Intussusception

What Is Intussusception?

Intussusception (in-tuh-suh-SEP-shun) happens when one part of the bowel slides into the next, much like the pieces of a telescope.

When this "telescoping" happens:

• The flow of fluids and food through the bowel can get blocked.
• The intestine can swell and bleed.
• The blood supply to the affected part of the intestine can get cut off. In time, part of the bowel can die.

Intussusception is a medical emergency that needs care right away. It's the most common abdominal emergency in children under 2 years old.

What Are the Signs & Symptoms of Intussusception?

Babies and children with intussusception have intense belly pain that:

• often begins suddenly
• makes the child draw the knees up toward the chest
• makes the child cry very loudly

As the pain eases, the child may stop crying for a while and seem to feel better. The pain usually comes and goes like this, but can be very strong when it returns.

Symptoms also can include:

• a swollen belly
• vomiting
• vomiting up bile, a bitter-tasting yellowish-green fluid
• passing stools (poop) mixed with blood and mucus, known as currant jelly stool
• grunting due to pain

As the illness continues, the child may:

• get weaker
• develop a fever
• appear to go into shock. In this life-threatening problem, a lack of blood flow to the body's organs makes the heart beat quickly and blood pressure drop.

What Causes Intussusception?

Most of the time, doctors don't know what causes intussusception. In some cases, it might follow a recent attack of gastroenteritis (or "stomach flu"). It also can follow a cold or the flu. Bacterial or viral gastrointestinal infections can make the infection-fighting lymph tissue that lines the intestine swell. This can cause part of the intestine to get pulled into the other.

In kids younger than 3 months old or older than 5, intussusception is more likely to be caused by an underlying condition like enlarged lymph nodes, a tumor, or a blood vessel problem in the intestines.

Intussusception is most common in babies 5 to 9 months old, but older children also can have it. Boys get intussusception more often than girls.

How Is Intussusception Diagnosed?

Doctors usually check for intussusception if a child keeps having periods of pain, drawing up the legs, vomiting, feeling drowsy, or poop with blood and mucus.

During the visit, the doctor will:

• do an exam, paying special attention to the belly, which may be swollen or tender to the touch. Sometimes the doctor can feel the part of the intestine that's involved.
• ask about the child's health, family health, any medicines taken, and any allergies

How Is Intussusception Treated?

If the doctor suspects intussusception, the child may be sent to an emergency room (ER). Usually, doctors there will ask a pediatric surgeon to see the child right away. The ER doctor might order an abdominal ultrasound or X-ray, which can sometimes show a blockage in the intestines. If the child looks very sick, suggesting damage to the intestine, the surgeon may take the child to the operating room right away to fix the blocked bowel.

Two kinds of enemas often can diagnose and treat intussusception at the same time:

• In an air enema, doctors place a small soft tube in the rectum (where poop comes out) and pass air though the tube. The air travels into the intestines and outlines the bowels on the X-rays. If there's intussusception, it shows the telescoping piece in the intestine. At the same time, the pressure of the air unfolds the inside-out section of bowel and cures the blockage.
• In a barium enema, a liquid mixture called barium is used instead of air to fix the blockage in the same way.

Both types of enema are very safe, and children usually do very well. Most children treated with the enema do not need surgery. In a few children, intussusception can return, usually within 72 hours of the procedure. They may need a repeat enema.

A child will need surgery if the intestine is torn, an enema doesn't work, or the child is too sick for an enema. This is often the case in older children. Then, surgeons will try to fix the obstruction. But if too much damage has been done, they may need to remove that part of the bowel.

After treatment, the child will stay in the hospital and get IV feedings until they can eat and have normal bowel function. Doctors will watch the child to make sure that the intussusception does not come back. Some babies also may get antibiotics to prevent infection.

When Should I Call the Doctor?

Intussusception is a medical emergency. Call your doctor or get emergency medical help right away if your child has any symptoms of intussusception, such as:

• repeated crampy belly pain
• vomiting
• drowsiness
• passing of currant jelly stool

Most children treated within the first 24 hours recover completely with no problems. But untreated intussusception can cause serious problems that get worse quickly. So it's important to get help right away — every second counts.