Intussusception is a very serious type of bowel obstruction that occurs in up to 4 in 1000 live births. The bowel (also called intestine) is shaped like a long tube. Intussusception occurs when a part of the bowel “telescopes” in on itself and is trapped by an adjacent portion of the small or large intestine. This causes swelling and obstruction, cutting off the blood supply to the intestine.
Causes
In many cases, there is no known cause for intussusception. However, intussusception may sometimes occur as a complication of some medical conditions, including:
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Viral infections
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Meckel's diverticulum
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Intestinal polyps
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Tumors, such as lymposarcoma and neurofibroma
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Lymphoma
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Cystic fibrosis
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Recent abdominal or chest surgery
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Henoch-Schonlein purpura
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Inflammatory bowel disease
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Hemophilia
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Hemangioma
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
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Age: It is the most common cause of obstruction in children 3 months to 6 years old, but the majority is younger than 12 months.
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Season: It is more common during respiratory and gastrointestinal virus seasons.
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Sex: Male
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Medical conditions in the list above
Symptoms
The initial symptoms may include:
Additional symptoms include:
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Poor feeding
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Diarrhea
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Shock
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Dehydration
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Fever
Intussusception cuts off the blood supply to the bowel. If this is not treated quickly, it can lead to bowel gangrene. Gangrene can cause tissue in the intestinal wall to die. This may lead to:
If not treated quickly, peritonitis can lead to death.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
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Blood and urine tests
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Fecal occult blood test, which checks the stool for blood
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Abdominal x-ray, ultrasound, or CT scan
Treatment
Air Enema
In many cases, giving an air enema will correct intussusception. Air enema is preferred over barium enema. This is often the preferred treatment when intussusception occurs in infancy. However, the test may occasionally cause a perforation to occur in the bowel. No form of enema should be done if the doctors know the bowel is perforated.
Surgery
Surgery may be required to release the trapped portion of the bowel and to clear the obstruction. If any bowel tissue has died due to gangrene, that part of the bowel may need to be removed.
After any treatment, intussusception may recur.
Prevention
There are no guidelines for preventing intussusception because the cause is unknown.
RESOURCES:
American Academy of Family Physicians
http://www.familydoctor.org
American Academy of Pediatrics
http://www.aap.org
Centers for Disease Control and Prevention
http://www.cdc.gov
References:
American Academy of Family Physicians website. Available at: http://www.familydoctor.org.
American Academy of Pediatrics website. Available at: http://www.aap.org.
Behrman RE, Kliegman RM , Jenson HB. Nelson Textbook of Pediatrics, 17th ed. Saunders: Philadelphia, PA; 2004.
Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov.
D’Augustino J. Common abdominal emergencies in children. Emerg Med Clin North Am. 2002;20(1):139-153.
King L. Pediatrics, intussusception. Emedicine website. Available at: www.emedicine.com/emerg/topic385.htm. 2005.
The Merck Manual of Medical Information. Simon and Schuster, Inc.; 2000.
O’Neill JA, Grosfeld JL, Fonkalsrud EW, Coran AG, Caldamone AA. Principles of Pediatric Surgery, 2nd ed. Mosby: St. Louis, MO; 2004.
Wood BP. Intussusception, child. Emedicine website. Available at: www.emedicine.com/radio/topic366.htm. 2005.
