Materiały źródłowe

• #1 Intussusception – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intussusception/symptoms-causes/syc-20351452

  Intussusception (in-tuh-suh-SEP-shun) is a serious condition in which part of the intestine slides into an adjacent part of the intestine. This telescoping action often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that’s affected. This can lead to infection, death of bowel tissue or a tear in the bowel, called perforation. […] In some cases in adults, the telescoping is caused by a growth in the intestine, such as a polyp or a tumor, called a lead point. The typical wavelike contractions of the intestine grab this lead point and pull it and the lining of the intestine into the bowel ahead of it. In most cases, however, no cause can be found for intussusception. […] In most cases of intussusception in children, the cause is unknown. Intussusception seems to occur more often in the fall and winter. And because many children with the problem also have flu-like symptoms, some suspect a virus may play a role in the condition. Sometimes, a lead point can be identified as the cause of the condition most frequently the lead point is a pouch in the lining of the small intestine (Meckel’s diverticulum).

• #2 Intussusception of the bowel in adults: A review

  https://www.wjgnet.com/1007-9327/full/v15/i4/407.htm

  Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. […] Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%-5% of intestinal obstructions in adults. […] In contrast, almost 90% of the cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point, such as carcinomas, polyps, Meckels diverticulum, colonic diverticulum, strictures or benign neoplasms, which are usually discovered intraoperatively. […] Secondary intussusception is believed to initiate from any pathologic lesion of the bowel wall or irritant within the lumen that alters normal peristaltic activity and serves as a lead point, which is able to initiate an invagination of one segment of the bowel into the other.

• #3 Intussusception: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/930708-overview

  Intussusception is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction. […] The pathogenesis of idiopathic intussusception is not well established. It is believed to be secondary to an imbalance in the longitudinal forces along the intestinal wall. In enteroenteral intussusception, this imbalance can be caused by a mass acting as a lead point or by a disorganized pattern of peristalsis (eg, an ileus in the postoperative period). […] As a result of imbalance in the forces of the intestinal wall, an area of the intestine invaginates into the lumen of adjacent bowel. The invaginating portion of the intestine (ie, the intussusceptum) completely telescopes into the receiving portion of the intestine (ie, the intussuscipiens). This process continues and more proximal areas follow, allowing the intussusceptum to proceed along the lumen of the intussuscipiens.

• #4 Intussusception pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Intussusception_pathophysiology

  The exact pathogenesis of intussusception is not fully understood. Intussusception occurs if there is an imbalance between the longitudinal and radial smooth muscle forces of intestine that maintain its normal structure. This imbalance leads to a segment of intestine to invaginate into another segment and cause entero-enteral intussusception. […] Under normal conditions, a balance between the longitudinal and radial smooth muscle forces maintains the normal structure of intestine. Intussusception occurs if there is an imbalance between these forces. This imbalance leads to a segment of intestine to invaginate into another segment and cause entero-enteral intussusception. […] Nitric oxide (NO) acts on these receptors. NO is a inhibitory neurotransmitter of the enteric nervous system. It acts by causing relaxation of smooth muscles. Overproduction of nitric oxide (NO) occurs during inflammation. This leads to relaxation of the ICV and causes altered intestinal motility. This can lead to ileocecal intussusception.

• #5 Intussusception – Sonographic Tendencies

  https://sonographictendencies.com/2016/11/26/intussusception/

  An intussusception is a medical condition in which a part of the intestine goes into another, typically the Ileum into the Ascending colon causing a intestinal obstruction. […] An easy way to visualize the mechanism is to imagine when you collapse a telescope, that is essentially what happens to the intestines. […] The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscepiens (think recipient). […] Intussusception is a medical emergency and a patient should be seen immediately to reduce complications up to and including bowel necrosis. […] There will often times be lymph nodes near and within the lesion, this is believed to be one of the causes, large lymph nodes can get trapped with peristalsis leading to the Intussusception. […] Intussusception is treated with air enema under radiographic guidance.

• #6 Pulsenotes | Intussusception

  https://app.pulsenotes.com/specialities/paediatrics/notes/intussusception

  Approximately 75% of cases of intussusception in children are said to be idiopathic. […] Intussusception occurs when (almost always) a proximal segment of intestine invaginates into a distal segment. There are therefore two components: Intussusceptum: the segment of bowel that telescopes into another. Intussuscipiens: the neighbouring portion of bowel that receives the intussusceptum. […] The mesentery of the affected segment becomes involved and pressure prevents normal venous and lymphatic drainage. The invaginated segment becomes oedematous and the bowel becomes obstructed. If untreated intestinal ischaemia occurs with resulting perforation and peritonitis. […] Cases may be idiopathic (approx. 75%) or secondary to a lead point (approx. 25%). When occurring in older children a higher proportion will have an identifiable lead point.

