Intussusception

About Intussusception

Intussusception (in-tuh-suh-SEP-shun) is the most common abdominal emergency affecting children under 2 years old. It happens when one portion of the bowel slides into the next, much like the pieces of a telescope.

When this “telescoping” happens, the flow of fluids and food through the bowel can become blocked, the intestine can swell and bleed, and the blood supply to the affected part of the intestine can get cut off. Eventually, this can cause part of the bowel to die.

Intussusception happens in 1 to 4 out of every 1,000 infants and is most common in babies 5 to 9 months old, though older children also can have it. Boys get intussusception more often than girls.

Signs and Symptoms

Babies and children with intussusception have intense abdominal pain, which often begins suddenly and causes the child to draw the knees up toward the chest. The pain often makes the child cry very loudly. As it eases, the child may stop crying for a while and may seem to feel better. The pain usually comes and goes like this, but can become very strong when it returns.

Symptoms also can include:

• abdominal swelling
• vomiting
• vomiting up bile, a bitter-tasting yellowish-green fluid
• passing stools (poop) mixed with blood and mucus, known as currant jelly stool
• grunting due to pain

As the illness continues, the child may gradually become weaker. He or she may develop a fever and appear to go into shock, a life-threatening medical problem in which lack of blood flow to the body’s organs causes the heart to beat quickly and blood pressure to drop.

Some babies with intussusception may just appear drowsy without vomiting, have stool changes, or have abdominal swelling.

Causes

Most of the time, doctors don’t know what causes intussusception. In some cases, it might follow a recent attack of gastroenteritis (or “stomach flu”). Bacterial or viral gastrointestinal infections may cause swelling of the infection-fighting lymph tissue that lines the intestine, which may result in one part of the intestine being pulled into the other.

In kids younger than 3 months of age or older than 5, intussusception is more likely to be caused by an underlying condition like enlarged lymph nodes, a tumor, or a blood vessel abnormality in the intestines.

Diagnosis and Treatment

Doctors usually check for intussusception if a child is having repeat episodes of pain, drawing up the legs, vomiting, feeling drowsy, or passing stools with blood and mucous.

During the visit, the doctor will ask about the child’s overall health, family health, any medications the child is taking, and any allergies the child may have. Next, the doctor will examine the child, paying special attention to the abdomen, which may be swollen or tender to the touch. Sometimes the doctor can feel the part of the intestine that’s involved.

If the doctor suspects intussusception, the child may be sent to an emergency room (ER). Usually, doctors there will ask a pediatric surgeon to see the child right away. The ER doctor might order an abdominal ultrasound or X-ray, which can sometimes show a blockage in the intestines. If the child looks very sick, suggesting damage to the intestine, the surgeon may take the child to the operating room right away to correct the bowel obstruction.

Two kinds of enemas (an air enema or a barium enema) often can diagnose and treat intussusception at the same time.

For an air enema, a small soft tube is placed in the rectum and air is passed through the tube. The air travels into the intestines and outlines the bowels on the X-rays. If intussusception is present it shows the doctors the telescoping piece in the intestine. At the same time, the pressure of the air unfolds the bowel that has been turned inside out and cures the blockage. Barium, a liquid mixture, is sometimes used in place of air to fix the blockage in the same way.

Both types of enema are very safe, and children usually do very well. However, it’s important to remember that the intussusception can return in 1 out of 10 cases. This usually happens within 72 hours following the procedure.

If the intestine is torn, an enema doesn’t work, or the child is too sick to try an enema, the child will need surgery. This is often the case in older children. Surgeons will try to fix the obstruction, but if too much damage has been done, that part of the bowel will be removed.

After treatment, the child will stay in the hospital and get intravenous (IV) feedings through a vein until he or she can eat and normal bowel function returns. Doctors will watch the child closely to make sure that the intussusception does not return. Some babies may also need antibiotics to prevent infection.

When to Call the Doctor

Intussusception is a medical emergency. If you’re worried that your child has some or all of the symptoms of intussusception, such as repeated crampy abdominal pain, vomiting, drowsiness, or passing of currant jelly stool, call your doctor or get emergency medical help immediately.

Most infants who are treated within the first 24 hours recover completely with no problems. But untreated intussusception can cause severe problems that get worse quickly. So it’s extremely important not to delay treatment — every second counts. Delayed treatment greatly increases the risk of irreversible tissue damage, tearing of the bowel, infection, and possibly death.