Clinical features

Perhaps the most important feature is the variability of the presentation - thus a high index of suspicion is required. Features include the following:

• history of paroxysms of abdominal colic, with screaming and pallor - the child is anxious on examination
• during each bout the infant becomes pale and draws up the legs. Spasms occur at intervals of about ten to 15 minutes, lasting two to three minutes, increasing in frequency.
• vomiting is an early symptom
• passage of blood and/or slime per rectum - this can be quite a late feature
• sausage-shaped mass is palpable in most cases, often in the right upper quadrant, not in the right iliac fossa. A mass is not always palpable in an ileo-ileal intussception, or if it is under the costal margin.
• rectal examination often reveals a mixture of bright red blood and slime described as ‘red current jelly’ on the examining gloved finger. This is a late feature. Rarely the tip of the intussusception can be felt.

If neglected, in less than 24 hours the child may be intensely toxic, have a distended abdomen, and exhibit feculent vomiting.

Chronic intussusception is rare and presents with much milder features. It may cause failure to thrive.

Reference

1. Marsicovetere P, Ivatury SJ, White B, et al. Intestinal intussusception: etiology, diagnosis, and treatment. Clin Colon Rectal Surg. 2017 Feb;30(1):30-9.