• #7 Current diagnosis and image-guided reduction for intussusception in children

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2021.01816

  Intussusception involves invagination of the proximal bowel into the distal bowel. Ileocolic intussusception is the most common type, comprising more than 80% of cases, while other types include ileoileocolic, enteroenteric, and rarely colocolic intussusceptions. Intussusception typically occurs in infants and toddlers aged 3-36 months old. The classic clinical presentation is abdominal pain, vomiting, bloody stools, and abdominal mass, but it occurs in only 20% of cases, and most children do not show the complete symptom triad (abdominal pain, vomiting, and bloody stool). The clinical presentation is also age-related; younger children are more likely to experience vomiting, irritability, lethargy, or bloody stools, while older children are more likely to present with abdominal pain. […] Intussusception is idiopathic in most cases without an identifiable lead point, except the hyperplastic lymphoid tissue in the terminal ileum. Previous studies reported seasonal variations or no clear seasonal pattern. Viral or bacterial gastroenteritis was postulated as a causative factor of intussusception. Enteric and nonenteric types of adenovirus infection had significant associations in multiple studies, being reported in approximately 30%-40% of cases.

• #8 Intussusception

  https://www.rch.org.au/clinicalguide/guideline_index/intussusception/

  Intussusception is the invagination (telescoping) of a proximal segment of bowel into the distal bowel lumen. The commonest site is a segment of ileum moving into the colon through the ileo-caecal valve. This process leads to bowel obstruction, venous congestion and bowel wall ischaemia. Perforation can occur and lead to peritonitis and shock […] Most cases are idiopathic (90%) […] In older children, a pathological lead point may be the cause.

• #9 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. It is the most common abdominal emergency in early childhood, particularly in children younger than two years of age. The majority of cases in children are idiopathic, and pathologic lead points are identified in only 25 percent of cases involving children. […] As the intussusception develops, the mesentery is dragged into the bowel. This leads to the development of venous and lymphatic congestion with resulting intestinal edema. If untreated, the process can ultimately lead to ischemia, perforation, and peritonitis. […] Approximately 75 percent of cases of childhood intussusception are idiopathic because there is no clear disease trigger or pathologic lead point. Idiopathic intussusception is most common in children between three months and five years of age.

• #10 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  An increasing body of evidence suggests that viral triggers may play a role in some cases, as illustrated by the following observations: The incidence of intussusception has a seasonal variation, with peaks coinciding with seasonal viral gastroenteritis in some populations. […] Intussusception has been associated with some forms of rotavirus vaccine. […] Approximately 30 percent of patients experience viral illness (upper respiratory tract infection, otitis media, flu-like symptoms) before the onset of intussusception. […] A lead point is a lesion or variation in the intestine that is trapped by peristalsis and dragged into a distal segment of the intestine, causing intussusception. […] In approximately 25 percent of cases, an underlying disease causes a pathologic lead point for the intussusception, which may be focal or diffuse.

• #11 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  An increasing body of evidence suggests that viral triggers may play a role in some cases, as illustrated by the following observations: The incidence of intussusception has a seasonal variation, with peaks coinciding with seasonal viral gastroenteritis in some populations. […] Intussusception has been associated with some forms of rotavirus vaccine. […] Approximately 30 percent of patients experience viral illness (upper respiratory tract infection, otitis media, flu-like symptoms) before the onset of intussusception. […] A lead point is a lesion or variation in the intestine that is trapped by peristalsis and dragged into a distal segment of the intestine, causing intussusception. […] In approximately 25 percent of cases, an underlying disease causes a pathologic lead point for the intussusception, which may be focal or diffuse.

• #12 Current diagnosis and image-guided reduction for intussusception in children

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2021.01816

  Intussusception involves invagination of the proximal bowel into the distal bowel. Ileocolic intussusception is the most common type, comprising more than 80% of cases, while other types include ileoileocolic, enteroenteric, and rarely colocolic intussusceptions. Intussusception typically occurs in infants and toddlers aged 3-36 months old. The classic clinical presentation is abdominal pain, vomiting, bloody stools, and abdominal mass, but it occurs in only 20% of cases, and most children do not show the complete symptom triad (abdominal pain, vomiting, and bloody stool). The clinical presentation is also age-related; younger children are more likely to experience vomiting, irritability, lethargy, or bloody stools, while older children are more likely to present with abdominal pain. […] Intussusception is idiopathic in most cases without an identifiable lead point, except the hyperplastic lymphoid tissue in the terminal ileum. Previous studies reported seasonal variations or no clear seasonal pattern. Viral or bacterial gastroenteritis was postulated as a causative factor of intussusception. Enteric and nonenteric types of adenovirus infection had significant associations in multiple studies, being reported in approximately 30%-40% of cases.

• #13 Intussusception pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Intussusception_pathophysiology

  The exact pathogenesis of intussusception is not fully understood. Intussusception occurs if there is an imbalance between the longitudinal and radial smooth muscle forces of intestine that maintain its normal structure. This imbalance leads to a segment of intestine to invaginate into another segment and cause entero-enteral intussusception. […] Under normal conditions, a balance between the longitudinal and radial smooth muscle forces maintains the normal structure of intestine. Intussusception occurs if there is an imbalance between these forces. This imbalance leads to a segment of intestine to invaginate into another segment and cause entero-enteral intussusception. […] Nitric oxide (NO) acts on these receptors. NO is a inhibitory neurotransmitter of the enteric nervous system. It acts by causing relaxation of smooth muscles. Overproduction of nitric oxide (NO) occurs during inflammation. This leads to relaxation of the ICV and causes altered intestinal motility. This can lead to ileocecal intussusception.

