis A et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009 Jan 28; 15(4): 407–411.</ref>
	**Up to 20% of cases do not have lead point		**Up to 20% of cases do not have lead point


	==Management==		==Management==

	*Stable children with a high clinical suspicion and/or radiographic evidence of intussusception and no evidence of bowel perforation should be treated with nonoperative reduction		*Stable children with a high clinical suspicion and/or radiographic evidence of intussusception and no evidence of bowel perforation should be treated with nonoperative reduction
	**NPO		**NPO
	**Consider [[NG tube]] as indicated		**Consider [[Special:MyLanguage/NG tube\|NG tube]] as indicated
	**Air-contrast enema (reduces 80%)		**Air-contrast enema (reduces 80%)
	**Hydrostatic (saline or water-soluble contrast) may also be used		**Hydrostatic (saline or water-soluble contrast) may also be used
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	**In stable, asymptomatic patient with ileo-ileal intussusception, short length of intussusception <2.3 cm, expectant management is reasonable as many of these cases will resolve spontaneously		**In stable, asymptomatic patient with ileo-ileal intussusception, short length of intussusception <2.3 cm, expectant management is reasonable as many of these cases will resolve spontaneously
	**In all adults with intussusception due to high incidence of malignancy		**In all adults with intussusception due to high incidence of malignancy


	==Disposition==		==Disposition==

	*Consider discharge if good follow-up, reasonable distance to hospital, parents that can watch		*Consider discharge if good follow-up, reasonable distance to hospital, parents that can watch
	**Recurrence occurs 5-12% of cases<ref>Gray MP, Li SH, Hoffmann RG, Gorelick MH. Recurrence rates after intussusception enema reduction: a meta-analysis. Pediatrics. 2014 Jul;134(1):110-9.</ref><ref>Beres AL, Baird R, Fung E, Hsieh H, Abou-Khalil M, Ted Gerstle J. Comparative outcome analysis of the management of pediatric intussusception with or without surgical admission. J Pediatr Surg. 2014 May;49(5):750-2.</ref>		**Recurrence occurs 5-12% of cases<ref>Gray MP, Li SH, Hoffmann RG, Gorelick MH. Recurrence rates after intussusception enema reduction: a meta-analysis. Pediatrics. 2014 Jul;134(1):110-9.</ref><ref>Beres AL, Baird R, Fung E, Hsieh H, Abou-Khalil M, Ted Gerstle J. Comparative outcome analysis of the management of pediatric intussusception with or without surgical admission. J Pediatr Surg. 2014 May;49(5):750-2.</ref>
	**Majority of recurrence does not occur within 24-48 hours		**Majority of recurrence does not occur within 24-48 hours
	*Admission also acceptable in appropriate patient population		*Admission also acceptable in appropriate patient population


	==See Also==		==See Also==
	*[[Abdominal Pain (Peds)]]
	*[[Ultrasound: Abdomen]]		*[[Special:MyLanguage/Abdominal Pain (Peds)\|Abdominal Pain (Peds)]]
			*[[Ultrasound: Abdomen\|Ultrasound: Abdomen]]


	==References==		==References==

	<references/>		<references/>

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:GI]]		[[Category:GI]]
			</translate>

Rossdonaldson1: /* Imaging */

2021-03-11T22:25:25Z

Imaging

← Older revision		Revision as of 22:25, 11 March 2021
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	[[File:Invagination Sonografie.jpg\|thumb\|Ultrasound showing characteristic target sign for intussusception.]]		[[File:Invagination Sonografie.jpg\|thumb\|Ultrasound showing characteristic target sign for intussusception.]]
	[[File:Intussusception Subramaniam.gif\|thumbnail\|Intussusception in both short axis and longitudinal view<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]		[[File:Intussusception Subramaniam.gif\|thumbnail\|Intussusception in both short axis and longitudinal view<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]
			[[File:VolvulusCT.png\|thumb\|Intussuception as seen on abdominal CT.]]
	*Sensitivity and specificity approach 100%, but operator dependent		*Sensitivity and specificity approach 100%, but operator dependent
	**Some emergency departments have successfully implemented bedside point-of-care ultrasound		**Some emergency departments have successfully implemented bedside point-of-care ultrasound

