Intussusception

Intussusception is a medical emergency. This happens when one portion of the bowel slides into the next. This would be similar to a telescope. When this happens, it blocks the bowel. It is most common in the first two years of life. The condition often resolves by itself, but the blockage can require surgery. When it happens, it may lead to swelling, inflammation (soreness and redness), and decreased blood flow to the intestines. This is the most common cause of intestinal obstruction in children between the ages of 3 months and 6 years. This condition usually:

  • Occurs most often in children between 5 and 10 months of age.

  • Is three to four times more common in boys than in girls.

The cause of intussusception is unknown; however when an adult or a child older than 3 years develops an intussusception, it's often the result of enlarged lymph nodes, a tumor, or a polyp in the intestine.

SYMPTOMS

Children with an intussusception have severe abdominal pain. It often begins so suddenly that it causes loud, anguished crying. It may cause the child to draw the knees up to the chest. The pain usually comes and goes and becomes stronger. As the pain lessens, a child with an intussusception may stop crying and seem fine.

Other common symptoms include:

  • Abdominal (belly) swelling

  • Weariness, sluggishness

  • Grunting

  • Passing stools mixed with blood and mucus

  • Vomiting bile (a greenish vomit).

  • Shallow breathing.

  • Pallor (child has lost his/her color).

Without treatment, a child may develop a fever, become weaker, and may go into shock. Symptoms of shock include tiredness, rapid heartbeat, weak pulse, low blood pressure, and rapid breathing. This will result in death if left untreated.

DIAGNOSIS

Your caregiver may be able to diagnose this condition just from talking to you (taking a history) and from checking the patient over. Special x-rays may be done.

TREATMENT

  • A barium enema is often used to both diagnose and treat a suspected intussusception. During a barium enema, a liquid mixture containing barium is given through a tube into the rectum. Special X-rays are then taken. Barium outlines the bowels on the X-rays. If an intussusception is found, it shows your caregiver where the telescoping piece of intestine is located.

  • When air is used instead of barium, this also outlines the bowels. The barium enema then not only shows the intussusception, but the pressure from putting it in the bowel may also unfold the bowel that has been telescoped. This then cures the obstruction.

  • The radiologist usually decides which test is most appropriate to perform. Both procedures are very safe and usually well tolerated. There's a small risk of recurrence. When recurrence happens, it is usually within 72 hours of the procedure.

  • If the child appears very ill, the surgeon may opt to take the child immediately to the operating room to correct the bowel obstruction. In these cases, the patient may not be well enough to tolerate x-rays.

  • Enemas as treatment are less successful in older children. These children are more likely to require surgery. Surgeons will try to fix the obstruction. If the bowel is too damaged, it may be removed or shortened.

  • Some babies with intussusception may be given antibiotics to prevent infection. Babies who have been treated for intussusception will be kept in the hospital and given IV feedings until they're able to eat and have their bowel (intestines) working well again. 

RELATED COMPLICATIONS

Most infants treated within the first 24 hours recover completely. Delay in treatment increases the risk of problems. Complications can include:

  • Permanent damage to the bowel

  • Infection

  • Holes may develop in the bowel

  • Death