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| {{DiseaseDisorder infobox |
| | #REDIRECT [[Intussusception]] |
| Name = Intussusception |
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| ICD10 = {{ICD10|K|38|8|k|35}}, {{ICD10|K|56|1|k|55}} |
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| ICD9 = {{ICD9|543.9}}, {{ICD9|560.0}} |
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| ICDO = |
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| Image = Intussusseption.jpg|
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| Caption = Intussusception <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>|
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| OMIM = 147710 |
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| MedlinePlus = 000958 |
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| eMedicineSubj = emerg|
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| eMedicineTopic = 385 |
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| DiseasesDB = 6913 |
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| MeshID = D007443 |
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| }}
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| {{SI}}
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| {{CMG}}
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| '''Associate Editor-In-Chief:''' {{CZ}}
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| ==Overview==
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| An '''intussusception''' is a situation in which a part of the [[intestine]] has [[prolapse]]d into another section of intestine, similar to the way in which the parts of a collapsible [[telescope]] slide into one another.<ref>{{cite|author=Gylys, Barbara A. and Mary Ellen Wedding|title=Medical Terminology Systems|publisher=F.A. Davis Company|date=2005}}</ref> The part which prolapses into the other is called the intussusceptum, and the part which receives it is called the intussuscipiens. The most frequent type of intussusception is one in which the [[ileum]] enters the [[cecum]], however other types are known to occur, such as when a part of the ileum or [[jejunum]] prolapses into itself. Almost all intussusceptions occur with the intussusceptum having been located [[proximal]]ly to the intussuscipiens. The reason for this is that [[peristalsis|peristaltic]] action of the intestine pulls the proximal segment into the distal segment. There are, however, rare reports of the opposite being true.
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| Intussusception in humans is almost exclusively a disease of the young, usually those between 2 months and 36 months old. This may be a result of its link with certain childhood [[Vaccine|vaccinations]]. The [[Centers for Disease Control and Prevention|CDC]] through the Federal Government of the United States through the [[Vaccine injury|National Vaccine Injury Compensation Program]] provides compensation for individuals who suffer intussusception as a result of their reaction to vaccines that contain "live, oral, [[Rhesus Macaque|rhesus-based]] [[rotavirus]]."<ref name="Generation Rescue">{{Cite web|url=http://www.generationrescue.org/vaccines.html|title=Vaccines: documented risks|accessdate=2007-11-15|year=2007}}</ref>
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| Intussusception occurs more frequently in boys than in girls, with a ratio of approximately 3:1.<ref name="eMedicine.com">{{Cite web|url=http://www.emedicine.com/emerg/topic385.htm|title=Pediatrics: Intussusception|accessdate=2006-06-05|year=2006|author=Lonnie King, M.D., FACEP}}</ref>
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| In adults, intussusception represents the cause of approximately 1% of [[bowel obstruction]]s and is frequently associated with [[neoplasm]], [[cancer|malignant]] or otherwise.<ref name=gayer>{{cite journal | author = Gayer G, Zissin R, Apter S, Papa M, Hertz M | title = Pictorial review: adult intussusception--a CT diagnosis. | journal = Br J Radiol | volume = 75 | issue = 890 | pages = 185-90 | year = 2002 | id = PMID 11893645. [http://bjr.birjournals.org/cgi/content/full/75/890/185 Free Full Text]}}</ref>
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| ==Symptoms==
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| Early symptoms can include [[nausea]], [[vomiting]], pulling legs to the chest area, and intermittent moderate to severe cramping [[abdominal pain]]. Later signs include [[rectal bleeding]], often with red currant jelly stool (stool mixed with blood and mucus), and lethargy. Physical examination may reveal a sausage-shaped mass felt upon [[palpation]] of the abdomen.
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| In children too young to communicate their symptoms verbally, they may [[cry]], draw their knees up to their chest or experience [[dyspnea]] with paroxsyms of pain.
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| [[Fever]] is not a symptom of intussusception. However, intussusception can cause a loop of bowel to become [[necrotic]]. This leads to perforation and [[sepsis]], which causes fever.
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| ==Diagnosis==
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| Intussusception is often suspected based on history and physical exam, including observation of [[Dance's sign]]. Per rectal examination is particularly helpful in children as part of the intussusceptum may be felt by the finger.
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| A definite diagnosis often requires confirmation by diagnostic imaging modalities. [[Ultrasound]] is today considered the imaging modality of choice for diagnosis and exclusion of intussusception due to its high accuracy and lack of radiation. An [[x-ray]] of the abdomen may be indicated for evaluation of intestinal obstruction or the presence of free intraperitoneal gas; the latter finding would imply that bowel perforation has already occurred. In some institutions, air enema is used for diagnosis as the same procedure can be used for treatment.
