Intussusception involves a section of the bowel sliding or folding into itself in a telescoping motion. Often, the ileum enters the caecum.
The affected section is thickened, leading to a palpable mass, and has a narrow lumen, obstructing the passage of faeces through the bowel. It most often occurs in infants between 3 months and 2 years of age and is more common in boys.
It may be associated with other conditions:
- Viral illnesses
- Henoch-Schonlein purpura
- Cystic fibrosis
- Intestinal polyps
- Meckel diverticulum
Presentation
The typical presentation is an infant under 2 years, with an acute onset of:
- Severe, colicky abdominal pain
- Bilious (green) vomiting
- Redcurrant jelly stool (a mix of blood, mucus and stool) is a later sign
On examination, there is a “sausage-shaped” mass in the right upper quadrant.
TOM TIP: If “redcurrant jelly stool” and a “sausage-shaped” mass in the abdomen appear in your exams, think of intussusception. The typical child in the exam will have had a viral upper respiratory tract infection preceding the illness and will have features of intestinal obstruction (vomiting, absolute constipation and abdominal distention).
Management
Diagnosis is by ultrasound scan, which shows the target or doughnut sign.
Therapeutic enemas can be used to try to reduce the intussusception. Contrast, water or air is pumped into the colon to force the folded bowel out of the bowel and into the normal position.
Surgical reduction may be necessary if enemas do not work.
Bowel resection is required where it cannot be reduced, there is gangrene (due to a disruption of the blood supply) or perforation.
Last updated February 2025
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