Diagnostic Considerations

In rare circumstances, intussusception presents with prolapse of the intussusceptum through the anus. Such prolapse can be confused with rectal prolapse. Careful examination can differentiate between the 2 presentations, as follows:

The anal crypts are everted with rectal prolapse and not with intussusception
An examining finger can be passed between the prolapse and the anus in patients with intussusception but not in patients with rectal prolapse

Conditions to consider in the differential diagnosis of intussusception, along with those in the next section, include the following:

Milk allergy
Incarcerated hernia
Internal hernia
Other, rare causes of intestinal obstruction
Adhesive band
Volvulus
Meckel diverticulum
Any process causing abdominal pain or GI bleeding

Differential Diagnoses

Abdominal Hernias
Appendicitis
Blunt Abdominal Trauma in Emergency Medicine
Colic
Cyclic Vomiting Syndrome
Emergent Treatment of Gastroenteritis
Gastric Volvulus
Testicular Torsion in Emergency Medicine

Workup

Bonnard A, Demarche M, Dimitriu C, et al. Indications for laparoscopy in the management of intussusception: A multicenter retrospective study conducted by the French Study Group for Pediatric Laparoscopy (GECI). J Pediatr Surg. 2008 Jul. 43(7):1249-53. [QxMD MEDLINE Link].
Fraser JD, Aguayo P, Ho B, et al. Laparoscopic management of intussusception in pediatric patients. J Laparoendosc Adv Surg Tech A. 2009 Aug. 19(4):563-5. [QxMD MEDLINE Link].
Milbrandt K, Sigalet D. Intussusception associated with a Meckel's diverticulum and a duplication cyst. J Pediatr Surg. 2008 Dec. 43(12):e21-3. [QxMD MEDLINE Link].
Soccorso G, Puls F, Richards C, Pringle H, Nour S. A ganglioneuroma of the sigmoid colon presenting as leading point of intussusception in a child: a case report. J Pediatr Surg. 2009 Jan. 44(1):e17-20. [QxMD MEDLINE Link].
Sanni RB, Nandiolo R, Coulibaly Diaoudia MT, Vodi L, Mobiot ML. Acute intussusception due to intestinal Kaposi's sarcoma in an infant. Afr J Paediatr Surg. 2009 Jul-Dec. 6(2):131. [QxMD MEDLINE Link].
Earl TM, Wellen JR, Anderson CD, et al. Small bowel obstruction after pediatric liver transplantation: the unusual is the usual. J Am Coll Surg. 2011 Jan. 212(1):62-7. [QxMD MEDLINE Link].
Bai YZ, Chen H, Wang WL. A special type of postoperative intussusception: ileoileal intussusception after surgical reduction of ileocolic intussusception in infants and children. J Pediatr Surg. 2009 Apr. 44(4):755-8. [QxMD MEDLINE Link].
Turkyilmaz Z, Karabulut R, Gulen S, et al. Role of nitric oxide and cyclooxygenase pathway in lipopolysaccharide-induced intussusception. Pediatr Surg Int. 2004 Aug. 20(8):598-601. [QxMD MEDLINE Link].
Lappalainen S, Ylitalo S, Arola A, Halkosalo A, Räsänen S, Vesikari T. Simultaneous presence of human herpesvirus 6 and adenovirus infections in intestinal intussusception of young children. Acta Paediatr. 2012 Jun. 101(6):663-70. [QxMD MEDLINE Link].
Zanardi LR, Haber P, Mootrey GT, et al. Intussusception among recipients of rotavirus vaccine: reports to the vaccine adverse event reporting system. Pediatrics. 2001 Jun. 107(6):E97. [QxMD MEDLINE Link].
Christie CD, Duncan ND, Thame KA, et al. Pentavalent rotavirus vaccine in developing countries: safety and health care resource utilization. Pediatrics. 2010 Dec. 126(6):e1499-506. [QxMD MEDLINE Link].
Ruiz-Palacios GM, Pérez-Schael I, Velázquez FR, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. 2006 Jan 5. 354(1):11-22. [QxMD MEDLINE Link].
Contopoulos-Ioannidis DG, Halpern MS, Maldonado Y. Trends in Hospitalizations for Intussusception in California in Relationship to the Introduction of New Rotavirus Vaccines, 1985-2010. Pediatr Infect Dis J. 2015 Jul. 34 (7):712-7. [QxMD MEDLINE Link].
Douglas D. More Intussusception Hospitalizations in California After Rotavirus Vaccine Intro. Reuters Health Information. Available at http://www.medscape.com/viewarticle/843091. April 14, 2015; Accessed: June 17, 2015.
Tate JE, Yen C, Steiner CA, Cortese MM, Parashar UD. Intussusception Rates Before and After the Introduction of Rotavirus Vaccine. Pediatrics. 2016 Sep. 138 (3):[QxMD MEDLINE Link].
Zickafoose JS, Benneyworth BD, Riebschleger MP, Espinosa CM, Davis MM. Hospitalizations for Intussusception Before and After the Reintroduction of Rotavirus Vaccine in the United States. Arch Pediatr Adolesc Med. 2012 Jan 2. [QxMD MEDLINE Link].
Niramis R, Watanatittan S, Kruatrachue A, et al. Management of recurrent intussusception: nonoperative or operative reduction?. J Pediatr Surg. 2010 Nov. 45(11):2175-80. [QxMD MEDLINE Link].
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Morrison J, Lucas N, Gravel J. The role of abdominal radiography in the diagnosis of intussusception when interpreted by pediatric emergency physicians. J Pediatr. 2009 Oct. 155(4):556-9. [QxMD MEDLINE Link].
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Tareen F, Mc Laughlin D, Cianci F, Hoare SM, Sweeney B, Mortell A, et al. Abdominal radiography is not necessary in children with intussusception. Pediatr Surg Int. 2016 Jan. 32 (1):89-92. [QxMD MEDLINE Link].
Hryhorczuk AL, Strouse PJ. Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception. Pediatr Radiol. 2009 Oct. 39(10):1075-9. [QxMD MEDLINE Link].
Munden MM, Bruzzi JF, Coley BD, Munden RF. Sonography of pediatric small-bowel intussusception: differentiating surgical from nonsurgical cases. AJR Am J Roentgenol. 2007 Jan. 188(1):275-9. [QxMD MEDLINE Link].
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Flaum V, Schneider A, Gomes Ferreira C, Philippe P, Sebastia Sancho C, Lacreuse I, et al. Twenty years' experience for reduction of ileocolic intussusceptions by saline enema under sonography control. J Pediatr Surg. 2016 Jan. 51 (1):179-82. [QxMD MEDLINE Link].
Sandler AD, Ein SH, Connolly B, Daneman A, Filler RM. Unsuccessful air-enema reduction of intussusception: is a second attempt worthwhile?. Pediatr Surg Int. 1999. 15(3-4):214-6. [QxMD MEDLINE Link].
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Media Gallery

