Intussusception

Intussusception is a type of bowel blockage caused when the bowel folds into itself like a telescope. It is a rare condition, but with prompt treatment almost all infants who develop intussusception fully recover.

Intussusception is most often seen in children ages six months to two years and is a major cause of bowel obstruction. It occurs more frequently in boys than in girls. It is an uncommon cause of bowel obstruction in teens and adults.

The cause of intussusception is mostly unknown. Some conditions might cause intussusception:

Children ages six months to two years are at greatest risk, and boys have a greater risk than girls. Children with cystic fibrosis are also at increased risk.

The earliest indicator of intussusception is sudden, loud crying caused by abdominal pain. The pain is colicky in nature, that is, the pain comes and goes in spasms, usually lasting 15 to 20 minutes. The pain gets stronger and lasts longer each time it returns. The pain may cause the child to draw up his or her knees toward the chest. Other signs include the following:

The healthcare provider takes a detailed health history and examines the patient. On examination of the abdomen, the doctor might feel a mass and touching the abdomen causes pain. There may also be signs of dehydration and shock (for example, low blood pressure) if the bowel has perforated and blood or bowel contents have leaked into the abdomen. An abdominal x-ray and ultrasound can help the healthcare provider determine whether the symptoms are caused by intussusception or a less serious problem, such as a milk allergy, and to detect the exact area of the problem.

If a healthcare provider suspects a child has intussusception, the child is sent for emergency care. The care team will make the child's condition stable. This might mean inserting an intravenous tube into the child to provide fluid and prevent dehydration. A tube (called a nasogastric tube) is inserted through the nose into the stomach to relieve pressure in the stomach and to suction (remove) stomach contents. If the bowel does not return to normal, the bowel blockage can be treated by a specialist called a radiologist. The radiologist places a small tube into the child's rectum and moves air through the tube. The air pressure usually corrects the intussusception, moving the intestine back into normal position. Parents should watch to make sure the intussusception does not recur in the first few days following the air enema.

If these treatments are not successful or the bowel has perforated (hole in the bowel), then surgery will need to be done to remove the diseased portion of the bowel and to reattach the ends of the bowel on either side of the area that has been removed.

* hemorrhagic (HEH-muh-rij-ik) shock is abnormally low blood pressure caused by uncontrolled or abnormal bleeding.

* septic shock is shock due to overwhelming infection, and is characterized by decreased blood pressure, internal bleeding, heart failure, and in some cases, death.

* infection (in-FEK-shun) is a disease caused by microorganisms that invade body tissues and/or fluids.

* gangrene (GANG-green) is the decay or death of living tissue caused by a lack of blood supply to the tissue or bacterial infection of the tissue.

* dehydration (dee-hi-DRAY-shun) is a condition in which the body is depleted of water, usually caused by excessive and unreplaced loss of body fluids, such as through sweating, vomiting, or diarrhea.

* tumor (TOO-mor) is an abnormal growth of body tissue that has no known cause or physiologic purpose. A tumor may or may not be cancerous.

* polyp (POH-lip) is a bump or growth usually on the lining or surface of a body part (such as the nose or intestine). Size can range from tiny to large enough to cause pain or obstruction. They may be harmless or benign, but they also may be cancerous or malignant.

* nodule (nod-yule) is a small rounded lump or swelling.

* lethargy (LETH-are-gee) is severe tiredness, sleepiness, drowsiness, or mental dullness.