Intussusception
Comprehensive High-Yield Study Guide
Basics
1. Intussusception is the invagination of a proximal segment of the bowel into the lumen of the
adjacent distal segment.
2. The proximal, invaginating segment of the bowel is anatomically referred to as the intussusceptum.
3. The distal, receiving segment of the bowel is anatomically referred to as the intussuscipiens.
4. It is the most common cause of acute intestinal obstruction in infants and toddlers.
5. The condition most frequently occurs in children between the ages of six and thirty-six months.
6. There is a documented male predominance with a male-to-female ratio of approximately three to
one.
7. The most common anatomical variant is ileocolic intussusception.
8. Ileocolic intussusception involves the terminal ileum invaginating directly into the ascending colon.
9. Ileoileal and colocolic variants occur but are significantly less common in the general pediatric
population.
10. Adult intussusception is exceptionally rare and represents fewer than five percent of all documented
cases.
11. In adults, the condition is almost exclusively driven by a distinct, identifiable pathological lead point.
12. Pediatric intussusception occurs most frequently in the fall and winter months correlating with viral
illness seasons.
Etiology & Pathophysiology
13. Approximately 90 percent of pediatric cases are classified as idiopathic without a discrete structural
lead point.
14. Idiopathic cases are strongly believed to result from transient lymphoid hyperplasia in the intestinal
wall.
15. Hypertrophied Peyer's patches in the terminal ileum frequently act as the functional lead point in
idiopathic cases.
16. This lymphoid hyperplasia often directly follows a recent upper respiratory tract or gastrointestinal
viral infection.
17. Adenovirus is the most commonly implicated viral pathogen associated with pediatric
intussusception.
18. Pathological lead points are identified in approximately 10 percent of pediatric cases and the vast
majority of adult cases.
19. Meckel's diverticulum is the most common pathological lead point identified in children.
20. Other potential pediatric lead points include intestinal polyps, duplication cysts, and Henoch-
Schönlein purpura hematomas.
21. In adults, malignant neoplasms such as adenocarcinoma or lymphoma are the most frequent
structural lead points.
22. As the intussusceptum telescopes, it rapidly drags its associated mesentery and vascular supply
along with it.
23. The resulting severe mesenteric compression immediately causes impaired venous return and
localized bowel edema.
24. Unrelieved edema progresses to arterial compromise, resulting in subsequent bowel ischemia,
necrosis, and potential perforation.
Clinical Identification
25. The classic clinical presentation features a sudden onset of severe, intermittent, and crampy
abdominal pain.
26. Pain episodes in infants are characteristically accompanied by inconsolable crying and drawing the
legs up to the chest.
27. Between discrete episodes of severe pain, the child may appear completely normal and entirely
pain-free.
28. Non-bilious vomiting is a highly frequent early symptom that often progresses to bilious vomiting as
obstruction worsens.
29. A palpable, sausage-shaped mass is frequently appreciated in the right upper quadrant during
physical examination.
30. The right lower quadrant may feel uncharacteristically empty on palpation, a clinical finding known
as Dance's sign.
31. Progressive bowel ischemia leads to the sloughing of necrotic mucosa mixed with blood and
mucus.
32. This sloughing produces the classic, late-stage "currant jelly" stool that is highly specific to the
condition.
33. Lethargy and altered mental status can occasionally be the sole presenting signs in very young
infants.
34. Severe dehydration rapidly develops due to persistent vomiting and decreased oral intake.
35. Unrelieved intussusception can quickly lead to toxic megacolon, systemic sepsis, and potentially
fatal hypovolemic shock.
36. Adult patients typically present with chronic or subacute symptoms of intermittent bowel obstruction
rather than acute crises.
Diagnosis
37. Abdominal ultrasonography is the primary and highly preferred imaging modality for diagnosing
pediatric intussusception.
38. Ultrasound possesses a diagnostic sensitivity and specificity approaching 100 percent in
experienced hands.
39. The classic ultrasonographic finding is the "target sign" or "doughnut sign" representing concentric
bowel layers in the transverse axis.
40. In the longitudinal axis, ultrasound typically reveals the "pseudokidney sign" representing the
telescoped bowel loops.
41. Plain abdominal radiography is generally less sensitive but is strictly required to rule out free
intraperitoneal air.
42. Radiographs may reveal a visible soft tissue mass or a characteristic paucity of gas in the right
lower quadrant.
43. The "meniscus sign" may be visible on plain films representing gas outlining the apex of the
intussusceptum.
44. Contrast enema using air or barium is both a definitive diagnostic test and a highly effective
therapeutic intervention.
45. Computed tomography (CT) of the abdomen is the preferred initial diagnostic imaging modality for
suspected adult intussusception.
46. CT scans effectively identify the specific location, the length of the involved segment, and potential
underlying lead points.
47. A complete blood count is typically ordered to assess for leukocytosis indicating potential bowel
necrosis or systemic infection.
48. Serum electrolytes must be closely evaluated to identify and rapidly correct imbalances caused by
persistent vomiting and dehydration.
Management
49. Immediate intravenous fluid resuscitation is universally required to restore intravascular volume
before any diagnostic or therapeutic procedure.
50. A nasogastric tube is heavily recommended to properly decompress the stomach and significantly
reduce the risk of aspiration.
51. Non-operative reduction via image-guided hydrostatic or pneumatic enema is the primary treatment
for stable pediatric patients.
52. Pneumatic reduction using air is generally preferred over hydrostatic barium reduction due to a
lower risk of chemical peritonitis.
53. Enema reduction is strictly contraindicated if there is clear evidence of bowel perforation or severe
hemodynamic instability.
54. The overall success rate of image-guided enema reduction in stable idiopathic pediatric cases
exceeds 80 percent.
55. Recurrence of intussusception following a successful enema reduction occurs in approximately 10
percent of pediatric patients.
56. Most recurrences happen within the first 72 hours following the initial successful reduction
procedure.
57. Surgical intervention is immediately mandated if enema reduction fails or if contraindications to the
procedure are present.
58. Surgery involves a laparoscopy or laparotomy to manually reduce the bowel and resect any necrotic
intestinal segments.
59. If a definitive pathological lead point is identified during surgery, it must be completely excised to
prevent recurrence.
60. Adult intussusception nearly always requires primary surgical resection without attempting prior
enema reduction due to the high risk of underlying malignancy.