Abdominal radiograph shows small bowel dilatation and paucity of gas in the right lower and upper quadrants.
Air contrast enema shows intussusception in the cecum.
Barium enema shows intussusception in the descending colon.
CT scan reveals the classic ying-yang sign of an intussusceptum inside an intussuscipiens.
Abdominal ultrasonography reveals the classic target sign of an intussusceptum inside an intussuscipiens.
Laparoscopic view of a jejuno-jejunal intussusception.
Note intussusception in the left upper quadrant on this plain film of an infant with pain vomiting. Courtesy of Kelley W Marshall, MD, Children's Healthcare of Atlanta, Emory University School of Medicine.
Intussusception evident during air contrast enema prior to reduction. Courtesy of Kelley W Marshall, MD, Children's Healthcare of Atlanta, Emory University School of Medicine.

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Author

A Alfred Chahine, MD Associate Professor of Surgery and Pediatrics, George Washington University School of Medicine and Health Sciences; Attending Surgeon, Children's National Health System

A Alfred Chahine, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Pediatric Surgical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Lonnie King, MD Consulting Staff, Department of Emergency Medicine, Children's Healthcare of Atlanta at Scottish Rite

Lonnie King, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Garry Wilkes, MBBS, FACEM Associate Director, Emergency Medicine, Goulburn Valley Health, Victoria, Australia; Clinical Associate Professor, University of Western Australia; Adjunct Associate Professor, Edith Cowan University, Western Australia

Disclosure: Nothing to disclose.

Felix C Blanco, MD Research Fellow, Department of Surgery, Children’s National Medical Center

Felix C Blanco, MD is a member of the following medical societies: American College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Additional Contributors

Hisham Nazer, MBBCh, FRCP, DTM&H Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, University of Jordan Faculty of Medicine, Jordan

Hisham Nazer, MBBCh, FRCP, DTM&H is a member of the following medical societies: American Association for Physician Leadership, Royal College of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Royal Society of Tropical Medicine and Hygiene, Royal College of Physicians and Surgeons of the United Kingdom

Disclosure: Nothing to disclose.

Intussusception Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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