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Published on: December 1, 2012
High risk and low incidence diseases: Pediatric intussusception
Brit Long1, Joshua Easter2, Alex Koyfman3
1Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Insights
Pediatric intussusception is a common abdominal emergency. Early diagnosis and management, including ultrasound and prompt reduction, are crucial to prevent serious complications like bowel necrosis.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Surgical Pediatrics
Background:
- Pediatric intussusception is a critical condition with significant morbidity and mortality risks.
- It involves intestinal telescoping, leading to edema and potential obstruction, ischemia, necrosis, and perforation if untreated.
Purpose of the Study:
- To review the key aspects of pediatric intussusception, focusing on presentation, diagnosis, and emergency department management.
- To highlight common challenges and best practices for clinicians managing this condition.
Main Methods:
- Review of current evidence on pediatric intussusception.
- Focus on diagnostic modalities and treatment strategies in the emergency setting.
Main Results:
- Intussusception is a frequent pediatric abdominal emergency, most common in children aged 3 months to 5 years.
- Classic symptoms (pain, currant jelly stool, mass) are infrequent; atypical presentations (altered mental status, lethargy) are common.
- Ultrasound is the preferred diagnostic tool; radiography aids in assessing obstruction/perforation.
Conclusions:
- Prompt reduction is the primary treatment, with non-operative methods (hydrostatic/pneumatic) favored for stable patients.
- Operative intervention is reserved for unstable patients, peritonitis, or focal lead points.
- Understanding mimics and key diagnostic features aids emergency clinicians in timely and effective management.
Introduction:
Pediatric intussusception is a serious condition that carries with it a high risk of morbidity and mortality.
Objective:
This review highlights the pearls and pitfalls of pediatric intussusception, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
Discussion:
Intussusception is one of the most common pediatric abdominal emergencies. This is associated with one part of the intestine telescoping into another, resulting in bowel edema. If the intussusception remains untreated, obstruction, ischemia, necrosis, and perforation may result. Most cases are idiopathic, with 10-25 % associated with a pathologic mass or lead point. The most common age group affected includes those between 3 months to 5 years. The triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon, though most patients will present with intermittent abdominal pain. Nonbilious emesis and bloody stools (gross blood or guaiac positive) are also common. Younger patients can present atypically, including altered mental status or lethargy. Thus, intussusception should be considered in pediatric patients with abdominal pain, emesis, and a sausage-shaped mass, as well as those with atypical presentations such as altered mental status or lethargy if there is no other etiology found on testing. The diagnostic modality of choice is ultrasound. Plain radiography may assist in evaluating for obstruction and perforation. Treatment includes prompt reduction of the intussusception. In patients who are stable and have no evidence of perforation, non-operative reduction with hydrostatic or pneumatic reduction should be attempted. Operative intervention is necessary in those who are unstable, peritonitic, or have a focal lead point. Discharge may be appropriate for patients following successful non-operative reduction if the patient is able to tolerate clear fluids, is asymptomatic, and can return for any recurrence of symptoms.
Conclusion:
An understanding of pediatric intussusception and its many potential mimics can assist emergency clinicians in diagnosing and managing this high risk disease.
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