Intussusception is a condition characterized by the telescoping of one segment of the intestine into a neighboring distal segment, which can result in bowel obstruction. This process of invagination can impair blood flow, cause inflammation, and, if not promptly managed, may progress to ischemia and necrosis of the involved intestinal segment. It represents the leading cause of intestinal obstruction in infants and young children, especially those aged between 6 months and 3 years.1 the condition has an estimated incidence ranging from 1 to 4 per 1,000 live births and occurs more frequently in males, with a male-to-female ratio of approximately 3:2. While most cases are idiopathic—particularly in infants—underlying pathological lead points such as Meckel’s diverticulum, polyps, or lymphoma are more commonly found in older children.2In idiopathic cases, the ileum often invaginate into the cecum, resulting in the ileocolic type, which constitutes about 90% of cases. It is believed that lymphoid hyperplasia, particularly of Peyer’s patches, following viral infections like adenovirus or rotavirus, may initiate the condition. A lead point can serve as a nucleus for the intestine to fold inward, causing compression of the mesenteric vessels, bowel wall swelling, and possibly infarction.3

Clinically, children usually present with a sudden onset of intense, intermittent abdominal pain, which may be associated with inconsolable crying and pulling of the legs toward the abdomen. Although the classic triad—abdominal pain, vomiting, and "currant jelly" stools (a mixture of mucus and blood)—is considered characteristic, it is only observed in a minority of cases. On examination, a sausage-shaped mass may sometimes be felt in the right upper quadrant of the abdomen.4

Ultrasound is the preferred diagnostic tool and typically reveals a “target” or “donut” sign on transverse section. Although abdominal X-rays may yield nonspecific findings, they are useful for excluding perforation. In uncertain cases, contrast enemas can serve both diagnostic and therapeutic purposes.5In the absence of perforation or peritonitis, most cases can be managed successfully with non-surgical reduction using a pneumatic or hydrostatic enema under imaging guidance. However, surgical treatment becomes necessary if non-operative reduction fails, or if a pathological lead point or bowel necrosis is suspected.6 This study aims to outline the clinical features, types and management of children less than 5 years presenting with intussusception.

A retrospective descriptive study was carried out involving all patients under 5 years of age diagnosed with intussusception who presented to the Pediatric Surgery department of Assam Medical College and Hospital, Dibrugarh, Assam between December 2021 and November 2024 (a three-year period). Cases were identified using the Brighton Collaboration Level 1 criteria for intussusception, based on radiological or surgical confirmation.2 Potential intussusception cases were initially identified through radiological records and surgical operative registers of Department of Pediatric Surgery. Ultrasound reports for all pediatric patients who underwent abdominal ultrasonography were reviewed. The study included all children under the age of 5 who had an ultrasound-confirmed diagnosis of intussusception that required intervention. Confirmation of the diagnosis was performed by examining medical records, operative notes, and other relevant investigations. Information regarding medical history, immunization status, clinical presentation, type and management details was retrospectively extracted from hospital and departmental records. The collected data were then subjected to analysis. Descriptive statistical methods were applied using Microsoft Excel, and Social Science Statistics (online platform). The analyzed data were subsequently presented to formulate conclusions.

A total of 51 patients presented with intussusception during the time period of November 2021 to December 2024 in the hospital. Table 1 show that the highest number of cases was of the age group of 6-12 months (25.5%). Out of the 51 cases, 38 (74.5%) cases were male and the rest 13(25.5%) cases were female. The mean age was calculated to be 21.2 months.

Table 1: Age wise distribution of intussusception patients

Table 2: Month wise distribution of intussusception patients

Table 3 show that majority of the patients presented with vomiting (80.4%) followed by pain abdomen (72.55%). 21 patients presented with Bleeding per rectum/ Red currant jelly stool and 37 patients presented abdominal mass.

Table 3: Clinical presentations of intussusception patients

Table 4 show that most of the intussusception in this study were of ileo colic type followed by colo colic. Only 3.92% of patients presented with ileocolocolic type of intussusception and 5.88% of patients presented with ileoileal type.

