Non Chronic Childhood Conditions Intussusception

Intussusception, a condition in which a portion of the bowel telescopes into itself, is the most common cause of bowel obstruction in infants. While intussusception typically affects children between the ages of three months and six years old, most cases occur in infants who are less than two years of age. Intussusception is three times more likely to affect male children than females.

Intussusception causes the walls of the bowel to become inflamed and swollen as the affected portions are pinched together. The result is decreased blood flow to the affected area. If left untreated, this condition can cause strangulation of the intestinal tissues and atrophy in parts of the bowel.

Causes of Intussusception

While the exact causes of intussusception remain unknown, experts believe the condition may be triggered by a virus. One of the reasons for this logic is that most cases of intussusception arise during the spring and fall when children are most susceptible to viral respiratory infections.

Other experts suspect a link between intussusception and swollen lymph nodes in the intestine. When infants are introduced to new foods, some develop a swelling of the lymph nodes that is thought to trigger the telescoping of the intestine. Polyps and tumors may also cause intussusception.

Intussusception and Rotavirus

Rotavirus is an intestinal virus that causes gastroenteritis (stomach and intestinal inflammation) in infants. It causes severe diarrhea, often resulting in hospitalization.

In 1999, a rotavirus vaccine called RotaShield® was withdrawn from the market when it was linked to an increase in intussusception cases. Recently, new vaccines against rotavirus have been tested and found to be effective in preventing rotavirus without increasing the risk of developing intussusception.

Symptoms of Intussusception

Children with intussusception tend to experience severe abdominal pain. An infant with the condition will cry suddenly and loudly and draw her knees up against her chest. Abdominal swelling may appear, and the pain tends to come and go. In its advanced stages, intussusception may cause high fever and shock.

Other symptoms of intussusception include:

  • currant-colored, jelly-like stools (feces mixed with blood and mucus)
  • increased lethargy and sleepiness
  • rapid heartbeat, weak pulse and shallow breathing
  • vomiting, including the vomiting of bile.

While intussusception can occur in either the large or small intestine, most common cases occur when the small intestine telescopes into the large intestine.

Doctors diagnose intussusception by feeling for a swollen mass in the abdomen and taking an X-ray of the affected area.

Intussusception Treatment

In many cases, intussusception is easy to treat with an enema, a process called intussusception reduction. During an intussusception reduction, a catheter is inserted into the rectum to fill the affected area with air or a barium mixture. This typically causes the bowels to unfold. The intussusception reduction procedure is most effective in infants.

Following the treatment, the child is kept for observation until he has a normal bowel movement. Doctors generally prescribe pain medication for a few days to relieve pain in the abdominal area.

Because the enema treatment is less effective with older children, surgery may be necessary to treat this condition. The same is true of more advanced or recurring cases in infants. If part of the bowel has become infected or atrophied, the surgeon will remove the affected portion.

Infection is the most likely complication of intussusception. Cases that aren’t treated within 24 hours may require emergency surgery and treatment with antibiotics. Without treatment, the bowel may perforate, endangering the child’s life.

Resources

Nemours Foundation. (reviewed January, 2004). KidsHealth for parents: Intussusception.

Peck, P. (January, 2006). Two investigational rotavirus vaccines safe and effective.

Shands Health Care. (reviewed December, 2002). Intussusception (children).

UCL Institute of Child Health. (nd). Intussusception.

YourSurgery.com. (nd). Intussusception: Telescoping bowel.