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Health condition · Clinically reviewed

Intussusception, the target sign, an air enema - and knowing when it is an adult problem.

A time-critical emergency in infants and a signpost to something else in adults. Recognised early, most children do very well.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against RCPCH, BSPGHAN, RCS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including image-guided pneumatic reduction and adult workup for a lead point.

Key facts

Intussusception at a glance.

The essentials, in plain English - who gets it, how it shows up, and how it is treated in the UK today.

  • What it is

    Telescoping of one segment of bowel into the next, which can obstruct blood flow and cause ischaemia if not treated quickly.

  • Who gets it

    Over 90 per cent of cases are children aged six months to two years, with a peak between six and nine months and a boyish predominance.

  • Adult cases

    About 5 per cent of cases occur in adults and almost always involve a pathological lead point such as a polyp or tumour.

  • Classic triad

    Colicky abdominal pain, vomiting and red-currant-jelly stools - though all three together is a late finding.

  • First-line imaging

    Abdominal ultrasound with its target or donut sign is the gold standard for diagnosis in children.

  • First-line treatment

    Image-guided air enema (pneumatic reduction) is successful in 80 to 90 per cent of paediatric cases.

Why this guide matters

Recognise it early, and most children do very well.

Intussusception is time-critical - but with prompt ultrasound and image-guided reduction most cases resolve without surgery. The three points below shape everything else on this page.

  • Ultrasound is the gold standard

    The target and donut signs on abdominal ultrasound confirm the diagnosis in children - fast, radiation-free and available in most emergency departments.

  • Air enema first, surgery second

    Pneumatic reduction succeeds in 80 to 90 per cent of paediatric cases. Surgery is reserved for failure, perforation or peritonism.

  • Adults are a different problem

    Adult intussusception almost always signals a pathological lead point - full workup for a colonic tumour is the standard.

How the diagnosis is made

From first symptoms to a settled plan.

The steps a UK paediatric or surgical team will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and red flags

    Sudden colicky pain in a well infant, episodes of pallor and inconsolable crying, vomiting, and any bloody or jelly-like stool.

  2. 02

    Assessing

    Focused examination

    Look for a sausage-shaped mass in the right upper quadrant and signs of dehydration, obstruction or peritonism.

  3. 03

    Assessing

    Stabilisation

    Nil by mouth, intravenous fluids, nasogastric decompression and analgesia - a specialist paediatric emergency from the outset.

  4. 04

    Confirming

    Ultrasound abdomen

    The target and donut signs on ultrasound confirm the diagnosis and guide reduction. See our guide to a private ultrasound scan.

  5. 05

    Confirming

    Bloods and gas

    FBC, U&Es, CRP and a venous gas help spot dehydration, electrolyte shift and any early sign of ischaemia.

  6. 06

    Preparing

    CT abdomen in adults

    For adults, contrast CT is the workhorse - it confirms the diagnosis and looks for the lead point that is almost always present.

  7. 07

    Preparing

    Paediatric surgical MDT

    A specialist commissioned team of paediatric radiology and surgery agree the plan for reduction and post-procedure care.

Typical timeline: assessment to reduction in hours, not days.

Symptoms

What intussusception looks like.

The classic infant picture - colicky pain, vomiting and pallor - and the vaguer subacute pattern that adults tend to present with.

  • Colicky abdominal pain

    Sudden severe cramps every 15 to 20 minutes with a well-looking child in between - a classic early feature.

  • Vomiting

    Initially non-bilious, becoming bilious as obstruction develops - a key sign to escalate quickly.

  • Red-currant-jelly stools

    Blood mixed with mucus from mucosal ischaemia - a late sign, but a clear one when it appears.

  • Palpable sausage-shaped mass

    Most often felt in the right upper quadrant with a strangely empty right iliac fossa (Dance sign).

  • Episodes of pallor and lethargy

    Between colicky episodes the child may look pale, drawn or unusually sleepy - a red flag in an infant.

  • Inconsolable crying

    Sudden, high-pitched crying with drawing up of the legs during each colicky episode.

  • Adult presentation

    Subacute or intermittent obstructive symptoms in adults - vaguer, longer-running and often mistaken for other causes.

  • Red flag - peritonism or shock

    A tense, tender abdomen, fever or shock suggests ischaemia or perforation - straight to theatre.

Treatment

How intussusception is treated in the UK.

Resuscitation first, image-guided reduction next, and surgery when reduction fails or a lead point is suspected.

  • Resuscitation first

    Nil by mouth, IV fluids, nasogastric tube and analgesia - stabilise the child before any attempt at reduction.

  • Air enema (pneumatic reduction)

    Image-guided pneumatic reduction is first-line for uncomplicated paediatric ileo-colic intussusception. See our guide to intussusception reduction.

  • Hydrostatic saline enema

    A saline alternative used in some centres - equally guided by ultrasound and safer than the older barium approach.

