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Intussusception is a cause of intestinal obstruction and in infants is a highly urgent surgical condition that requires early diagnosis and treatment to avoid complications from prolonged ischemia caused in the intestinal tract. Intussusception occurs when a section of the intestine, either the large or small intestine, penetrates another part of the intestine (intussusception of a section of intestine into the adjacent intestine).

The intestine is obstructed by the intussusception in which the compression of the vessels initially leads to venous occlusion, resulting in a progressively worsening edema and then leads to arterial occlusion, ischemia and subsequent necrosis if not treated promptly.

In the majority of cases it is idiopathic and appears at the age of 6-36 months, in fact, during an upper respiratory infection or gastroenteritis. The adenoma is implicated in >50% of cases. More rarely and at the age of >2 years it may be secondary, that is, there may be anatomical factors that caused the intussusception (e.g., in order of frequency, Meckel’s appendix, polyp, duplication, appendiceal appendix, hemangioma, etc.).

In infancy or toddlerhood, it has a typical presentation. Sudden onset of intermittent and progressively increasing pain accompanied by inconsolable crying and drawing the legs towards the abdomen, often with pallor. Episodes usually occur at 15 to 20 minute intervals and become more frequent and severe over time. Vomiting is often a prominent symptom, often starting shortly after the first episodes of abdominal pain. If the condition continues and is not treated promptly, blood may appear in the stool after 5 to 6 hours. The stool is bloody in up to 50% of cases (a mixture of blood and mucus, giving it the appearance of raisin jelly). Between painful episodes, the child may behave relatively normally and be in no pain. As symptoms progress, lethargy often develops.

However, there are cases with an atypical presentation. Up to 20% have no obvious pain, and about one-third of patients do not have blood or mucus in the stool. Older children have only pain without other symptoms. Occasionally, the initial sign is lethargy or altered consciousness alone, without pain, rectal bleeding, or other symptoms suggestive of an intra-abdominal process. Therefore, intussusception should be considered in the evaluation of otherwise unexplained lethargy or altered consciousness, especially in infants. It may initially be assessed as constipation or gastroenteritis.

The diagnosis is made either by abdominal radiography or abdominal ultrasound, which is also the method of choice for diagnosis. Abdominal CT or MRI are not indicated in the acute phase except when malignancy is suspected. Initial treatment is conservative and is performed with resection by liquid or air enema as it has more advantages (safer, shorter time and less exposure to fluoroscopy).

If resection is achieved, the child remains in the hospital initially fasting and is monitored with simultaneous correction of electrolyte disorders. Surgical treatment is indicated in cases of failure of conservative treatment or its non-completion, in cases of signs of peritonitis due to intestinal rupture during resection and in the presence of a pathological cause. Recurrence is rare after surgical resection.

A careful history and physical examination are therefore essential for determining the cause of the acute abdominal event and identifying those children with intestinal intussusception. Understanding the clinical signs is essential for avoiding life-threatening consequences from prolonged ischemia. In intussusception, the contribution of the radiologist is important.