Approximately 60 percent of children with intussusception are younger than one year old, and 80 to 90 percent are younger than two years. Intussusception intestinal obstruction news medical. Intussusception is the most common cause of intestinal obstruction in patients aged 5 months3 years and accounts for up to 25% of abdominal emergencies in children up to age 5. However, only 20% of patients present with this triad.
Most cases of intussusception occur in the first year or two year of life. Intussusception has long been discussed in medical literature. Clinical presentation of intussusception in swedish children under 3 years of. The pain is colicky and not continuous intermittent, but it comes back often. The peak age is 48 months and the baseline incidence varies. The child is found to have periods of lethargy alternating with crying spells, and this cycle repeats every 1530 minutes. Delayed presentation of intussusception can manifest as small bowel obstruction, bowel perforation, peritonitis andor shock. If you cant get an appointment at once, head to the. He has had several normal stools which do not contain mucous or blood.
It typically involves the small bowel and less commonly the large bowel. Intussusception is the most common cause of intestinal obstruction in children younger than 3. In most infants, the intussusception involves the ileum invaginating through the ileocecal valve into the cecum. Symptoms include abdominal pain which may come and go, vomiting, abdominal bloating, and bloody stool. Intussusception is the leading cause of abdominal surgery in children age 5 and younger. However, most cases occur in children ages 6 months to 2 years. Its clinical features, diagnosis and treatment bring out a lot of debate among clinicians. Johns hopkins university population information program. Intussusception is a rare form of bowel obstruction in adults, which is defined as the telescoping of a proximal segment of the gastrointestinal tract, into the lumen of the. Statistical analysis included descriptive analyses of age, sex, time to resolution selflimiting or surgical, length of intussusception, and frequency of ascites or smallbowel obstruction.
It occurs when a segment of the intestine telescopes or folds back on itself. Consider intussusception in infants and children with intermittent distress, vomiting or isolated unexplained lethargy. Patients aged 5 months to 3 years who have intussusception rarely have a lead point ie, idiopathic intussusception and are usually responsive to nonoperative reduction. In 1742, cornelius henrik velse performed the first successful operation on adult intussusception. Clinical presentation of intussusception in swedish children under 3. Adenoviruses in children older than age two, and to a lesser extent rotaviruses, have been implicated in up to 50% of cases. Intussusception in children presenting to the emergency. All children, aged 0 to 17 years, were identified with intussusception by international classification of diseases, ninth revision diagnostic coding.
Two thirds of patients are under one year old, the peak age being between 510 months. It is the most common cause of bowel obstruction in infants, occurring usually between 4 and 10 months of age. It is the most common cause of intestinal obstruction in this age group and occurs roughly equally in male and female children age. Intussusception is uncommon in children who are malnourished. We analyzed the data of children below 18 years of age, from the national. Intussusception is the invagination of one segment of the intestine within a more distal segment. In kids younger than 3 months old or older than 5, intussusception is more likely to be caused by an underlying condition like enlarged lymph nodes, a tumor, or a blood vessel problem in the intestines. Diagnostic imaging plays an important role in the diagnosis of the condition. The classic clinical triad of intussusception is colicky abdominal pain, vomiting and bloody stools. Intussusception generally occurs between 6 months and 3 years of age, with 65% of cases occurring before age 1 and 80 to 90% occurring before age 2. Intussusception typically presents between 6 and 36 months of age, and is the most common cause of intestinal obstruction in this age group. Intussusception, telescoping of a segment of the intestine into an adjacent segment, producing a mechanical obstruction of the alimentary canal. Evaluation of intussusception after monovalent rotavirus.
Intussusception definition of intussusception by medical. The lower age limit for adults has never been conventionally fixed. Boys are more prone to suffer from intussusception than girls. Although extremely rare, intussusception has been reported in the neonatal period. One large swiss study found an overall incidence of 38, 31 and 26 cases per 100,000 live births in the first, second and third year of life respectively. Intussusception occurs when one part of the intestine slides into the section next to it. A pediatric health information system database study.
