Intussuception occurs when part of the intestines "telescopes" into the intestines that follows.  The most common type of intussuception occurs when the last part of the small intestines (the ileum) pokes into the colon.  Intussuception is likely triggered by a "lead point" in the intestinal wall.  A lead point, in this case, is a hard or swollen part of the intestinal wall or some sort of bulge (i.e., a swollen lymph node) that gets pulled forward by the wave-like muscle contractions of the intestines (peristalsis).  The result of intussuception is a bowel obstruction, which can cause vomiting and abdominal pain.  In severe cases, a portion of the bowel may lose adequate blood supply and die.  This can cause a perforation and the child may be extremely ill.  The first attempt to fix the problem is usually a air-contrast barium enema.  This helps confirm the diagnosis and often will force the intestines back into a normal position, curing the problem.  In some cases, surgery is necessary.

 

 

What is intussuception?

Intussuception is a "telescoping" of the bowel.  This is similar to a sock being turned inside out.  The result of intussuception is a total blockage of the intestines.

What causes intussuception?

Some cases occur without any known cause.  Other cases occur after a swollen area of intestines is pulled downstream by the wave-like muscle contractions (peristalsis).  This bowel wall thickening is called a "lead point." Some causes of lead points include: swollen lymph tissue or a lymph node, local inflammation, or some sort of malformation (i.e., a hemangioma).

Who gets intussuception?

• Children of all ages may get intussuception, however it is most common between the ages of 3 months and 2 years.
• Children with an illness are more likely to have swollen lymph nodes, which may serve as a lead point in the intestines.
• Disorders that cause local swollen lesions in the intestines (i.e., Henoch-Schonlein purpura) increase the risk of intussuception.
• Polyps and Meckel's diverticulum are other causes of potential lead points.

What are the symptoms of intussuception?

Intussuception is difficult to diagnose in young children and infants.  Symptoms may be vague.  They include:

• Vomiting
• Abdominal pain (often occurring in sharp, intermittent episodes)
• Lethargy
• Irritability
• Poor feeding
• Ill appearance
• Bloody, mucousy stools

How is intussuception diagnosed?

The history and clinical appearance of a child often suggests the diagnosis. 

Sometimes a physician can feel a long, sausage-like mass in the right, lower abdomen.  A digital rectal exam is often helpful for making the diagnosis.

Stools with blood and mucous (that looks like red jelly) suggest the diagnosis.

A barium enema is a study in which air or liquid (with contrast material) is injected into the anus of the child while the physician watches a moving X-ray picture.  This study shows the double-barrel appearance of intussuception and may also force the bowel back into a normal position.  This maneuver should be performed by an experienced radiologist, with a surgeon as backup. 

How is intussuception treated?

• The barium enema with air or liquid contrast under pressure will often cure intussuception.
• If a bowel perforation (hole in the intestines) is suspected, the child should undergo surgery.  These children will require intravenous fluids and antibiotics.

What happens after intussuception is fixed?

• After an uncomplicated case of intussuception, the child should be monitored in the hospital until the medical team is convinced that the problem does not quickly happen again and to make sure there is no bowel perforation (which would cause fever, abdominal pain, and an ill-appearance).
• About 5% of cases will recur despite appropriate care.