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Diseases & Conditions

Intussusception

Intussusception is a condition in which one segment of intestine "telescopes" inside of another, causing an intestinal obstruction. Although it can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestines. The obstruction can cause swelling and inflammation that can lead to tearing of the intestines.

The exact cause of intussusception is unknown. In most cases, it is preceded by a virus that produces swelling of the lining of the intestine, which then slips into the intestine below. In some children, it is caused by a condition that the child is born with, such as a polyp or diverticulum.

What are the symptoms of intussusception?

The main signs and symptoms of intussusception are episodic, severe, crampy abdominal pain alternating with periods of lethargy (feeling tired). Small children may draw their knees up to their chest.

Other possible symptoms of intussusception include nausea, vomiting, and rectal bleeding (red jelly-like stools), sometimes mixed with mucus. These symptoms begin suddenly, usually one week after a non-specific viral illness.

How common is intussusception?

Intussusception occurs most commonly between the ages of 3 and 36 months, but may occur at any age. It is seen in approximately 1 in 1,200 children, and more often in boys. Intussusception occurs most frequently in the fall and winter months during viral season, but may occur at any time of the year.

How is intussusception diagnosed?

Intussusception can be felt as an abdominal mass during a physical examination. Ultrasonography is able to identify the mass with 100 percent accuracy and is the first radiologic test prescribed for patients with suspected intussusception. Two other radiologic tests--barium enema and air contrast enema--also are used to help diagnose intussusception.

How is intussusception treated?

Once intussusception is diagnosed, the next step is to attempt reduction (to push the intestine back) using a liquid contrast enema or air contrast enema (same test used for diagnosis). This is a radiologic procedure, not a surgical procedure, and the patient does not need anesthesia.

These procedures (liquid contrast enema and air contrast enema) have a 60 to 70 percent success rate, with a 6 percent to 10 percent rate of intussusception recurrence (return). They have a low risk of complications, as well. If hydrostatic reduction is unsuccessful, then the patient will need surgery. Surgery may also be done if there is significant infection, or if the patient is too ill for the radiologic procedure.

During the surgery
  • The child is fully sedated by a pediatric anesthesiologist (a specialist in pain relief and sedation in children).
  • If laparoscopy will be performed, small instruments and a camera will be inserted through small stab incisions (cuts) into the abdominal cavity.
  • Alternatively, a small incision is made on the right side of the abdomen, and the intestine is pushed back into its normal position.
  • If the intussusception cannot be reduced, then the surgeon will remove the involved segment of bowel.
After the surgery

Your child is given pain medication to keep him or her comfortable after the surgery. The child will require intravenous (in the vein) fluids for several days, because the intestines are temporarily slowed. Feedings are withheld during this period. Most children are able to resume eating in 1 to 3 days.

What to expect after discharge

Your child will be ready for discharge when he or she can eat a regular diet, has no fever or drainage from the incision, and has normal bowel function.

Most children will require a few days of rest at home before returning to school, and 2 to 4 weeks before returning to gym and sports.

When to call your child's health care provider

You may notice some minor swelling around the incision; this is normal. However, call your health care provider if your child develops:

  • fever
  • vomiting
  • excessive swelling, redness, or drainage from the incision
  • bleeding
  • increasing pain

Follow-up office appointment

A follow-up outpatient visit will be scheduled for 4 weeks after your child's surgery. Your child's health care provider will examine the wound and evaluate his or her recovery.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/12/2013…#10793

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