• #14 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  An increasing body of evidence suggests that viral triggers may play a role in some cases, as illustrated by the following observations: The incidence of intussusception has a seasonal variation, with peaks coinciding with seasonal viral gastroenteritis in some populations. […] Intussusception has been associated with some forms of rotavirus vaccine. […] Approximately 30 percent of patients experience viral illness (upper respiratory tract infection, otitis media, flu-like symptoms) before the onset of intussusception. […] A lead point is a lesion or variation in the intestine that is trapped by peristalsis and dragged into a distal segment of the intestine, causing intussusception. […] In approximately 25 percent of cases, an underlying disease causes a pathologic lead point for the intussusception, which may be focal or diffuse.

• #15 Intussusception (medical disorder) – Wikipedia

  https://en.wikipedia.org/wiki/Intussusception_(medical_disorder)

  Intussusception is a medical condition in which a part of the intestine folds into the section immediately ahead of it. […] The cause in children is typically unknown; in adults a lead point is sometimes present. […] An anatomic lead point (that is, a piece of intestinal tissue that protrudes into the bowel lumen) is present in approximately 10% of intussusceptions. […] The lead point (best exemplified by a polyp) serves as a focal area of traction, which the peristaltic action pulls into the distal bowel, thus invaginating the attached bowel segment. […] The trapped section of bowel may have its blood supply cut off, which causes ischemia (lack of oxygen in the tissues). The mucosa (gut lining) is very sensitive to ischemia, and responds by sloughing off into the gut. This creates the classically described „red currant jelly” stool, which is a mixture of sloughed mucosa, blood, and mucus.

• #16 Current diagnosis and image-guided reduction for intussusception in children

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2021.01816

  The prevalence of pathological lead points has reportedly 0.3%-20%. In a meta-analysis, the pooled proportion of pathologic lead points was 4% in children with intussusception, and Meckel’s diverticulum was the most common cause. Other pathological lead points included duplication cyst, polyp, lymphoma, and lymphoid hyperplasia. The incidence of pathologic lead points increases in children older than the typical age groups (5 years). Children with multiple episodes of recurrent intussusception are at an increased risk of pathologic lead points despite most with recurrences not having a pathologic lead point.

• #17 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  A variety of conditions have been associated with intussusception, including Meckel diverticulum, polyps, small bowel lymphoma, duplication cysts, vascular malformations, inverted appendiceal stumps, parasites, immunoglobulin A vasculitis, cystic fibrosis, and hemolytic-uremic syndrome. […] The mechanisms leading to intussusception depend upon the specific cause. […] In patients with IgAV (HSP), a small bowel wall hematoma acts as the lead point. […] In patients with cystic fibrosis, thick inspissated stool may act as the lead point. […] Celiac disease appears to be associated with a modestly increased risk for intussusception, as suggested by a large study in Sweden. […] The diagnosis can be difficult to establish because intussusception may be confused with postoperative paralytic ileus.

• #18 Intestinal Intussusception: Etiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5179276/

  Adult intussusception is rare, accounting for only 1 to 5% of bowel obstructions. […] The causes of nonidiopathic adult intestinal intussusception are shown in Table 2. […] Benign or malignant neoplasms cause two-thirds of cases with a lead point; the remaining cases are caused by infections, postoperative adhesions, Crohn granulomas, intestinal ulcers (Yersinia), and congenital abnormalities such as Meckel diverticulum. […] Most adult intussusceptions arise from the small bowel, and most lesions are benign with a rate of 50 to 75% in most series. […] Less commonly, malignant tumors may act as lead points with metastatic disease (i.e., carcinomatosis) being the most common. […] The etiologies of adult intussusception defined earlier apply mainly to the Western developed world.

• #19 Intussusception: What It Is, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/10793-intussusception

  Intussusception involves one segment of the intestine folding partially inside another segment, causing a blockage. […] In most cases of intussusception, healthcare providers aren’t sure of the cause. […] In children, there does seem to be a relationship between viral infections and developing this condition. […] Causes in adults are more clear-cut. Adults with intussusception are more likely to develop it because they have colon cancer (malignant tumors) or benign (noncancerous) colon growths. […] Prompt treatment can typically fix the telescoping intestine. But, untreated intussusception can lead to life-threatening complications, including death. […] A hole in your intestine (gastrointestinal perforation). Food and digestive juices can become backed up behind the blockage from the intussusception. […] Severe inflammation and infection (peritonitis). The inflammation and tearing can cause the contents of your intestine to leak out. […] Tissue death (bowel necrosis). The injury to your intestine can cause the tissue to die.

• #20 Intestinal Intussusception: Etiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5179276/

  Adult intussusception is rare, accounting for only 1 to 5% of bowel obstructions. […] The causes of nonidiopathic adult intestinal intussusception are shown in Table 2. […] Benign or malignant neoplasms cause two-thirds of cases with a lead point; the remaining cases are caused by infections, postoperative adhesions, Crohn granulomas, intestinal ulcers (Yersinia), and congenital abnormalities such as Meckel diverticulum. […] Most adult intussusceptions arise from the small bowel, and most lesions are benign with a rate of 50 to 75% in most series. […] Less commonly, malignant tumors may act as lead points with metastatic disease (i.e., carcinomatosis) being the most common. […] The etiologies of adult intussusception defined earlier apply mainly to the Western developed world.