Intussusception is the most frequent cause of intestinal obstruction during the first two years of life and commonly affects children between three to 12 months of age. A multicountry study of intussusception in children under. Intussusception in children inpatient care what you. It is more commonly secondary to an identifiable bowel lesion in 90% of cases, whereas 10% have no discernable cause. We confirmed that pediatric intussusception in south korea shows a. Intussusception often involves both small and large bowels.
Intussusception is the infolding telescoping of one segment of the intestine within another. The age distribution of intussusception incidence and number of cases were similar, with lowest incidence among children 02 months of age 37 per 100,000 and peak incidence among those 47 months of age 97 126 per 100,000. Lethargy can be the sole presenting symptom, which makes the diagnosis challenging. The peak incidence is found in children aged between 4 and 6 months.
The first sign of intussusception is very often sudden, loud crying caused by abdominal pain. In about 85% of cases the cause is idiopathic meaning unknown. Statistical analysis was performed using the spss 18. Age and sex distribution intussusception in adults can occur at any age, but this condition is much more common in infants and young children. Ileocolic or colocolonic intussusceptions are usually treated with air or contrast enema in children. Presentation, management, and outcomes of 148 patients. Congenital malformation of the intestine, such as malrotation increases the risk for intussusception.
This can cause part of the intestine to get pulled into the other. Intussusception is highly uncommon in adults and accounts for only 5% of all reported cases. Intussusception can affect both children and adults. Acute intussusception in infants and children world health. The proportion of children with intussusception who died after presenting to. The aim of this study was to evaluate the clinical presentation, diagnosis and management of patients with intussusception, with special regard to the duration of symptoms, referral from other hospitals, outcome and complications related to delayed diagnosis. The operating surgeon should be familiar with the various treatment strategies, because usually the real cause of the intussusception is diagnosed by laparotomy. From a clinical perspective, using a cutoff age of 3 years is helpful for dividing patients with intussusception into 2 groups. On the other hand, intussusception with an organic lesion as the lead point usually presents with the clinical picture of bowel obstruction 15, 16. Its the most common cause of intestinal obstruction in children under the age of 3. Intussusception is a medical condition in which a part of the intestine folds into the section immediately ahead of it. Intussusception can lead to a tear in the bowel perforation, infection and death of bowel tissue.
This clinical presentation primarily occurs in infants and is often confused with sepsis. A total of 1060 infants who were younger than 12 months of age and had intussusception were enrolled in surveillance from 29 sentinel hospitals located in seven countries. It is the most common abdominal emergency in early childhood 2. In infants, 3 boys develop intussusception for every 2 girls that do, but as children age, the rate changes sharply and the disorder becomes much more common in boys. Pdf intussusception in children clinical presentation, diagnosis. The disease is three times more common in males than in females. Two thirds of patients are under 1 year old, the peak age being between 510 months. Comparison of the clinical presentation of intussusception in.
Diagnosis is difficult due to nonspecific symptoms of the disease. The diagnosis of intussusception requires a high index of suspicion. Intussusception is the most common cause of intestinal obstruction in patients aged 5 months to 3 years and accounts for up to 25% of abdominal emergencies in children up to age 5. Adult bowel intussusception is a rare and challenging condition for the surgeon. Characteristics of intussusception among children in korea. Higher age at intussusception may point to underlying malignancy since the mean age for benign malig. Intussusception see the image below is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction. Intussusception merck manuals professional edition. Intussusception is a condition that causes part of the bowel to fold into itself like a telescope. He is normal between episodes but has decreased overall intake. Intussusception is the main cause of bowel obstruction in children aged.
