ABSTRACT
Prenatal intussusception is a recognized cause of intestinal
atresia.1,2 The presentation is that of a bowel obstruction at
birth. Preoperative evaluation usually fails to yield a definite
diagnosis1 and the diagnosis is made at laparotomy.2 Prenatal
intussusception may be associated with fetal ascites3 or
meconium peritonitis.4 Some cases are due to a Meckel’s
diverticulum.5 Prenatal intussusception may result in an ileal
Although intussusception is common in the first year of life, it
is rare in neonates and premature infants,3,6 accounting for
fewer than 1% of cases. The intussusceptions may be multi-
ple6,7 in which situation there may be no obvious pathological
lesions at the lead points. Generally, however, when intussus-
ception occurs in a neonate or infant, the possibility of a
pathological lesion at the lead point must be entertained, and
of these, a duplication cyst, inverted Meckel’s diverticulum, or
an ileal polyp are the most likely.8 An early rotavirus vaccine
(Rotashield†) was withdrawn from the market because of its
association with intussusception. In contrast, the new live,
oral, attenuated rotavirus vaccines (RotaTeq† and Rotarix†)
appear to have no increased risk of intussusception.9,10
It is now well recognized that in the neonate and infant
under three months of age, the likelihood of a pathological
lesion at the lead point is significantly greater than in
intussusception that occurs later in the first year of life.1,11
When intussusception occurs in premature infants or in the
neonatal period, its presentation may mimic neonatal
necrotizing enterocolitis: the infant develops bile-stained
vomiting, increased nasogastric aspirates, blood in the stools,
and intestinal dilatation but without evidence of intramural gas (pneumatosis intestinalis) that is pathognomonic of
necrotizing enterocolitis.12 It is not surprising that diagnostic
confusion with necrotizing enterocolitis can lead to delay in
appropriate treatment.13 Similarly, in the neonate, the
combination of bowel obstruction and rectal bleeding may
lead to confusion with malrotation and volvulus; given the
rarity of the condition in this age group, the diagnosis is often
made only at operation.