• #21 Most Adult Intussusceptions are Caused by Tumors: A Single-Centre Anal | CMAR

  https://www.dovepress.com/most-adult-intussusceptions-are-caused-by-tumors-a-single-centre-analy-peer-reviewed-fulltext-article-CMAR

  Most Adult Intussusceptions are Caused by Tumors: A Single-Centre Analysis […] The main pathogenesis of intussusception was malignant tumors in 51 cases (36.7%) and benign tumors and polyps in 49 cases (35.3%). […] Malignant and benign tumors are the main causes of adult intussusception. […] Among the 150 patients, the pathologic causes were identified in 139 patients who underwent surgery. The results showed that the intussusception of 100 (100/139, 71.9%) patients were related to tumors and polyps, among whom 51 patients (51/139, 36.7%) had malignant tumors, and 49 (49/139, 35.3%) had benign tumors. […] The aetiology of adult intussusception is complex, with nonspecific clinical symptoms and signs. We also found two cases of ectopic pancreas in this study. Ectopic pancreas may arise anywhere along the primitive foregut but is most common in the stomach, duodenum, and Meckels diverticulum. Clinically, ectopic nodules may result in bleeding, ulceration or bowel obstruction caused by intussusception. The diagnosis and treatment of adult intussusception is still a challenge for abdominal surgeons. […] Because 71.9% of the cases of adult intussusception were found to be related to tumors and polyps in this study, the results suggested that surgical treatment should be the preferred choice for adult intussusception patients.

• #22 Intussusception: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/930708-overview

  If the mesentery of the intussusceptum is lax and the progression is rapid, the intussusceptum can proceed to the distal colon or sigmoid and even prolapse out the anus. The mesentery of the intussusceptum is invaginated with the intestine, leading to the classic pathophysiologic process of any bowel obstruction. […] Early in this process, lymphatic return is impeded; then, with increased pressure within the wall of the intussusceptum, venous drainage is impaired. If the obstructive process continues, the pressure reaches a point at which arterial inflow is inhibited, and infarction ensues. The intestinal mucosa is extremely sensitive to ischemia because it is farthest away from the arterial supply. Ischemic mucosa sloughs off, leading to the heme-positive stools and subsequently to the classic „currant jelly stool” (a mixture of sloughed mucosa, blood, and mucus). If untreated, transmural gangrene and perforation of the leading edge of the intussusceptum occur.

• #23 Intussusception – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/intussusception

  Impaired lymphatic drainage and increasing pressure in intussusceptum bowel wall venous impairment congestion of mesenteric vessels ischemia of intussusceptum bowel wall sloughing of bowel mucosa (most sensitive to bowel ischemia since it is the furthest from the arterial supply) transmural necrosis and perforation with prolonged ischemia.

• #24 Intussusception: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/930708-overview

  If the mesentery of the intussusceptum is lax and the progression is rapid, the intussusceptum can proceed to the distal colon or sigmoid and even prolapse out the anus. The mesentery of the intussusceptum is invaginated with the intestine, leading to the classic pathophysiologic process of any bowel obstruction. […] Early in this process, lymphatic return is impeded; then, with increased pressure within the wall of the intussusceptum, venous drainage is impaired. If the obstructive process continues, the pressure reaches a point at which arterial inflow is inhibited, and infarction ensues. The intestinal mucosa is extremely sensitive to ischemia because it is farthest away from the arterial supply. Ischemic mucosa sloughs off, leading to the heme-positive stools and subsequently to the classic „currant jelly stool” (a mixture of sloughed mucosa, blood, and mucus). If untreated, transmural gangrene and perforation of the leading edge of the intussusceptum occur.

• #25 Child Intussusception – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431078/

  The trapped section of the bowel may have its blood supply cut off, which causes ischemia. The mucosa is sensitive to ischemia and responds by causing sloughing off into the gut. This creates a „red currant jelly” stool, which sloughed mucosa, blood, and mucus. „Red currant jelly” occurs in a minority of cases of intussusception and should be considered in the differential diagnosis of children passing any bloody stool. […] The causes of intussusception are not known. About 90% of cases of intussusception in children arise from an unknown cause. They can include infections, anatomical factors, and altered motility. […] An anatomic lead point occurs in approximately 10% of intussusceptions.

• #26 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children/print

  An increasing body of evidence suggests that viral triggers may play a role in some cases, as illustrated by the following observations: The incidence of intussusception has a seasonal variation, with peaks coinciding with seasonal viral gastroenteritis in some populations. […] A lead point is a lesion or variation in the intestine that is trapped by peristalsis and dragged into a distal segment of the intestine, causing intussusception. […] In approximately 25 percent of cases, an underlying disease causes a pathologic lead point for the intussusception, which may be focal or diffuse. Underlying disease processes account for a greater proportion of cases of intussusception in children younger than three months or older than five years. […] The mechanisms leading to intussusception depend upon the specific cause. As examples: Meckel diverticulum, polyps, duplication cysts, lymphomas, areas of reactive lymphoid hyperplasia, or other focal abnormalities of the intestinal tract act as lead points for peristalsis advancing the intestine into a distal segment of intestine.

