Intussusception
Intussusception is a telescoping of
the intestine into itself
statistical analysis
morbidity: 1/2000
age ：The disease occurs most commonly in children
between 6 and 18 months of age, but has been
described in all age groups including babies in metra
and in adults.
the ratio of male and female ：2:1-3:1
The most common form is ileo-colic in 80–90% of
cases（the other forms including ileo-ileo-colic、
ileo-ileal、colo-colic、jejuno-jejunal、caeco-colic）
aetiology
1、Idiopathic (or Primary) Intussusception（do not
have a pathologic lead point）： the vast majority
of cases of intussusception do not have a
pathologic lead point and are classified as primary or
idiopathic intussusceptions ； Most cases of
primary intussusception occur in children between the
ages of 6 to 36 months of age ； there is a high
susceptibility to these viruses which is generally
attributed to hypertrophied Peyer’s patches
（lymphoid tissue）within the ileal wall leading to
intestinal stenosis。
aetiology
2、Secondary Intussusception（especially after 2 years
of age）.
The most common pathologic lead point is a
Meckel’s diverticulum 、 polyps and duplications .
Other benign lead points are the appendix,
hemangiomas, carcinoid tumors, ectopic pancreas
and lipomas. Malignant causes, which are very rare,
include lymphomas ，lymphosarcomas, small bowel
tumors, and melanomas.
clinical presentation
Intermittent, crampy abdominal pain ：The abdominal
pain is sudden in onset in a child who was previously
comfortable. During painless intervals, the child
might look comfortable。the cramping episodes
usually occur every 15 to 30 minutes accomanying
the rate of regular peristaltic activities.
vomitting：As the obstruction worsens, the child will
have bilious emesis
physical examination
abdominal mass：During painless intervals，a tender
mass might be palpable anywhere in the abdomen or
even visualized if the child is relatively thin，The
right lower abdominal quadrant may appear flat or
empty (Dance’s sign) 。
fecal blood：The progression of bowel ischemia,
sloughing of mucosa, and compression of the mucous
glands within the intussusceptum leads to the
evacuation of dark, or “currant jelly” stool. The
latter is often a late sign.
Abdominal Radiography
In about half of cases, the diagnosis of
intussusception can be suspected on plain flat and
upright abdominal radiographs：include “coiled
spring ” sign ；However, plain films have limited
value in confirming the diagnosis and cannot be used
as the sole diagnostic test。
Ultrasonography
This transverse sonographic finding has been referred
to as a “target” lesion ，The “pseudokidney” sign
is seen on a longitudinal section；
nonoperative managemant(enema)
Enema：Hydrostatic Reduction and Pneumatic
Reduction
The advantages of nonoperative ： are decreased
morbidity, cost, and length of hospitalization.
contraindications to nonoperative reduction are：
intestinal perforation, peritonitis, or persistent
hypotension.
Hydrostatic or Pneumatic reduction
hydrostatic or Pneumatic reduction are preferred
under fluoroscopic or ultrasound guidance 。
Complications of the reduction are perforation and
contrast medium intraperitoneally。
nonoperative managemant
1、Hydrostatic reduction：Hydrostatic reduction was
always done by a barium 。Successful reduction
patients is seen in about 85% of cases；
2、Pneumatic Reduction：The procedure is
fluoroscopically monitored as air is insufflated into
the rectum；
The maximum safe air pressure is 80 mm Hg for
younger infants and 110 to 120 mm Hg for older
infants;
In comparison to barium enema ,the method is
quicker and safer, decreases the exposure time to
radiation , no risk of barium peritonitis and a higher
reduction rate (75 vs. 90%).
operative treatment
Surgery is indicated when nonoperative reduction is
unsuccessful or incomplete for peritonitis, for the
presence of a pathologic lead point, or for
radiographic evidence of pneumoperitoneum;
Once the leading edge of the intussusceptum is
identified, it is gently manipulated back toward its
normal position in the terminal ileum；
recurrent intussusception
Recurrent intussusception has been described in 2%
to 20% of cases (average about 5%), with about one
third occurring within 24 hours and the majority
within 6 months of the initial episode； they are less
likely to occur after surgical reduction or resection
comparing to enema reduction。