Intussusception: Causes, Risk Factors, Symptoms, Tests, Treatment

What is Intussusception?

Intussusception is a serious medical condition where a part of the intestine slips into a neighboring part of the intestine resulting in blockage of food or fluid from passing through and loss of blood supply to the affected part of the intestine. Intussusception may also cause bowel perforation, infection and necrosis (death) of bowel tissue. Intussusception is the leading cause of intestinal obstruction in children aged below 3 years. Adults rarely suffer from intussusception and it occurs often as a result of an underlying medical condition, such as a tumor; whereas the cause of intussusception in children is often not known.

In children, often the intestines can be pushed back into its original position with the help of an x-ray procedure; whereas in adults, surgery is usually required to correct the intussusception.

Causes of Intussusception

• In human body, the intestine is formed like a long tube. In intussusception, a part of the intestine (commonly the small intestine) slides inside an adjacent part. This is also known as telescoping as it resembles the manner in which a collapsible telescope folds together.
• Sometimes, intussusception may be caused by an abnormal growth, such as a polyp or a tumor, in the intestine. This is known as a lead point. The peristaltic movements, which are the wave-like contractions of the intestine, hold this lead point and pull it along with the intestinal lining inside the section of the bowel present before it.
• In majority of the cases of intussusception, the cause cannot be identified, especially in children. As the intussusception tends to occur more in the fall and winter with the children experiencing flu-like symptoms, some experts believe that a virus may be the cause of this condition.
• In some cases the lead point, commonly the Meckel’s diverticulum, is thought to be the cause.
• In adults, the intussusception commonly occurs as a result of medical conditions such as tumor, intestinal adhesions, hematoma, inflammatory conditions such as Crohn’s disease and the presence of surgical scars in the small intestine or colon.

Risk Factors of Intussusception

• Children are at a higher risk to develop intussusception than adults. Intussusception is the most common cause for bowel obstruction in children aged between 6 months and 3 years.
• Boys are more prone to suffer from intussusception than girls.
• Congenital malformation of the intestine, such as malrotation increases the risk for intussusception.
• Past history of intussusception increases the risk to develop it again.
• Individuals suffering from AIDS are at a higher risk for developing intussusception.

Symptoms of Intussusception in Children

• The child may start crying suddenly and insistently.
• Abdominal pain where the child may pull his/her knees to their chests when crying; this is a significant indication of intussusception.
• Periodic episodes of pain; commonly every 15 to 20 minutes. As the time goes on, the duration and frequency of these episodes increases.
• Presence of blood and mucus in the stool, also known as “currant jelly” due to its appearance.
• Vomiting.
• A lump is felt in the abdomen.
• Weakness.
• Diarrhea may be present.
• Fever may be present.
• Constipation may be present.

There are some infants who have no obvious symptoms and some older children who only suffer from pain, but have no other symptoms.

Symptoms of Intussusception in Adults

Adults rarely have intussusception; therefore, symptoms are rather general and this condition may be difficult to diagnose. The most common symptom is pain in the abdomen which is followed by nausea, vomiting, and diarrhea. Majority of the individuals have no symptoms at all.

Tests to Diagnose Intussusception

• Medical history and physical examination where a sausage-shaped lump may be felt in the abdomen.
• Ultrasound, x-ray or computerized tomography (CT) scan of the abdomen helps in showing intestinal obstruction which is caused by intussusception. Imaging will usually reveal a “bull’s eye,” showing the intestine twisted within the intestine. Imaging of the abdomen also reveals perforation of the intestine, if any.
• Air or barium enema is an x-ray of the colon where air or liquid barium is passed into the colon via rectum. This helps in giving sharper images on the x-ray. Majority of the times, air or barium enema usually rectifies the intussusception in the children with no further treatment required. If there is intestinal perforation, then a barium enema cannot be done.

Treatment of Intussusception

• Intussusception is often treated as a medical emergency to prevent dehydration, shock, and infection.
• Upon arrival to the hospital, the doctor will first try to stabilize the child’s condition by:
  1. Giving IV (intravenous) fluids.
  2. Passing a nasogastric tube through the child’s nose and into the stomach. This helps in decompressing the intestines.
• For treating the intussusception, a barium or air enema is done. This acts as both a diagnostic procedure as well as treatment and is extremely successful in children, but rarely done in adults. If this is successful in resolving the intussusception, then further treatment is often not required.
• Surgery is required in the following cases:
  1. If the enema is not successful in correcting the problem.
  2. If there is intestinal perforation.
  3. If a lead point is the cause of intussusception.
• During the surgery the surgeon will free the trapped portion of the intestine, free the obstruction and remove any necrotic intestinal tissue if present.
• In adults and in serious cases, the surgery is the main line of treatment.
• In some patients, intussusception could be temporary and resolves on its own without any treatment.
• In some cases, intussusception recurs and requires treatment again.

References: