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Intussusception
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/intussusception/DS00798
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Definition
Intussusception (in-tuh-suh-SEP-shun) is a serious disorder in which part of the intestine — either the small intestine or colon — slides into another part of the intestine. This "telescoping" often blocks the intestine, preventing food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected.
Intussusception is the most common cause of intestinal obstruction in children. Intussusception is rare in adults. Most cases of adult intussusception are the result of an underlying medical condition. In contrast, most cases of intussusception in children have no demonstrable cause.
With prompt attention, intussusception can often be successfully treated without lasting problems.
Symptoms
Children
Signs and symptoms of intussusception in children include:
- Severe abdominal pain that comes and goes (intermittent pain)
- Stool mixed with blood and mucus (sometimes referred to as "currant jelly" stool because of its appearance)
- A lump in the abdomen
- Swollen (distended) abdomen
- Vomiting, possibly vomiting bile (yellow-brown or greenish fluid)
- Diarrhea
- Fever
- Dehydration
- Lethargy
The first sign of intussusception in an otherwise healthy infant may be sudden, loud crying caused by abdominal pain. Infants who have abdominal pain may pull their knees to their chests when they cry. The pain of intussusception comes and goes, usually every 15 to 20 minutes at first. These painful episodes last longer and happen more often as time passes.
Adults
Although rare, intussusception can happen in adults. Signs and symptoms of intussusception in adults may come and go (intermittent symptoms), or they may be unrelenting. They may include:
- Changes in the frequency of bowel movements
- An urgent need to move your bowels (urgency)
- Rectal bleeding
- Crampy abdominal pain
- Abdominal pain or swelling
- Nausea
- Vomiting
When to see a doctor
Intussusception requires emergency medical care. If you or your child develops the signs or symptoms listed above, seek medical help right away.
In infants, remember that signs of abdominal pain may include recurrent bouts of pulling the knees to the chest and crying.
Causes
Your intestine is shaped like a long tube. Intussusception is a disorder in which one part of your intestine — usually the small intestine — slides inside another part. This is sometimes referred to as "telescoping" because it's similar to the way a collapsible telescope folds together.
Some medical conditions may cause intussusception. But, in many cases, doctors can't determine the exact cause. If you're an adult when you develop intussusception, it's more likely that an underlying medical condition is causing the problem.
Children
For most cases of intussusception in children, the cause is unknown. Possible triggers may be:
- Viral infection
- A noncancerous growth or a cancerous tumor in the intestine
In the past, some cases of intussusception seemed to be associated with a version of the rotavirus vaccine. Rotavirus is a childhood illness that causes severe diarrhea, vomiting, fever and dehydration. That vaccine was removed from the market in 1999. There's no evidence that a newer rotavirus vaccine (RotaTeq) causes intussusception.
Adults
In adults, the cause of intussusception may be:
- Noncancerous (benign) or cancerous (malignant) growths
- Scar-like tissue in the intestine (adhesions)
- Surgical scars in the small intestine or colon
- Problems with the movement of food through the digestive tract (motility disorders, such as irritable bowel syndrome, gastroparesis and Hirschsprung's disease)
- Long-term (chronic) diarrhea
Risk factors
Risk factors for intussusceptions include:
- Age. Children are much more likely to develop intussusception than adults are. It's the most common cause of bowel obstruction in children between the ages of 3 months and 6 years, with the majority of cases occurring in children younger than 1 year.
- Sex. Intussusception affects boys more often than girls.
- Abnormal intestinal formation at birth. Malrotation, a condition present at birth (congenital) in which the intestine doesn't develop correctly, also is a risk factor for intussusception.
- A prior history of intussusception. Once you've had intussusception, you're at increased risk to develop it again.
Complications
Intussusception can cut off the blood supply to the affected portion of the intestine. If left untreated, lack of blood causes tissue of the intestinal wall to die. Tissue death can lead to a tear (perforation) in the intestinal wall, which can cause peritonitis, an infection of the lining of the abdominal cavity.
