Intussusception



Intussusception


Paige E. Finkelstein





  • Intussusception was first described in 1674 by Paul Barbette of Amsterdam, but it was defined by Treves in 1899.1


  • Cornelius Velse successfully operated on an adult with intussusception in 1742, but John Hutchinson was the first person to operate successfully on an infant in 1873.1,2


  • Samuel Mitchell reported the first case of successful air enema reduction in childhood in 1836.2


RELEVANT ANATOMY



  • Certain anatomic features in the GI tract may dispose a patient to intussusception, including the anterior insertion of the ileum with respect to the cecum, decreased rigidity of the cecum secondary to abnormal taeniae coli, and abnormal muscle fibers at the ileocecal valve.3


  • Hypertrophy of Peyer patches and/or mesenteric lymphadenopathy may act as a lead point for intussusception after infection.1,3


  • Many other anatomic anomalies have been identified as lead points, including Meckel diverticulum, appendix, duplication cyst, heterotrophic tissues, lipoma lymphoma, ganglioneuroma, Kaposi sarcoma, hamartomas secondary to Peutz-Jeghers syndrome, cystic fibrosis, hemorrhagic edema, pseudomembranous colitis, bacterial infections, and hematomas due to trauma.4


  • Anatomic location breakdown of intussusception5:



    • 77% Ileocolic


    • 12% Ileoileocolic


    • 5% Ileoileal


    • 2% Colocolic


    • 4% other



EPIDEMIOLOGY AND ETIOLOGY

Incidence: It is 56 per 100 000 children, with increased incidence during the winter months.4



  • The mean age of intussusception in children is 6 to 18 months, with a male predominance of 2:1.3,4


  • Intussusception is uncommon below 3 months or above 3 years of age.1


  • In the pediatric population, ileocolic intussusception is the most common type.3

Etiology: An alteration of normal peristalsis by a lesion in the bowel that creates a telescoping effect (Figure 22.1). It can occur anywhere in the small bowel or colon. Most etiologies are unknown; only 10% have identifiable cause.1,3



  • Intussusception is the most common abdominal emergency in early childhood and second most common cause of obstruction after pyloric stenosis.1,3


CLINICAL PRESENTATION

Classic presentation: A child with acute, colicky abdominal pain, knees drawn up to chest, with excessive irritability. Child may either return to normal state after episodes or appear lethargic as the pain begins to intensify again (episodes occur about every 15-25 min).1,3

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May 5, 2019 | Posted by in PEDIATRICS | Comments Off on Intussusception

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