Intussusception

What is intussusception?

Intussusception is the most common cause of intestinal obstruction in children between ages three months and six years. Male babies are affected four times as often as female babies. Intussusception occurs when a portion of the intestine folds like a telescope, with one segment slipping inside another segment. This causes an obstruction, preventing the passage of food that is being digested through the intestine.

The walls of the two "telescoped" sections of intestine press on each other, causing irritation and swelling. Eventually, the blood supply to that area is cut off, which can cause damage to the intestine.

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What causes intussusception?

The cause of intussusception is not known. It may occur more frequently in people who have relatives who also had intussusception.

An increased incidence of developing intussusception is often seen in children:

• who have cystic fibrosis and are also dehydrated.
• who have abdominal or intestinal tumors or masses.
• who have an intestinal virus known as gastroenteritis.
• who have an upper respiratory tract infection, including infection with adenovirus.
• who have just finished taking chemotherapy for cancer.

A rotavirus vaccine that was approved by the US Food and Drug Administration (FDA) in 1998 was pulled from the market in 1999 because of an association between the vaccine and an increased risk for intussusception in infants aged one year or younger. However, no direct link was established to the vaccine as a cause of intussusception.

A new rotavirus vaccine was approved by the FDA in 2006. The risk for intussusception with the new vaccine was evaluated in a large clinical trial of over 70,000 children, and no increased risk was found. The manufacturer of the vaccine will continue to closely monitor the vaccine’s safety in additional clinical studies.

How often does intussusception occur?

Intussusception is rarely seen in newborn infants. Sixty percent of those who develop intussusception are between 2 months and 1 year of age. Although 80 percent of the children who develop the condition are less than 2 years old, intussusception can also occur in older children, teenagers, and adults.

• Boys develop intussusception four times more often than girls.
• Intussusception seems to occur more often in the spring and fall months.

Why is intussusception of concern?

Intussusception is a life-threatening illness. If left untreated, it can cause serious damage to the intestines, since their blood supply is cut off. Intestinal infection can occur, and the intestinal tissue can also die. Untreated intussusception can also cause internal bleeding and a severe abdominal infection called peritonitis.

What are the symptoms of intussusception?

The most common symptom of intussusception is sudden onset of intermittent pain in a previously well child. However, each child may experience symptoms differently. The pain may be mistaken for colic at first, and occurs at frequent intervals. Infants and children may strain, draw their knees up, act very irritable, and cry loudly. Your child may recover and become playful in-between bouts of pain, or may become tired and weak from crying.

Vomiting may also occur with intussusception, and it usually starts soon after the pain begins.

Your child may pass a normal stool, but the next stool may look bloody. Further, a red, mucus or jelly-like stool is usually seen with intussusception.

Symptoms of intussusception may resemble other conditions or medical problems. Please consult your child's physician for a diagnosis.

How is intussusception diagnosed?

A physician will obtain a medical history and perform a physical examination of your child. Imaging studies are also done to examine the abdominal organs, and may include:

• abdominal x-ray - a diagnostic test which may show intestinal obstruction.
• barium enema - a procedure performed to examine the large intestine for abnormalities. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems. On some occasions, the pressure exerted on the intestine while inserting barium will help the intestine to unfold, correcting the intussusception.

Treatment for intussusception:

Specific treatment for intussusception will be determined by your child's physician based on the following:

• the extent of the problem
• the health of the child
• the opinion of the physicians involved in the child's care
• your opinion and preference

In some instances, intussusception will fix itself while being diagnosed with a barium enema. However, if your child is very ill with an abdominal infection or other complications, your physician may not choose to perform this procedure.

Treatment may include:

surgery
An operation is necessary for intussusception that does not resolve with a barium enema, or for those who are too ill to have this diagnostic procedure. Under anesthesia, the surgeon will make an incision in the abdomen, locate the intussusception, and push the "telescoped" sections back into place. The intestine will be examined for damage, and, if any sections are not working correctly, they will be removed.

If there is damage to the intestine and the section removed is small, the two sections of healthy intestine will be sewn back together.

If the injured section of intestine is large, a significant amount of intestine may be removed. In this case, the parts of the intestine that remain after the damaged section is removed cannot be attached to each other surgically. A colostomy may be done so that the digestive process can continue. With a colostomy, the two remaining healthy ends of intestine are brought through openings in the abdomen. Stool will pass through the opening (called a stoma) and then into a collection bag. The colostomy may be temporary or permanent, depending on the amount of intestine that needed to be removed.

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What is the long-term outlook for a child with intussusception?

If not treated, intussusception is a life-threatening disorder. If treated within 24 hours, most babies recover completely.

The long-term outlook depends on the extent of intestinal damage (if any). Children with intestinal injury who had the damaged part removed may have long-term problems. When a large portion of the intestine is removed, the digestive process can be affected. Removing a large segment of the intestine can prevent a child from getting adequate nutrients and fluids. In this case, nutrition may need to be supplemented with long-term, high calorie IV (intravenous) solutions given through special IV catheters.

Consult your physician regarding the prognosis for your child.

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