Intussusception

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Intussusception is a condition in which one segment of the bowel (intestine) will telescope into another segment of the bowel. A model of the defect can easily be demonstrated by taking a rubber glove and pushing the end of one of the fingers back into itself. It is the most common cause of intestinal obstruction. It typically will occur in children between the ages of 3 months to 3 years. It tends to occur in boys more frequently than in girls, and can be found more commonly in children with cystic fibrosis. Over 90% of the cases do have a pathological cause stemming from such conditions as polyps (an abnormal growth in the intestine) in the colon, lymphoma (cancer of lymphoid tissue) or Meckels diverticulum (small out pouching of the small intestine). As the bowel is compressed resulting from this telescoping, the blood vessels and the lymphatic system becomes obstructed. This leads to disruption in blood supply (and oxygen) to the bowel which ultimately will lead to death of the bowel tissue involved.

Symptoms

Symptoms you can see with this condition includes sudden acute abdominal pain and abdominal distention, vomiting , lethargy, passage of red, currant jelly –like stool (stool mixed with blood and mucus) and a palpable sausage shaped mass in the right upper quadrant of the abdomen. You may see your child experiencing episodes of pain, manifested by screaming and drawing up their knees to the chest alternating with periods of normalcy and no pain. Eventually fever, extreme physical weakness and exhaustion will ensue.

Diagnostic Evaluation and Treatment

In conjunction with the subjective findings, the diagnosis can be confirmed with an ultrasound. Statistically, spontaneous reduction of this condition has occurred in approximately 10% of cases.

Medical correction includes the following. A Radiologist guided pneumo-enema (air enema) with or without water-soluble contrast. Your doctor may choose to try an ultrasound guided hydrostatic (saline) enema. The principle of hydrostatic reduction can be demonstrated taking that same glove and filling it with water. This pushes that telescoping finger back into a fully extended position. The advantage to using the latter approach is the absence of exposure to radiation. A reoccurrence of the intussusception, after these interventions, is fairly uncommon. Prior to the reduction procedure, your child may receive IV fluids and antibiotic therapy. An NG (nasogastric) tube may be inserted to allow for stomach decompression. If the medical procedures are unsuccessful, the condition may require surgical correction. Surgery involves an incision into the abdomen and manually reducing the telescoping of the bowels. Surgery may also require resecting (or cutting out) any intestine that has died due to the lack of blood supply (along with the life sustaining oxygen that goes along with that blood). The two ends of the viable (living portion of intestine) are connected after the resection. After either approach for correction, your child may be required to maintain an NPO (nothing by mouth status), NG tube decompression ( if surgery was performed), IV fluids and antibiotics.

Prognosis

With early diagnosis and treatment, any serious complications are very rare. Statistically, approximately 80% of non-operative reductions are successful and surgery is required if the reduction is not successful.