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- Invagination (telescoping) of a portion of intestine into itself
- May involve any part of small intestine or ileocolic (95%) or colocolic segment
- System(s) affected: gastrointestinal (GI)
- 5% of all intussusceptions occur in adults.
- <5% of intestinal obstruction cases in adults are due to intussusception.
- 90% of adult cases have pathologic lead point.
- Most common abdominal emergency in infancy
- Most are idiopathic ileocolic intussusceptions; pathologic lead point identified only in 2–12%
- Postoperative intussusception (1 to 24 days postoperatively) typically involves the small bowel and is difficult to reduce hydrostatically.
Incidence: 30 per 100,000 infants annually in the United States
- Predominant age
- 5 to 10 months (~65% are <1 year of age)
- Only 10–25% of cases occur after 1 year of age.
- Predominant sex: male > female (3:2). Male preponderance is more obvious in older infants.
Etiology and Pathophysiology
- Marked hypertrophy of Peyer patches: 92–98%
- Lead point in 2–12%
- Meckel diverticulum, duplication cyst, aberrant tissue, intestinal polyp, ectopic pancreas, lymphoma, Henoch-Schönlein purpura as causes of pathologic lead point (if identified)
- Allergic reactions, diet changes, and changes in intestinal activity may be contributory.
- Idiopathic intussusceptions commonly associated with preceding adenovirus infection (24–40%)
- 1/10,000 to 1/32,000 vaccinated children developed intussusception with previous versions of rotavirus vaccine which has been withdrawn.
- Safety and efficacy trials of newer rotavirus vaccines (RV1 [Rotarix] and RV5 [RotaTeq]) show minimal intussusception risk (5.3 per 100,000 infants with RV1 and 1.5 excess cases of intussusception per 100,000 with RV5).
- Adults: Pathologic lead point is typical.
- Neoplasm in 70% of adult intussusceptions
- Intussusception of small bowel is usually caused by benign neoplasms; large bowel is usually caused by malignant neoplasms.
- Any syndrome with polyp or hamartoma (i.e., Peutz-Jeghers syndrome, Cowden syndrome) can provide a lead point.
- Age (<1 year of age)
- Recent upper respiratory tract infection (24–40%)
- Recent operation (1 to 24 days previously)
- Recent viral GI illness
- Meckel diverticulum
- Recent operative procedure
- Intestinal polyp or neoplasia
Commonly Associated Conditions
- Henoch-Schönlein purpura
- Intussusception is a rare but well-recognized complication.
- Cystic fibrosis
- Intussusceptions occur in ~1% of cystic fibrosis patients.
- Lymphoma (rare)
- Polyps (rare)
- Small bowel carcinoma
- Peutz-Jeghers syndrome