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Intussusception

Intussusception is essentially a prolapse or telescoping of 1 segment of intestinal tract into another segment of intestinal tract. The area of prolapse usually occurs at the junction between the small and large intestine. It occurs most commonly between the ages of 6 and 12 months, and is more common in boys.

It may occur at almost any age, however most cases cluster between 3 months and 5 or 6 years of age. It happens to about 1 in every 4 thousand children, so it is not common.

The most commonly seen 3 symptoms are vomiting, intermittent abdominal pain, and stools containing blood that look like “currant jelly”. These 3 are not present in every case of intussusception which is why there is a delay in diagnosis in some cases. At the beginning, it may appear to be a stomach bug (and in many cases a stomach bug will precede intussusception).

It may take several days for the appearance of “currant jelly stools”. The abdominal pain associated with intussusception is characterized by periods of inconsolable crying followed by periods of either normal behavior or sleepiness. Examination usually reveals a tender belly and in some cases a sausage-shaped mass in the right side of the abdomen representing the prolapsed intestine. There are no blood tests to help confirm the diagnosis, although your physician may chose to perform some tests to evaluate for dehydration from vomiting and also for possible infection. Diagnosis and treatment require the use of imaging (x-ray, ultrasound, and saline or air enema).

An x-ray or plain film is usually the first radiologic test performed. This may be normal or may show obstruction of the bowel. A critical reason to first image with a plain film is also to look for the presence of air in the abdomen–this is not normal. If there is air present, it indicates that the bowel has perforated and will need to be repaired immediately by a surgeon. If the x-ray does not help with the diagnosis, the radiologist will next perform and ultrasound looking at the intestine.

 

This is successful in making the diagnosis in over 90% of cases. The ultrasound is also very good at looking directly at the intestine itself, looking for signs that the intestine may have a compromised blood flow therefore needing immediate surgery. If the intestine looks healthy, the next test will either be an air or saline enema. The purpose of the enema is to reduce or correct the prolapsed intestine, and it is successful 80-90% of the time. If the enema is not successful at correcting the intussusception, it will have to be corrected surgically.

Once the diagnosis of intussusception is made, it needs to be corrected emergently. If not corrected, the complications include intestinal perforation, and intestinal necrosis (death) due to loss of blood flow to the prolapsed section of intestine.