BACKGROUND:

-One segment of intestine telescopes into another

-Most commonly ileum into colon

-Most common cause of intestinal obstruction in children under 2 y/o

-Rare before 2 months old

CLINICAL:

-Classically infant with intermittent episodes of severe abdominal pain with legs drawn to chest, asymptomatic between episodes

-Classic Triad: abdominal pain, palpable sausage shaped abdominal mass, bloody stools (“currant jelly”)

- rarely all 3 present

-Various presentations - may present as unexplained lethargy (neurologic intussusception)

-Physical exam often normal between episodes

-Vomiting may develop after 6-12 hrs (may be bilious)

-Rarely have classic “currant jelly” stool - gross blood in stool only seen in about 50% of cases

DIAGNOSIS / TREATMENT:

-Ultrasound - sensitivity / specificity nearly 100%

-Classic findings are the target sign in transverse view or the pseudo kidney sign in longitudinal view

-If high suspicion should undergo air contrast enema - both diagnostic and therapeutic, IVF and surgical consult before procedure

-Approximately 10% recurrence rate after enema reduction (usually within first 24-48 hrs)

REFERENCES:

Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.