• #27 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children/print

  In patients with IgAV (HSP), a small bowel wall hematoma acts as the lead point. Intussusception typically occurs after resolution of the HSP-associated abdominal pain. […] In patients with cystic fibrosis, thick inspissated stool may act as the lead point. […] Celiac disease appears to be associated with a modestly increased risk for intussusception, as suggested by a large study in Sweden. The proposed mechanism is that celiac disease may promote enteroenteric (small bowel) intussusception because of dysmotility and excessive secretions or bowel wall weakness. […] The mechanisms leading to intussusception depend upon the specific cause.

• #28 Rotavirus vaccines and intussusception

  https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/rotavirus-vaccines/intussusception

  GACVS last reviewed the safety profile of RotaTeq and Rotarix vaccines during its December 2011 meeting. At that time, the Committee concluded that both vaccines had a good safety profile, but that they may be associated with an increased (up to 6-fold) risk of intussusception after the first dose of vaccine in some populations. […] GACVS acknowledged that the findings from both countries tend to confirm a risk of intussusception following administration of both vaccines, in particular during the first 7 days following a first dose. The Committee noted that attributable risk estimates vary across studies. This might reflect differences in the background rate of intussusception (estimated to be double in Australia compared to the USA) but could also reflect sampling uncertainty in all available estimates and limitations of the surveillance systems that lead to some uncontrolled biases (e.g. differences in diagnostic tests and case definitions in different settings). Overall, the findings remain reassuring that the risk of intussusception following current rotavirus vaccines remains small compared to the benefits of preventing the impact of severe diarrhoea.

• #29 Rotavirus vaccines and intussusception

  https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/rotavirus-vaccines/intussusception

  Since the recommendation in 2009, post-licensure safety investigations in some countries revealed an increased risk of intussusception after use of Rotarix (Australia and Mexico) and RotaTeq (Australia). The risks where they have been found are substantially lower than those previously associated with RotaShield. Studies with active case finding indicated that, with the current vaccines in use, 4- to 6-fold increases in risk were clustered within the first week after the first dose. […] The Committee concluded that available data suggest that both Rotarix and RotaTeq continue to exhibit a good safety profile, but may be associated with an increased (up to 6-fold) risk of intussusception after the first dose of vaccine in some populations. The levels of risk observed are substantially less than those observed with the previous vaccine, RotaShield.

• #30 Rotavirus vaccines and intussusception

  https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/rotavirus-vaccines/intussusception

  Since the recommendation in 2009, post-licensure safety investigations in some countries revealed an increased risk of intussusception after use of Rotarix (Australia and Mexico) and RotaTeq (Australia). The risks where they have been found are substantially lower than those previously associated with RotaShield. Studies with active case finding indicated that, with the current vaccines in use, 4- to 6-fold increases in risk were clustered within the first week after the first dose. […] The Committee concluded that available data suggest that both Rotarix and RotaTeq continue to exhibit a good safety profile, but may be associated with an increased (up to 6-fold) risk of intussusception after the first dose of vaccine in some populations. The levels of risk observed are substantially less than those observed with the previous vaccine, RotaShield.

• #31 Rotavirus vaccines and intussusception

  https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/rotavirus-vaccines/intussusception

  In summary, postmarketing surveillance indicates the possibility of an increased risk of intussusception shortly after the first dose of rotavirus vaccine in some populations. If the findings are confirmed, the level of risk observed in these studies is substantially lower than the risk of 1 case/5000-10 000 in infants who received the RotaShield vaccine.

• #32 Intestinal Intussusception: Etiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5179276/

  Intussusception results from the alteration of normal peristalsis by a lesion in the bowel wall that creates invagination. […] The natural history of intussusception starts with a lead point, typically neoplastic (such as lymphadenopathy, polyp, or cancer), which acts as a focal area of traction that draws the proximal bowel within the peristalsing distal bowel. […] Certain anatomic features in the developing gastrointestinal tract may predispose the pediatric bowel to an intussusception, including an anterior insertion of the terminal ileum with respect to the cecum, decreased rigidity of the cecum secondary to the absence or underdeveloped taeniae coli, and lack of mature participation of the longitudinal muscle fibers of the colon at the level of the ileocecal valve. […] The development of intussusception may thus result from the invagination of the muscular ileocecal valve into the cecum due to the decreased rigidity of the cecal wall caused by the paucity of developed taeniae coli.

• #33 Intestinal Intussusception: Etiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5179276/

  Intussusception results from the alteration of normal peristalsis by a lesion in the bowel wall that creates invagination. […] The natural history of intussusception starts with a lead point, typically neoplastic (such as lymphadenopathy, polyp, or cancer), which acts as a focal area of traction that draws the proximal bowel within the peristalsing distal bowel. […] Certain anatomic features in the developing gastrointestinal tract may predispose the pediatric bowel to an intussusception, including an anterior insertion of the terminal ileum with respect to the cecum, decreased rigidity of the cecum secondary to the absence or underdeveloped taeniae coli, and lack of mature participation of the longitudinal muscle fibers of the colon at the level of the ileocecal valve. […] The development of intussusception may thus result from the invagination of the muscular ileocecal valve into the cecum due to the decreased rigidity of the cecal wall caused by the paucity of developed taeniae coli.

