Intussusception

Intussusception is the most common cause of intestinal obstruction in children between the ages of 3 months and 3 years and 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.

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

Boys develop intussusception four times more often than girls. Additionally, the disorder seems to occur more often in the spring and fall months.

Intussusception is a life-threatening illness and if left untreated, can cause serious damage to the intestines as their blood supply becomes 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 Causes of Intussusception?

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

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

• Cystic fibrosis and dehydration
• Abdominal or intestinal tumors or masses
• An intestinal virus, known as gastroenteritis
• An upper respiratory tract infection, including infection with adenovirus
• Just finished taking chemotherapy for cancer

A rotavirus vaccine 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 more than 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.

What Are the Symptoms of Intussusception?

The most common first 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 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 the following:

• Abdominal X-ray
  • A diagnostic test that may show intestinal obstruction
• An enema using barium, saline or air
  • This is a procedure performed to examine the large intestine for abnormalities. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages) and other problems. On some occasions, the pressure exerted on the intestine during the enema helps the intestine to unfold, thereby correcting the intussusception.

How Is Intussusception Treated?

Specific treatment for intussusception will be recommended 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

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

Surgery will be necessary for intussusception that does not resolve with an 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 and the two sections of healthy intestine will be sewn back together.

What Are the Long-term Effects of 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, if any, of intestinal damage.

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. Consult your physician regarding the prognosis for your child.