Pediatric emergency medicine trisk 3753 3753

Triad of bilious emesis, abdominal mass, and blood per rectum is seen
in less than 10% of cases
Intussusception should be considered in infants and toddlers with
emesis and altered mental status
Children with intussusception may arrest during a pneumatic reduction
and therefore the clinical team must be prepared
After successful enema reduction, intussusception recurs in
approximately 5% of cases within the first 48 hours
Current Evidence
Intussusception occurs when one segment of bowel invaginates into a more distal
segment. This is the leading cause of acute intestinal obstruction in infants, and it
occurs most commonly between 3 and 12 months of age. The most common
intussusception is ileocolic but the small bowel may intussuscept into itself.
Typically, this small bowel intussusception then prolapses through the ileocecal
valve ( Figs. 116.6 and 116.7 ). The intussusception continues through the colon a
variable distance, occasionally as far as the rectum, where it can be palpated on
rectal examination. Colocolic intussusceptions are rare. In infants, the lead point
for ileocolic intussusception may be hypertrophied Peyer patches. In children
older than 2 years of age, a specific lead point such as a polyp, a Meckel
diverticulum, an intestinal duplication, or a tumor should be considered. A
diarrheal illness or viral syndrome may occur several days to a week before the
onset of abdominal pain and obstruction. Henoch–Schönlein purpura has been
associated with intussusception (generally small bowel–small bowel). Small
bowel–small bowel intussusceptions may cause symptoms but generally selfresolve.
Clinical Considerations
Clinical Recognition. The primary manifestation of intussusception is colicky
abdominal pain in an infant or toddler. Children with intermittent abdominal pain
and vomiting, especially if bilious, should be evaluated for intussusception. The
condition of the patient is highly variable between being happy and playful
between episodes to critically ill children with evidence of peritonitis and shock.
Occasionally, the primary complaint may be blood per rectum or vomiting and

altered mental status.