Critical Care Medicine
Gastrointestinal Emergencies: Intussusception
1. Description of the problem
What every clinician needs to know
Intussusception is defined as a "telescoping" of the intestine into itself. Idiopathic intussusception occurs predominantly in children under the age of 3 years and is rare after the age of 6. However, if there is a pathologic cause intussusception can occur at any age, including in adults.
Sudden onset of severe crampy episodic abdominal pain
Vomiting (can become bilious)
Often asymptomatic between episodes
Currant-jelly stools (classic description but found in less than 10% of children)
Key management points
Trial of non-operative reduction of intussusception - contrast or air enema
Surgical reduction of intussusception
2. Emergency Management
Stabilize the hemodynamic status of the child - due to significant vomiting and anorexia due to pain, many children are at least moderately dehydrated when presenting for possible intussusception. Aggressive fluid resuscitation is often necessary followed by a high index of suspicion and early identification with abdominal ultrasound.
Ultrasound - classic imaging modality identifying a "bull's eye" lesion. Can also detect the possibility of a lead point.
CT scan - can be used if US cannot be performed or cannot detect a lesion and is able to detect a possible lead point; however, given the risks of CT scan, including radiation exposure and time/sedation, it is not the preferred method of diagnosis.
4. Specific Treatment
Non-surgical reduction: Studies have demonstrated an 80-95% reduction rate of ileo-colonic intussusceptions with non-surgical methods, most commonly a contrast or air enema performed by radiology. Small bowel intussusceptions (ileo-ileal, jejuno-ileal, jejuno-jejunal) can be reduced non-surgically but are more likely to require surgical intervention. Sigmoid intussusceptions can often be reduced endoscopically with a colonoscope.
Surgical reduction: Surgical reduction is necessary if non-surgical reduction is unsuccessful or if there are signs of perforation.
5. Disease monitoring, follow-up and disposition
Idiopathic intussusception requires no disease monitoring and the long-term outcome is excellent.
The outcome of intussusception with an identified lead point depends on the underlying disorder.
Intussusception can be divided into idiopathic intussusception and intussusception with a lead point. Idiopathic intussusception is predominantly limited to children under the age of 6 and is most common between 3-36 months of age. Lead point intussusception can occur at any age and varies with the underlying condition.
Idiopathic intussusception may be triggered by a virus or other infection. A true cause-and-effect relationship is difficult to prove, although an abundance of evidence suggests a viral trigger, including seasonal variation, associated with early form of rotavirus vaccine, association with a known viral illness prior to intussusception in up to 40% of cases in multiple populations. Adenovirus may have the strongest association with intussusception.
Meckel's diverticulum (most common)
Stool (typically in cystic fibrosis with inspissated stool)
Inflammatory disorders (Crohn's, celiac)
Idiopathic intussusception: Appromately 75% of childhood intussusception cases are idiopathic or believed to be caused by a viral etiology.
Lead point intussusception: The remaining 25% of intussusceptions are due to a specific lead point.
Recurrent intussusception: Up to 10% of children may have a recurrence of intussusception after reduction. Any child with 2 occurrences of intussusception should undergo a complete work-up as a lead point is commonly identified in recurrent intussusception.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Sign Up for Free e-newsletters
Regimen and Drug Listings
GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION
|Head and Neck Cancer||Regimens||Drugs|
|Renal Cell Carcinoma||Regimens||Drugs|
Cancer Therapy Advisor Articles
- Metastatic Prostate Cancer Responds to Novel Radiation Therapy
- Clinical Applications of Liquid Biopsies in Cancer
- Two-Drug Combination Superior to Sunitinib in Patients With Untreated Advanced Renal Cell Carcinoma
- Radical Prostatectomy Compared With Watchful Waiting in Localized Prostate Cancer
- Immunotherapy in Glioblastoma: Peaks and Pits
- Treatment Guidelines in Cancer: Assessing Industry Influence on Recommendations
- American Society of Breast Surgeons Recommends Genetic Testing for All Patients With Breast Cancer
- No Benefit Seen From HSCT in Hypodiploid B-ALL
- Patients With CP-CML Deemed Less Likely to Continue Taking Generic Imatinib
- Opinion: Understanding the FDA's Take on Cannabidiol