• #34 Intussusception | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/intussusception?lang=us

  Intussusception occurs when one segment of the bowel is pulled into itself or a neighboring loop of the bowel by peristalsis. […] A proximal part of the bowel is pulled into the distal lumen and propulsed forwards as if it were a bolus of food. The prolapsing part of the bowel is described as the intussusceptum, while the distal segment of bowel receiving the intussusceptum is described as the intussuscipiens. As the mesentery is incorporated into the intussusception, venous return is compromised, resulting in edema and further restriction of blood flow. Eventually, arterial supply to the bowel is interrupted, and ischemia and necrosis ensue. […] In children, a lead point is not identified in 90% of cases, and this is most frequently thought to relate to hypertrophic lymphoid tissue following an infection. This potentially explains the relative rarity of the condition in the first three months of life, when passive immunity is still paramount. […] In infants and adults, a lead point is more frequently identified, with up to 90% of adult cases having a lead point (which is usually malignant in the large bowel and benign in the small bowel).

• #35 Current diagnosis and image-guided reduction for intussusception in children

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2021.01816

  Intussusception involves invagination of the proximal bowel into the distal bowel. Ileocolic intussusception is the most common type, comprising more than 80% of cases, while other types include ileoileocolic, enteroenteric, and rarely colocolic intussusceptions. Intussusception typically occurs in infants and toddlers aged 3-36 months old. The classic clinical presentation is abdominal pain, vomiting, bloody stools, and abdominal mass, but it occurs in only 20% of cases, and most children do not show the complete symptom triad (abdominal pain, vomiting, and bloody stool). The clinical presentation is also age-related; younger children are more likely to experience vomiting, irritability, lethargy, or bloody stools, while older children are more likely to present with abdominal pain. […] Intussusception is idiopathic in most cases without an identifiable lead point, except the hyperplastic lymphoid tissue in the terminal ileum. Previous studies reported seasonal variations or no clear seasonal pattern. Viral or bacterial gastroenteritis was postulated as a causative factor of intussusception. Enteric and nonenteric types of adenovirus infection had significant associations in multiple studies, being reported in approximately 30%-40% of cases.

• #36 Child Intussusception – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431078/

  Intussusception is a condition in which part of the intestine folds into the section next to it. […] This activity reviews the cause, pathophysiology, and presentation of intussusception and highlights the role of the interprofessional team in its management. […] The cause is typically unknown in children, while in adults, a lead point due to cancer is often present. Risk factors in children include infections, cystic fibrosis, and intestinal polyps. Risk factors in adults include endometriosis, bowel adhesions, and intestinal tumors. Medical imaging often supports a diagnosis. In children, ultrasound is a preferred method to diagnose, while in adults, a CT scan is preferred. […] Usually, the ileum enters the cecum. Rarely does a part of the ileum or jejunum prolapse into itself. Almost all intussusceptions occur with the intussusceptum having been located proximally to the intussuscipiens. This is because a peristaltic action of the intestine pulls the proximal segment into the distal segment.

• #37 Intestinal Intussusception: Etiology, Diagnosis, and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5179276/

  Adult intussusception is rare, accounting for only 1 to 5% of bowel obstructions. […] The causes of nonidiopathic adult intestinal intussusception are shown in Table 2. […] Benign or malignant neoplasms cause two-thirds of cases with a lead point; the remaining cases are caused by infections, postoperative adhesions, Crohn granulomas, intestinal ulcers (Yersinia), and congenital abnormalities such as Meckel diverticulum. […] Most adult intussusceptions arise from the small bowel, and most lesions are benign with a rate of 50 to 75% in most series. […] Less commonly, malignant tumors may act as lead points with metastatic disease (i.e., carcinomatosis) being the most common. […] The etiologies of adult intussusception defined earlier apply mainly to the Western developed world.

• #38 Transient small bowel intussusception in an adult: case report with intraoperative video and literature review | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-015-0020-6

  The term intussusception refers to invagination of a segment of the gastrointestinal tract into the lumen of an adjacent segment. […] Intussusception is a rare form of bowel obstruction in adults, which is defined as the telescoping of a proximal segment of the gastrointestinal tract, into the lumen of the adjacent distal segment. […] Intussusception in adults is usually secondary to an existing pathology; in pediatric population, however it is mostly primary in origin. […] The mechanism behind intussusception could be explained by the presence of a bowel lesion that alters the normal peristaltic movements and serves as a lead point for intussusception. […] On the other hand, the mechanism of the rare entity of transient small bowel intussusception, as in our case, is not well described in medical literature.

• #39 Transient small bowel intussusception in an adult: case report with intraoperative video and literature review | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-015-0020-6

  Transient intermittent intussusceptions were reported in literature in patients with celiac or Crohns disease. […] However, they are frequently idiopathic and reduce spontaneously without any surgical intervention. […] The transient intermittent small bowel intussusception is a rare condition with only few similar cases reported in literature. […] Catalano reported 5 cases of transient small bowel intussusception. […] He described intussusception as momentary dysrhythmic contractions resulting in abnormal peristalsis. […] In adults, intussusception is usually accompanied with intermittent abdominal pain, nausea, vomiting, constipation, melena, weight loss, and fever. […] Transient small bowel intussusception can carry a further challenge as it often presents with nonspecific symptoms and signs.

