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