Intussusception happens when one part of the intestine slides into the next part like a telescope, most often in children between 6 months and 3 years old. It can block the bowel and cut off its blood supply, so it needs fast diagnosis and treatment.
Key symptoms
- Sudden episodes of severe belly pain with crying and drawing up the legs
- Calm or sleepy periods between episodes
- Vomiting, which may become green
- Bloody, mucus stools like red currant jelly, a late sign
- Lethargy or unusual floppiness
What you find on exam
- Vital signs and hydration status
- Sausage-shaped mass in the right or upper belly
- Belly distension, tenderness or signs of peritonitis
- Blood in the stool on rectal check
Tests
- Abdominal ultrasound: target or donut sign
- Abdominal X-ray if free air or obstruction is suspected
- Electrolytes and blood count if dehydrated or unwell
Treatment basics
- IV access, fluids and nothing by mouth
- Air or contrast enema reduction by radiology, with a surgeon available
- Surgery if enema fails, perforation or peritonitis
- Nasogastric tube for bilious vomiting
- Observe after reduction, since it can recur
Red flags
- Green, bilious vomiting
- Signs of shock or very lethargic child
- Rigid belly or signs of perforation
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.