Is intussusception common in 10-month-old infants?

Intussusception in 10-Month-Old Infants

Intussusception is uncommon but not rare in 10-month-old infants, with peak incidence typically occurring between 3-9 months of age. 1 It represents one of the most common pediatric abdominal emergencies in young children, particularly in those between 3 months and 5 years of age. 2

Epidemiology and Risk Factors

• Incidence rates in Europe range from 0.66 to 2.24 per 1,000 children in inpatient settings 1
• Most cases (80%) occur in children under 12 months of age, with median age of 7 months 3
• Peak incidence occurs in the 3-9 month age range 1
• By 10 months of age, the incidence begins to decline from its peak
• Most cases (75-90%) are idiopathic, with only 10-25% associated with a pathologic lead point 2

Clinical Presentation

The classic triad of intussusception symptoms is present in only 29-33% of patients: 1

• Intermittent abdominal pain (present in 80% of cases) 4
• Palpable abdominal mass (present in 60% of cases) 4
• Bloody stools, often described as "currant jelly" (present in 53% of cases) 4

Additional common symptoms include:

• Nonbilious vomiting 2
• Lethargy (present in 45% of cases) 4
• Altered mental status in younger patients 2

Diagnosis

• Ultrasound is the diagnostic modality of choice 2
• Plain radiography may assist in evaluating for obstruction and perforation 2
• Air enema can both confirm diagnosis and provide therapeutic reduction 3

Management

• Prompt reduction of the intussusception is essential 2
• In stable patients without evidence of perforation, non-operative reduction with hydrostatic or pneumatic enema should be attempted first 2
• Success rates for air reduction are approximately 82% 3
• Surgical intervention is necessary for patients who are unstable, peritonitic, or have a focal lead point 2
• Recurrence occurs in approximately 10% of patients 1

Risk Factors for Complications

Factors associated with increased risk of intestinal resection include: 3

• Abdominal distension (32%)
• Bowel obstruction on abdominal X-ray (27%)
• Hypovolemic shock (40%)
• Symptoms present for more than 48 hours 4

Association with Rotavirus Vaccination

• The first licensed rotavirus vaccine (RRV-TV/Rotashield) was withdrawn due to association with intussusception, with risk estimated at approximately 1 case per 10,000 vaccine recipients 5
• Current rotavirus vaccines have been shown to be safe without significantly increasing intussusception risk 6
• Rotavirus vaccination is now considered an important preventive measure against severe rotavirus disease 6

Prognosis

With modern management techniques, outcomes are generally favorable:

• Mortality is extremely rare with prompt diagnosis and treatment 1, 3
• Average hospital stay is 1.5 days after successful barium enema reduction, 9.6 days after manual reduction, and 13.8 days after bowel resection 4

Intussusception requires prompt recognition and treatment to prevent complications such as bowel obstruction, ischemia, necrosis, and perforation. While not common in 10-month-old infants, it remains an important diagnosis to consider in any infant presenting with intermittent abdominal pain, vomiting, and bloody stools.