Intussusception is a common abdominal emergency that affects children at the age of 3 months to 3 years. In intussusception, a section of a child’s intestine folds the way you see with telescope where one segment slides inside the other. Intussusception may occur in the colon, between the colon and small bowel, or in the small bowel itself. When intussusception occurs, there is blockage of the colon or small bowel that causes obstruction. The blockage prevents digested food and fluids from passing through the intestine.
The sections of the ‘telescoped’ or folded intestines may have their walls pressed on each something that causes irritation and swelling. With time, if not checked, blood supply may be cut off meaning that area that has folded does not get the nutrients, oxygen, and minerals it requires. Eventually, damage may occur to the intestine because of tissue death due to lack of oxygen, nutrients, and minerals necessary for cell function.
If not treated, intussusception may result in internal bleeding causing a serious condition or infection of the abdomen referred to as peritonitis. Although intussusception is rarely seen among infants, it affects babies who are about 5 to 9 months in age but older kids can still have it. It is estimated that intussusception occurs in about 1 to 4 in every 1000 newborns. Boys are susceptible to the condition than girls.
Causes of Intussusception
Doctors don’t exactly know what contributes to intussusception but in some cases, it may occur when a child has had a recent attack of stomach flu or gastroenteritis. Infections caused by bacteria and virus may make the tissue of the lymph that fights infections and lines the intestine to swell. When this happens, it makes a part of the intestine to become pulled into another. In children aged 3 months and older, the folding and sliding of the intestine or bowel may be as a result of an underlying condition such as a tumor, anomaly with intestine’s blood vessels, or enlarged lymph node.
In adults, intussusception may occur due to medical procedures or conditions like a polyp or tumor, inflammation associated with Crohn’s disease, adhesions or scar-like tissue forming in the intestine, and weight loss surgery or gastric bypass.
Intussusception Signs and Symptoms
Children having intussusception experience pain in the abdomen. The pain mostly starts suddenly causing the child to draw his or her knees upwards toward the chest. A child may cry loudly because of the pain. However, as the pain eases, a child stops crying for sometime showing signs of feeling better. Although the pain will come and go in that pattern, sometimes, a child may feel very strong pain after it returns. The symptoms associated with intussusception include:
- Vomiting
- Abdominal swelling
- Grunting because of pain
- Vomiting up bile which is a yellow-green fluid tasting bitter
- Sweating
- Dehydration
- Lethargy
- Fever
- Stool that has blood and mucus, also given the name ‘currant jelly’ stool due to its appearance
- Abdominal lump
As the condition persists, a child may become weak and develop fever. The child may look like he or she has gone into shock, which can be life-threatening because there is lack of circulation of blood to the organs of the body as a result of faster beating of the heart and reduced blood pressure. At other times, a baby will only look drowsy and he or she may not vomit. There may be changes in stool and the abdomen may swell.
Sometimes, the pain can be mistaken for something else like colic, and a child may strain and act very irritable. The child may also recover and seem to be okay often becoming playful in-between episodes of the intussusception. The child may have normal stool, however, the next tool could be bloody. Also, the stool looks jelly-like and has red mucus.
There may also be an abdominal distention or a kind of lump being felt in the abdomen or the area where the intussusception develops. The lump may resemble some other medical conditions or problems. So, it is important that a child is taken to the hospital for immediate diagnosis and treatment.
Diagnosis of Intussusception
Doctors may use different imaging tests to diagnose intussusception. Palpation of the abdominal area may be conducted to feel any kind of lump that could arise due to the folded intestine. The imaging tests include:
Abdominal X-ray: This test shows if there is obstruction of the intestine
Ultrasound: Using an ultrasound machine that comprises high frequency sound waves, examination is done on the abdomen. The machine creates images displayed in a computer. The images show the tissues, organs, and blood vessels in the abdominal area. Ultrasounds are intended to view the way organs are functioning and to check the flow of blood through the vessels.
Barium enema or lower GI series: This is a procedure conducted to check abnormalities in the large intestine. A fluid known as barium is used to make a coating to the inside of organs to allow the areas to be visible on X-ray images. Barium is put into a child’s rectum in form of enema. Using X-ray machine, in the presence of barium, it is able to show strictures or narrowed areas in abdomen, blockages, or obstructions in the area as well as other problems. At times, when inserting barium into the rectum, it may put pressure on the intestine helping the folded sections to unfold thus correcting the problem.
Upper GI series: This test helps examine organs within the upper areas of the GI system, which include stomach, duodenum, and esophagus. Barium fluid is also used to allow a doctor better examine and evaluate the upper gastrointestinal areas.
Treatment of Intussusception
Treatment depends of the extent of intussusception, the health of a child, the examination, and opinion of the doctor. Sometimes, the problem fixes itself when diagnosis is being conducted using barium enema. A doctor may also consider air enema to help unfold the folded intestines. Air enema is done using a small tube that is placed in the rectum of the child and air inserted through it. The air pushes the intestines back to their normal position. If a child appears to be very sick or there is an abdominal infection, other procedures may be performed.
Surgery: If barium or air enema doesn’t seem to correct the problem, surgery may be opted. The surgery is performed under anesthesia and a surgeon makes an incision right in the abdomen of the child to locate the area of intussusception. This helps to reach and push the ‘telescoped’ or folded sections back into their place. A surgeon examines the intestine to see if there is any damage. If there are sections that may not be working correctly, they are removed. When there is some damage done to the intestine and the parts taken out are small, the remaining two sections of the child’s intestine can be sewn together.
Although rarely, the damaged part of the intestine could be large and more tissue is removed, so the sections that remain may not be able to be joined together through surgery. In such a situation, ileostomy is carried out to help with the digestive process. During an ileostomy, the ends of the remaining intestine are taken through openings to reach the abdomen. This helps stool to pass in those openings known as stoma and collected in a bag. In most cases, ileostomy is temporary, however, in extreme cases, it can be permanent. So it depends on how much of the intestine tissue has to be removed.
