7-Month-Old Boy With Abdominal Pain and Rectal Bleeding

Jaime Shalkow, MD

Disclosures

December 17, 2015

Most intussusceptions are idiopathic; only 2%-8% of cases are caused by an underlying disease or condition that creates a pathologic lead point for the intussusception.[2] Although the cause of intussusception is unknown in 90%-95% of children, a viral etiology is suspected because of the seasonal predisposition for intussusception to occur in spring and autumn, as well as a higher incidence of adenoid hypertrophy in children with intussusceptions. Although diarrhea is a common symptom preceding intussusception, recent studies have failed to prove statistical significance of a specific viral infection as a cause for intussusception.[3]

Older children with intussusception may have lead points as the cause of the condition. These include Meckel diverticulum, cocaine abuse, laxatives, and antibiotic use. It has also been described in patients with parasites, particularly Ascaris lumbricoides, and Henoch-Schönlein purpura, where mucosal hematomas are thought to act as the lead point.[4,5,6]Acute appendicitis in patients with Burkitt lymphoma has also been reported as an etiology.[2]

Figure 5.

Figure 1.

Peutz-Jeghers syndrome , familial polyposis coli, and juvenile polyposis can also cause intussusceptions.[7]A vermiform appendix may occasionally cause the disease (Figure 5). Familial cases of intussusception have been described. Intestinal lymphomas should be suspected in all children older than 6 years with intussusception.

Compression of the mesentery at the point of invagination leads to venous stasis and edema. Goblet cells pour copious amounts of mucus into the intestinal lumen. The engorged hyperemic intestinal mucosa seeps blood, which mixes with the mucus to form the currant-jelly stool that occurs in 60% of patients (Figure 1). Tissue pressure eventually exceeds arterial pressure, and necrosis ensues within 24 hours.

The peak age at presentation is between 5 and 10 months; it is more common in males. Less than 1% of intussusceptions are found in neonates. Early diagnosis and prompt treatment prevent catastrophic complications. In 95% of cases, the intussusception is in the ileocecal area. Ileoileal and colocolic intussusceptions are rare.

After nonoperative reduction, the recurrence rate of intussusception is usually less than 10% but has been reported to be as high as 15%. Most intussusceptions recur within 72 hours; however, some recurrences have been noted as long as 36 months later. If there is more than one recurrence, a lead point is suggested. The onset of the same symptoms typically signals recurrence. Treatment for a recurrence is similar, unless a lead point is strongly suggested, which would indicate that surgical exploration is needed.

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