Intussusception occurs when a portion of the small or large intestine slides forward into itself, like a telescope. An intussusception can block flow through the intestines and also limit the blood supply to that area of intestine. It is most commonly seen in children who are younger than 1 year. The cause is usually unknown, but an intussusception can follow viral gastroenteritis (an infection) or intra-abdominal surgery or be caused by a tumor in the intestine. Although intussusceptions can occur anywhere in the small or large intestine, they are most commonly found near the transition from the small intestine to the large intestine. These types of intussusception are called ileocolic intussusceptions. The February 8, 2012, issue of JAMA includes an article about the risk of intussusception and rotavirus vaccines.
Children with intussusceptions suddenly develop severe abdominal pain with vomiting at frequent intervals.
During the episodes of pain, they may draw their knees up to their abdomen while crying.
They may appear well in between episodes of pain.
If the intussusception is not treated, symptoms can worsen to include bilious (dark green) vomit and bloody stool (often called currant jelly stool because of its appearance).
A history of intermittent severe abdominal pain with vomiting and bloody diarrhea is highly suggestive of an intussusception.
On physical examination, the doctor may feel a sausage-shaped mass in the area of the abdomen that corresponds to the small or large intestine.
An abdominal ultrasound can confirm a case of intussusception. The doctor may see evidence of bowel telescoping on itself. On an ultrasound, this is called a target sign.
Once an ileocolic intussusception is diagnosed, it should be treated (reduced) as soon as possible. Physicians often check electrolyte and hemoglobin levels in the child's blood and may give intravenous fluids.
A radiological reduction of the intussusception is usually attempted first. This involves a contrast enema. Using a catheter (tube), the doctor pushes air or contrast material (a substance used to make structures like the intestine stand out on a radiological image) into the bowel through the child's rectum. This forces the affected segment of intestine out and into a normal position.
Surgery is performed when a contrast enema is unsuccessful or the doctor is concerned about damage to the intestines. Surgery may involve reducing the intussusception or removing the involved intestine. The appendix is often also removed during this operation.
Early recognition and treatment of intussusception are important to reduce the risk of damage to the intestine.
Children who have had an intussusception are at higher risk of having a recurrence soon after reduction.
American Academy of Pediatrics www.healthychildren.org
Mayo Clinic www.mayoclinic.com/health/intussusception/DS00798
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at www.jama.com. Many are available in English and Spanish.
Sources: American Academy of Pediatrics, Mayo Clinic
Topic: GASTROINTESTINAL DISEASES
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Punnoose AR, Kasturia S, Golub RM. Intussusception. JAMA. 2012;307(6):628. doi:10.1001/jama.2012.45