Intussusception
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Intussusception

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Definition

Intussusception is a very serious type of bowel obstruction. It occurs in up to 4 in 1000 live births. The bowel (also called intestine) is shaped like a long tube. Intussusception occurs when a part of the bowel “telescopes” in on itself and is trapped by an adjacent portion of the small or large intestine. This causes swelling and obstruction, cutting off the blood supply to the intestine.

Intussusception

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Causes

In many cases, there is no known cause for intussusception. However, intussusception may sometimes occur as a complication of some medical conditions, including:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Age: it is the most common cause of obstruction in children 3 months to 6 years old, but the majority are younger than 24 months.
  • Season: more common during respiratory and gastrointestinal virus seasons.
  • Sex: male
  • Medical conditions in the list above

Symptoms

The initial symptoms may include:

  • Abdominal pain
    • Usually severe
    • Colicky or cramping
    • Usually comes on suddenly
    • In children, this may be indicated by drawing knees to chest and crying.
  • Vomiting (sometimes yellow or green tinged)
  • Stools mixed with mucus and blood (often described as currant jelly)
  • Lethargy

Additional symptoms include:

Intussusception cuts off the blood supply to the bowel. If this is not treated quickly, it can lead to bowel gangrene. Gangrene can cause tissue in the intestinal wall to die. This may lead to:

  • Perforation of the intestinal wall
  • Peritonitis (inflammation of the lining of the abdominal cavity) and infection

If not treated quickly, peritonitis can lead to death.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:

  • Blood and urine tests
  • Fecal occult blood test, which checks the stool for blood
  • Abdominal x-ray, ultrasound , or CT scan

Treatment

Air Enema

In many cases, giving an air enema will correct intussusception. Air enema is preferred over water-soluble contrast or barium enema. This is often the preferred treatment when intussusception occurs in infancy. However, the test may occasionally cause a perforation to occur in the bowel. No form of enema should be done if the doctors know the bowel is perforated.

Surgery

Surgery may be required to release the trapped portion of the bowel and to clear the obstruction. If any bowel tissue has died due to gangrene, that part of the bowel may need to be removed.

After any treatment, intussusception may recur.

Antibiotics may be administered and a nasogastric tube placed prior to attempted reduction.

Prevention

There are no guidelines for preventing intussusception because the cause is unknown.

RESOURCES:

American Academy of Family Physicians
http://www.familydoctor.org

American Academy of Pediatrics
http://www.aap.org

Centers for Disease Control and Prevention
http://www.cdc.gov

CANADIAN RESOURCES

About Kids Health
http://www.aboutkidshealth.ca

BC Health Guide
http://www.bchealthguide.org/

References:

American Academy of Family Physicians website. Available at: http://www.familydoctor.org .

American Academy of Pediatrics website. Available at: http://www.aap.org .

Behrman RE, Kliegman RM , Jenson HB, et al. Nelson Textbook of Pediatrics . 18th ed. Saunders: Philadelphia, PA; 2007.

Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov .

D’Augustino J. Common abdominal emergencies in children. Emerg Med Clin North Am . 2002;20(1):139-153.

King L. Pediatrics, intussusception. Emedicine website. Available at: www.emedicine.com/emerg/topic385.htm.

The Merck Manual of Medical Information . Simon and Schuster, Inc.; 2000.

O’Neill JA, Grosfeld JL, Fonkalsrud EW, Coran AG, Caldamone AA. Principles of Pediatric Surgery . 2nd ed. Mosby: St. Louis, MO; 2004.

Wood BP. Intussusception, child. Emedicine website. Available at: www.emedicine.com/radio/topic366.htm. 2005.



Last reviewed March 2008 by Kari L. Kassir, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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