Intussusception

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Intussusception

Topic Overview

What is intussusception?

Intussusception means that one part of the intestine has folded into itself, like a telescope. This can happen anywhere along the intestinal tract. It usually happens between the lower part of the small intestine and the beginning of the large intestine. See a picture of intussusception.

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.

Intussusception usually happens in young children. It is rare in adults. This topic focuses on intussusception in children.

What causes intussusception?

The cause of intussusception in children is not known in most cases. Sometimes it happens after a child has a cold or has inflammation in the stomach and intestines.

What are the symptoms?

Symptoms usually begin suddenly. Your child may:

  • Act fussy.
  • Vomit often. You may see green fluid in the vomit.
  • Have severe belly pain and cramping that last from 1 to 5 minutes. Afterward, your child may seem normal, but another period of pain may start 5 to 30 minutes later.
  • Have diarrhea or stools that contain blood or mucus.
  • Have a swollen, painful belly. Your child may have a sausage-shaped lump in the upper right side of the belly.

If your child has symptoms of intussusception, call your doctor right away.

How is intussusception diagnosed?

The doctor will ask about your child’s health history and symptoms and do an examination. Intussusception can be hard to diagnose, because symptoms may come and go.

Your child may need an X-ray, ultrasound, enema, or other tests to confirm whether he or she has intussusception.

How is it treated?

Intussusception needs to be treated in the hospital with an enema or surgery. If it is not treated, dangerous problems can develop.

Most children get better if treatment begins within 24 hours after the start of symptoms. After your child is treated, watch for symptoms. The disease may come back.

Talk to your doctor about how to care for your child at home.

Frequently Asked Questions

Learning about intussusception:

Being diagnosed:

Getting treatment:

Living with intussusception:

Symptoms

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 (belly) 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, colour, or pattern.

Intussusception may sometimes be mistaken for other conditions with similar symptoms, such as a hernia or appendicitis.

Examinations and Tests

A diagnosis of intussusception is usually based on the child's symptoms. If intussusception is suspected, the doctor will do a physical examination. As part of the physical examination, the doctor examines the child's:

  • Abdomen, for a tender, sausage-shaped lump, which suggests telescoping of the intestine. This lump may be hard 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. For best results, look for a doctor whose focus is treating children (a pediatric specialist). 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 work.
  • 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 also.
  • 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 for a little while. This is an opening in which waste leaves the small intestine and collects in an odour-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.

Most adults with intussusception need surgery.

Home Treatment

If your child has symptoms of intussusception, home treatment is not appropriate. Take the child to your doctor immediately for a physical examination. If your child has episodes of severe abdominal (belly) pain, you may need to take him or her for emergency treatment.

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 in general include irritability, recurring belly 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 11 and Younger.
  • Take care of the child's abdominal incision. It may need to be cleaned regularly and checked for signs of infection (such as redness, warmth, pain, or swelling).

Other Places To Get Help

Organizations

Canadian Digestive Health Foundation
Web Address: www.cdhf.ca
 

The Canadian Digestive Health Foundation provides educational information about digestive diseases and supports research into their causes and treatment.


KidsHealth for Parents, Children, and Teens
4600 Touchton Road East, Building 200
Suite 500
Jacksonville, FL  32246
Phone: (904) 232-4100
Fax: (904) 232-4125
Web Address: www.kidshealth.org
 

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.


References

Citations

  1. 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.
  2. 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. (2010). Intussusception section of Pediatric surgery. In FC Brunicardi et al., eds., Schwartz's Principles of Surgery, 9th ed., pp. 1433–1434. 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.

Credits

By Healthwise Staff
Primary Medical Reviewer John Pope, MD - Pediatrics
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer Brad W. Warner, MD - Pediatric Surgery
Last Revised September 3, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.