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Intussusception

By

William J. Cochran

, MD, Geisinger Clinic

Last full review/revision Aug 2021| Content last modified Aug 2021
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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 Polyps of the Colon and Rectum A polyp is a projecting growth of tissue from the wall of a hollow space, such as the intestines. Some polyps are caused by hereditary conditions. Bleeding from the rectum is the most common... read more Polyps of the Colon and Rectum , Meckel diverticulum Meckel Diverticulum A Meckel diverticulum is a saclike outpouching of the wall of the small intestine that is present in some children at birth. Most children do not have symptoms, but sometimes painless rectal... read more , cancerous (malignant) tumor (such as lymphoma Overview of Lymphoma Lymphomas are cancers of lymphocytes, which reside in the lymphatic system and in blood-forming organs. Lymphomas are cancers of a specific type of white blood cells known as lymphocytes. These... read more Overview of Lymphoma ), or immunoglobulin A–associated vasculitis Immunoglobulin A–Associated Vasculitis Immunoglobulin A–associated vasculitis (formerly called Henoch-Schönlein purpura) is inflammation of mainly small blood vessels that most often occurs in children. A rash of reddish purple bumps... read more Immunoglobulin A–Associated Vasculitis . Children who have cystic fibrosis Cystic Fibrosis (CF) Cystic fibrosis is a hereditary disease that causes certain glands to produce abnormally thick secretions, resulting in tissue and organ damage, especially in the lungs and the digestive tract... read more 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 Peritonitis Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery... read more ).

Symptoms of Intussusception

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 (dark red 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 of Intussusception

  • Imaging tests, typically ultrasonography

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

If an imaging study done for some other reason shows an intussusception but the child has no symptoms, no treatment is needed. However, the doctor will advise parents to be alert for symptoms, such as pain, vomiting, and irritability.

Treatment of Intussusception

  • 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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