Intussusception is a disorder in which one segment of the intestine slides into another, much like the parts of a telescope. The affected segments block the bowel and block blood flow.
Intussusception is the most common cause of intestinal blockage among children between the ages of 6 months and 3 years. Boys are affected slightly more than girls. In most cases, the cause is unknown. In about 25% of children with intussusception, typically very young children and older children, the sliding (telescoping) is caused by something in the intestine such as a polyp, Meckel diverticulum, cancerous (malignant) tumor (such as lymphoma), or immunoglobulin A–associated vasculitis. Children who have cystic fibrosis are also at risk of developing intussusception.
Sometimes the sliding (telescoping) segments return to normal without treatment. If not, the telescoping segments block the intestine and then shut off the blood flow (called ischemia) to the affected area. If blood flow is shut off for more than a few hours, the affected intestine may die (develop gangrene). If a segment of the intestine dies, small holes (perforations) can develop, allowing bacteria to enter the abdominal cavity, resulting in a serious infection (peritonitis).
Intussusception usually causes episodes of stomach pain and vomiting to begin suddenly in a child who is otherwise healthy. The episodes typically last 15 to 20 minutes. At first, the child appears relatively well between episodes. Later, as ischemia develops, the pain becomes continuous, the child becomes irritable and/or lethargic, and some children pass currant jelly–like stools (stools containing blood and mucus) or develop a fever. Children who have a perforation appear ill and have pain when the abdomen is touched. Sometimes doctors can feel a sausage-shaped mass in the abdomen where the intussusception is located.
Rarely, children who have intussusception do not have pain. Instead, these children appear lethargic as though they have been drugged.
A doctor may suspect intussusception based on the child’s symptoms and a physical examination.
If ultrasonography confirms intussusception, an air enema is done.
With an air enema, the doctor puts air into the child’s rectum through a small tube and then takes x-rays. The pressure of the air usually pushes the telescoped portion of the intestine back into place. The x-rays show whether the procedure was successful. If the air enema is successful, the child can be sent home after an overnight hospital stay. Parents are advised to watch for further symptoms because intussusception can recur in the next 1 to 2 days.
When intussusception is corrected with the air enema and not with a surgical procedure, it recurs in about 5 to 10% of children.
Surgery is needed for intussusception if
In the case of a recurrence, surgery is done not only to correct the disorder but also to look for a polyp, tumor, or other abnormality that could explain why the intussusception recurred.