Intussusception in Children: Recognition, Diagnosis, and Treatment

Intussusception is a pediatric emergency where one segment of intestine telescopes into an adjacent segment, causing obstruction, venous congestion, and potential bowel ischemia. It is the most common cause of acute intestinal obstruction in infants 3 months to 3 years old, with a peak incidence at 5-9 months.

Clinical Presentation

• Classic triad (seen in ~40%): Intermittent severe colicky abdominal pain, vomiting, currant jelly stools (blood + mucus).
• Pain episodes: Infant draws knees up, screams, turns pale; episodes every 15-20 minutes, lasting minutes.
• Lethargy: Between episodes, child may appear shockingly limp/unresponsive—a hallmark sign.
• Palpable mass: Sausage-shaped mass in right upper quadrant or mid-abdomen (Dance's sign: emptiness in right lower quadrant).

Risk Factors

• Age 3 months - 3 years (peak 5-9 mo)
• Male predominance (3:2)
• Cystic fibrosis, Henoch-Schönlein purpura, intestinal polyps, Meckel's diverticulum, lymphoma (lead points)
• Recent viral illness (adenovirus, rotavirus) — lymphoid hyperplasia as lead point
• Post-vaccination (rotavirus vaccine: small increased risk ~1-5/100,000 doses)

Diagnosis

• Ultrasound: First-line. "Target sign" (transverse) or "pseudokidney sign" (longitudinal). Sensitivity >95%.
• Air/contrast enema: Both diagnostic and therapeutic. Performed under fluoroscopy or ultrasound guidance.

Treatment

Non-Operative Reduction (First-Line)

• Air enema (preferred) or contrast (barium/saline) enema.
• Success rate: 80-95% for ileocolic intussusception without peritonitis/perforation.
• Recurrence: 5-10% (usually within 72 hours); repeat reduction often successful.

Surgical Reduction

• Indications: Peritonitis, perforation, failed enema reduction, suspected lead point (age >3 yr or <3 mo), recurrence >2 times.
• Laparoscopic or open; manual reduction preferred; resection only if non-viable or lead point identified.

Key Points for Parents

• Sudden, intermittent, severe abdominal pain in an infant = emergency department now.
• Do not feed or give laxatives.
• Early presentation (<24 hrs) = higher enema success, lower surgery risk.
• Most children recover fully with no long-term issues.

Intussusception is frightening but highly treatable when recognized promptly. Trust your instincts—if your baby's pain pattern seems unusual, seek care immediately.