Intussusception

Intussusception occurs when one portion of the intestine slides into another, similar to the way a telescope collapses.  This can block the passage of food through the intestine, and have potentially fatal consequences.

If the blood supply is cut off, the segment of intestine pulled inside can die.

Incidence; Causes and Development

Intussusception affects mainly children under the age of 2 years, males 3-4 times as females, and 1 in every 1,900 infants under 12 months of age in the United States.  It can, however, affect anyone at any time.

The precise cause of intussusception is unknown.  Suspected triggers include viral infections, anatomical factors, altered motility, lymph nodes, polyps, and tumors.

Signs and Symptoms

Early symptoms may include nausea, vomiting, and significant intermittent cramping abdominal pain.  Later symptoms include rectal bleeding, often with "red currant jelly" stool (stool mixed with blood and mucus), and lethargy.

Children who are too young to communicate may pull their legs up to the chest, cry, or experience difficult/painful breathing.

Fever is not a direct symptom of intussusception, but a necrotic (dying) or infected section of bowel may lead to perforation and sepsis, which causes fever.

Diagnosis and Tests

Examination may reveal a sausage-shaped mass in the abdomen, and signs of dehydration or shock.  Further testing may include abdominal ultrasound (accurate, no risk of radiation) or X-ray, and air enema or contrast enema.

Treatment and Prevention

The condition is not usually immediately life-threatening, but can easily become so.  A barium or water-soluble contrast enema or an air-contrast enema can be used to both confirm and (in 80% of cases) reduce intussusception.  If this doesn't work then surgery may be required.

Prognosis; Complications

Prognosis is good with early treatment, but recurrence is very possible.  If not treated, intussusception is almost always fatal.

The pressure of the intestine walls against each other can cause decreased blood flow, irritation, and swelling.  The affected section of the intestine can die, and the patient can have significant internal bleeding.

If the intestine becomes perforated, infection, shock, and dehydration can take place very rapidly.