Rossdonaldson1: /* Imaging */

2021-03-11T22:23:55Z

Imaging

← Older revision		Revision as of 22:23, 11 March 2021
Line 52:		Line 52:
	[[File:Invagination Sonografie.jpg\|thumb\|Ultrasound showing characteristic target sign for intussusception.]]		[[File:Invagination Sonografie.jpg\|thumb\|Ultrasound showing characteristic target sign for intussusception.]]
	[[File:Intussusception Subramaniam.gif\|thumbnail\|Intussusception in both short axis and longitudinal view<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]		[[File:Intussusception Subramaniam.gif\|thumbnail\|Intussusception in both short axis and longitudinal view<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]
	**Sensitivity and specificity approach 100%, but operator dependent		*Sensitivity and specificity approach 100%, but operator dependent
	***Some emergency departments have successfully implemented bedside point-of-care ultrasound		**Some emergency departments have successfully implemented bedside point-of-care ultrasound
	*Scanning technique involves using a linear probe and applying graded compression serially over all 4 quadrants of the abdomen, looking for a "bullseye lesion" in the short axis view and a "pseudokidney sign" in the longitudinal view		*Scanning technique involves using a linear probe and applying graded compression serially over all 4 quadrants of the abdomen, looking for a "bullseye lesion" in the short axis view and a "pseudokidney sign" in the longitudinal view
	*Ultrasound can diagnose ileo-ileal intussusception, whereas contrast enema cannot		*Ultrasound can diagnose ileo-ileal intussusception, whereas contrast enema cannot

Rossdonaldson1: /* Imaging */

2021-03-11T22:23:31Z

Imaging

← Older revision		Revision as of 22:23, 11 March 2021
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	===Imaging===		===Imaging===
	'''[[Ultrasound: Abdomen\|Ultrasound]]'''		'''[[Ultrasound: Abdomen\|Ultrasound]]'''
			[[File:Invagination Sonografie.jpg\|thumb\|Ultrasound showing characteristic target sign for intussusception.]]
	[[File:Intussusception Subramaniam.gif\|thumbnail\|Intussusception in both short axis and longitudinal view<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]		[[File:Intussusception Subramaniam.gif\|thumbnail\|Intussusception in both short axis and longitudinal view<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]
	**Sensitivity and specificity approach 100%, but operator dependent		**Sensitivity and specificity approach 100%, but operator dependent

Rossdonaldson1: /* Background */

2021-03-11T22:20:40Z

Background

← Older revision		Revision as of 22:20, 11 March 2021
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	==Background==		==Background==
			[[File:Intussusception EN.png\|thumb\|Schematic of intussusception.]]
	*Most common cause of intestinal obstruction in 6mo-6yr		*Most common cause of intestinal obstruction in 6mo-6yr
	**Usually occurs in 6-36 months		**Usually occurs in 6-36 months

ClaireLewis at 22:47, 5 October 2019

2019-10-05T22:47:38Z

← Older revision		Revision as of 22:47, 5 October 2019
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	===Classic Triad===		===Classic Triad===
	The classic triad may only be present in up to 21% of cases<ref>Bruce J, Huh YS, Cooney DR, et al. Intussusception: evolution of current management. J Pediatr Gastroenterol Nutr 1987;6:663-674. </ref>		The classic triad may only be present in up to 21% of cases<ref>Bruce J, Huh YS, Cooney DR, et al. Intussusception: evolution of current management. J Pediatr Gastroenterol Nutr 1987;6:663-674. </ref>
	#Sudden colicky pain		#Sudden colicky [[abdominal pain]]
	#Palpable sausage shaped mass on right		#Palpable sausage shaped mass on right
	#Currant jelly stool (only 50% of cases; late manifestation of the disease)		#Currant jelly stool (only 50% of cases; late manifestation of the disease)

	===Adults===		===Adults===
	*Typically have partial/[[SBO]] symptoms		*Typically have partial/[[SBO]] symptoms
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	*Prior to procedure, IV hydration, NG tube decompression, surgery consult		*Prior to procedure, IV hydration, NG tube decompression, surgery consult
	*Hydrostatic (saline or water-soluble contrast) enema also may be used		*Hydrostatic (saline or water-soluble contrast) enema also may be used
	'''CT ~~Abdodmen~~'''		'''CT Abdomen'''
	*For adults (air contrast or barium enemas not sufficient)<ref>Marinis A et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009 Jan 28; 15(4): 407–411.</ref>		*For adults (air contrast or barium enemas not sufficient)<ref>Marinis A et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009 Jan 28; 15(4): 407–411.</ref>
	**Up to 20% of cases do not have lead point		**Up to 20% of cases do not have lead point

ClaireLewis at 21:45, 29 September 2019

2019-09-29T21:45:23Z

← Older revision		Revision as of 21:45, 29 September 2019
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	==Clinical Features==		==Clinical Features==
	Intermittent episodes of pain are often present and may be associated with other symptoms such as:		Intermittent episodes of pain are often present and may be associated with other symptoms such as:
	*[[Vomiting]]		*[[Vomiting]] (non-bilious, late stages bilious)
	*Child pulls up knees to chest		*Child pulls up knees to chest
	*Asymptomatic periods between episodes where patient has no pain		*Asymptomatic periods between episodes where patient has no pain
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	**Suspect intussusception if there are recurrent brief pain episodes, especially if wake child from sleep		**Suspect intussusception if there are recurrent brief pain episodes, especially if wake child from sleep
	**Later stages may be associated with [[altered mental status (peds)\|lethargy]]		**Later stages may be associated with [[altered mental status (peds)\|lethargy]]
	*May have vomiting (non-bilious, late stages bilious)
	*May present as [[altered mental status (peds)\|lethargy]] alone ('''Neurologic intussusception'''), without any of the classic triad		*May present as [[altered mental status (peds)\|lethargy]] alone ('''Neurologic intussusception'''), without any of the classic triad
	*Neurologic intussusception has also been described as presenting with an isolated [[seizure (peds)\|seizure]] and [[abdominal pain\|abdominal pain]]<ref>Kleizen KJ et al. Acta Paediatr. 2009 Nov;98(11):1822-4</ref>		*Neurologic intussusception has also been described as presenting with an isolated [[seizure (peds)\|seizure]] and [[abdominal pain\|abdominal pain]]<ref>Kleizen KJ et al. Acta Paediatr. 2009 Nov;98(11):1822-4</ref>
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	*Stable children with a high clinical suspicion and/or radiographic evidence of intussusception and no evidence of bowel perforation should be treated with nonoperative reduction		*Stable children with a high clinical suspicion and/or radiographic evidence of intussusception and no evidence of bowel perforation should be treated with nonoperative reduction
	**NPO		**NPO
	**Consider NG tube as indicated		**Consider [[NG tube]] as indicated
	**Air-contrast enema (reduces 80%)		**Air-contrast enema (reduces 80%)
	**Hydrostatic (saline or water-soluble contrast) may also be used		**Hydrostatic (saline or water-soluble contrast) may also be used

ClaireLewis at 01:00, 15 September 2019

2019-09-15T01:00:56Z

← Older revision		Revision as of 01:00, 15 September 2019
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	==Clinical Features==		==Clinical Features==
	Intermittent episodes of pain are often present and may be associated with other symptoms such as:		Intermittent episodes of pain are often present and may be associated with other symptoms such as:
	*Vomiting		*[[Vomiting]]
	*Child pulls up knees to chest		*Child pulls up knees to chest
	*Asymptomatic periods between episodes where patient has no pain		*Asymptomatic periods between episodes where patient has no pain
	**May be completely benign, smiling, playful		**May be completely benign, smiling, playful
	**Suspect intussusception if there are recurrent brief pain episodes, especially if wake child from sleep		**Suspect intussusception if there are recurrent brief pain episodes, especially if wake child from sleep
	**Later stages may be associated with lethargy		**Later stages may be associated with [[altered mental status (peds)\|lethargy]]
	*May have vomiting (non-bilious, late stages bilious)		*May have vomiting (non-bilious, late stages bilious)
	*May present as lethargy alone ('''Neurologic intussusception'''), without any of the classic triad		*May present as [[altered mental status (peds)\|lethargy]] alone ('''Neurologic intussusception'''), without any of the classic triad
	*Neurologic intussusception has also been described as presenting with an isolated seizure and abdominal pain<ref>Kleizen KJ et al. Acta Paediatr. 2009 Nov;98(11):1822-4</ref>		*Neurologic intussusception has also been described as presenting with an isolated [[seizure (peds)\|seizure]] and [[abdominal pain\|abdominal pain]]<ref>Kleizen KJ et al. Acta Paediatr. 2009 Nov;98(11):1822-4</ref>
	===Classic Triad===		===Classic Triad===
	The classic triad may only be present in up to 21% of cases<ref>Bruce J, Huh YS, Cooney DR, et al. Intussusception: evolution of current management. J Pediatr Gastroenterol Nutr 1987;6:663-674. </ref>		The classic triad may only be present in up to 21% of cases<ref>Bruce J, Huh YS, Cooney DR, et al. Intussusception: evolution of current management. J Pediatr Gastroenterol Nutr 1987;6:663-674. </ref>
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	===Adults===		===Adults===
	*Typically have partial/[[SBO]] symptoms		*Typically have partial/[[SBO]] symptoms
	*Vomiting, rectal bleeding, constipation		*[[Vomiting]], [[rectal bleeding]], [[constipation]]
	*~~Distended~~		*Abdominal distension
	*Late Stage: sepsis		*Late Stage: [[sepsis]]

	==Differential Diagnosis==		==Differential Diagnosis==