Intussusception: Causes, Symptoms & Treatment
Intussusception occurs when one part of the intestine slides into an adjacent section, causing a blockage. It is a medical emergency most common in infants and young children.
Things worth knowing about "Intussusception"
Intussusception occurs when one part of the intestine slides into an adjacent section, causing a blockage. It is a medical emergency most common in infants and young children.
What is Intussusception?
Intussusception is a serious medical condition in which one segment of the intestine telescopes into a neighboring segment. This causes a mechanical bowel obstruction and can cut off the blood supply to the affected portion of the intestine. Intussusception is a medical emergency that requires prompt diagnosis and treatment to prevent life-threatening complications such as bowel necrosis (tissue death).
Who is Affected?
Intussusception is the most common cause of acute intestinal obstruction in infants and young children. It most frequently affects children between 3 months and 3 years of age, with a peak incidence between 5 and 9 months. Boys are affected more often than girls. In adults, intussusception is rare and is usually caused by an identifiable structural abnormality in the intestine.
Causes
In infants and young children, no specific cause is found in the majority of cases (idiopathic intussusception). It is thought that enlarged lymph nodes in the intestinal wall, often following a viral infection, act as a lead point that triggers the telescoping movement of the bowel.
- Enlarged mesenteric lymph nodes (lymphadenitis mesenterica)
- Meckel diverticulum
- Intestinal polyps or tumors (more common in older children and adults)
- Viral infections (e.g., adenovirus, rotavirus)
- Henoch-Schonlein purpura (a form of vasculitis)
Symptoms
Symptoms often begin suddenly and may occur in episodes. Classic signs include:
- Sudden, colicky abdominal pain occurring in waves (the child draws the knees up toward the abdomen)
- Vomiting (initially non-bilious, later bilious)
- Currant jelly stool (stool mixed with blood and mucus – a characteristic sign)
- A palpable sausage-shaped mass in the abdomen, typically in the right upper quadrant
- General malaise, pallor, and lethargy
- In advanced cases: signs of shock if left untreated
Diagnosis
Diagnosis is confirmed using imaging techniques:
- Ultrasound (sonography): The preferred first-line method. Shows a characteristic target sign (also called doughnut sign) in cross-section and a pseudokidney sign in longitudinal view.
- Abdominal X-ray: May show signs of bowel obstruction.
- Contrast enema: Can be used for both diagnosis and treatment.
Treatment
Non-Surgical Treatment
In many cases, intussusception can be reduced non-surgically using a hydrostatic or pneumatic enema (using liquid contrast or air) performed under imaging guidance. This approach is the first-line treatment for uncomplicated cases and has a high success rate.
Surgical Treatment
If the enema is unsuccessful, if there are signs of intestinal perforation, or if the patient is in poor clinical condition, surgery is required. The surgeon manually reduces the intussusception (desinvagination). If the bowel tissue is no longer viable, the affected segment must be surgically removed.
Prognosis
With early diagnosis and prompt treatment, the prognosis is excellent. Without treatment, however, intussusception can lead to life-threatening complications including bowel perforation, peritonitis, and septic shock. Recurrence occurs in approximately 5 to 10 percent of cases following successful treatment.
References
- Waseem, M. & Rosenberg, H. K.: Intussusception. Pediatric Emergency Care, 2008; 24(11):793–800. PubMed PMID: 19018225.
- Pepper, V. K., Stanfill, A. B., & Pearl, R. H.: Diagnosis and Management of Pediatric Appendicitis, Intussusception, and Meckel Diverticulum. Surgical Clinics of North America, 2012; 92(3):505–526.
- World Health Organization (WHO): Pocket Book of Hospital Care for Children. 2nd edition. WHO Press, Geneva 2013. Available at: https://www.who.int
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