  • Surgery when enema fails

    Laparotomy or laparoscopy is needed if enema reduction fails, or where there is perforation, peritonism or a suspected lead point.

  • Bowel resection

    Necrotic or non-viable bowel is removed and reanastomosed - a specialist commissioned paediatric or colorectal decision.

  • Adult surgical resection

    Adults almost always need resection and formal workup for malignancy - see our guide to colon cancer.

  • Post-reduction observation

    Children are watched for at least 24 hours after successful reduction for recurrence, which happens in around one in ten.

  • Multidisciplinary follow-up

    Specialist commissioned paediatric surgery, radiology and, in adults, colorectal teams share ongoing care.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

If you are worried about your child, ring 999 or go to your nearest emergency department. This is a time-critical condition.

  • Royal College of Paediatrics and Child Health (RCPCH). Guidance on paediatric abdominal emergencies.

  • British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN). Intussusception standards.

  • Royal College of Surgeons (RCS) and Association of Coloproctology of Great Britain and Ireland (ACPGBI). Adult intussusception and bowel obstruction guidance.

  • NICE Clinical Knowledge Summaries. Acute abdominal pain in children.

Red flags

When it becomes a surgical emergency.

Most children respond to image-guided reduction. These are the signals that mean theatre, not radiology.

  • Peritonism

    A rigid, tender abdomen with guarding suggests ischaemia or perforation - straight to surgery, no enema.

  • Shock or sepsis

    Tachycardia, hypotension, mottled skin or fever mean urgent resuscitation and theatre, not radiology.

  • Bilious vomiting in an infant

    Any green vomiting in a baby is a surgical red flag and needs same-hour assessment.

  • Red-currant-jelly stools

    A late sign of mucosal ischaemia - do not wait for it, but if present treat as time-critical.

  • Failed enema reduction

    Two failed image-guided attempts, or any perforation during the procedure, moves the child to theatre.

  • Recurrence after reduction

    Recurrence in around one in ten - a persistent lead point, especially in older children, warrants surgical review.

  • Adult intussusception

    Almost always a pathological lead point in adults - full malignancy workup and resection are standard.

  • Post-HSP abdominal pain

    Intussusception can complicate Henoch-Schonlein purpura - low threshold for imaging in that setting.

  • Chronic anaemia with obstruction

    Iron-deficiency anaemia with intermittent obstructive symptoms in an adult points to a right-sided colonic tumour until proven otherwise.

Living with it

After the emergency, a clear path back.

Four things that matter in the days and weeks after treatment - gentle recovery, awareness of recurrence, following through in adults, and reassurance for worried parents.

A quiet reminder

Most children recover fully within days.

After successful reduction, the vast majority of infants go home well within 24 to 48 hours and return to normal feeding quickly.

  1. 01 Recovery

    Take the first days gently

    After successful reduction, most children go home within a day or two - expect a soft diet and a short spell of tiredness.

  2. 02 Watch

    Know the recurrence signs

    Around one in ten recurs, usually within 48 hours - the same pain, pallor and vomiting pattern warrants a return to hospital.

  3. 03 Adults

    Complete the malignancy workup

    In adults, follow through with colonoscopy or CT-colonography as advised - the lead point matters more than the reduction itself.

  4. 04 Reassure

    It is rarely anyone's fault

    Most paediatric cases are idiopathic and linked to viral infection - not diet, feeding or care at home.

Frequently asked

Everything we get asked about intussusception.

Quick answers on symptoms, ultrasound, air enema, and what adult cases mean.

  • What is intussusception?

    It is when one segment of intestine slides (telescopes) into the next, most often at the ileo-colic junction. That folding can block the bowel and cut off its blood supply, so it needs urgent assessment and imaging.

  • Who is most likely to get it?

    Over 90 per cent of cases are children aged six months to two years, with a peak at six to nine months and a slight predominance in boys. Adults account for around 5 per cent of cases, almost always with a pathological lead point.

  • What are the warning signs in a baby?

    Sudden colicky pain with pallor, inconsolable crying, drawing up of the legs, vomiting and - late in the picture - red-currant-jelly stools. A sausage-shaped mass may be felt in the right upper quadrant. Any of these needs same-day assessment.

  • How is it diagnosed?

    Abdominal ultrasound is the gold standard in children and shows the classic target or donut sign. In adults, a contrast CT is more usual and also looks for the lead point that is nearly always present.

  • How is it treated?

    In children, the first step is image-guided air enema (pneumatic reduction), which succeeds in 80 to 90 per cent of cases. Surgery is reserved for failed reduction, perforation, peritonism or a suspected lead point. Adults nearly always need surgical resection.

  • What is different about adult intussusception?

    In adults there is almost always a pathological lead point, most often a polyp, a benign tumour or a malignancy. Enema reduction is not the answer - surgery and a full workup for cancer are the standard.

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