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Intussusception
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Intussusception

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Also called

Telescoping of the Intestine

ICD-10

K56.1

Specialty

Gastroenterology

Onset

Chronic

Reviewed

July 2026
On This Page

Overview

  • Most common in infants and young children, and is usually idiopathic (no clear cause).

Typical symptoms include:

  • Sudden, colicky (intermittent) abdominal pain
  • Intermittent vomiting
  • Child drawing the knees up to the chest
  • Sometimes blood in the stool and a palpable abdominal mass
  • Ultrasound is the preferred diagnostic test in children.

Etiology & Risk Factors

-Etiology

  • Idiopathic (most common in children, ~90%)
  • No identifiable cause.
  • Often follows a viral illness (e.g., adenovirus), with enlarged Peyer patches acting as a temporary lead point.
  • Pathological lead point
  • Children (uncommon): Meckel diverticulum (most common), intestinal polyps, benign tumors, lymphoma, hematoma, hemangioma.

Adults (common): Usually caused by a neoplasm (tumor); other causes include infections, postoperative adhesions, Crohn disease, and congenital abnormalities.

-Risk Factors

  • Age 3–12 months (highest risk in children)
  • Recent viral illness
  • Children > 5 years or recurrent intussusception (more likely to have a pathological lead point)
  • Meckel diverticulum
  • Cystic fibrosis
  • IgA vasculitis (Henoch-Schönlein purpura)
  • Intestinal tumors or polyps (especially in adults)

Pathophysiology

Lead point or enlarged Peyer patches → Intestinal telescoping (intussusception) → Bowel obstruction → Lymphatic obstruction → Venous congestion → Bowel wall edema → Reduced arterial blood flow → Intestinal ischemia → Necrosis (if untreated) → Perforation → Peritonitis

Clinical Presentation

  • Symptoms

    • Sudden intermittent (colicky) abdominal pain
    • Child draws knees to the chest during pain episodes
    • Vomiting (may become bilious with bowel obstruction)
    • Bloody or “currant jelly” stool (late sign, suggests bowel ischemia)
    • Restlessness, irritability, or lethargy

    Physical signs

    • Abdominal tenderness
    • Palpable sausage-shaped abdominal mass (usually in the right upper quadrant or epigastrium)
    • Abnormal bowel sounds (high-pitched early, absent late)
Intussusception Overview
Intussusception Overview

History Taking

  • Ask about:

    • When did the abdominal pain start?
    • Is the pain intermittent (comes and goes) or constant?
    • Does the child pull the knees to the chest during pain?
    • Has the child been vomiting? Is it green (bilious)?
    • Have you noticed blood or mucus in the stool?
    • Has the child had diarrhea or constipation?
    • Is the child irritable, restless, or unusually sleepy (lethargic)?
    • Has the child had a recent viral illness (fever, cough, or cold)?
    • Has this happened before?
    • Does the child have any known bowel disease or previous abdominal surgery?

Physical Examination

  • Assess vital signs (fever, tachycardia, signs of shock)
  • Inspect the abdomen for distension
  • Palpate for abdominal tenderness
  • Feel for a sausage-shaped abdominal mass (usually in the right upper quadrant or epigastrium)
  • Look for Dance sign (empty right lower quadrant; uncommon)
  • Auscultate for high-pitched bowel sounds early or absent bowel sounds late
  • Examine the stool for blood or “currant jelly” stool

Investigations

  • Laboratory Tests

    • CBC – assess anemia or infection
    • BMP (electrolytes) – assess dehydration and electrolyte imbalance
    • Lactate – evaluate for bowel ischemia

    Imaging

    • Ultrasound abdomen (preferred in children)
      • Target sign (concentric rings)
      • Pseudokidney sign
    • CT abdomen (preferred in adults)
      • Target sign
      • Detects lead point (e.g., tumor)
      • Assesses for bowel ischemia
    • Image-guided enema
      • Used if diagnosis is uncertain and/or for reduction
      • Contraindicated if bowel perforation is suspected
    • Abdominal X-ray
      • Not the initial test
      • May show distended bowel loops if performed

Diagnosis

  • Diagnosis is based on clinical suspicion and confirmed with imaging.

