Intussusception: Symptoms, Causes, Treatment

What are the symptoms of intussusception?

Intussusception is a serious condition primarily affecting infants and toddlers, where a part of the intestine (usually the small intestine) folds into itself, much like a telescope. The symptoms can include:

1. Severe Abdominal Pain: Sudden and severe abdominal pain, often intermittent, which may cause the child to pull their legs towards their chest.
2. Vomiting: Often starts with vomiting, which may be projectile and greenish in color.
3. Bloody Stool: Stools may appear red or contain blood and mucus.
4. Palpable Abdominal Mass: A firm mass or lump may sometimes be felt in the abdomen.
5. Lethargy or Irritability: The child may appear unusually tired or irritable.
6. Episodes of Crying: Episodes of crying that may be intense and then subside (often referred to as “colicky” episodes).

If you suspect intussusception in a child, immediate medical attention is crucial as it can lead to bowel obstruction, reduced blood flow to the affected intestine, and tissue damage.

What are the causes of intussusception?

Intussusception occurs when one segment of the intestine (typically the small intestine) telescopes into another, causing a blockage. The exact cause often isn’t clear, but several factors may contribute:

1. Viral Infections: In some cases, a viral infection of the intestine, such as adenovirus or rotavirus, may trigger the condition. These infections can lead to swelling of the lymph nodes in the intestine, potentially initiating the telescoping process.
2. Meckel’s Diverticulum: This is a congenital abnormality where a small pouch in the wall of the intestine (Meckel’s diverticulum) can serve as a lead point for intussusception.
3. Polyps or Tumors: Benign tumors (like polyps) or rarely, malignant tumors, can sometimes act as a lead point, initiating intussusception.
4. Enlarged Lymph Nodes: Enlarged lymph nodes due to infections or other causes can occasionally lead to intussusception.
5. Inflammatory Conditions: Conditions that cause inflammation of the intestine, such as Crohn’s disease, may increase the risk.
6. Post-surgical Adhesions: After abdominal surgery, adhesions (scar tissue) can form, which may predispose to intussusception.

While these factors can increase the risk, intussusception often occurs spontaneously without a clear cause identified in many cases. Prompt medical attention is essential for diagnosis and treatment to prevent complications.

How is the diagnosis of intussusception made?

The diagnosis of intussusception is typically made through a combination of medical history, physical examination, imaging studies, and sometimes laparoscopy or surgical exploration. Here are the common methods used to diagnose intussusception:

1. Medical history and physical examination: The doctor will take a detailed history of the child’s symptoms, including the duration and characteristics of abdominal pain, vomiting, and bloody stools. A physical examination will be performed to check for abdominal tenderness, guarding, and masses.
2. Imaging studies:
   • Abdominal X-ray: An X-ray of the abdomen may show a “target sign” or “coiled spring sign”, which is a characteristic radiolucent (light) ring or spiral shape within the intestinal lumen, indicating an intussusception.
   • Ultrasound: Ultrasonography (US) is the primary imaging modality used to diagnose intussusception. It can show the location and extent of the intussusception, as well as detect any associated complications such as bowel perforation or peritonitis.
   • Computed Tomography (CT) scan: A CT scan may be ordered if the diagnosis is uncertain or if there are concerns about perforation or peritonitis.
3. Barium enema: A barium enema is a diagnostic procedure where a contrast agent (barium) is inserted into the rectum to outline the intestines on an X-ray. This test can help confirm the diagnosis and identify the location and extent of the intussusception.
4. Laparoscopy or surgical exploration: In some cases, laparoscopy or open surgery may be necessary to confirm the diagnosis and rule out other conditions that may be causing similar symptoms.

The diagnostic algorithm for intussusception typically involves:

1. Initial evaluation: Medical history, physical examination, and abdominal X-ray.
2. Imaging studies: US and/or CT scan to confirm the diagnosis.
3. Barium enema: If the diagnosis is uncertain or if there are concerns about perforation or peritonitis.
4. Surgical intervention: If the diagnosis is confirmed and medical treatment has failed to reduce the intussusception.

It’s essential to note that a timely diagnosis and prompt treatment are crucial in managing intussusception, as delayed treatment can lead to complications such as bowel obstruction, perforation, or peritonitis.

What is the treatment for intussusception?

The treatment for intussusception depends on the severity of the condition, the age and overall health of the child, and the presence of any complications. The primary goals of treatment are to reduce the intussusception, alleviate symptoms, and prevent complications. Here are the common treatment options:

1. Enema reduction: This is the most common treatment for intussusception, especially in children under 3 years old. An enema is a fluid or air injection into the rectum to push the intussuscepted segment back into its normal position. This can be done using a barium enema, air enema, or saline enema.
2. Hydrostatic reduction: This involves inflating the rectum with air or saline to push the intussuscepted segment back into its normal position. This method is less invasive than surgery and has a higher success rate.
3. Surgical reduction: Surgery is typically reserved for children who do not respond to enema reduction or have a suspected perforation or peritonitis. The surgeon will make an incision in the abdomen and manually reduce the intussusception.
4. Resection and anastomosis: If the intussuscepted segment is severely damaged or necrotic, surgical resection (removal) of the segment and anastomosis (reattachment) of the remaining bowel may be necessary.

Medical management:

• Pain management: Medications such as acetaminophen or ibuprofen can help alleviate abdominal pain and discomfort.
• Fluid replacement: IV fluids may be necessary to replace lost fluids and electrolytes due to vomiting and diarrhea.
• Anti-diarrheal medications: Medications like loperamide can help manage diarrhea.

Indications for hospitalization:

• Children under 3 months old
• Severe abdominal distension
• Fever over 101.5°F (38.6°C)
• Signs of shock or hypovolemic shock
• Refusal of oral fluids
• Presence of blood in stool
• Presence of peritonitis or perforation

Post-treatment follow-up:

• After enema reduction, children are usually monitored for 2-4 hours to ensure that the intussusception has resolved.
• After surgical reduction, children are typically monitored in the hospital for 1-3 days before being discharged.
• Follow-up appointments with a pediatrician or surgeon are necessary to monitor for any potential complications.

It’s essential to seek immediate medical attention if you suspect your child has intussusception. Delayed treatment can lead to serious complications, such as bowel obstruction, perforation, or peritonitis.