Intussusception In Babies, Children, and Adults

Picture of the lower digestive tract. About 60% of children with intussusception are under one year of age, and 80% to 90% are younger than two years.

• Intussusception is a serious medical condition that occurs when one part of the intestine slides into another part of the intestine (like a telescope), resulting in severe belly pain. Both the small or large intestine may be affected.
• Intussusception causes blockage in the intestine, and air, fluid, and food can get stuck, which causes painful symptoms. In addition, the flow of blood to the intestine may be reduced (ischemia). This also causes painful symptoms and can lead to the death of the intestinal tissues (gangrene).
• Most cases of intussusception occur in babies and children, especially those younger than 3 years old, though it is rare in newborns.
• About 60% of children with intussusception are under one year of age, and 80% to 90% are younger than two years.
• Rarely, intussusception also can occur in older children and adults. 

Signs and symptoms of intussusception usually have a sudden acute onset and may include severe, intermittent belly pain that comes in waves. In the beginning, episodes of pain occur approximately every 15 to 20 minutes, and over time they become more frequent. 

This transient pain can result in:

• Pulling the knees up to the chest like a child is trying to poop
• Irritability
• Loud crying
• Fatigue and weakness from crying
• Vomiting
• Bloody stool
• Sleepiness/difficulty waking child up 

The side effects of intussusception are same as the symptoms and are due to obstruction or ischemia or gangrene of the intestine. 

Causes of Intussusception

The cause of intussusception often is unknown (idiopathic) especially in children. It may be caused by:

• Viral infections.
• An abnormality in the intestines such as a polyp or a cancer
• A result of recent intestinal surgery.
• Rarely, affter the rotavirus vaccine.

Risk Factors for Intussusception

Risk factors for intussusception include age under 2 years (80% of cases are in children under 2 years) and being male (some estimates state males are two to four times more likely to develop the condition). 
 

Rarely, intussusception can occur from the rotavirus vaccination, which usually happens within a week after the first or second dose of the vaccine. 

Intussusception is a medical emergency. Call your baby or child's pediatrician or go to an emergency department right away if your child has symptoms of intussusception.

A doctor will start with a medical history and physical examination. Imaging tests may be ordered to make a diagnosis including:

• Abdominal X-ray: Can detect intestinal obstruction    
• Ultrasound: Can find a target-like sign indicative of intussusception
• Air or contrast enema: This procedure can help diagnose intussusception and can also be used as treatment.

Intussusception is a medical emergency that requires prompt attention. Early diagnosis and treatment of intussusception is needed to prevent serious complications.

Intussusception may be treated without surgery with either a water-soluble contrast enema or an air-contrast enema, which also can be used to confirm the diagnosis.

For the enema, aa tube is inserted through the anus into the child’s rectum and air or fluid is pushed through the tube into the intestine. When the air or fluid reaches the telescoping bowel that is causing the intussusception, it can cause the part of the intestine that is stuck to be pushed back out to its normal position. An X-ray or ultrasound accompanies the enema procedure so the doctor can visualize the area of the intussusception. 

In most cases, an enema procedure will reverse the intussusception, but in 10% to 15% of cases it does not work, and surgery is required. 

Surgical management for intussusception is considered a bowel reduction, which involves correcting the intussusception by pushing the intestine back into place. 

The two types of procedures used for bowel reduction surgery are:

1. An open procedure, which involves a large incision.
2. Laparoscopic procedure, which involves small incisions and a camera.

The type of procedure will be dictated by the child’s condition. 

If the bowel is unable to be successfully reduced (put back into place), or part of it has developed gangrene, the affected section will be removed and the two remaining healthy sections are sewn back together.
 

After surgery for intussusception you should eat a regular diet with a variety of healthy foods. 

• Whole-grain breads
• Low-fat dairy products
• Beans
• Fruits
• Vegetables
• Lean meats
• Fish

Ask the surgeon if you, your baby, or toddler needs to be on a special diet to avoid certain foods.

Children usually are kept in the hospital overnight for recovery and in case intussusception recurs. If the surgical incision was closed with a gauze bandage, it is typically removed within a few days post-op. A child may take a bath or shower two days after surgery, and a follow-up with the doctor is usually scheduled for 2-3 weeks later. 

In about 10% of cases, intussusception returns within 72 hours after a procedure, regardless of whether it was an enema or surgery. 
 

Complications of intussusception if it is not treated include injury or death of the intestine which can result in surgical removal of the bowel, life-threatening infection (sepsis), and death.

Intussusception generally cannot be prevented.