AKT · Child health/Neonatal & surgical

Intussusception

Telescoping of bowel (commonly ileocolic)

Overview

Invagination of one bowel segment into another (usually ileocolic), peaking at 3 months–2 years. Classic triad: colicky pain with drawing-up of legs, redcurrant-jelly stool, and a sausage-shaped abdominal mass.

Recognise

Episodic colicky pain, drawing legs up, pallor/screaming then settling
REDCURRANT-JELLY stool (blood + mucus, late sign)
Sausage-shaped mass (often RUQ); vomiting; lethargy between episodes

Red flags

Peritonitis, shock, or failed enema → surgery; profound lethargy

Differentials & how to tell them apart

Gastroenteritisdiarrhoea predominant, no mass/target sign

Volvulus/malrotationbilious vomiting, upper-GI series

Constipationno colic episodes, no mass/target

Henoch-Schönlein purpuracan be the lead point — purpuric rash, arthralgia

Investigations

USS: "target"/"doughnut" sign (and "pseudokidney"). Consider a pathological lead point (Meckel, HSP, lymphoma) in older children.

Management

Air (pneumatic) enema reduction

1Resuscitate with IV fluids. Air (pneumatic) enema for reduction — diagnostic and therapeutic.Gate: Peritonitis, perforation or shock → straight to surgery (do not attempt enema)
2Surgical reduction ± resection if enema fails or there is a pathological lead point.

Air (pneumatic) or contrast enema — both diagnostic AND therapeutic — first-line reduction

Surgery — if enema fails, perforation, or peritonitis

Key points

Redcurrant-jelly stool is a LATE sign — do not wait for it. Older children: look for a lead point.

Monitor & prognosis

Recurrence after enema (~10%); perfusion.

Good with prompt reduction.

Source: Paediatric surgery guidance