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Intussusception

Intussusception is a topic covered in the 5-Minute Clinical Consult.

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5-Minute Clinical Consult

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Basics

Description

  • 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)
Geriatric Considerations
  • 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.
Pediatric Considerations
  • 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.

Epidemiology

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

  • Children
    • 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to 1/32,000 vaccinated children developed intussusception with previous versions of rotavirus vaccine which has been withdrawn.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.

Risk Factors

  • 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

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Citation

Stephens, Mark B., et al., editors. "Intussusception." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. 5minute, www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816106/all/Intussusception.
Intussusception. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816106/all/Intussusception. Accessed May 26, 2019.
Intussusception. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816106/all/Intussusception
Intussusception [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 May 26]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816106/all/Intussusception.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Intussusception ID - 816106 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816106/all/Intussusception PB - Wolters Kluwer ET - 27 DB - 5minute DP - Unbound Medicine ER -