From the Guidelines
Intussusception is primarily caused by a segment of intestine folding into an adjacent segment, creating a telescoping effect that can lead to bowel obstruction, with the most common causes including pathological lead points such as polyps, tumors, Meckel's diverticulum, or surgical adhesions, as well as certain medical procedures like gastrojejunostomy, as noted in the study by De Simone et al. 1. The causes of intussusception can be categorized into different types, including:
- Idiopathic, which is the most common cause in children, accounting for about 90% of cases, although viral infections may play a role by causing swelling of lymphoid tissue in the intestinal wall 1
- Secondary to a pathological lead point, such as polyps, tumors (benign or malignant), Meckel's diverticulum, or surgical adhesions, which serve as an anchor for the telescoping process 1
- Other causes, including intestinal lymphoma, lipoma, hamartoma, and inflammatory conditions like Crohn's disease or celiac disease 1
- Certain medical procedures, like gastrojejunostomy, which can predispose patients to intussusception, as seen in patients who have undergone laparoscopic Roux-en-Y gastric bypass (LRYGB) 1
- In rare cases, medications that increase intestinal motility may contribute to this condition, although this is not a well-established cause 1 The mechanism of intussusception involves abnormal peristalsis that pulls one segment of bowel into another, potentially compromising blood flow to the affected area and causing ischemia if not promptly addressed, as described in the study by De Simone et al. 1. Patients typically present with abdominal pain, vomiting, and sometimes "currant jelly" stools due to intestinal bleeding, and the diagnosis can be made using imaging studies, such as CT or ultrasound, as well as clinical evaluation, including digital rectal examination, anal manometry, and balloon expulsion test 1. It is essential to note that the management of intussusception depends on the underlying cause and the severity of the condition, and may involve endoscopic or surgical intervention, as well as supportive care to manage symptoms and prevent complications, as discussed in the study by De Simone et al. 1.
From the Research
Causes of Intussusception
The causes of intussusception can be categorized into two main types: idiopathic and those with a lead point.
- Idiopathic intussusception is the most common form in children, typically managed with nonoperative reduction via pneumatic and/or hydrostatic enemas 2.
- Lead points, on the other hand, are more common in adults and can be caused by various factors, including:
- Meckel's diverticulum: a congenital anomaly of the gastrointestinal tract that can lead to complications such as obstruction and intussusception 3, 4, 5.
- Neoplasms: such as primary adenocarcinoma, which is the most frequent malignant lead point pathology in adult ileocolic and colonic intussusception 2.
- Duplication cysts: although rare, can also serve as a lead point for intussusception 3.
- Other conditions: such as ulcerative colitis, which can present with overlapping symptoms, making diagnosis challenging 5.
Age-Related Differences in Intussusception Causes
The causes of intussusception vary with age:
- In infants between five and nine months of age, the etiology is usually idiopathic 6.
- In neonates, older children, and adults, lead points such as Meckel's diverticulum or neoplasms are more common 6, 2.
- Adult intussusception is often associated with lead point pathology, which can be benign or malignant 2, 4, 5.