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# Intussusception (children)

Intussusception is when one part of the bowel slides into the next like a telescope; it is the commonest cause of bowel blockage in babies and toddlers.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Ileum](https://durgical.com/en/anatomy/ileum/)
- [Cecum](https://durgical.com/en/anatomy/cecum/)
- [Ascending colon](https://durgical.com/en/anatomy/ascending-colon/)
- [Appendix](https://durgical.com/en/anatomy/vermiform-appendix/)
- [Mesenteric lymph nodes](https://durgical.com/en/anatomy/superior-mesenteric-nodes/)
- [Ileocolic artery](https://durgical.com/en/anatomy/ileocolic-artery/)
- [Mesenteric veins](https://durgical.com/en/anatomy/superior-mesenteric-vein/)
- [Transverse colon](https://durgical.com/en/anatomy/transverse-colon/)

## In immunology

- [Live vaccines: who should not receive them](https://durgical.com/en/immunology/live-vaccines-who-should-not-receive-them/)

## In embryology

- [Meckel diverticulum and other vitelline duct remnants](https://durgical.com/en/embryology/meckel-diverticulum-and-other-vitelline-duct-remnants/)

## In physiology

- [Small bowel and colon motility](https://durgical.com/en/physiology/small-bowel-and-colon-motility/)

## Why it happens

- [Infarction: red vs white, and what decides the damage](https://durgical.com/en/general-pathology/infarction-red-vs-white-and-what-decides-the-damage/)
- [Enteroendocrine cells and GALT](https://durgical.com/en/histology/enteroendocrine-cells-and-galt/)

## What it is

Telescoping of one segment of bowel into the next, most often the end of the [ileum](https://durgical.com/en/anatomy/ileum/) into the colon (ileocolic). It is the commonest cause of bowel obstruction in infants and toddlers and a surgical emergency.

## Who gets it

Most cases occur between about 6 months and 3 years of age, peaking in infancy, and boys are affected more often. Cases follow viral infections. In adults it is rare and usually caused by a tumour.

## Causes

- Idiopathic in most children: swollen Peyer patches (lymphoid hyperplasia) after a viral infection act as the lead point
- Pathological lead points, more likely outside the usual age: Meckel diverticulum, polyps, lymphoma, duplication cysts
- IgA vasculitis (Henoch–Schönlein purpura): bowel wall haematoma, often small bowel into small bowel
- Cystic fibrosis

## Risk factors

- Age 6 months to 3 years
- Male sex
- Recent viral gastroenteritis or respiratory infection
- A small rise in risk after rotavirus vaccination, far outweighed by its benefits
- Previous intussusception

## Pathophysiology

Peristalsis drags the proximal bowel (intussusceptum) with its mesentery into the distal bowel (intussuscipiens). The mesentery is compressed, so venous and lymphatic return are blocked first: the bowel swells and the mucosa bleeds, producing mucus mixed with blood. Without reduction the arterial supply fails, leading to ischaemia, necrosis and perforation.

## Classification

- Ileocolic (most common), ileoileal or colocolic
- Idiopathic or with a pathological lead point
- Short transient small-bowel intussusception seen on ultrasound, which often resolves by itself

## Symptoms and signs

- Sudden bouts of colicky abdominal pain: the child screams and draws up the legs, then settles between attacks
- Vomiting, becoming bilious as obstruction progresses
- Red-currant jelly stool (blood and mucus), often a late sign
- Sausage-shaped mass in the right or upper [abdomen](https://durgical.com/en/anatomy/region/abdomen/), with an empty right lower quadrant
- Lethargy or drowsiness, sometimes the only sign in infants

## Red flags

- Bilious vomiting
- Peritonitis, abdominal distension or signs of perforation
- Shock or marked lethargy
- Bloody stool in an infant with episodes of inconsolable crying
- Long duration of symptoms before arrival

## Diagnosis

**Clinical**
Suspected in an infant or toddler with intermittent inconsolable crying, vomiting and lethargy; the classic triad of colicky pain, a mass and red-currant jelly stool is present in only a minority.

**Tests**
Blood tests are nonspecific: electrolytes and blood gas for dehydration and acidosis, blood count, and blood group before reduction or surgery.

**Imaging**
Ultrasound is the test of choice: a target (doughnut) sign in transverse view and a pseudokidney sign in longitudinal view. A plain abdominal X-ray may show obstruction or free air but cannot rule it out.

## Differential diagnosis

- Acute gastroenteritis
- Infant colic
- Malrotation with midgut volvulus
- Incarcerated inguinal hernia
- Meckel diverticulum
- Appendicitis or IgA vasculitis

## Goal of treatment

Rapid fluid resuscitation and reduction of the intussusception before the bowel becomes ischaemic, with surgery when reduction fails or the child has peritonitis.

## Treatment

**Acute**
Intravenous fluid resuscitation, nasogastric decompression if vomiting, analgesia and early surgical assessment.

**Procedure**
Image-guided enema reduction with air (pneumatic) or with saline or contrast (hydrostatic), under fluoroscopy or ultrasound, in stable children without peritonitis; it succeeds in most cases.

**Surgical**
Surgery (laparoscopic or open) after a failed enema or with perforation, peritonitis or shock: manual reduction, or resection of non-viable bowel or a lead point.

**Follow-up**
Observation after reduction, because recurrence can occur, usually soon after.

## Complications

- Bowel ischaemia and necrosis
- Perforation during the illness or, rarely, during the enema
- Peritonitis and sepsis
- Hypovolaemic shock
- Recurrence

## Prognosis

Excellent with early diagnosis and reduction; delay increases the risk of bowel resection and death.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common type of intussusception in children?

Ileocolic: the end of the ileum telescopes into the cecum and colon.

## What is the classic ultrasound sign of intussusception?

The target (doughnut) sign in transverse view; the pseudokidney sign in longitudinal view.

## What is red-currant jelly stool?

Stool made of blood and mucus from congested, ischaemic bowel mucosa; it is a late sign.

## What is the first-line treatment for a stable child without peritonitis?

Image-guided air (pneumatic) or hydrostatic enema reduction.

## What is the usual lead point in idiopathic childhood intussusception?

Enlarged Peyer patches (lymphoid tissue) after a viral infection.

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## Related conditions

- [Small bowel obstruction](https://durgical.com/en/conditions/small-bowel-obstruction/)
- [Acute appendicitis](https://durgical.com/en/conditions/acute-appendicitis/)
- [Inguinal hernia](https://durgical.com/en/conditions/inguinal-hernia/)
- [Acute (viral) gastroenteritis](https://durgical.com/en/conditions/acute-gastroenteritis/)
- [Rectal prolapse](https://durgical.com/en/conditions/rectal-prolapse/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Child Intussusception](https://www.ncbi.nlm.nih.gov/books/NBK431078/) (StatPearls (NCBI Bookshelf), 2023).

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Source: https://durgical.com/en/conditions/intussusception/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/intussusception/