Intussusception is a
condition that develops when one part of the
intestine folds into itself, like a telescope.
Although this can occur anywhere along the intestinal tract, it most commonly
occurs between the lower part of the small intestine and the beginning of the
large intestine. See a picture of
intussusception.
When intussusception
occurs, the part of the intestine that folds inward may lose some or all of its
blood supply. This section of the intestine becomes swollen and painful. If
intussusception is not treated, the intestine may become blocked. In rare
cases, the intestine may tear, and stool may leak from it into the child's
abdomen, causing a serious, life-threatening condition as well as
gangrene.
Intussusception is the most
common cause of intestinal blockage in children 3 months to 6 years of
age.1 It occurs mainly in young children. It is rare
in adults. This topic focuses on intussusception in children.
What causes intussusception?
In children, the
cause of intussusception is not known in most cases. But it probably involves
swelling of
lymph nodes within the intestine wall. Intussusception
sometimes develops after a child has a viral cold or
inflammation in the stomach and intestines.
What are the symptoms?
A child with
intussusception may have recurring episodes of severe abdominal pain and may
scream and draw up his or her knees from severe cramping. During a bout of
pain, the child may look pale. The cramping lasts from about 1 to 5 minutes.
Afterward, the child may seem normal, only to have another episode of pain from
5 to 30 minutes later. Some children have an episode of pain before passing
stool. As the condition gets worse, the child may become listless and weak
between painful episodes.
How is intussusception diagnosed?
Based on your
child's symptoms, the doctor will check your child's abdomen for a tender,
sausage-shaped lump and will check the
rectum for signs of bleeding or bulging of tissue into
the rectum (prolapse).
An
X-ray of the abdomen is usually done to look for a
blockage in the intestine.
The doctor may want to do other tests,
such as an abdominal ultrasound or an enema using air, saline, or barium. A
computed tomography (CT) scan may be done to diagnose
intussusception in adults, but it is rarely used in children.
How is it treated?
Most children with
intussusception get better if treatment is started within 24 hours of the onset
of symptoms. Treatment may involve an enema or surgery to return the intestine
to its usual position. But in children who have other diseases that involve
their intestines, intussusception may develop into a more serious problem that
requires surgical removal of the affected section of the intestine.
Symptoms of
intussusception usually begin suddenly. Typically,
symptoms in a child include:
Irritability. A child may act fussy or
uncomfortable and be difficult to soothe.
Recurring episodes of
sudden, severe abdominal pain. During a bout of pain, the child may look pale
and may scream and draw up his or her knees. In the early stages, the child may
seem normal between bouts of pain, which tend to recur every 5 to 30 minutes
and gradually get worse. As the condition progresses, the child becomes weak
and listless between episodes of pain.
Frequent vomiting. As a
child's condition gets worse, vomiting decreases. Green fluid in vomit is a
sign that the intestine is blocked.
Passing irregular stools.
Early on, stools may appear normal. After a few hours, stools often are smaller
but occur more frequently, and diarrhea may develop. About half of children
begin to pass bloody stools, usually within about 12 hours to 1 or 2 days of
the start of other symptoms. As the condition progresses, stools may become
deep red and also contain mucus, making them look like jelly.
A
swollen, tender abdomen. You may be able to feel a mass shaped somewhat like a
sausage, usually along the upper right side of the abdomen.
Very few intussusceptions heal on their own. If
intussusception is not treated, serious and life-threatening complications can
develop, such as infection of the lining of the abdominal wall (peritonitis) or a hole or opening (perforation) in the
intestinal wall.
Signs that intussusception is getting worse
include:
In
adults, the symptoms of intussusception may be less
obvious but include vague abdominal pain, nausea and vomiting, abdominal
bloating, or a change in the usual stool output, color, or pattern.
A diagnosis of
intussusception is usually based on the child's
symptoms. If intussusception is suspected, the doctor will do a physical exam.
As part of the physical exam, the doctor examines the child's:
Abdomen, for a tender, sausage-shaped lump,
which suggests telescoping of the intestine. This lump may be difficult to
detect, especially if the child is crying.
Rectum, for the
presence of blood or signs of bleeding or bulging of tissue into the rectum
(prolapse).
An
X-ray of the abdomen is usually done also. The X-ray
may show nothing unusual in the child's intestines, or it may show signs of a
blockage in the intestine.
If the child has rectal bleeding, and
an abdominal X-ray strongly suggests the condition, the diagnosis is likely to
be intussusception.
Ultrasound of the abdomen and an enema are
used to confirm a diagnosis of intussusception.
Ultrasound of the abdomen
An
ultrasound of the abdomen can determine whether
intussusception is present and show how much swelling there is in a child's
intestinal wall.
Air or barium enema
During an enema, air, saline, or
barium (a milky-white liquid) is flushed through a
child's rectum into the intestines. If intussusception is present, X-rays taken
during the enema will show a blockage or a small opening in the affected part
of the intestine.
Enemas using air or saline rather than barium
are generally preferred in babies and young children.
Because of
the risk of intestinal rupture during an enema, this procedure should only be
done in a hospital where access to surgery is immediately
available.
An enema is also used as a treatment to help clear the
intestinal blockage.
A
computed tomography (CT) scan of the abdomen is
helpful in diagnosing intussusception in
adults. It is rarely done in children.
Treatment Overview
Ideally, treatment for
intussusception begins within 24 hours after the start
of symptoms. Normally, a child is treated in the hospital with either an enema
or surgery. The type of treatment varies depending on the age of the child and
the extent of the problem in the
intestine.