This sliding is similar to how a telescope folds into itself and. Intussusception usually results in a blockage of the intestine. Intussusception occurs primarily in infants boys more often than girls but can also occur in adults and older children. The mean age at presentation th decade of life3,15,33. Delayed presentation of intussusception in childrena surgical audit. Intussusception is a medical emergency and is a condition that is as a result of one part of the intestine sliding into another. The fold blocks the bowel and its blood supply, which can damage the bowel. Patients were followed for 6 months from initial presentation or until bowel resection occurred. It is the most common cause of bowel obstruction in children. It has a presentation ranging from the classical to. From 517 potential cases identified, 476 92% cases were classified as definite, 21 probable, 10 possible and 10 suspected for intussusception. When smallbowel intussusception is detected in infants and children undergoing abdominal sonography, intussusception length greater than 3. Though rare in adults, most cases of adult intussusception are the result of an underlying medical condition, such as a tumor.
The most common type of intussusception is ileocolic also known as ileocecal 90%. This retrospective study was performed using hospital charts, ultrasound and radiological reports and surgical notes from. Joining the program was the best thing i did to help my recovery. Intussusception is the most common cause of intestinal obstruction in patients aged 5 months to 3 years. Update on the global epidemiology of intussusception.
Among the 476 definite is cases, the median age at presentation was 6. Primary intussusception is sometimes congenital and rarely appears later than the third year of life. If left untreated, intussusception in adults can lead to infection, shock, and possibly death. Intussusception in children clinical presentation, diagnosis and management. Intussusception is the most common cause of intestinal obstruction in kindergarteners, preschool children, toddlers, and in babies after the early newborn period. The presentation of intussusception differs at several points between the age groups. While ultrasound is the modality of choice in children for the diagnosis of intussusception, in adults, ct is the diagnostic modality. Intussusception is the most common cause for bowel obstruction in children aged between 6 months and 3 years. He has nonbilious emesis during some of these episodes. Sonography of pediatric smallbowel intussusception. If you suspect your child has it, call a doctor right away.
The statistical significance of differences between group 1 and group 2 were calculated with statistical software graphpad instat, graphpad software. In summary, adult intussusception commonly presents with a bowel obstructionlike. Intussusception also cuts off the blood supply to the part of the intestine thats affected. Adult intussusception a surgical dilemma m a rathore, s i h andrabi, m mansha. Age at presentation and management of pediatric intussusception. The clinical presentation in adult intussusceptions is often chronic, and most patients present with nonspecific symptoms that are suggestive of intestinal obstruction. Also, childhood intussusception a have a high rate of spontaneous or post hydrostatic reduction, whereas in adults such cases are surgically corrected. The cause of most cases of intussusception in children is unknown. It is often difficult to diagnose because of the variable presentation of symptoms in a young infant. There were 114 large bowel intussusceptions, with a mean age of 27. Intussusception is promoted by polypoidal benign neoplasms lipoma, adenoma or malignant mass lymphoma, carcinomas or enlarged lymphoid tissues following an infection or even a worm 1. The median age at presentation was 1 year interquartile range.
With early diagnosis, appropriate fluid resuscitation, and therapy, the mortality rate. Patients are found to have an intestinal process late. Age distribution of intussusception hospital admissions age distributions were fitted to all studies that had at least three age bands below the age of 1. Intussusception the invagination of a part of the intestine into itself. Intussusception occurs most often in patients between 3 to 12 months of age. Preoperative diagnosis is often missed or delayed because of nonspecific symptoms. The majority of the patients were caucasian 60 % and had public insurance 53 %. Other complications may include peritonitis or bowel. What are the clinical presentations of intussusception.
Barbette of amsterdam described the first case in 1674. Past history of intussusception increases the risk to develop it again. Patient presentation a 24monthold male came to the emergency room with a 12 hour history of colicky abdominal pain every 1520 minutes. Upon physical examination, the patient is usually chubby and in good health. Intussusception can account for as many as 25% of abdominal surgical emergencies in children younger than 5 years, exceeding the incidence of appendicitis. Epidemiology is the most common cause of intestinal obstruction in infants between 6 and 36 mo of age.
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