Intussusception

Intussusception in Children

What is intussusception in children?

Intussusception is a serious problem in the intestine. It occurs when 1 part of the intestine slides inside another part. The intestine then folds into itself like a telescope. This creates a blockage or obstruction. It stops food that is being digested from passing through the intestine.

Intussusception is the most common cause of intestinal blockage in children between ages 3 months and 3 years. It's rare in newborn babies. But it can also occur in older children, teens, and adults.

Intussusception is a medical emergency. It's the most common abdominal emergency in early childhood. If not treated, it can cause infection or even death.

What causes intussusception in a child?

Experts don’t know what causes intussusception. It may occur more often in children who have a family history of the disorder.

Experts have found a link in some cases with other conditions. These include viral infection, abdominal or intestinal tumors or masses, appendicitis, parasites, celiac disease, cystic fibrosis, and Crohn's disease.

What are the symptoms of intussusception in a child?

Intussusception is a medical emergency. If you think your child may have the disorder, get medical care right away.

Each child’s symptoms may vary. The most common symptom is sudden, loud crying. This is caused by sudden, severe belly (abdominal) pain in an otherwise healthy child.

This belly pain occurs often. At first it may seem to be colic. Infants or children may strain, draw their knees up, act very irritable, and cry loudly. Your child may feel better and be playful between bouts of pain. Or your child may become tired and weak from crying.

Other symptoms include:

• Vomiting
• Bloody stool
• Red, jelly-like stool
• Fever
• Extreme tiredness or lethargy
• Vomiting bile
• Diarrhea
• Sweating
• Dehydration
• Swollen belly  

Symptoms of intussusception may seem like other health problems. See your child's healthcare provider for a diagnosis.

How is intussusception diagnosed in a child?

Your child’s healthcare provider will take a health history and give your child a physical exam.  Imaging studies are also done to check the belly (abdominal) organs. These tests can be very upsetting to your child. As much as possible, and in an age-appropriate manner, explain to your child what will be happening and why it's happening before the procedure. These tests may include:

• Abdominal X-ray. A diagnostic test that may show intestinal blockage.
• Ultrasound. A diagnostic imaging method that uses high frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view organs as they work and to check blood flow through various vessels.  
• Upper GI series or barium swallow. This test looks at the organs of the top part of the digestive system. It checks the food pipe (esophagus), the stomach, and the first part of the small intestine (duodenum). Your child will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray. Then X-rays are taken to check the digestive organs.
• Barium enema or lower GI series. This is an X-ray exam of the rectum, the large intestine, and the lower part of the small intestine. Your child will be given a metallic fluid called barium. Barium coats the organs so they can be seen on an X-ray. The barium is put into a tube and inserted into your child’s rectum as an enema. An X-ray of the belly will show if there are any narrowed areas called strictures, any blockages, or other problems. In some cases, the intussusception fixes itself during this test. The intestine may go back into place on its own. This can happen because of the pressure put on the intestine while the barium is inserted.

How is intussusception treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Sometimes intussusception will repair itself while a child has a barium enema. In many cases, the healthcare provider can correct the problem by giving an air enema or saline enema. This is done by placing a small tube in your child's rectum. The healthcare provider uses ultrasound or X-rays (fluoroscope) to help place the tube. Air is inserted in the tube. The air may help move the intestine back into its normal position. But if your child is very ill with an abdominal infection or other problems, the provider may choose not to do this.

Your child will need surgery if the intussusception is not repaired with a barium enema. Your child will also need surgery if they are too ill to have a barium enema, saline enema, or air enema. For the surgery, your child will be given anesthesia so they may comfortably sleep during the procedure. The surgeon will make a cut (incision) in the belly. The surgeon will find the intussusception and push the parts of the intestine back into place. The intestine will be checked for damage. If any sections are not working correctly, they will be removed.

If your child’s intestine is damaged and the part removed is small, the 2 sections of healthy intestine will be sewn back together.

In very rare cases, a large amount of intestine may be removed. This happens if the damaged section of intestine is large. In this case, surgery can’t link together the parts of the intestine that remain after the damaged section is removed. An ileostomy may be done so that the digestive process can continue. With an ileostomy, the 2 remaining healthy ends of intestine are brought through openings in the belly. Stool will pass through the opening (stoma). It will then collect in a bag on the outside of the body. The ileostomy may be short-term. Or, in very rare cases, it may be long-lasting or permanent. It depends on how much intestine was removed.

What are possible complications of intussusception in a child?

Intussusception is a medical emergency. It's a life-threatening illness. If not treated, it can cause serious problems such as:

• Intestinal infection
• The death of intestinal tissue
• Internal bleeding
• A severe abdominal infection called peritonitis
• A very serious illness called sepsis that occurs when the body has an overwhelming response to an infection
• Shock, which refers to life-threatening changes in blood pressure, pulse, and breathing

How can I help my child live with intussusception?

If not treated, intussusception is a life-threatening disorder.

Your child’s long-term outlook depends on how much damage was done to the intestines. Most children will have no long-term complications of intussusception if treated correctly. Children who had the damaged part of their intestine removed may have long-term problems. Removing a large part of the intestine can affect the digestive process. These children may need to eat and drink more to get the nutrients and fluids that they need.

Talk with your child's healthcare provider about your child’s prognosis.

When should I call my child's healthcare provider?

Intussusception is a medical emergency. Call your child's healthcare provider if your baby has:

• Sudden, severe belly (abdominal) pain
• Bloody or red jelly-like stools
• Fever
• Vomiting
• Other signs of severe illness

Key points about intussusception in children

• Intussusception is a serious problem in the intestine. It's a medical emergency.
• It occurs when 1 part of the intestine slides inside another part. The intestine then folds into itself like a telescope.
• This creates a blockage or obstruction. It stops food that is being digested from passing through the intestine.
• In many cases, it can be corrected during diagnostic testing. Sometimes it goes away on its own. In some cases, surgery may be needed.
• If not treated, intussusception can be life-threatening.
• Intussusception can happen again, especially if it's not treated correctly or with surgery the first time.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.