What is intussusception?
Intussusception is a condition in which one segment of intestine "telescopes" inside of another, causing an intestinal obstruction (blockage). Although intussusception 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 intestinal injury.
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.
How common is intussusception?
Intussusception occurs most commonly between the ages of three and 36 months, but may appear at any age. It is seen in approximately one in 1,200 children, and more often in boys. Intussusception occurs most frequently in the fall and winter months during viral season, but can happen at any time of the year.
Symptoms and Causes
What are the symptoms of intussusception?
The main symptom of intussusception is severe, crampy abdominal pain alternating with periods of no pain. Painful episodes may last 10 to 15 minutes or longer, followed by periods of 20 to 30 minutes of no pain, after which the pain returns. After symptoms have been present for a while, some children may become lethargic (feel very tired). Small children may draw their knees up to their chest during the episodes of pain.
Other possible symptoms of intussusception include:
- Rectal bleeding (red jelly-like stools), sometimes mixed with mucus.
These symptoms begin suddenly, usually one week after a non-specific viral illness.
Diagnosis and Tests
How is intussusception diagnosed?
Although intussusception can sometimes be felt as an abdominal mass during a physical examination, ultrasonography is able to identify the mass with 100% accuracy, and is the first radiologic test ordered for patients who are thought to have intussusception. Two other radiologic tests — barium enema and air contrast enema — also are used to help diagnose intussusception.
Management and Treatment
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 (the same tests that are used for diagnosis). This is a radiologic procedure, not a surgical procedure, and your child doesn’t need anesthesia.
The liquid contrast enema and air contrast enema procedures have a 60% to 70% success rate, with a 6% to 10% rate of intussusception recurrence (return). They also have a low risk of complications. If radiologic reduction is unsuccessful, then your child will need surgery. Surgery may also be done if there is a great deal of infection, or if your child is too ill for the radiologic procedure.
During the surgery
- Your 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 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 can’t 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 aren’t given during this period. Most children are able to eat again in one to three days.
Outlook / Prognosis
What should you expect after your child is discharge from the hospital?
Your child will be ready for discharge from the hospital 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 three to four weeks before returning to gym and sports.
Follow-up office appointment
A follow-up outpatient visit will be scheduled for four weeks after your child's surgery. Your child's healthcare provider will examine the wound and evaluate their recovery.
When should you call your child's healthcare provider?
You may notice some minor swelling around the incision. This is normal. However, call your healthcare provider if your child develops:
- Excessive swelling, redness, or drainage from the incision.
- Increasing pain.
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