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Intussusception (children)

Definition

Intussusception is the sliding of one part of the intestine into another.

Causes, incidence, and risk factors

Intussusception is caused by part of the intestine being pulled inward into itself. This can block the passage of food through the intestine. If the blood supply is cut off, the segment of intestine pulled inside strangles and can die.

The pressure created by the walls of the intestine pressing together causes irritation, swelling, and decreased blood flow. The intestine can die, and the patient can have significant bleeding. If a hole occurs, infection, shock and dehydration can take place very rapidly.

The cause of intussusception is not known, although viral infections may be responsible in some cases. Sometimes a lymph node, polyp, or tumor can trigger the telescoping. The older the child, the more likely such a trigger will be found.

Intussusception can affect both children and adults, although most cases occur in children between the age of 6 months and 2 years. It affects boys twice as often as girls.

The first sign of intussusception is usually sudden, loud crying caused by abdominal pain. The pain is colicky and intermittent (not continuous), but recurs frequently, increasing in both intensity and duration.

As the condition progresses, an infant may become weak and may go into shock. Vomiting and fever are common, and some infants will have a bloody, mucus-like bowel movement sometimes referred to as a "currant jelly" stool.

Prompt diagnosis results in the best outcomes.

Symptoms

• Abdominal pain alternating with pain-free periods
• Vomiting
• Stool mixed with blood and mucus
• Shock (pale color, lethargy, sweating)
• Fever

An infant with severe abdominal pain may draw the knees to the chest while crying.

Signs and tests

Your doctor will perform a thorough examination, which may reveal a mass in the abdomen. There may also be signs of dehydration or shock.

Tests may include:

• Abdominal x-ray
• Air or contrast enema

Treatment

The child will first be stabilized. A nasogastric tube will be passed into the stomach through the nose to help the bowels decompress. An intravenous (IV) line will be placed in the arm and fluids will be given to prevent dehydration.

In some cases, the bowel obstruction can be treated with an air or contrast enema performed by a skilled radiologist. There is a risk of bowel perforation with this procedure, and it is not used if the bowel has already developed a hole.

If conservative treatment is unsuccessful, the child will need surgery. The bowel tissue can usually be saved, but any dead tissue will be removed.

Intravenous feeding and fluids will be continued until the child has a normal bowel movement.

Expectations (prognosis)

The outcome is good with early treatment. There is a risk the condition will recur.

Complications

Perforation is a serious complication due to risk of infection.

Calling your health care provider

Intussusception is an EMERGENCY. Call your health care provider immediately, then call 911 or go immediately to the emergency room.

Review Date:10/25/2006
Reviewed By:Daniel Rauch, M.D., FAAP, Director, Pediatric Hospitalist Program, Associate Professor of Pediatrics, NYU School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network.

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