What Is Intussusception?

Overview

Intussusception is a medical emergency that is common among children under 3 years.¹ This is categorized as an emergency, but curable completely with prompt treatment.

Intussusception refers to a medical condition where a portion of the bowel (intussusceptum) telescopes into itself and enters another section of the bowel (intussuscipiens), causing an obstruction.² The term "intussusception" is derived from the Latin words "intus" meaning "within or inside" and "suscipere" meaning "to receive".

This condition is commoner among people assigned males at birth (AMAB) than people assigned females at birth (AFAB) with a AMAB to AFAB ratio of 3:1.³ This is the commonest cause of bowel blockage among infants and young children.¹

In this article, you can explore more about Intussusception, about causes, signs and symptoms, management and treatment options, how to diagnose intussusception, risk factors, and FAQs at the end.

Causes of intussusception

There is no definitive cause for intussusception.⁴ However, this condition usually presents with a link to an infection. Your kid may have a cold, cough, or high temperature in the days preceding the intussusception. Also, vomiting, and stools (poo) mixed with blood can be associated. Your child may show signs of tummy ache depending on the age, like crying or verbally expressing tummy ache. 

In addtion to infections, interssusception can sometimes occur with the following conditions.⁴

• Anatomical abnormalities in the bowel
• Meckel’s diverticulum
• Altered bowel motility
• Intestinal duplication
• Bowel polyps
• Appendicitis

Signs and symptoms of intussusception

Intussusception happens very suddenly which makes the child cry or scream in pain. There can be episodes of crying and the child may stay normal in between (colicky pain). The child may bend their knees towards the chest or tummy when crying.

Vomiting which sometimes looks greenish also presents with intussusception. Your child’s poo may look like ‘red currant jelly’ or stained with blood.

Diagnosis of intussusception

Your doctor will examine your child. If intussusception is suspected, the doctor may usually request an abdominal ultrasound scan of the tummy to help the diagnosis of intussusception. Sometimes, blood tests will be carried out.

During this period, a nurse will monitor your child closely. Also, the baby will not be allowed to eat and drink as this is important in the following steps of management of intussusception. Your child may be given intravenous fluid (drip via cannula) to prevent dehydration. Also, a small tube (nasogastric tube) may be inserted via the nose into the tummy and the free end will be connected to a bag so that the food already eaten will be collected into the bag rather than being vomited. Also, this step will make the child a bit more comfortable as well.

Management and treatment for intussusception

There are two main approaches of treating intussusception. One is a non-surgical approach while the other is surgical.² 

Antibiotics will be given before both these approaches to prevent or treat infections.

Air Enema/ Enema reduction (non-surgical)

This is carried out at the X-ray department. A small tube is passed into your child’s bottom. Then the air is passed through the tube into the bowels with gentle pressure which will help to reduce the telescoped bowel part into its correct position. This process is monitored using abdominal X-rays.

If this procedure is successful, the child will be sent to the ward and will be allowed to eat and drink after a few hours. Sometimes the child may be discharged and will be allowed to go home on the same day.

However, if the child is unwell or if the procedure is unsuccessful the surgical correction will be done under general anaesthesia. 

Surgical correction

If the air enema does not work or if the child is too ill to have an air enema the option of surgical correction will be chosen. This will be carried out under general anaesthesia. 

Usually, it will be a keyhole surgery (laparoscopic). Occationally, the surgeon will make a small cut in the child’s abdomen and locate the telescoped part of the bowel (open surgery). Then this will be pushed gently to its correct place. Also, the surgeon will examine for bowel damage that occurred due to lack of blood supply to the bowel due to blockage. If the bowel is damaged the damaged part will be removed.

Your child will be monitored closely after the operation. The bowel functions may not return soon after the surgery. Therefore, intravenous fluid will be continued until the child is fit enough to eat and drink.

Antibiotics and pain medication will be continued. Once the child is fit enough to eat and drink and pass stools, the child will be discharged to go home.

Risk factors

There are no identified risk factors for this. However, AMAB have a higher incidence of having intussusception.³ Also, some undetected abnormalities in the bowel can lead to intussusception.⁴ Apart from these, viral infections have a strong link with intussusception.⁵

Complications

If intussusception is misdiagnosed or not treated promptly this can lead to bowel obstruction that can damage the bowels, which will ultimately lead to bowel perforation, and bowel ischaemia (reduce blood supply to the bowel).⁴ Also, in extreme cases, perforated bowels can lead to sepsis and peritonitis.¹

FAQs

How common is intussusception

Intussusception is the commonest cause of abdominal emergencies among infants and young kids under 3 years of age. This condition is commoner in AMAB with a ratio of 3:1.

How can I prevent intussusception

Intussusception cannot be prevented. However, if your child shows symptoms of intussusception, consulting a doctor immediately can prevent its complications.

When should I see a doctor

Immediately if your child shows symptoms of intussusception like crying and screaming in bouts, tummy ache with vomiting, and blood-mixed stools.

Summary

Intussusception is a paediatric emergency that can be completely cured or treated with prompt diagnosis and treatment. There is no specific cause for intussusception to occur. However, most of the time there is a link to an infection.

Commonly children present with a tummy ache, crying and screaming in bouts, vomiting, and passing blood-mixed poo. Management decision between the surgical and non-surgical options will be taken by the doctor depending on the child’s condition.