What is intussusception?
- Intussusception is the infolding (telescoping) of one segment of the intestine within another.
- Intussusception usually results in a blockage of the intestine.
- Intussusception occurs primarily in infants (boys more often than girls) but can also occur in adults and older children.
- The primary symptoms of intussusception include abdominal pain and vomiting.
- Early diagnosis and treatment of intussusception are essential to save the intestine and the patient.
What is intussusception?
Intussusception is the telescoping of one segment of intestine into another adjacent distal ("downstream") segment of the intestine. (The term "intussusception" is pronounced "in-tuh-suh-sep-shun" with the accent on the "in." It comes from the Latin "intus", within + "suscipere", to receive = to receive within). Common mispellings of intussusception include: intususception, intussuseption, intersusception.
Intussusception is the most common cause of intestinal obstruction in children between 3 months and five years of age. It is extremely rare in children under 3 months of age or in older children and adults.
What happens during intussusception?
During intussusception, a segment of bowel (intussusceptum) telescopes into a more distal segment (intussuscipiens), and drags the associated mesentery, vessels, and nerves with it. This results in compression of the veins, followed by swelling of the region leading to obstruction and a subsequent decrease in blood flow to the affected part of the intestine. Most cases affect the ileocolic region of the intestine (where the small intestine meets the large intestine).
The compression of blood vessels in the involved intestine reduces the supply of blood to the affected intestine. If the blood supply is greatly reduced, the involved intestine may swell, causing an obstruction, or even die (become gangrenous) and bleed. It also may rupture and lead to abdominal infection and shock.
What are the symptoms for intussusception?
The first sign of intussusception in an otherwise healthy infant may be sudden, loud crying caused by Abdominal pain. Infants who have Abdominal pain may pull their knees to their chests when they cry.
The pain of intussusception comes and goes, usually every 15 to 20 minutes at first. These painful episodes last longer and happen more often as time passes.
Other frequent signs and symptoms of intussusception include:
- Stool mixed with blood and mucus (sometimes referred to as "currant jelly" stool because of its appearance)
- A lump in the abdomen
Not everyone has all of the symptoms. Some infants have no obvious pain, and some children don't pass blood or have a lump in the abdomen. Some older children have pain but no other symptoms.
Because intussusception is rare in adults and symptoms of the disorder often overlap with the symptoms of other disorders, it's more challenging to identify. The most common symptom is Abdominal pain that comes and goes. Nausea and Vomiting may also occur. People sometimes have symptoms for weeks before seeking medical attention.
When to see a doctor
Intussusception requires emergency medical care. If you or your child develops the signs or symptoms listed above, seek medical help right away.
In infants, remember that signs of Abdominal pain may include recurrent bouts of pulling the knees to the chest and crying.
What are the causes for intussusception?
Your intestine is shaped like a long tube. In intussusception, one part of your intestine — usually the small intestine — slides inside an adjacent part. This is sometimes called telescoping because it's similar to the way a collapsible telescope folds together.
In some cases, the telescoping is caused by an abnormal growth in the intestine, such as a polyp or a tumor (called a lead point). The normal wave-like contractions of the intestine grab this lead point and pull it and the lining of the intestine into the bowel ahead of it. In most cases, however, no cause can be identified for intussusception.
In the vast majority of cases of intussusception in children, the cause is unknown. Because intussusception seems to occur more often in the fall and winter and because many children with the problem also have flu-like symptoms, some suspect a virus may play a role in the condition. Sometimes, a lead point can be identified as the cause of the condition — most frequently the lead point is a Meckel's diverticulum (a pouch in the lining of the small intestine).
In adults, intussusception is usually the result of a medical condition or procedure, including:
- A polyp or tumor
- Scar-like tissue in the intestine (adhesions)
- Weight-loss surgery (gastric bypass) or other surgery on the intestinal tract
- Inflammation due to diseases such as Crohn's disease
What are the treatments for intussusception?
The treatment of intussusception may or may not require surgery. In some cases, the intestinal obstruction can be reversed with an enema. The enema carries a risk of intestinal rupture and cannot be done if the bowel has already perforated. The procedure also requires the availability of a surgeon, in case the patient's bowel ruptures or the intussusception cannot be reduced.
If the intestinal obstruction cannot be reversed by an enema, surgery is necessary to reverse the intussusception and relieve the obstruction. If a portion of the intestine has become gangrenous, it must be removed. After surgery, intravenous feeding and fluids are continued until normal bowel movements resume. Because of the risk of recurrence, patients who are successfully reduced by enema usually are admitted for observation during the first 24 hours post procedure, and have no ill effects. Recently, research has suggested that a select population of the children may be observed for shorter periods of time (6 hours) after undergoing reduction of the intussesception by enema, but currently, most patients stay the full 24 hours.
What are the risk factors for intussusception?
Risk factors for intussusception include:
- Age. Children — especially young children — are much more likely to develop intussusception than adults are. It's the most common cause of bowel obstruction in children between the ages of 6 months and 3 years.
- Sex. Intussusception more often affects boys.
- Abnormal intestinal formation at birth. Intestinal malrotation is a condition in which the intestine doesn't develop or rotate correctly, and it increases the risk for intussusception.
- A prior history of intussusception. Once you've had intussusception, you're at increased risk of developing it again.
- A family history. Siblings of someone who's had an intussusception are at a much higher risk of the disorder.
Is there a cure/medications for intussusception?
Intussusception is frequently treated as a medical emergency. To avoid serious dehydration, shock, and infection that can happen when a section of the intestine dies due to a lack of blood, immediate medical attention is necessary.
There are several possible treatments for intussusception:
- An air enema or water-soluble contrast: This is both a diagnostic and therapeutic process. In most cases, additional therapy is not required if an enema is effective. Ninety percent of the time, intussusception in children can be resolved with this treatment alone. This treatment is not applicable to ripped (perforated) intestines.
- Up to 20% of the time, intussusception recurs, necessitating repeating the therapy. Even if an enema is intended as part of the treatment, it is crucial to see a surgeon. This is due to the slight possibility that this therapy will cause a bowel rip or rupture.
- Surgery: Surgery is required if the intestine is torn, an enema is unable to resolve the issue, or a lead point is to blame. The surgeon will release the obstructed section of the intestine, remove the obstruction, and, if required, remove any dead intestinal tissue. The primary form of treatment for adults and those who are very ill is surgery.
Cystic fibrosis,Crohn's disease,Lump in abdomen