Intussusception
A problem with the intestine in which one portion of the bowel slips into the next like a collapsible tube, blocking the intestine so that the walls of the bowel press against one another. This can lead to inflammation, swelling, and loss of blood to the intestines. The condition can occur in children between three months and six years of age, although most cases happen between five months and nine months. It affects between one and four infants out of 1,000 and is two to three times more common in boys.
Causes
In infants the causes of intussusception are unknown. Some experts believe that the problem is caused by the aftereffects of a viral intestinal infection. Viral infections can cause swelling of the infection-fighting lymph tissue that normally lines the intestine. Because intussusception is seen most often in spring and fall, this seems to suggest a possible connection to the kinds of viruses children catch at these times.
When an older child or adult develops intussusception, it is often the result of a tumor or polyp in the intestine.
Symptoms
Intussusception usually triggers loud, anguished crying from the intense pain, as the baby draws the knees to the chest. Other common symptoms include vomiting, fever, irritability, lethargy, abdominal swelling, shallow breathing or grunting, and constipation. There may be some blood and mucus mixed with the stools.
In some babies with intussusception the pain may come and go, and in between pains the infant may stop crying. However, the pain always returns. Over time, an infant can become weak and suffer from severe dehydration or shock.
Diagnosis
A detailed patient and symptom history, together with a physical exam on the baby, may reveal a sausage-shaped mass in the abdomen, which suggests intussusception. Additional tests may help diagnose intussusception, including an abdominal X ray. If the diagnosis is certain and the child seems to be very sick or is losing blood, the pediatric surgeon may decide to operate right away to correct the bowel obstruction. If the diagnosis is still uncertain after regular X rays and a surgical examination and the baby is not seriously ill, a barium or air enema may be prescribed. A barium enema is a special X ray in which a substance called barium is put in the baby’s rectum, and several X rays are taken. Barium can outline a telescoping intestine, and the obstruction may be cured by the pressure from placing the enema in the bowel. A rectal air enema can be used together with X rays to make the final diagnosis, but not many hospitals use them on children.
Treatment
Treatment often depends on the severity of the problem, but if the child is treated early enough, the enema will correct the problem and relieve the obstruction without surgery. Both procedures are very safe and usually well tolerated by the child, although there is a very small risk of infection or bowel perforation.
If these procedures do not cure the intussusception, or if the infant is too sick to have the enema, surgery will be required to fix the obstruction and save the bowel. If there is any dying or infected bowel, that part of the tissue will be removed. Most infants who are treated within the first 24 hours recover completely.
Complications
If left untreated, intussusception can cause many severe complications, including death of bowel tissue, perforation of the bowel, infection, and death.
Call the Doctor
Call a doctor immediately if a child exhibits symptoms. Intussusception is a medical emergency, but with early treatment most infants recover completely. In many cases, early diagnosis means surgery can be avoided.
Causes
In infants the causes of intussusception are unknown. Some experts believe that the problem is caused by the aftereffects of a viral intestinal infection. Viral infections can cause swelling of the infection-fighting lymph tissue that normally lines the intestine. Because intussusception is seen most often in spring and fall, this seems to suggest a possible connection to the kinds of viruses children catch at these times.
When an older child or adult develops intussusception, it is often the result of a tumor or polyp in the intestine.
Symptoms
Intussusception usually triggers loud, anguished crying from the intense pain, as the baby draws the knees to the chest. Other common symptoms include vomiting, fever, irritability, lethargy, abdominal swelling, shallow breathing or grunting, and constipation. There may be some blood and mucus mixed with the stools.
In some babies with intussusception the pain may come and go, and in between pains the infant may stop crying. However, the pain always returns. Over time, an infant can become weak and suffer from severe dehydration or shock.
Diagnosis
A detailed patient and symptom history, together with a physical exam on the baby, may reveal a sausage-shaped mass in the abdomen, which suggests intussusception. Additional tests may help diagnose intussusception, including an abdominal X ray. If the diagnosis is certain and the child seems to be very sick or is losing blood, the pediatric surgeon may decide to operate right away to correct the bowel obstruction. If the diagnosis is still uncertain after regular X rays and a surgical examination and the baby is not seriously ill, a barium or air enema may be prescribed. A barium enema is a special X ray in which a substance called barium is put in the baby’s rectum, and several X rays are taken. Barium can outline a telescoping intestine, and the obstruction may be cured by the pressure from placing the enema in the bowel. A rectal air enema can be used together with X rays to make the final diagnosis, but not many hospitals use them on children.
Treatment
Treatment often depends on the severity of the problem, but if the child is treated early enough, the enema will correct the problem and relieve the obstruction without surgery. Both procedures are very safe and usually well tolerated by the child, although there is a very small risk of infection or bowel perforation.
If these procedures do not cure the intussusception, or if the infant is too sick to have the enema, surgery will be required to fix the obstruction and save the bowel. If there is any dying or infected bowel, that part of the tissue will be removed. Most infants who are treated within the first 24 hours recover completely.
Complications
If left untreated, intussusception can cause many severe complications, including death of bowel tissue, perforation of the bowel, infection, and death.
Call the Doctor
Call a doctor immediately if a child exhibits symptoms. Intussusception is a medical emergency, but with early treatment most infants recover completely. In many cases, early diagnosis means surgery can be avoided.
