History and exam

Key diagnostic factors

common

presence of risk factors

Risk factors include male sex and age 2 to 12 months.​​[8][9][10]

male sex

Boys are more commonly affected than girls (ratio 2:1).[8][9]

age 2 to 12 months

Intussusception is rare in infants aged <2 months.[8] Peak incidence is between aged 5 and 9 months of age.[6][8][9][10]​ Most cases occur in children under the age of 12 months.

colicky abdominal pain

The abdominal pain of intussusception is commonly colicky, lasting 1 to 3 minutes, with the infant acting normally between episodes of pain.[2] Present in 69% to 100% of cases.[3][11][18]

vomiting

Vomiting can be non-bilious or bilious.[17] Present in 78% to 91% of cases.[2][3][11][18]

lethargy/irritability in between waves of pain

May be the only presenting complaint. Present in 67% to 87% of cases.[3][11][18]

blood per rectum/red currant jelly stool

Blood per rectum may signal more severe disease with more prolonged symptoms, and by definition, the presence of mucosal oedema/ulceration. It may also indicate that the intussusceptum has extended distally.

Rectal bleeding can be occult or frank and if containing a mixture of blood and mucus, may be described as red currant jelly. Present in 35% to 73% of cases.[3][11][18]

uncommon

hypovolaemic shock

Finding of concern for the presence of intestinal ischaemia, gangrene, or perforation. Present in 5% to 10% of cases.[3]

Other diagnostic factors

common

pallor

Present in 42% to 85% of cases.[3][18]

palpable abdominal mass

Usually present in the right upper quadrant or epigastrium.[1]​ Present in 45% to 71% of cases.[3][11][18]

uncommon

poor feeding

Present in 17% of cases.[18]

abdominal distention

Present in 10% to 35% of cases.[3][11][18]

Risk factors

strong

male sex

Boys are more commonly affected than girls (ratio 2:1).​[8][9]

age 2 to 12 months

Intussusception is rare in infants aged <2 months.[8] Peak incidence is between 5 and 9 months of age.[6][8][9][10]​ Most cases occur in children under the age of 12 months.​

weak

antecedent viral illness

Idiopathic intussusception is commonly thought to result from lymphoid hyperplasia disrupting normal longitudinal forces. Hyperplasia of Peyer's patches and lymphoid may occur subsequent to viral illness. Symptoms of an antecedent viral illness are identified in approximately 25% of cases of intussusception.[3][11]

first-generation rotavirus vaccination

Historically, intussusception was diagnosed with increased frequency in children who received the first-generation rotavirus vaccine (tetravalent rhesus-human reassortant rotavirus vaccine [RRV-TV]).[12][13]

This vaccine is no longer marketed. A subsequent monovalent rotavirus vaccine (RV1) is reported to be associated with a much lower risk of intussusception.[14][15]​​

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