Intussusception overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
An intussusception is a situation in which a part of the intestine has prolapsed into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another.[1] The part which prolapses into the other is called the intussusceptum, and the part which receives it is called the intussuscipiens. The most frequent type of intussusception is one in which the ileum enters the cecum, however other types are known to occur, such as when a part of the ileum or jejunum prolapses into itself. Almost all intussusceptions occur with the intussusceptum having been located proximally to the intussuscipiens. The reason for this is that peristaltic action of the intestine pulls the proximal segment into the distal segment. There are, however, rare reports of the opposite being true.
Intussusception in humans is almost exclusively a disease of the young, usually those between 2 months and 36 months old. This may be a result of its link with certain childhood vaccinations. The CDC through the Federal Government of the United States through the National Vaccine Injury Compensation Program provides compensation for individuals who suffer intussusception as a result of their reaction to vaccines that contain "live, oral, rhesus-based rotavirus."[2]
Intussusception occurs more frequently in boys than in girls, with a ratio of approximately 3:1.
In adults, intussusception represents the cause of approximately 1% of bowel obstructions and is frequently associated with neoplasm, malignant or otherwise.[3]
Blood Vessel Growth
For information regarding the intussusception process of blood vessel growth, see the page intussusception (blood vessel growth)
Historical Perspective
Intussusception was first mentioned in 1674 by Barbette of Amsterdam. It was described in detail in 1789 by John Hunter. He called it "introssusception" and described it as a rare form of bowel obstruction in adults, in which telescoping of an intestine segment occurs into another segment of intestine. In 1871, a case of intussusception in a child was operated upon by Sir Jonathan Hutchinson.
Classification
Intussusception may be classified into several subtypes based on location and etiology. According to location of intussusception it is classified into subtypes:- Ileocolic, Ileo-ileo-colic, Jejuno-jejunal, Jejuno-ileal, and Colo-colic. According to etiology of intussusception it is classified into :- idiopathic or lead point(pathologic) types.
Pathophysiology
Causes
Common causes of Intussusception in children can be idiopathic and pathologic. Idiopathic causes include seasonal viral gastroenteritis, rotavirus vaccine, adenovirus infection, and bacterial enteritis. Pathologic causes of intussusception in children include henoch-schonlein purpura, cystic fibrosis, celiac disease, crohn's disease, meckel's diverticulum, polyps, duplication cysts, and lymphoma. Intussusception is adults is mostly due to a pathologic lead point. Non-idiopathic adult intestinal causes for intussusception can further be divided into benign and malignant enteric causes, and benign and malignant colonic causes.
Differentiating Intussusception from Other Diseases
Epidemiology and Demographics
Intussuception is a common pediatric emergency. The incidence of intussusception is estimated to be 2000 cases in children born in USA in the first year of life. The prevelance of intussusception does not vary with geographic and demographic distribution. Males are more commonly affected by intussusception than females. Male to female ratio is approximately 3:2. Intussusception most commonly affects children between the age of 6 months and 36 months. It can occur in adults but is mostly related to an underlying pathology (lead point).
Risk Factors
Common risk factors in the development of intussusception include male gender, age 6 to 12 months and anatomical anomaly of intestine. Less common risk factors in the development of intussusception include antecedent viral illness, seasonal variation, first generation rotavirus vaccine, meckel's diverticulum, celiac disease, polyp, cystic fibrosis, Henoch-Schönlein purpura (HSP), Post-operative, duplication cyst, lymphomas, and areas of reactive lymphoid hyperplasia.
Screening
There is insufficient evidence to recommend routine screening for intussusception.
Natural History
If left untreated, patients with intussusception may progress to develop intestinal obstruction, intestinal perforation, and peritonitis.
Complications
Common complications of intussusception include intestinal perforation,intestinal hernia, intestinal adhesion, peritonitis, intestinal necrosis, electrolyte imbalance, and recurrence of intussusception
Prognosis
Prognosis is generally excellent if diagnosed and treated early. If intussusception is not treated then intussusception can result in death in 2-5 days.
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ Template:Cite
- ↑ "Vaccines: documented risks". 2007. Retrieved 2007-11-15.
- ↑ Gayer G, Zissin R, Apter S, Papa M, Hertz M (2002). "Pictorial review: adult intussusception--a CT diagnosis". Br J Radiol. 75 (890): 185–90. PMID 11893645. Free Full Text.