Intussusception (children) is a telescoping of one portion of the intestine into another, which results in decreased blood supply of the involved segment.
Causes, incidence, and risk factors
This condition results in an obstruction of the intestine caused by part of the gut being pulled inward (like a telescope). Strangulation of the segment of intestine which has been pulled inside the lower intestinal segment can occur. The pressure created by the two walls of the intestine pressing together causes inflammation, swelling and decreased blood flow. Death of bowel tissue can occur with significant bleeding , perforation, and infection. Shock and dehydration can occur very rapidly. The cause of intussusception is not known although viral infections may be a possible cause. Sometimes a mass like a lymph node, a polyp, or a tumor can serve as a lead point triggering the telescoping of the gut. Recently, it has been suggested that a new vaccine for Rotavirus is associated with an increased incidence of intussusception. The vaccine was subsequently pulled from the market. Intussusception affects boys 3 times more often than girls. Most cases occur in children between 5 months and 1 year of age.
Intussusception often begins with sudden loud and pained crying caused by abdominal pain . The pain is colicky and intermittent (not continuous), but recurs frequently increasing in both intensity and duration. As the condition progresses the infant may become weak and then shocky. Vomiting and fever are common and about half of the infants will pass bloody, mucus-like stool sometimes referred to as a "currant jelly" stool.
Early diagnosis is important in order to salvage both the bowel and the infant.
Signs and tests
A physical examination may reveal a mass in the abdomen . Signs of dehydration or shock may be present. Tests:
An abdominal X-ray may suggest obstruction.
A barium enema may show telescoping bowel.
Treatment
In some cases, the bowel obstruction can be reduced with a barium enema by a skilled radiologist. There is a risk of bowel perforation with this procedure, and the procedure is not used if a bowel perforation is already present. If nonoperative reduction is unsuccessful, a surgical reduction is indicated. Usually the bowel tissue can be saved, but if dying tissue is present, surgical removal of part of the bowel (resection) will be performed. Intravenous feeding and fluid will be continued until a normal bowel movement has passed.
Expectations (prognosis)
The probable outcome is good with early treatment. In older children, intussusception may develop because of the presence of polyps or tumor .
Complications
Perforation with infection is a complication.
Calling your health care provider
INTUSSUSCEPTION IS AN EMERGENCY CONDITION! Call the health care provider or go to the emergency room immediately.