Intussusception

Intussusception occurs when one section of intestine slides inside a nearby part. This movement makes the intestine to fold around itself.  As a result, food and fluid have a difficult time passing through the intestine. The condition can also reduce blood supply to the affected area, resulting to:

• A tear in the intestine wall

• Infection

• Possibly death of tissue

Primary symptoms of intussusception

Intussusception doesn’t always occur with visible symptoms. When symptoms begin, they usually start suddenly. This is true for both children and adults.

Pain is the most common symptom of intussusception, but there are other symptoms that may be existent. Older children and adults may experience only pain and none of the other common symptoms.

Symptoms in children

Because intussusception is most common in children under 3 years, they may not be able to describe their symptoms. The first sign of trouble may be a sudden cry of pain.

Young children may stoop or try to pull their knees up to their chest. Bouts of abdominal pain may come and go every 15 minutes. They may last longer each time until treatment starts. Other symptoms in children may include:

• Nausea and vomiting

• Diarrhea

• Stool mixed with blood and mucus

• Fever

• Little or no energy

You may also be able to feel a small lump in the lower abdomen.

Symptoms in adults

Among the challenges of diagnosing intussusception in adults are that it’s rare and is normally accompanied by nonspecific symptoms.

When symptoms of adult intussusception are present, they may include abdominal pain, nausea and vomiting. These symptoms may come and go, usually leading people to go weeks before seeking medical attention.

What can cause intussusception?

Intussusception usually occurs in the small intestine. This is the long, winding tube that allows the body to absorb essential nutrients.

Growth in the intestine

It’s not always clear why intussusception occurs, though in certain cases it’s due to a growth in the intestine like a polyp or tumor.

As the muscles within the intestinal wall move back and forth during digestion, tissue may catch on the growth, known as a lead point. This may cause some of the surrounding tissue to fold over on itself. But there can be other causes. Some are more common in children than adults.

Additional causes in children

A virus may play a role, as many children with intussusception have flu-like symptoms and regularly develop the condition during the fall or winter when flu season peaks.

If a lead point is to blame, the problem may be diagnosed as Meckel’s diverticulum, a pouch or bag that forms in the small intestine.

Additional causes in adults

A polyp or tumor in the intestine may trigger intussusception in adults. A digestive disorder like Crohn’s disease may also lead to intussusception. Weight loss surgery or other procedures on the intestine may lead to intussusception.

Risk factors for intussusception

Intussusception can occur in anyone at any age. About seventy five percent of cases occur during the first 2 years of life while ninety percent occur in children up to age 3. Intussusception is also more common in males.

Abnormal formation of the intestine at birth is a risk factor for intussusception. Children who’ve had a intussusception have a greater chance of having more.

A family history of the condition, particularly having a sibling with an intussusception history can also increase a child’s chances of having this condition.

How is intussusception diagnosed?

Diagnosing intussusception normally starts with a review of symptoms and a physical examination.

A doctor may gently press on the abdomen to feel for a lump or other factor like tenderness that could help determine the cause of the child’s symptoms.

Imaging tests are usually needed to confirm the diagnosis. These tests may include the following:

• Abdominal X-ray. This imaging test may display a blockage in the intestine.

• Upper gastrointestinal (GI) series or barium swallow. An upper GI series depends on a special liquid that, when swallowed, coats the upper GI tract. The liquid increases the visibility and detail of the upper GI tract on an X-ray.

• Lower GI series or barium enema. In this test, liquid barium or other fluid is inserted into the rectum to get a detailed X-ray image of the lower part of the small intestine. In cases of mild intussusception, the pressure of the barium insertion can at times cause the folded tissue to return to its normal position.

• Ultrasound. This type of test uses sound waves and a computer to generate images of inside the body. An ultrasound of the intestine can usually detect tissue problems or circulation disruptions.

How is intussusception treated?

The severity of intussusception is one of the major factors in determining its treatment. The age of the child and their general health is also considered. Usually, a nonsurgical procedure will be considered first.

Nonsurgical methods

A barium or saline enema may be enough, as it starts with the injection of air into the intestine. The pressure from the air may push the affected tissue back into its initial position.

The fluid administered through the tube in the rectum may also help return the affected tissue to its proper place.

Surgical methods

If an enema is ineffective, surgery may be required. General anesthesia is needed as the operation requires an incision in the belly.

The doctor may be able to manually restore the intestine to its normal, healthy position. If any tissue has been damaged, part of the intestine may have to be taken out. The remaining sections are then stitched back together. Surgery is the main approach or method for adults with intussusception and for children who are very ill with the condition.

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