Intussusception

Intussusception occurs when a portion of your child's intestine folds inside another segment — this causes an obstruction that prevents the passage of food, which is being digested.

• The walls of the two sections of intestine press on each other, causing irritation and swelling.
• Eventually, the blood supply to that area is cut off, which can cause damage to the intestine.
• Intussusception is the most common cause of intestinal obstruction in children who are between 3 months and 6 years old.
• Boys are affected four times as often as girls.

• Intussusception occurs in one out of every 250 to 1,000 infants and children.
  • Intussusception is rarely seen in newborn infants.
  • Sixty percent of those who develop intussusception are between 2 months and 1 year old.
  • Although 80 percent of the children who develop the condition are less than 2 years old, intussusception can also occur in older children, teenagers, and adults.
• Boys develop intussusception three to four times more often than girls.
• Intussusception seems to occur more often in the spring and fall months.

Intussusception is a life-threatening illness.

• If left untreated, it can cause serious damage to the intestines, since their blood supply is cut off.
• Intestinal infection can occur, and the intestinal tissue can also die.
• Untreated intussusception can also cause internal bleeding and a severe abdominal infection called peritonitis.

A rotavirus vaccine that was approved by the U.S. Food and Drug Administration (FDA) in 1998 was pulled from the market in 1999 because of an association between the vaccine and an increased risk for intussusception in infants aged one year or younger. However, no direct link was established to the vaccine as a cause of intussusception.

A new rotavirus vaccine was approved by the FDA in 2006. The risk for intussusception with the new vaccine was evaluated in a large clinical trial of more than 70,000 children, and no increased risk was found. The manufacturer of this vaccine will continue to closely monitor the vaccine's safety in additional clinical studies.

Each child experiences symptoms differently, but the most common symptom of intussusception is sudden onset of intermittent pain in a previously well child.

• The pain may be mistaken for colic at first; it occurs at frequent intervals.
• Infants and children may strain, draw their knees up, act very irritable, and cry loudly. Your child may recover and become playful in between bouts of pain, or may become tired and weak from crying.
• Vomiting may also occur with intussusception, and it usually starts soon after the pain begins.
• Your child may pass a normal stool, but the next stool may look bloody. A red, mucus, or jelly-like stool is usually seen with intussusception.

We don't really know. An increased incidence of developing intussusception is often seen in children:

• Who have cystic fibrosis and are also dehydrated
• Who have abdominal or intestinal tumors or masses
• Who have an intestinal virus known as gastroenteritis
• Who have an upper respiratory tract infection, including infection with adenovirus
• Who have just finished taking chemotherapy for cancer

Your child's physician will obtain a medical history and perform a physical examination. Imaging studies are also done to examine the abdominal organs, and may include:

• Abdominal X-ray: a diagnostic test that may show intestinal obstruction
• Barium or air enema: a procedure performed to examine the large intestine for abnormalities. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) or air is given into the rectum as an enema. An X-ray of the abdomen shows narrowed areas, obstructions and other problems.

In some cases, the pressure exerted on your child's intestine while inserting the barium or air will help the intestine to unfold, correcting the intussusception.

An operation is necessary for intussusception that does not resolve with a barium enema, or for those who are too ill to have this diagnostic procedure.

Under anesthesia, the surgeon will make an incision in your child's abdomen, locate the intussusception, and push the affected sections back into place. Your child's intestine will be examined for damage, and, if any sections are not working correctly, they will be removed.

• If there is damage to the intestine and the section removed is small, the two sections of healthy intestine will be sewn back together.
• If the injured section of intestine is large, a significant amount of intestine may be removed.

In this case, the parts of the intestine that remain after the damaged section is removed may not be attached to each other surgically. An enterostomy may be created so that the digestive process can continue.

With an enterostomy, the two remaining healthy ends of intestine are brought through openings in the abdomen. Stool will pass through the opening (called a stoma) and then into a collection bag. The enterostomy will be temporary.

If not treated, intussusception is a life-threatening disorder. If treated within 24 hours, most babies recover completely.

The long-term outlook depends on the extent of intestinal damage (if any).

• Children with intestinal injury who had a large portion of the intestine removed may have long-term problems.
• Removing a large segment of the intestine can prevent a child from getting adequate nutrients and fluids. In this case, nutrition may need to be supplemented with long-term, high calorie solutions given through special IV catheters.

Intussusception recurs in up to 10 percent of children. Your child's physician will be able to give you the most accurate prognosis for your child.