Justin cried loudly and drew his tiny legs up to his chest as his bewildered parents tried to soothe him. Their 7-month-old had been colicky before, but this was something new — his crying was more urgent, his mood much more irritable. As the afternoon wore on, Justin's dad noticed that his son's small belly was distended, and when it was time to change the baby's diaper, he suspected that something was wrong.
After speaking with Justin's doctor, Justin's dad bundled him up and took him to the emergency department, where he was diagnosed with and successfully treated for intussusception (pronounced: in-tuh-suh-sep-shun), the most common abdominal emergency to affect children under 2 years of age. Keep reading to learn about intussusception, its symptoms, its treatment, and more.
What Is Intussusception?
Intussusception occurs when one portion of the bowel slides into the next, much like the pieces of a telescope. When this occurs, it creates an obstruction in the bowel, with the walls of the intestines pressing against one another. This, in turn, leads to swelling, inflammation, and decreased blood flow to the intestines involved.
The most common cause of intestinal obstruction in children between the ages of 3 months and 6 years, intussusception:
- occurs most often in children between 5 and 10 months of age (80% occur before a child is 24 months old)
- affects between one and four infants out of 1,000
- is three to four times more common in boys than in girls
Signs and Symptoms
Children with an intussusception have intense abdominal pain, which often begins so suddenly that it causes loud, anguished crying and causes the child to draw the knees up to the chest. The pain is usually intermittent, but recurs and becomes stronger. As the pain subsides, a child with an intussusception may stop crying and seem fine.
Other common symptoms include:
- abdominal swelling or distension
- passing stools (or poop) mixed with blood and mucus, known as currant jelly stool (60% percent of infants with an intussusception will pass currant jelly stool)
- vomiting
- vomiting up bile, a bitter-tasting fluid secreted by the liver that's often golden-brown to greenish in color
- lethargy (i.e., drowziness or sluggishness)
- shallow breathing
- grunting
As the illness progresses, a child will become progressively weaker and may develop a fever and appear to go into shock. Symptoms of shock include lethargy, rapid heartbeat, weak pulse, low blood pressure, and rapid breathing.
Causes
In infants, the causes of intussusception are unknown, although there are some theories about why it occurs. Because intussusception is seen most often in spring and fall, this seems to suggest a possible connection to the kinds of viruses that children catch during these seasons, including upper respiratory infections.
In some cases, intussusception may follow a recent bout of gastroenteritis (sometimes called stomach flu). Gastrointestinal infections may cause swelling of the infection-fighting lymph tissue that lines the intestine, which may pull one part of the intestine into the other. Intussusception is most common around the age that infants are being introduced to solid foods. It has been suggested that the introduction of new foods may also cause some swelling of the lymph tissue in the intestines, increasing the chance of developing an instussusception.
Usually when an adult or a child older than 3 develops an intussusception, it's often the result of enlarged lymph nodes, a tumor, or a polyp in the intestine.
Diagnosis and Treatment
The doctor will then perform a physical exam on the child, paying special attention to the abdomen. Often, the doctor can feel the part of the intestine that's involved, which is swollen and tender and often is described as a "sausage-shaped mass." Symptoms like pain, drawing up the legs, vomiting, lethargy, and passing bloody or currant jelly stool are meaningful in helping the doctor reach a diagnosis. In addition to doing a physical examination, the doctor will ask the parent about any concerns and symptoms their child has, the child's past health, your family's health, any medications the child is taking, any allergies the child may have, and other issues. This is called the medical history.
If the doctor thinks an intussusception may be the cause of the child's pain, a pediatric surgeon will be consulted to examine the child and decide about treatment. The doctor may order an abdominal X-ray, which may or may not show an obstruction. An ultrasound examination may also help make the diagnosis. If the child appears very ill, suggesting damage to the intestine, the surgeon may opt to take the child immediately to the operating room to correct the bowel obstruction.
A barium or air enema is often used to both diagnose and treat a suspected intussusception. During a barium enema, a liquid mixture containing barium is given through a catheter tube into the child's rectum, and special X-rays are taken. Barium outlines the bowels on the X-rays and, if an intussusception is present, shows the doctors the telescoping piece of intestine.
In many instances, the barium enema not only shows the intussusception, but the pressure from putting it in the bowel may also unfold the bowel that has been turned inside out, instantly curing the obstruction. An air enema, given rectally in a similar way as barium, can also be used to diagnosis and treat an intussusception.
The radiologist usually decides which test is most appropriate to perform. Both procedures are very safe and usually well tolerated by the child, although there is a very small risk of infection or bowel perforation. There's a 10% risk of recurrence, which usually occurs within 72 hours following the procedure.
If the barium or air enema procedures aren't successful or the child is too ill to attempt the enema, the child will undergo surgery. Enemas are less successful in older children, and they're more likely to require surgery to treat intussusception. Surgeons will try to fix the obstruction but if too much damage has been done, that part of the bowel will be removed.
Some babies with intussusception may be given antibiotics to prevent infection. Babies who have been treated for intussusception will be kept in the hospital and given intravenous feedings until they're able to eat and have normal bowel function.
Complications
If left untreated, intussusception can cause severe complications. Complications are directly related to the amount of time that passes from when the intussusception occurred until it's treated. Most infants who are treated within the first 24 hours recover completely from an intussusception with no problems. Further delay increases the risk of complication which include irreversible tissue damage, perforation of the bowel, infection, and death.
When to Call Your Child's Doctor
Intussusception is a medical emergency. If you're concerned that your child has some or all of the symptoms of intussusception, such as abdominal pain, vomiting, or passing of currant jelly stool, call your child's doctor or emergency medical services immediately.
The outcome for most infants with intussusception is very good, and with early treatment, complications are much less likely to develop. Do not delay, though — in many cases, early diagnosis can mean a child can be successfully treated without surgery.
Reviewed by: Thom E Lobe, MD
Date reviewed: October 2007
