Intussusception in Children

 Intussusception in Children

An intussusception is a condition in which a section of intestine folds into or slides inside the next section of intestine. This is similar to the way a telescope folds when you close it.

The intestines are the part of the digestive system that absorb food and liquids after they pass through the stomach. Most digestion takes place in the upper part of the intestines (small intestine). Water is absorbed and stool is formed in the lower part of the intestines (large intestine). Most intussusceptions happen in the area where the small intestine connects to the large intestine (ileocecal junction). This condition is most common in children.

Intussusception causes a blockage in the intestines. It also puts pressure on the part of the intestine that has folded in. This part can become swollen, irritated, and bloody. The increased pressure can also cut off the blood supply to that part of the intestine. If this happens, a hole (perforation) in the wall of the intestine may develop. Blood and fluids from the intestines may leak into the belly, causing irritation (peritonitis). Peritonitis is a medical emergency that needs to be treated right away.

What are the causes?

In most cases, the cause of this condition is not known. In some cases, the cause may be an abnormal growth in the intestine.

What increases the risk?

Children are more likely to develop this condition if they:

  • Are male.
  • Are younger than 3 years of age. Intussusception is uncommon in infants younger than 3 months and in children 6 years and older.
  • Recently had a viral infection.
  • Have an abnormal growth in the intestine, such as a:
    • Polyp.
    • Cyst.
    • Tumor.
    • Poorly formed blood vessel (malformation).
  • Had a recent surgery in the intestines.
  • Have had an intussusception in the past.
  • Recently received the rotavirus vaccine. This is a rare side effect of the vaccine.

What are the signs or symptoms?

Symptoms of this condition include:

  • Sudden and severe pain in the abdomen. At first, the pain may last for 15–20 minutes, go away, and then come back. Over time, the pain gets worse and lasts longer.
  • Crying.
  • Refusing to eat or drink.
  • Pulling his or her knees up to the chest.

Other signs and symptoms may include:

  • Vomiting.
  • Bloody stools tinged with mucus (currant jelly stools).
  • Swelling and hardening of the belly.
  • Fever.
  • Weakness.
  • Pale skin.
  • Sweating.
  • Being cranky, sleepy, or difficult to wake up.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your child’s symptoms.
  • Your child’s medical history.
  • A physical exam. Your child’s health care provider may feel the child’s abdomen for a hard, “sausage-shaped” lump.
  • Imaging tests to confirm the diagnosis. These may include ultrasound and X-ray of the abdomen.

How is this treated?

This condition is treated in the hospital. The goal of treatment is to correct the intussusception before peritonitis develops. Treatment may include:

  • Giving fluids and medicine through an IV.
  • Placing a tube into your child’s stomach through his or her nose (nasogastric tube) to remove stomach fluids.
  • If there is no perforation or peritonitis:
    • Your child may be given an enema. This passes air or fluid into the intestine. The pressure of the air or fluid can:
      • Clear the intussusception.
      • Help the health care provider clearly see where the problem is.
    • Your child will have an ultrasound to make sure air and fluids in the intestines are flowing normally.
  • Your child may need surgery if:
    • Enema treatment has not worked to clear the intussusception.
    • There is any sign of perforation or peritonitis.
    • Areas of dead or perforated intestinal tissue need to be removed.
    • The condition returns after enema treatment.
  • Your child may need to stay in the hospital so the health care team can make sure that:
    • The intussusception does not happen again.
    • He or she passes stool normally.
    • He or she can eat a normal diet.

Follow these instructions at home:

Medicines

  • Give over-the-counter and prescription medicines only as told by your child’s health care provider.
  • Do not give your child aspirin because of the association with Reye’s syndrome.
  • If your child was prescribed an antibiotic medicine, give it to him or her as told by the child’s health care provider. Do not stop giving the antibiotic even if he or she starts to feel better.

General instructions

  • Follow all instructions from your child’s health care provider.
  • Follow the health care provider’s directions about your child’s activity level. Ask the health care provider what activities are safe for your child.
  • Watch for any signs and symptoms of intussusception returning.
  • Keep all follow-up visits as told by your child’s health care provider. This is important.

Get help right away if:

  • Your child develops signs or symptoms of intussusception at home. These include:
    • Crying excessively, refusing to eat or drink, or pulling his or her knees up to the chest.
    • Repeated vomiting.
    • Bloody stools tinged with mucus (currant jelly stools).
    • Swelling and hardening of the belly.
    • Fever.
    • Weakness.
    • Pale skin.
    • Sweating.
    • Being cranky, sleepy, or difficult to wake up.

Summary

  • Intussusception is a folding of the intestine that causes a blockage in the intestines.
  • In most cases, the cause of this condition is not known. Risk factors include being male, being 3 months to 3 years old, or having had a recent viral infection.
  • The goal of treatment is to remove the blockage. Sometimes surgery is needed. A medical emergency can result if this is not treated.
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