Intussusception

Intussusception is a serious condition in which one segment of the intestine slides inside another.

With intussusception, a part of the intestine slides into another part of the intestine, like sections of a telescope fitting into each other. This life-threatening form of bowel obstruction can block food or fluid from passing through.

This condition is most commonly seen in infants and young children under 3, but can also rarely occur in adults.

Learn more about intussusception, including its definition, causes, symptoms, diagnosis, treatment, and potential risks and complications.

What is intussusception?

Intussusception occurs when a part of the intestine folds into the section immediately ahead of it, much like the parts of a collapsible telescope. This leads to the obstruction of the affected segment, impairing blood flow and causing a range of symptoms. If untreated, it can lead to severe complications such as bowel necrosis and perforation.

Causes of intussusception

The cause of most cases of intussusception is not known.

In children, viral infections (such as the flu) may be associated with intussusception. Other causes of intussusception in children may include growths in the intestines, such as enlarged lymphoid tissue or a congenital abnormality called Meckel diverticulum.

In adults, intussusception may be caused by:

• Tumors: Both benign and malignant tumors can act as lead points for intussusception.
• Polyps: Non-cancerous growths in the intestine.
• Adhesions: Scar tissue from previous surgeries or infections that might cause abnormal movement of the intestines.
• Foreign bodies: Ingested items or indigestible materials.
• Inflammatory bowel disease (IBD): Conditions like Crohn’s disease or ulcerative colitis can predispose to intussusception.

Symptoms of intussusception

Children

It is important to know the signs of intussusception in case this rare condition occurs.

One common sign of intussusception in an otherwise healthy baby is sudden crying caused by belly pain.

• Sudden onset of abdominal pain: Intermittent and severe, causing the child to cry, draw their knees up to their chest, and appear distressed.
• Vomiting: Often bilious (green or yellow).
• Bloody stool: Stool that looks like “currant jelly” – a mix of blood and mucus.
• Lethargy and irritability: The child may seem unusually tired or irritable between episodes of pain.
• Palpable abdominal mass: A sausage-shaped mass that may be felt in the abdomen.

Adults

Intussusception is rare in adults. The signs and symptoms of intussusception in adults are often similar to symptoms of other abdominal issues, which can make it more difficult to recognize. Symptoms of intussusception in adults may include:

• Chronic or intermittent abdominal pain: Less sudden but persistent pain, often associated with an underlying condition.
• Vomiting and nausea: Consistent with bowel obstruction.
• Changes in bowel habits: Including diarrhea or constipation.
• Weight loss: If there is a chronic underlying cause, such as a tumor.

Diagnosis of intussusception

To diagnose intussusception, a health care provider may use tests including:

• Symptom assessment: Detailed inquiry about the onset, duration, and severity of symptoms, and any relevant medical history or recent illnesses.
• Physical examination: Palpation of the abdomen to detect any masses or areas of tenderness.
• Ultrasound: The preferred initial imaging test, highly sensitive for detecting intussusception and appears as the characteristic “target” or “doughnut” sign.
• X-ray: Can show signs of bowel obstruction, such as air-fluid levels and dilated loops of intestine.
• Contrast enema: Using air or barium, can both diagnose and sometimes treat intussusception by reducing the telescoping with pressure from the injected contrast.
• CT scan: More commonly used in adults to identify the lead point or underlying cause, especially looking for tumors or polyps.

Treatment of intussusception

Non-surgical treatments

• Air or barium enema: The enema can both diagnose and reduce the intussusception. It works by using hydrostatic pressure to unfold the telescoped segment.
  • Indications: Most effective in children with suspected idiopathic intussusception.
  • Success rate: High success rate in children when performed by experienced personnel.

Surgical treatments

• Emergency surgery: Required if non-surgical reduction is unsuccessful, if there is evidence of bowel perforation, or if the patient is unstable.
  • Manual reduction: Surgeon gently manipulates the affected bowel to reduce the intussusception.
  • Resection: If the affected bowel segment is necrotic or cannot be reduced, it is surgically removed with subsequent anastomosis (rejoining) of the healthy bowel ends.

Post-operative care

• Monitoring: Close monitoring in a healthcare facility for recovery and to manage any complications.
• Pain management: Administration of pain relief medications to ensure comfort during recovery.
• Wound care: Instructions on keeping the surgical area clean and allowing it to heal properly.
• Nutrition: Gradual reintroduction of feedings, starting with clear liquids and advancing as tolerated under medical supervision.

Long-term care

• Follow-up appointments: Routine follow-up with the surgical team to monitor recovery and ensure there are no complications or recurrence.
• Monitoring for recurrence: Regular check-ups and potentially additional imaging if symptoms return, as intussusception can recur, particularly in children.

Potential risks and complications

Complications of untreated intussusception

• Bowel necrosis: Death of bowel tissue due to lack of blood flow, leading to perforation and peritonitis.
• Peritonitis: Inflammation of the abdominal lining, often due to perforation, which can cause severe infection and sepsis.
• Sepsis: A life-threatening response to infection.

Treatment risks

• Perforation: During enema reduction or surgery, there is a risk of creating a hole in the bowel.
• Infection and wound complications: Risk of infection post-surgery, including at the site of the surgical incision.

Long-term considerations

• Recurrence: Intussusception can recur, particularly in children, and vigilance for symptoms is required.
• Underlying conditions: Identification and management of any underlying causes or conditions that may predispose to intussusception.

Impact on quality of life

• Physical well-being: Successful treatment should restore normal bowel function and alleviate symptoms.
• Emotional well-being: Effective management addresses anxiety and distress related to the condition and its treatment.

Intussusception is a serious condition that requires prompt diagnosis and treatment to prevent severe complications. Understanding the causes, symptoms, diagnostic methods, and treatment options is essential for effective management. If you or a loved one are experiencing symptoms of intussusception, consulting with a health care provider or seeking immediate medical attention will help develop an appropriate treatment plan tailored to your specific needs and circumstances.