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Intussusception

By

William J. Cochran

, MD, Geisinger Clinic

Last full review/revision Feb 2020| Content last modified Feb 2020
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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.

  • The cause of intussusception usually is unknown.

  • Symptoms include episodes of stomach pain and vomiting that start suddenly and come and go several times per hour, and then later, stools may become bloody.

  • An air enema can confirm the diagnosis and also treat the condition.

  • Sometimes surgery is needed.

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, especially after 4 years of age. 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).

Symptoms

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.

What Is Intussusception?

One part of the intestine slides into another, much like the parts of a collapsible telescope. As a result, the intestine is blocked.

What Is Intussusception?

Diagnosis

  • Imaging tests, typically ultrasonography

A doctor may suspect intussusception based on the child’s symptoms and a physical examination.

Ultrasonography can be done to confirm the diagnosis. Plain x-rays of the abdomen may show a blockage in the intestines but do not confirm intussusception. Less commonly, computed tomography (CT) is done to evaluate the child for abdominal pain and can diagnose intussusception.

Treatment

  • Air enema

  • Surgery

If ultrasonography confirms intussusception, an air enema is done.

Air enema

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 happen again in the next 1 to 2 days.

When intussusception is corrected with the air enema and not with a surgical procedure, it happens again in about 5 to 10% of children.

Surgery

Surgery is needed for intussusception if

  • The child has signs of intestinal perforation.

  • The air enema does not correct the intussusception.

  • The disorder returns.

If the disorder returns, surgery is done to correct the disorder and also to look for a polyp, tumor, or other abnormality that could explain why the intussusception returned.

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