Intussusception

The term intussusception refers to the invagination of the part of the intestine into the adjacent segment. It is one of the most common causes of acute abdomen in children. Idiopathic intussusception is more frequent within the first 2 years of age with most cases presenting at around 6 months of age. Symptomatic intussusception with a pathologic lead point can occur at any age, especially in older patient. Idiopathic intussusception seems to be related to an intestinal dysmotility after weaned or gastrointestinal/respiratory infections. The main symptoms are colic abdominal pain, vomit, and “red currant jelly stool.” Ultrasounds (US) are the first-level investigation for the diagnosis: the intussuscepted tract appears as two rings of low echogenicity with an intervening hyperechoic ring similar to a donut or a target. Contrast enema confirms the diagnosis and can be curative allowing progressive reduction of intussusception. In case of failure of the conservative treatment, a surgical approach is necessary. Classical operation is performed by laparotomy (small right-sided transverse incision). The intussusception mass is palpated and is brought outside the wound, and the reduction is attempted by exerting gentle and persistent pressure at its distal end. Laparoscopic reduction has been described as an effective alternative with reduced scarring, adhesions, pain, and hospitalization length although its role is still questioned. Delay in diagnosis is the main factor related to morbidity and mortality.