• #40 Transient small bowel intussusception in an adult: case report with intraoperative video and literature review | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-015-0020-6

  Transient intermittent intussusceptions were reported in literature in patients with celiac or Crohns disease. […] However, they are frequently idiopathic and reduce spontaneously without any surgical intervention. […] The transient intermittent small bowel intussusception is a rare condition with only few similar cases reported in literature. […] Catalano reported 5 cases of transient small bowel intussusception. […] He described intussusception as momentary dysrhythmic contractions resulting in abnormal peristalsis. […] In adults, intussusception is usually accompanied with intermittent abdominal pain, nausea, vomiting, constipation, melena, weight loss, and fever. […] Transient small bowel intussusception can carry a further challenge as it often presents with nonspecific symptoms and signs.

• #41 Transient small bowel intussusception in an adult: case report with intraoperative video and literature review | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-015-0020-6

  It has been reported that transient small bowel intussusception can be completely asymptomatic. […] The diagnosis of this condition is often made by using abdominal CT scan. […] Imaging techniques, especially CT scan, are helpful in the diagnosis of intussusception. […] However, laparoscopy offers the advantage of distinguishing transient intussusception from persistent intussusception and other pathological conditions that require immediate surgical treatment.

• #42 Current diagnosis and image-guided reduction for intussusception in children

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2021.01816

  Intussusception involves invagination of the proximal bowel into the distal bowel. Ileocolic intussusception is the most common type, comprising more than 80% of cases, while other types include ileoileocolic, enteroenteric, and rarely colocolic intussusceptions. Intussusception typically occurs in infants and toddlers aged 3-36 months old. The classic clinical presentation is abdominal pain, vomiting, bloody stools, and abdominal mass, but it occurs in only 20% of cases, and most children do not show the complete symptom triad (abdominal pain, vomiting, and bloody stool). The clinical presentation is also age-related; younger children are more likely to experience vomiting, irritability, lethargy, or bloody stools, while older children are more likely to present with abdominal pain. […] Intussusception is idiopathic in most cases without an identifiable lead point, except the hyperplastic lymphoid tissue in the terminal ileum. Previous studies reported seasonal variations or no clear seasonal pattern. Viral or bacterial gastroenteritis was postulated as a causative factor of intussusception. Enteric and nonenteric types of adenovirus infection had significant associations in multiple studies, being reported in approximately 30%-40% of cases.

• #43 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  An increasing body of evidence suggests that viral triggers may play a role in some cases, as illustrated by the following observations: The incidence of intussusception has a seasonal variation, with peaks coinciding with seasonal viral gastroenteritis in some populations. […] Intussusception has been associated with some forms of rotavirus vaccine. […] Approximately 30 percent of patients experience viral illness (upper respiratory tract infection, otitis media, flu-like symptoms) before the onset of intussusception. […] A lead point is a lesion or variation in the intestine that is trapped by peristalsis and dragged into a distal segment of the intestine, causing intussusception. […] In approximately 25 percent of cases, an underlying disease causes a pathologic lead point for the intussusception, which may be focal or diffuse.

• #44 Adult Intussusception Secondary to COVID-19 Infection: A Case Report and Literature Review | Published in Journal of Brown Hospital Medicine

  https://bhm.scholasticahq.com/article/57555-adult-intussusception-secondary-to-covid-19-infection-a-case-report-and-literature-review

  Intussusception is a rare cause of bowel obstruction in adults. […] This case report aims to draw attention to the development of intussusception as a possible result of COVID-19 infection in the adult population and therefore guide less invasive management in these patients. […] Our case report suggests that COVID-19 may be implicated in the development of intussusception. […] The exact mechanism leading to invagination of one portion of the bowel into an immediately adjacent one in the setting of COVID-19 infection is not fully understood yet, but this presentation could possibly be related to bowel peristalsis changes as a result of viral replication in the intestinal cells. Lymphoid hypertrophy of the intestinal Peyers patches could also be contributing to this presentation. […] As the awareness regarding COVID-19-mediated GI manifestations increases COVID-19 may be more frequently considered in the differential diagnosis of non-mass related intussusception in adult patients.

• #45 Adult Intussusception Secondary to COVID-19 Infection: A Case Report and Literature Review | Published in Journal of Brown Hospital Medicine

  https://bhm.scholasticahq.com/article/57555-adult-intussusception-secondary-to-covid-19-infection-a-case-report-and-literature-review

  This consideration could subsequently guide further decisions regarding less invasive management in this patient population, including surgical / laparoscopic reduction without colectomy, or even endoscopic reduction. […] Given the absence of malignancy in such cases, and provided that there is no necrotic tissue in the setting of early diagnosis, avoiding unnecessary bowel resection and its potential side effects would be of utmost importance for the recovery of these patients.