Peritonitis is a life-threatening condition that requires immediate medical attention. Signs and symptoms of peritonitis include:
- Abdominal pain
- Abdominal swelling
- Fever
- Thirst
- Low urine output
Peritonitis may cause your child to go into shock. Signs and symptoms of shock include:
- Cool, clammy skin that may be pale or gray
- A weak and rapid pulse
- Abnormal breathing that may be either slow and shallow or very rapid
- Lackluster eyes that seem to stare blankly
- Profound listlessness
A child who is in shock may be conscious or unconscious. If you suspect your child is in shock, seek emergency medical care right away.
Preparing for your appointment
Emergency medical care is required to treat intussusception. As a result, you may not have much time to prepare for the appointment.
What to expect from your doctor
Your child's doctor is likely to ask you a number of questions, including:
- When did your child begin experiencing abdominal pain or other symptoms?
- Does your child's pain appear to be continuous — or is it occurring in bouts?
- Does the pain begin and end suddenly?
- Has your child experienced nausea, vomiting or diarrhea?
- Have you noticed any blood in your child's stool?
- Have you noticed any swelling or a lump in your child's abdomen?
What you can do in the meantime
Don't give your child any over-the-counter medications to treat symptoms before the appointment.
Tests and diagnosis
To confirm a diagnosis of intussusception, your child may need:
- A physical exam. The doctor may suspect intussusception or another type of intestinal obstruction if your child has a lump in the abdomen, along with intermittent pain or inconsolable crying.
- Blood or urine tests. Your child's doctor may order blood and urine tests, as well as a fecal occult blood test, which checks for blood in the stool.
- Ultrasound or other abdominal imaging. Taking images of your abdomen or your child's abdomen with an ultrasound, X-ray or computerized tomography (CT) scan may reveal intestinal obstruction caused by intussusception. Abdominal imaging also can show if the intestine has been torn (perforated).
- Air or barium enema. An air or barium enema is basically a colon X-ray. The doctor will likely use air first and use barium only if necessary as a second choice. During the procedure, the doctor will insert air or liquid barium into your colon or your child's colon through the rectum. This makes the images on the X-ray clearer. Sometimes an air or barium enema will correct intussusception, and no further treatment is needed. A barium enema can't be used if the intestine is torn.
Treatments and drugs
Emergency medical care is required to treat intussusception to avoid severe dehydration and shock, as well as prevent infection that can occur when a portion of intestine dies due to lack of blood.
Initial care
When your child arrives at the hospital, the doctors will first stabilize his or her medical condition. This includes:
- Giving your child fluids through an intravenous (IV) line.
- Helping the intestines decompress by putting a tube through the child's nose and into the stomach (nasogastric tube).
Correcting the intussusception
To treat the problem, your child's doctor may recommend:
- A barium or air enema. This can correct the telescoping intestine and successfully treat intussusception. If an enema works, further treatment is usually not necessary.
- Surgery. If the intestine is torn or if an enema is unsuccessful in correcting the problem, surgery is necessary. The surgeon will free the portion of the intestine that is trapped, clear the obstruction and, if necessary, remove any of the intestinal tissue that has died.
In some cases, intussusception may be temporary and improve on its own without treatment. If no underlying medical condition is found that caused the intussusception, no further treatment is necessary.
Prevention
Because its cause is unknown in most cases, intussusception generally can't be prevented.
- Intussusception. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec19/ch275/ch275c.html?qt=intussusception&alt=sh. Accessed July 25, 2010.
- Kitigawa S, et al. Intussusception in children. http://www.uptodate.com/home/index.html. Accessed July 20, 2010.
- Anatomic problems of the colon. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/anatomiccolon/. Accessed July 25, 2010.
- Sondheimer JM, et al. Gastrointestinal tract. In: Hay WW, Jr., et al. Current Diagnosis and Treatment: Pediatrics. 19th ed. New York, N.Y.; McGraw Hill Medical: 2009. http://www.accessmedicine.com/content.aspx?aID=3403837. Accessed July 26, 2010.
- Rotavirus vaccine (RotaShield) and intussusception. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/rotavirus/vac-rotashield-historical.htm. Accessed July 26, 2010.
- Waseem M, et al. Intussusception. Pediatric Emergency Care. 2008;24:793.
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