From the Guidelines
Intussusception is the type of bowel obstruction that results in trapping the bowel and associated mesentery in a telescoping fashion. This condition occurs when a segment of intestine folds into the adjacent intestinal segment, similar to how a telescope collapses, as described in the context of small-bowel obstruction diagnosis and management 1. The process creates an obstruction and can compromise blood flow to the affected area. Intussusception is most common in children, particularly those under two years of age, though it can occur in adults as well. In children, it's often idiopathic, while in adults it's typically associated with a pathological lead point such as a tumor or polyp. The telescoping nature of intussusception distinguishes it from other types of bowel obstructions:
- External hernias involve protrusion through a wall or opening
- Adhesions cause obstruction through fibrous bands
- Volvulus involves twisting of the bowel around its mesenteric axis These distinctions are crucial for diagnosis and management, as imaging plays a key role in identifying the cause of small-bowel obstruction, with adhesions being the most common cause, accounting for 70% of all cases, followed by other causes including hernias, malignancies, and intussusception 1. Patients with intussusception typically present with intermittent abdominal pain, vomiting, and sometimes "currant jelly" stools due to intestinal bleeding. Early diagnosis and treatment are essential to prevent complications such as bowel ischemia, which can significantly increase mortality rates, ranging between 2% and 8% overall, and as high as 25% when associated with bowel ischemia 1.
From the Research
Types of Bowel Obstructions
- External hernia: a condition where part of the intestine bulges through a weak area in the abdominal wall [not directly related to the question]
- Adhesions: bands of fibrous tissue that can form between loops of intestine, potentially causing obstruction [not directly related to the question]
- Intussusception: a condition where one segment of the bowel invaginates into an adjacent segment [directly related to the question]
- Volvulus: a condition where the intestine twists around its mesentery, potentially causing obstruction [not directly related to the question]
Intussusception
- Defined as the invagination of one segment of the bowel into an immediately adjacent segment of the bowel 2, 3, 4
- Results in the trapping of the bowel and associated mesentery in a telescoping fashion 2, 3, 4
- Can be caused by a lead point, such as a tumor or polyp, which acts as a focal area of traction pulling the proximal portion of bowel into the peristalsing distal portion 2, 3, 4
- More common in children, but can also occur in adults, often with a malignant lead point 2, 3, 4
- Diagnosis can be made using cross-sectional imaging, such as CT or MRI, or intraoperatively 2, 3, 4
- Treatment options include nonoperative reduction via pneumatic or hydrostatic enemas, or surgical resection 2, 3, 4, 5, 6