• #46 Intussusception: What It Is, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/10793-intussusception

  Intussusception involves one segment of the intestine folding partially inside another segment, causing a blockage. […] In most cases of intussusception, healthcare providers aren’t sure of the cause. […] In children, there does seem to be a relationship between viral infections and developing this condition. […] Causes in adults are more clear-cut. Adults with intussusception are more likely to develop it because they have colon cancer (malignant tumors) or benign (noncancerous) colon growths. […] Prompt treatment can typically fix the telescoping intestine. But, untreated intussusception can lead to life-threatening complications, including death. […] A hole in your intestine (gastrointestinal perforation). Food and digestive juices can become backed up behind the blockage from the intussusception. […] Severe inflammation and infection (peritonitis). The inflammation and tearing can cause the contents of your intestine to leak out. […] Tissue death (bowel necrosis). The injury to your intestine can cause the tissue to die.

• #47 Intussusception | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/intussusception

  Intussusception occurs when a portion of your child’s intestine folds inside another segment — this causes an obstruction that prevents the passage of food, which is being digested. […] The walls of the two sections of intestine press on each other, causing irritation and swelling. […] Eventually, the blood supply to that area is cut off, which can cause damage to the intestine. […] We don’t really know. An increased incidence of developing intussusception is often seen in children: […] who have abdominal or intestinal tumors or masses. […] If left untreated, it can cause serious damage to the intestines, since their blood supply is cut off. […] Intestinal infection can occur, and the intestinal tissue can also die. […] Untreated intussusception can also cause internal bleeding and a severe abdominal infection called peritonitis.

• #48 Pediatric Intussusception Surgery: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/937730-overview

  Intussusception results in bowel obstruction, followed by congestion and edema with venous and lymphatic obstruction. This progresses to arterial obstruction and subsequent necrosis of the bowel. Ischemia and then necrosis result in fluid sequestration and bleeding from the gastrointestinal (GI) tract. If untreated, the bowel may perforate, resulting in sepsis. […] Vascular compromise and subsequent bowel necrosis are the primary concerns with intussusception. Among patients who undergo operative reduction of intussusception, those with long-standing intussusceptions, mostly due to late presentation, bear the risks of resection of affected bowel.

• #49 Intussusception: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/930708-overview

  Intussusception is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction. […] The pathogenesis of idiopathic intussusception is not well established. It is believed to be secondary to an imbalance in the longitudinal forces along the intestinal wall. In enteroenteral intussusception, this imbalance can be caused by a mass acting as a lead point or by a disorganized pattern of peristalsis (eg, an ileus in the postoperative period). […] As a result of imbalance in the forces of the intestinal wall, an area of the intestine invaginates into the lumen of adjacent bowel. The invaginating portion of the intestine (ie, the intussusceptum) completely telescopes into the receiving portion of the intestine (ie, the intussuscipiens). This process continues and more proximal areas follow, allowing the intussusceptum to proceed along the lumen of the intussuscipiens.

• #50 Intussusception Nursing Care Management Study Guide

  https://nurseslabs.com/intussusception/

  Intussusception is a process in which a segment of intestine invaginates or telescopes into the adjoining intestinal lumen, causing bowel obstruction. […] The pathogenesis of intussusception is not well established. […] It is believed to be secondary to an imbalance in the longitudinal forces along the intestinal wall. […] As a result of an imbalance in the forces of the intestinal wall, an area of the intestine invaginates into the lumen of the adjacent bowel. […] The invaginating portion of the intestine (ie, the intussusceptum) completely telescopes into the receiving portion of the intestine (ie, the intussuscipiens); this process continues and more proximal areas follow, allowing the intussusceptum to proceed along the lumen of the intussuscipiens. […] If the mesentery of the intussusceptum is lax and the progression is rapid, the intussusceptum can proceed to the distal colon or sigmoid and even prolapse out the anus. […] The mesentery of the intussusceptum is invaginated with the intestine, leading to the classic pathophysiologic process of any bowel obstruction.

• #51 Intussusception of the bowel in adults: A review

  https://www.wjgnet.com/1007-9327/full/v15/i4/407.htm

  Intussusception of the bowel is defined as the telescoping of a proximal segment of the gastrointestinal tract within the lumen of the adjacent segment. […] Adult intussusception represents 5% of all cases of intussusception and accounts for only 1%-5% of intestinal obstructions in adults. […] In contrast, almost 90% of the cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point, such as carcinomas, polyps, Meckels diverticulum, colonic diverticulum, strictures or benign neoplasms, which are usually discovered intraoperatively. […] Secondary intussusception is believed to initiate from any pathologic lesion of the bowel wall or irritant within the lumen that alters normal peristaltic activity and serves as a lead point, which is able to initiate an invagination of one segment of the bowel into the other.

• #52 Intussusception of the bowel in adults: A review

  https://www.wjgnet.com/1007-9327/full/v15/i4/407.htm

  Schematically, intussusception could be described as an internal prolapse of the proximal bowel with its mesenteric fold within the lumen of the adjacent distal bowel as a result of overzealous or impaired peristalsis, further obstructing the free passage of intestinal contents and, more severely, compromising the mesenteric vascular flow of the intussuscepted segment. The result is bowel obstruction and inflammatory changes ranging from thickening to ischemia of the bowel wall.

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