Summary of Intussusception
PATHOLOGY & CAUSES
Condition that occurs when part of intestine folds into adjacent section → obstruction
Ileocecal region most commonly affected
May be idiopathic/caused by abnormal structure (causes pathological lead point) → peristalsis causes one part of bowel to move ahead of adjacent section → bowel telescoping → ↑ pressure, impaired venous return → bleeding, bowel ischemia, infarction
Adults: abnormal growth (e.g. polyp, tumor)
Infants: post-infection lymphoid hyperplasia (Peyer’s patches), Meckel’s diverticulum
- Most common < 24 months old, intestinal malrotation history, previous intussusception, intussusception in sibling, biologically male
- Peritonitis, sepsis
SIGNS & SYMPTOMS
Intermittent abdominal pain (worsens with peristalsis)
Straining efforts, draw knees toward chest
Sausage-like abdominal mass
“Red currant jelly” stool (blood, mucus)
Ultrasound, X-ray, CT scan
Telescoped intestine: visualized as classic bull’s-eye image
Intestinal obstruction signs
- May be felt during digital rectal examination (children)
- Free telescoped intestine portion → clear obstruction → remove necrotic tissue
- Reduction by air/hydrostatic contrast material enema (e.g. saline, barium)
Transcript for Intussusception
Content Reviewers:Rishi Desai, MD, MPH, Kyle Slinn, RN, BScN, MEd, Vincent Waldman, PhD, Tanner Marshall, MS
Intussusception is a condition that occurs when a part of the intestine folds into another section of intestines, resulting in obstruction.
This is commonly referred to as telescoping, because it’s similar to how one part of a collapsible telescope retracts into another part.
Intussusception is the most common cause of intestinal obstruction in infants and young children, with about two-thirds of them happening among infants under one year of age, though adults can occasionally have intussusception too.
Now, intussusception usually happens in the ileocecal region of the intestines, which is where the ileum of the small intestine and cecum of the large intestine meet, and almost all intussusceptions happen when the ileum folds, or telescopes, into the cecum.
In adults, telescoping is usually caused by an abnormal growth in the intestine, like a polyp or a tumor, which serves as a lead point or leading edge.
What happens is that the normal wave-like contractions of the intestine, called peristalsis, grab this leading edge and pull it into the part of the bowel ahead of it.
In babies the leading edge is most often caused by lymphoid hyperplasia, or the enlargement of lymphoid tissue.
There are a ton of tiny lymph nodes sprinkled throughout the intestines called Peyer’s patches, and they’re particularly common in the ileum.
When a child gets some sort of viral infection in the gastrointestinal tract, usually caused by rotavirus or norovirus, the Peyer’s patches enlarge to help fight off the infection, and sometimes become a lead point that drags the ileum into the cecum, causing intussusception.
Intussusception can also be caused by a Meckel’s diverticulum, which is an abnormal outpouching of gastrointestinal tissue, that sticks out of the ileum and into the peritoneal cavity.
Occasionally, the diverticulum can invert and stick back into the intestine, allowing it to serve as a lead point that again drags the ileum into the cecum.
Although these are well known mechanisms for intussusception, the majority of cases are considered idiopathic, meaning that they happen without a clear cause.
Risk factors include having had one previously or having a sibling with intussusception, as well as having intestinal malrotation - which is a condition where the intestine doesn't rotate correctly during fetal development.
Now, when an intussusception develops, the first sign is intermittent abdominal pain that worsens with peristalsis, sometimes causing a child to guard their abdomen—for example, they may swat away the hands of a caretaker—or draw their knees up toward the chest.
Other classic findings include vomiting, and the presence of a hard sausage-like mass in the abdomen.
There’s also a lot of pressure on the walls of the trapped section of bowel which squeezes shut the tiny blood vessels running in the walls, causing ischemia—or lack of blood flow—and infarction—death of the tissues.