Intussusception

Introduction

Intussusception is the invagination of one part of the intestine into another. It is one of the most frequent causes of acute bowel obstruction in infants and toddlers, with about 75% occurring in the first 2 years and 90% in children within 3 years of age. It can also occur in older children or adults.

Intussusception is an emergent condition. Without treatment, it can cause obstruction and reduce blood flow to the intestine leading to bowel ischaemia and necrosis or even bowel perforation.

Causes

The cause for most cases of childhood intussusception is not known, although viral infections may be responsible in some cases. After an upper respiratory infection (like coughs and colds) or gastroenteritis, the enlarged lymphoid tissue at the terminal ileum can cause the invagination of the terminal ileum into the caecum and colon, leading to ileo-colic intussusception.

In some cases, however, it may be secondary to an underlying bowel pathology such as Meckel’s diverticulum, polyps, etc. which act as a lead point.

Signs and Symptoms

Children with intussusception may complain of colicky abdominal pain (intermittent irritability). Children may draw their knees up when they cry. Some will have vomiting. Some children may have blood and mucus in their stool (red currant jelly stool). Not everyone has all the symptoms so a high index of suspicion is necessary.

Diagnosis

The condition may be suspected on clinical assessment and confirmed by radiological imaging such as abdominal ultrasonography.

Treatment

Initial stabilisation

Initial treatment includes rehydration with intravenous fluid and close monitoring. If the child is in a critical condition, aggressive resuscitation is necessary. Some children may need a nasogastric tube for bowel decompression.

Reduction of intussusception

Urgent reduction of the intussuscepted bowel is required to prevent the ischaemia and necrosis of the bowel.

i. Pneumatic reduction
Non-operative pneumatic reduction is the treatment of choice if the child is stable without signs of peritonitis or bowel perforation, and there is no evidence of any lead point. Pneumatic reduction is performed under fluoroscopic guidance in the Department of Radiology in the presence of a radiologist and a paediatric surgeon. A tube is inserted into the rectum and air is released into the bowel to push the telescoping bowel back to its normal position. The overall success rate is around 80%.

After successful reduction, your child will be closely monitored for any recurrence and feeding will be restarted when appropriate. Recurrence after a successful enema reduction can occur in up to 20% of cases. A repeated abdominal ultrasound should be performed if abdominal pain or vomiting recurs.

ii. Operative reduction
Operative reduction under general anaesthesia is required if enema reduction is contra-indicated or failed. Surgery may be done with one large incision (an open procedure) or laparoscopically, with small incisions and a laparoscope (a camera).

During the procedure, the bowel is examined and a careful attempt at reduction of intussusception is carried out. After successful reduction, the bowel is examined for its viability and the presence of any bowel pathology (lead point). If the bowel is not healthy, the intussusception is not reducible or there is a bowel pathology, the segment of the abnormal bowel will be resected.

After surgery, the patient will be closely monitored. Sometimes there may be a nasogastric tube or a bladder catheter in place after surgery. Feeding will be restarted when appropriate.

Follow-up Care

Most children with intussusception recover well. They can be discharged once they are feeding normally.

The long-term outcome depends on the extent of bowel damage and the need for bowel resection. Long-term follow up will be required in children who underwent bowel resection.

References

• I, Levy N, Dreznik Y, Cytter Kuint R, Soudack M. [INTUSSUSCEPTION IN CHILDREN - GUIDELINES FOR DIAGNOSIS AND TREATMENT]. Harefuah. 2024 Jul;163(7):462-467. Hebrew. PMID: 39569957.
• Plut D, Phillips GS, Johnston PR, Lee EY. Practical Imaging Strategies for Intussusception in Children. AJR Am J Roentgenol. 2020 Dec;215(6):1449-1463. doi: 10.2214/AJR.19.22445. Epub 2020 Oct 21. PMID: 33084362.
• Sadigh G, Zou KH, Razavi SA, Khan R, Applegate KE. Meta-analysis of Air Versus Liquid Enema for Intussusception Reduction in Children. AJR Am J Roentgenol. 2015 Nov;205(5):W542-9. doi: 10.2214/AJR.14.14060. PMID: 26496576.
• Sklar CM, Chan E, Nasr A. Laparoscopic versus open reduction of intussusception in children: a retrospective review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2014 Jul;24(7):518-22. doi: 10.1089/lap.2013.0415. PMID: 24987845.

Acknowledgement

Principle author: Dr Chan Yick-ting on behalf of Department of Paediatric Surgery, HKCH

Initial posting: Oct 2026

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