Intussusception is the telescoping of one portion of the intestine into another. It generally occurs in young children.
In this condition, one part of intestine abnormally slides inside the part of intestine next to it. This can be compared to one part of a telescope sliding into itself. When this occurs in the bowels, the veins and arteries are squeezed. This results in less blood flow to the intestine.
Typically, the child will have several minutes of severe abdominal pain. The pain is usually so intense that a parent cannot console the child. The child may pull his or her legs up against the chest. A completely pain-free period usually follows. The child may vomit with the first pain or soon after. There may be blood and mucus in the child's stools.
In most cases, the cause of the intussusception is unknown. Risk factors for the condition include the following: abnormalities in the bowel, such as a colorectal polypcystic fibrosis, a disease affecting the bowelsa foreign body in the bowel, such as a swallowed coininjury to the abdomen that causes bleeding in the bowela recent illness with diarrheaupper respiratory infection, such as a cold or flu
Intussusception is three times more common in males than in females. It is seen most often in infants from 3 to 12 months of age.
In the late 1990s, a number of cases of intussusception were found to be related to the receipt of the rotavirus vaccine that was on the market at that time. This vaccine was recalled. Careful watch is being kept to assure that the new rotavirus vaccine (released in 2006) does not have the same problem. Thus far, there is no evidence that the new vaccine causes intussusception.
There is usually nothing a parent can do to prevent this condition.
Diagnosis is made by barium enema in most cases. Barium is a liquid that can be seen on X-rays. Once barium is inserted into the intestine through the rectum, certain X-ray patterns identify the condition. Other X-ray tests may be used to diagnose this condition in some cases.
Once intussesception is treated, the long-term effects are minimal. When the condition recurs, it usually does so within the first 24 hours after treatment. Recurrence occurs less than 10% of the time. If left untreated, this condition may result in permanent damage to the bowels or even death.
Intussusception is not contagious and poses no risk to others.
If intussusception is not diagnosed and treated promptly, death will occur in 3 to 5 days. Treatment is highly effective, and death in treated children is rare. Barium or air is inserted through the rectum, causing the pressure inside the intestine to increase. This pressure forces the intestines back into their normal place.
If this procedure fails, surgery is necessary. During surgery, the intestine is physically pulled back into normal position. The surgeon will look for and repair any cause of the intussusception.
Rarely, a barium enema can put a hole in the intestine. If this occurs, surgery will be necessary. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.
After treatment, the child is monitored in the hospital for at least 24 hours. When the child is eating well, he or she can usually go home. Intussusception recurs 3% to 11% of the time. A second episode is most common in children who were treated with barium enema rather than surgery.
Any new or worsening symptoms should be reported to the healthcare provider.
Pediatric Emergency Medicine: Concepts and clinical practice. Barkin et al.