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Intussusception - children

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

This article focuses on intussusception in children.

Causes

Intussusception is caused by part of the intestine being pulled inward into itself.

The pressure created by the walls of the intestine pressing together causes:

  • Decreased blood flow
  • Irritation
  • Swelling

Intussusception can block the passage of food through the intestine. If the blood supply is cut off, the segment of intestine pulled inside can die. Heavy bleeding may also occur. If a hole develops, infection, shock , and dehydration can take place very rapidly.

The cause of intussusception is not known. Conditions that may lead to the problem include:

  • Viral infection
  • Nodule on the lymph node
  • Polyp or tumor

The reason for the problem is more likely to be found in older children.

Intussusception can affect both children and adults. However, most cases occur in children ages 6 months - 2 years. It affects boys four times as often as girls.

Symptoms

The first sign of intussusception is very often sudden, loud crying caused by abdominal pain . The pain is colicky and not continuous (intermittent), but it comes back often. The pain will get stronger and last longer each time it returns.

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

Other symptoms include:

  • Bloody, mucus-like bowel movement, sometimes called a "currant jelly" stool
  • Fever
  • Shock (pale color, lethargy , sweating)
  • Stool mixed with blood and mucus
  • Vomiting

Exams and Tests

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

Tests may include:

Treatment

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

In some cases, the bowel blockage can be treated with an air or contrast enema. This is done by a radiologist skilled with the procedure. There is a risk of bowel tearing (perforation) with this procedure.

The child will need surgery if these treatments do not work. The bowel tissue can very often be saved. Dead tissue will be removed.

Antibiotics may be needed to treat any infection.

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

Outlook (Prognosis)

The outcome is good with early treatment. There is a risk this problem will come back.

When a hole or tear in the bowel occurs, it must be treated promptly. If not treated, intussusception is almost always fatal for infants and young children.

When to Contact a Medical Professional

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

References

Chu A, Liacouras CA. Ileus, adhesions, intussusceptions, and closed-loop obstructions. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 325.

Hostetler MA. Gastrointestinal disorders. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Mosby Elsevier; 2013:chap 172.

Updated: 5/14/2014

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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