From the Guidelines
Intussusception in the pediatric population is most commonly caused by idiopathic factors, with specific viral triggers and pathological lead points playing a significant role in its development. The condition involves one segment of intestine telescoping into an adjacent segment, potentially leading to bowel obstruction. In idiopathic cases, hypertrophied lymphoid tissue (Peyer's patches) in the intestinal wall often serves as the lead point, particularly following viral infections, as noted in the context of gastrointestinal issues in infants 1. Specific viral triggers include adenovirus, rotavirus, and norovirus, which can cause lymphoid hyperplasia.
Common Causes and Risk Factors
- Idiopathic factors, accounting for about 90% of cases in children under 2 years of age
- Viral infections leading to lymphoid hyperplasia
- Pathological lead points, such as Meckel's diverticulum, intestinal polyps, lymphoma, and other tumors, more common in older children
- Additional risk factors include cystic fibrosis, Henoch-Schönlein purpura, and recent abdominal surgery
- Certain medications like antihistamines and laxatives have been associated with intussusception
- Anatomical abnormalities such as intestinal duplications or malrotation may also predispose children to this condition
Specific Conditions and Their Relation to Intussusception
- Peutz-Jeghers syndrome (PJS), an autosomal dominant polyposis syndrome, can lead to intussusception due to the development of characteristic hamartomatous gastrointestinal polyps 2
- Other conditions, such as hypertrophic pyloric stenosis (HPS), pylorospasm, formula intolerance, and gastroenteritis, can also contribute to the risk of intussusception in infants and children, as discussed in the evaluation of vomiting in infants 1
Clinical Evaluation and Diagnosis
Understanding the causes and risk factors of intussusception is crucial for clinicians to evaluate and determine appropriate diagnostic and treatment approaches for pediatric patients presenting with symptoms suggestive of intussusception. A thorough clinical evaluation, including history and physical examination, can lead to the diagnosis in most instances, with additional diagnostic workup as needed to identify underlying pathologies or conditions that may be contributing to the development of intussusception.
From the Research
Causes of Intussusception in Pediatric Population
The causes of intussusception in the pediatric population can be categorized into two main types: idiopathic and those with a pathologic lead point.
- Idiopathic intussusception is the most common type, accounting for 75-90% of cases, and is often seen in children between 3 months to 5 years of age 3, 4, 5.
- Pathologic lead points, on the other hand, are more common in older children and adults, and can include conditions such as Meckel's diverticulum, intestinal duplication, benign polyps, and malignant lymphoma 4, 6, 7.
Pathologic Lead Points
Pathologic lead points can be further divided into several subtypes, including:
- Meckel's diverticulum, which is a congenital anomaly of the small intestine 6, 7
- Intestinal duplication, which is a rare congenital anomaly where a portion of the intestine is duplicated 6, 7
- Benign polyps, which are non-cancerous growths in the intestine 7
- Malignant lymphoma, which is a type of cancer that can occur in the intestine 7
- Other rare conditions, such as Peutz-Jeghers syndrome, mesenteric cyst, intestinal wall hematoma of hemophilia, allergic purpura, and hamartoma 7
Clinical Characteristics
Children with intussusception secondary to pathologic lead points often present with typical clinical manifestations, including abdominal pain, vomiting, and bloody stools 7.
- The average age of children with intussusception secondary to pathologic lead points is around 4.9 years old 7.
- Recurrent intussusception is common, with 51 out of 65 patients experiencing recurrence in one study 7.
- Surgical reduction of intussusception is often necessary, and the type of surgery performed depends on the underlying condition causing the intussusception 7.