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| ===Plain film===
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| *May be normal
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| *Dilated small bowel and absence of gas in the region of the cecum.
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| *Occasionally, a mass impression within the colonic gas indicates an intraluminal mass created by the intussuscepting loop
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| '''Patient #1'''
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| [[Image:Intussusseption 1.jpg|left|300px|thumb|Direct graphy: Intussusception [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology].]]
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| <br clear="left"/>
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| '''Patient #2: 65 y/o male with intermittent abdominal pain'''
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| [http://www.radswiki.net Images courtesy of RadsWiki]
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| <gallery>
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| Image:Intussusception-01.jpg|Intussusception
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| Image:Intussusception-02.jpg|Intussusception
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| Image:Intussusception-03.jpg|Intussusception
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| </gallery>
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| '''Patient #3'''
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| [http://www.radswiki.net Images courtesy of RadsWiki]
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| <gallery>
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| Image:Intussusception-101.jpg|Intussusception
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| Image:Intussusception-102.jpg|Intussusception
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| Image:Intussusception-106.jpg|Intussusception
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| Image:Intussusception-107.jpg|Intussusception
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| Image:Intussusception-103.jpg|Intussusception
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| Image:Intussusception-104.jpg|Intussusception
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| Image:Intussusception-105.jpg|Intussusception
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| </gallery>
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| '''Patient #4: Colocolonic intussesception with a polyp as a lead point in a patient with [[Peutz-Jeghers syndrome]]
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| [http://www.radswiki.net Images courtesy of RadsWiki]
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| <gallery>
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| Image:Colocolonic intussusception 001.jpg
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| Image:Colocolonic intussusception 002.jpg
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| Image:Colocolonic intussusception 003.jpg
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| </gallery>
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| ==Treatment==
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| When the condition is not immediately life-threatening, the intussusception is usually treated with either a barium [[enema]] or an air-contrast enema, which both confirms the diagnosis of intussusception, and in most cases successfully reduces it. The success rate is over 80%. However approximately 10% of these recur within 24 hours.
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| If it cannot be reduced by an enema or if the intestine is damaged, then a surgical reduction is necessary. In a surgical reduction, the abdomen is opened and the part that has telescoped in is pulled out manually by the surgeon or if the surgeon is unable to successfully reduce it or the bowel is damaged, the affected section will be resected. Often, the intussusception can be reduced by laparoscopy, whereby the segments of intestine are pulled apart by forceps.
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| == Prognosis ==
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| Intussusception is a [[medical emergency]], as it will eventually cause death if not reduced. When an intussusception or any other severe medical problem is suspected, the person must be taken to a hospital immediately.
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| The outlook for intussusception is excellent when treated quickly, but when untreated it can lead to death within 2–5 days. Fast treatment is a necessity, because the longer the intestine segment is prolapsed the longer it goes without bloodflow, and the less effective a non-surgical reduction will be. Prolonged intussusception also increases the likelihood of bowel ischemia and necrosis, requiring surgical resection.
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| ==Transient Intussusception==
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| *Transient non obstructing intussusception without a lead point is known to occur in both adults and children and occurs more frequently than was previously reported. <ref>Young H. Kim, Michael A. Blake, Mukesh G. Harisinghani, Krystal Archer-Arroyo, Peter F. Hahn, Martha B. Pitman, and Peter R. Mueller. [http://radiographics.rsnajnls.org/cgi/content/abstract/26/3/733 Adult Intestinal Intussusception: CT Appearances and Identification of a Causative Lead Point.] RadioGraphics 2006 26: 733-744.</ref>
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| *Transient intussusception of the small bowel has been reported in adults with [[celiac disease]] and [[Crohn disease]] but is most frequently detected incidentally and is presumed to be innocuous.
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| *Intussusception without a lead point is known to appear as a non obstructing segment, usually smaller in diameter and shorter than an intussusception with a lead point.
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| [http://www.radswiki.net Images courtesy of RadsWiki]
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| <gallery>
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| Image:Transient-intussusception-001.jpg|Transient intussusception
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| Image:Transient-intussusception-002.jpg|Transient intussusception
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| Image:Transient-intussusception-003.jpg|Transient intussusception
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| Image:Transient-intussusception-004.jpg|Transient intussusception
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| </gallery>
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| == References ==
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| {{Reflist|2}}
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| {{gastroenterology}}
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| [[Category:Gastroenterology]]
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| [[Category:Surgery]]
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| [[de:Intussuszeption]]
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| [[fr:Invagination intestinale aiguë du nourrisson]]
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| [[ru:Инвагинация кишечника]]
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| [[pl:Wgłobienie]]
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| [[zh:腸套疊]]
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| [[tr:İntussusepsiyon]]
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