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Abstract SUMMARY AND RECOMMENDATIIONS Intussusception refers to the invagination of a part of the intestine into itself. It is the most common cause of intestinal obstruction in infants between 6 and 36 months of age. Approximately 75 percent of cases of intussusception are considered ”idiopathic”, although some of these episodes may be triggered by viral infections. The remaining 25 percent of cases are caused by an underlying disease or condition which creates a pathological lead point for the intussusception, including Meckel diverticulum. Intussusception typically presents with the sudden onset of intermittent, severe, crampy, progressive abdominal pain, sometimes with vomiting and grossly bloody stools. In a minority of cases, the initial presenting sign may be lethargy or altered consciousness alone, without apparent abdominal symptoms. Ultrasonography is the method of choice to detect intussusception in most institutions. A ”bull’s eye” or ”coiled spring” lesion is seen, representing layers of the intestine within the intestine. Summary - 98 - For stable patients with radiographic evidence of intussusception and no evidence of bowel perforation, recommend nonoperative reduction of the intussusception rather than surgery or observation). The reduction can be guided by fluoroscopy or ultrasound, and either hydrostatic or pneumatic enemas may be used. The success rates and risks of these techniques are similar; ultrasound-guided approaches have the benefit of better identification of pathological lead points and lower exposure to radiation. Intussusception recurs after successful nonoperative reduction in approximately 10 percent of patients. If the patient is stable, suggest treating recurrences with repeated nonoperative reduction rather than surgery. Patients with one or more recurrences are more likely to have pathological lead points. Surgical treatment is indicated as a primary intervention for patients with suspected intussusception who are acutely ill or have evidence of perforation. Surgery also may be appropriate when the patient is treated in a location where the radiographic facilities and expertise to perform nonoperative reduction are not readily available. Surgery also may be necessary for patients in whom nonoperative reduction is unsuccessful, or for evaluation or resection of a pathological lead point |