    • Children: Ultrasound abdomen (preferred)
      • Target sign
      • Pseudokidney sign
    • Adults: CT abdomen (preferred)
      • Target sign
      • Identifies a pathological lead point and bowel ischemia
    • Image-guided enema
      • Used if diagnosis is uncertain and/or for reduction
      • Do not use if bowel perforation is suspected
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Related Topics

Management

  • Initial Management

    • ABCDE assessment
    • NPO (nothing by mouth)
    • IV fluids for resuscitation
    • Pain management
    • Consider NG tube for gastric decompression
    • Antibiotics if bowel ischemia or perforation is suspected
    • Urgent surgical and/or radiology consultation

    Definitive Treatment

    • Clinically stable children:
      • Image-guided pneumatic or hydrostatic enema reduction (first-line)
    • Surgery if:
      • Enema reduction fails
      • Bowel perforation or intestinal ischemia is suspected
      • Pathological lead point is present
      • Most adult cases

    After Successful Reduction

    • Observe the child.
    • Discharge if stable, asymptomatic, and tolerating oral fluids after observation.
    • Admit if symptoms persist, reduction is unsuccessful, or risk factors for recurrence/complications are present.

Complications

  • Bowel obstruction – blockage of intestinal contents.
  • Intestinal ischemia – reduced blood supply leading to bowel injury.
  • Bowel necrosis – death of bowel tissue if ischemia is prolonged.
  • Gastrointestinal (bowel) perforation – rupture of the bowel wall.
  • Peritonitis – inflammation/infection of the abdominal cavity after perforation.
  • Recurrence – intussusception can recur after successful reduction.
  •  

Prognosis

  • Intussusception is the telescoping of one part of the intestine into another.
  • It is the most common cause of bowel obstruction in infants and young children.
  • Most cases in children are idiopathic; adults usually have a pathological lead point (e.g., tumor).
  • Classic symptoms: intermittent colicky abdominal pain, vomiting, and knees drawn to the chest.
  • Currant jelly stool is a late sign and suggests bowel ischemia.
  • Ultrasound is the diagnostic test of choice in children.
  • CT abdomen is the diagnostic test of choice in adults.
  • Pneumatic or hydrostatic enema is the first-line treatment in stable children.
  • Surgery is required if enema reduction fails, perforation or ischemia is suspected, or in most adults.
  •  

Key Points / Clinical Pearls

  • Vascular emergency with high mortality (50–70%).
  • Most common cause: Superior mesenteric artery (SMA) embolism.
  • Most important risk factor: Atrial fibrillation.
  • Hallmark symptom: Severe abdominal pain out of proportion to the physical examination.
  • Classic triad: Severe abdominal pain + bloody diarrhea + atrial fibrillation.
  • CT angiography (CTA) is the test of choice.
  • Do not delay CTA while waiting for laboratory results.
  • Normal lactate does not exclude acute mesenteric ischemia early in the disease.
  • Initial treatment: ABCDE, oxygen, IV fluids, NPO, NG tube, IV antibiotics, IV heparin (if appropriate), urgent surgical/vascular consultation.
  • Peritonitis or hemodynamic instability = emergency laparotomy
  • National Center for Biotechnology Information (NIH). Child Intussusception, StatPearls.
  • Qiang H, Fu M, Feng S, et al. Repeated Ultrasound-Guided Hydrostatic Reduction for Pediatric Intussusception: Attempt Number, Interval, and Success. Eur J Med Res. 2025. PMID: 41291924.
  • MedlinePlus, National Library of Medicine (NIH). Intussusception: Medical Encyclopedia.
  • Determinants of Ultrasound-Guided Reduction Failure and Pathological Lead Points in Pediatric Intussusception. Pediatr Surg Int. 2025. PMC12909316.
  • Gfroerer S, Fiegel H, Rolle U. Twenty Years' Experience for Reduction of Ileocolic Intussusceptions by Saline Enema Under Sonography Control. Pediatr Surg Int. 2016;32:679-682. PMID: 27154198.
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