Table 4: Types of intussusception

In Table 5, it can be seen that the most common cause of intussusception was idiopathic accounting for two third of the cases, followed by intussusception caused by Meckel’s diverticulum which accounts for 11.76% of cases.

Table 5: Association/Cause of intussusception in our study

Table 6 show that the majority of patients were treated with successful pneumatic reduction (49.02%). Operative intervention was needed in 50.98% of patients in which majority of the patients underwent operative reduction with/without serosal tear repair which accounts for 33.3%.

Table 6: Management of intussusception patients

Intussusception is a pediatric surgical emergency next to appendicitis as the most common cause of an acute abdominal emergency in children.7 we evaluated 51 cases of intussusception which were diagnosed by ultrasound imaging. Most children developed intussusception in first 2 years of their life. There were 31 children (60.78%) under the age of 2 years who presented with intussusception. The age group is similar to the result of the study of stringer and colleagues who found 80% cases occurring before 2 years of age8. Intussusception is rare in neonates. Weihmiller et al found median age to be 21.1 months in their study.9 In the present study median age was 21.2 months. Out of 51 children 38 (74.5%) were males. Several investigators world over have found a Male predominance.

In our study, children most commonly presented with vomiting (80.4%) followed by pain abdomen (72.55%). This is comparable to the results of the study by Yalcin et al where vomiting was the commonest complaint.10 Abdominal pain was felt in 78.08% of patients in the study by Khan J et al, 50- 85% patients in studies reported by Julie EB et al, Hutchinson et al and Ein SH et al.11–13 The most reliable abdominal sign if present, is a palpable mass in the right upper quadrant of the abdomen. It was present in 39.3% in study conducted by Wong et al, and was a risk factor suggesting the need of operative treatment.14 Presence of palpable mass mostly signifies, relatively longer duration of intussusception that causes complete intestinal obstruction. In our study palpable mass was seen in 56.86% of cases and all cases were surgically managed.

Ultrasound was the main diagnostic tool used in our study. The ability to detect or exclude disease through ultrasound is a crucial radiologic competency in any setting that cares for pediatric patients. Prompt treatment of intussusception is heavily dependent on access to pediatric ultrasound facilities. Nonoperative reduction is recommended for the majority of patients presenting with acute primary intussusception. The primary techniques include air enema reduction under fluoroscopic guidance or B-ultrasound-guided hydrostatic enema (B-USGHE). According to existing literature, these methods have reported success rates of at least 80%, with some studies achieving up to 100%. In our study pneumatic reduction was attempted in 29 patients in which 25 of the intussusception was reduced with a success rate of almost 86%. The findings of this study were consistent with those of Nayak D. et al.15, who demonstrated that USG-guided hydrostatic reduction (USGHR) is a simple, safe, and highly effective method for managing childhood intussusception. In their study the success rate was 81.37%.

In developing nations, surgery is often the primary method used to treat childhood intussusception, particularly in cases marked by delayed presentation, late referral, or suspected bowel gangrene. The most common anatomical type observed was ileocolic noted in 80.4% of children. This was in accordance with the study done by RK Ghritlaharey et al.16 Primary (idiopathic) intussusception accounted for 34 cases (66.67%), while 17 children (33.33%) had secondary intussusception associated with pathological lead points (PLPs). This was also comparable to studies done by other authors in India.

Intussusception remains the leading cause of acute intestinal obstruction in infants and young children, particularly in those under two years of age. It represents a heterogeneous condition that is predominantly idiopathic, although well-defined pathological lead points may occasionally be present, necessitating additional intervention. Delays in referral, diagnosis, and initiation of treatment are significantly associated with the development of bowel gangrene, the requirement for bowel resection during surgical management, and higher mortality rates. Therefore, early recognition and timely intervention are essential to ensure favorable outcomes and to reduce the risk of severe complications.

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