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Overview (“What is it?”)
- Intussusception [in-tuh s-suh-sep-shuh n] is the condition when part of the intestine slides into an adjacent part of the intestine. It is similar to the intestine telescoping into itself. When the intestine telescopes into itself, this portion of the intestine (intussusception) gets kinked. This then leads to the cut off of the blood supply to that part of the intestine and blocks the passage of food and fluid.
- Intussusception occurs more frequently in males. Although intussusception can occur in all pediatric ages, 75% of cases occur in the first two years of life and 90% in children by three years old. There is a seasonal variation that correlates with viral infections where most occur during May to July.
Signs and Symptoms (“What symptoms will my child have?”)
- Early signs/symptoms: (1) intermittent episodes of sudden onset of severe abdominal pain that lasts only a few minutes. Infants may pull up their legs during episodes of pain; (2) vomiting; (3) abdominal mass in the right upper side of the abdomen; (4) lethargy due to dehydration.
- Later signs/symptoms: (1) bloody stools with a mucus-like texture that resemble currant jelly; (2) bilious (green) vomiting from intestinal obstruction; (3) fever, low blood pressure, and fast heart rate can be signs of bowel perforation.
Diagnosis (“What tests are done to find out what my child has?”)
- Labs and tests: The most common blood tests obtained are complete blood count (CBC) and electrolytes. The white blood cell count may be high if the intussuscepted bowel is compromised or ischemic (lack of blood flow). The most accurate initial study is ultrasound. Ultrasound may show concentric rings of affected intestine and is termed a “target sign". A contrast enema (injecting dye or air into the colon) may be both diagnostic and therapeutic.
- Conditions that mimic this condition: Include other causes for bowel obstruction such as malrotation and midgut volvulus. Conditions that cause cramping pain such as gastroenteritis may also mimic intussusception.
Treatment (“What will be done to make my child better?”)
- Medicine: The initial treatment for patients with intussusception is fluid resuscitation as most patients are dehydrated. If the patient is stable, radiologic reduction is attempted with liquid or air contrast enemas under fluoroscopic or sonographic guidance. This can usually be attempted multiple times. If radiologic reduction is successful, the radiologist will see a sudden rush of air or barium flow into the distal ileum. After successful enema reduction, the child is typically admitted to the hospital for observation to watch for recurrence. In some instances, patients can be discharged from the Emergency Room once they tolerate fluids and are relieved of pain and other symptoms.
- Preoperative preparation: Surgery is indicated for patients with suspected ischemic or compromised bowel. These patients may have free air on X-rays or evidence of worsening infection (sepsis) and tenderness (on physical exam). Other reasons for surgery include suspicion of a pathologic lead point such as a diverticlum or polyp, or failed attempts from radiologic reduction. The type of intervention will be individualized and discussed by the treating team. Patients will be started on antibiotics and may need transfusions of blood products prior to surgery.
- Postoperative care: Patients will not be fed for a period of time after surgery until their intestine begins to work again. Patients may require additional procedures.
- Risks/Benefits: In the majority of patients, reduction of the intussusception is successful with contrast enema and surgery is avoided. There is a small risk of the intestine being injured during the contrast enema necessitating surgery. If patients are clinically deteriorating or have free air on X-ray, surgical intervention is required. Sometimes, part of the intestine may need to be removed.
Home Care (“What do I need to do once my child goes home?”)
- Diet: Regular diet.
- Activity: Normal pediatric activity.
- Wound care: None
- Medicines: None
- What to call the doctor for: Monitor for recurrent symptoms that include abdominal pain, vomiting, bloody stools.
- Follow-up care: If patient had surgery, follow up in 1-2 weeks. If patient had radiologic reduction, routine follow-up with pediatrician.
Long-Term Outcomes (“Are there future conditions to worry about?”)
There are usually no long-term complications. However, on average, there is roughly a 5% recurrence rate after radiologic enema reduction. Recurrence usually occurs within 6 months of the original episode. If patient had surgery, a potential condition is the development of scar tissue within the abdomen (adhesions) that can lead to bowel obstructions. After surgical reduction of the intussusception, there is also a 5% chance the intussusception can recur.
Authors: Steven L. Lee, MD; Nhan Huynh
Editors: Patricia Lange, MD; Marjorie J. Arca, MD