Enemas
An enema usually consists of air or saline,
although
barium (a milky-white liquid) may also be used. This
procedure can also confirm a diagnosis. The enema increases the pressure in the
child's intestine, which can often cause the affected area to return to its
normal position. This process is called reduction.
Enemas to treat
intussusception are done in the X-ray department of a hospital. During the
enema, an
X-ray or
ultrasound is used to check the condition of the
intestine.
On average, enemas help about 75 out of 100 children
with intussusception. The success rate of air enemas appears to be better than
liquid (barium or saline) enemas, but more study is needed.2 The success rate partly depends on how long symptoms have
been present. The longer the symptoms have been present, the less likely it is
that an enema reduction will be successful.
Bowel tears
(perforations) occur in up to 25 out of 1,000 attempted barium and saline
enemas. And tears occur in up to 2 out of 1,000 air enemas.1
Sometimes more than one enema is needed. But an
enema should not be used more than 2 or 3 times.
An enema should
not be used if there is evidence of an infection in the lining of the abdominal
wall (peritonitis), a ruptured intestine, a severe reaction
to an infection that has spread throughout the blood and tissues (sepsis), or the death and decay of tissue (gangrene) in the bowel.
Surgery
Sometimes
surgery is needed for intussusception. Surgery may be needed if:
Enemas have not corrected the problem after two
or three attempts.
Doctors suspect that the intestine has been
damaged and needs to be repaired.
The child is very ill or the
intestine has ruptured, leaking stool into the abdomen.
During surgery to correct intussusception:
An incision is made through the skin into the
abdomen.
In children, the affected part of the intestine is
stretched out and returned to its usual position. Any damaged part is removed.
The appendix is usually removed as well.
The incision through the
skin into the abdomen is closed.
If a large portion of the intestine is removed during
surgery or the intestine has developed a serious infection, the child may need
an ileostomy. This is an opening in which waste leaves
the small intestine and collects in an odor-proof plastic pouch fastened to the
skin.
If intussusception is not treated, the affected part of the
intestine will be blocked and may then rupture. This can cause serious
infection and possibly death.
Sometimes intussusception recurs.
About 10% of the time, intussusception recurs
in children after it has been treated with enemas.1 If
intussusception recurs after it has been treated with enemas, additional enemas
or surgery may be needed.
From 2% to 5% of the time,
intussusception recurs in children after it has been treated with
surgery.1 If intussusception recurs after surgery,
another surgery of the abdomen is usually needed to correct it again, to look
for other conditions that may be causing the condition, or to remove the
portion of the intestine that is involved.
If your child has symptoms of
intussusception, home treatment is not appropriate.
Take the child to your doctor immediately for a physical exam. If your child
has episodes of severe abdominal pain, you may need to take him or her for
emergency evaluation.
If your child has had an enema to correct
intussusception, watch for signs that the intussusception has recurred. The
symptoms may be the same as those from the first episode, which generally
include irritability, recurring abdominal pain, vomiting, diarrhea or irregular
stools that may contain blood and mucus, and a swollen or tender
abdomen.
If your child has had surgery for intussusception, talk
with your doctor about your child's care. Usually after this surgery, parents
need to:
Check for signs of complications of surgery,
such as nausea, vomiting, diarrhea, or a high
fever that does not decrease with home treatment. For
more information about fever in children, see the topic
Fever, Age 3 and Younger or
Fever, Age 4 and Older.
This Web site is sponsored by Nemours Foundation. It has
a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This Web site
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly e-mails about your area of interest.
National Digestive Diseases Information Clearinghouse
(NDDIC)
2 Information Way
Bethesda, MD 20892-3570
Phone:
1-800-891-5389
Fax:
(703) 738-4929
E-mail:
nddic@info.niddk.nih.gov
Web Address:
www.digestive.niddk.nih.gov
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
Wyllie R (2007). Intussusception section of Ileus,
adhesions, intussusception, and closed-loop obstructions. In RM Kliegman et
al., eds., Nelson Textbook of Pediatrics, 18th ed., pp.
1569-1571. Philadelphia: Saunders Elsevier.
Kaiser AD, et al. (2007). Current success in the
treatment of intussusception in children. Surgery,
42(4): 469-477.
Other Works Consulted
Hackam DJ, et al. (2005). Intussusception section of Pediatric surgery. In FC Brunicardi et al., eds., Schwartz's Principles of Surgery, 8th ed., pp. 1493-1494. New York: McGraw-Hill.
Justice FA, et al. (2006). Intussusception: Trends in clinical presentation and management. Journal of Gastroenterology and Hepatology, 21(5): 842-846.
Schafermeyer RW (2004). Pediatric abdominal emergencies. In JE Tintinalli et al., eds., Emergency Medicine: A Comprehensive Study Guide, 6th ed., pp. 813-821. New York: McGraw-Hill.
Stevenson RJ (2003). Intussusception section of
Gastroenterology and nutrition. In CD Rudolph et al., eds., Rudolph's Pediatrics, 21st ed., pp. 1407-1408. New York:
McGraw-Hill.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Wyllie R (2007). Intussusception section of Ileus,
adhesions, intussusception, and closed-loop obstructions. In RM Kliegman et
al., eds., Nelson Textbook of Pediatrics, 18th ed., pp.
1569-1571. Philadelphia: Saunders Elsevier.
Kaiser AD, et al. (2007). Current success in the
treatment of intussusception in children. Surgery,
42(4): 469-477.
