What Is Intussusception?
Intussusception develops when a part of the intestine folds into the next section, creating an intestinal obstruction. It does not allow the food or fluid to pass through. Furthermore, the blood supply to the folded part of the intestine is cut. A medical emergency could become lethal if unaddressed in two to five days. Boys and girls below four years are equally prone to intussusception. A common area for developing intussusception is the junction between the small and large intestines. The obstruction can cause intestinal injury due to swelling and inflammation. Some children develop a retrograde intussusception. It is a type of intussusception with an extremely low incidence. This type of intussusception is hard to diagnose before or after surgery.
What Causes Intussusception in Children?
The human intestine appears like a long tube. When one portion of the intestine, usually the small intestine, slides into the adjacent part, it causes intussusception. The process is also known as telescoping. The condition frequently occurs in children between six months to three years. Most cases develop before one year of age. However, the exact cause remains unknown. Most children develop intussusception during fall and winter. Some factors responsible for intussusception development are abnormal growth, improper intestine alignment of the intestine, or tumors. Other causes are intestinal peristalsis disorder caused by enhanced mobility of ileocecal mesentery, adenovirus infection, and hyperplasia of lymphatic tissues.
As children with intussusception exhibit upper respiratory tract infection, otitis media (middle ear disease), and flu-like symptoms, a viral cause is suspected. Adenoviral infection is increasingly associated with intussusception in children. In a few, a lead point is the cause for the development of intussusception. The most common lead point is Meckel’s diverticulum (Pouch formation within the small intestine lining). Additional factors that cause intussusception in children are intestinal malrotation (an anomaly in the midgut) and medical disorders such as cystic fibrosis (a genetic disorder), IgA vasculitis (accumulation of immunoglobulin in small blood vessels), Crohn’s disease (regional enteritis), and celiac disease.
What Are the Symptoms of Intussusception in Children?
The first sign of intussusception in a healthy infant is severe abdominal pain. The pain tends to be intermittent, with 15 to 20 minutes duration, during the initial phase. The pain gradually tends to increase in duration and frequency. The symptoms are:
- Stool mixed with mucus (red currant jelly stool).
- Vomiting and nausea.
- Diarrhea.
- Fever.
- Abdominal mass that appears sausage-shaped when palpated.
- Children cry loudly by pulling their knees up to their chest because of abdominal pain.
- Rectal bleeding.
- Lethargy and weakness.
However, not all children tend to develop all symptoms. Some children might not have pain, whereas others do not have bloody stool or abdominal mass. Some children tend to develop intussusception one week following viral disease.
How Is Intussusception Diagnosed in Children?
Most children with intussusception present as a medical emergency. Medical history, physical examination, and tests help with diagnosis. The dance sign (right lower abdominal quadrant inspected for retraction) is essential for diagnosis.
A digital rectal examination is performed to diagnose intussusception. A sausage-shaped lump felt in the child’s abdomen can raise the suspicion for intussusception. The doctor may advise X-ray, ultrasound, or CT (computed tomography) scans to identify intestinal obstruction. Ultrasound is a preferred method of diagnosis for children. The appearance of a doughnut sign in an ultrasound of 3 cm (centimeter) diameter confirms the diagnosis. If the diagnosis is unclear, a barium enema is administered to obtain a better image, which also acts as a treatment procedure.
What Is the Differential Diagnosis for Intussusception in Children?
Some of the differential diagnoses are:
- Abdominal hernia.
- Appendicitis.
- Colic.
- Cycling vomiting syndrome.
- Gastric volvulus.
How Is Intussusception in Children Treated?
Intussusception is a medical emergency; taking over-the-counter medication without diagnosis could be dangerous. It is recommended to seek immediate medical attention if symptoms of intussusception become apparent. The child must not be fed during the meantime. Healthcare providers might try to push the intestine in position using liquid or air contrast enema. These procedures have a success rate of about 60 to 70 % and a recurrence rate of 6 to 10 %. However, the procedure has a low complication rate. Most children require a minor surgical procedure that fixes the intestine to the correct position. Surgery is suggested when other methods fail, there is a higher infection rate, or the child is very ill. The main goal of treatment for severe intussusception is to remove the obstruction or a part of the intestine.
Enema is administered to the child before surgery. The anesthesiologist sedates the child undergoing the surgical procedure. If laparoscopy is possible, a camera and small instruments are inserted through small abdominal incisions. An alternative method is to make incisions in the right side of the abdomen to fix the intestine into a normal position. If the correction is not possible, then a part of the affected intestine is removed. The child is given painkillers after surgery to alleviate pain. Intravenous fluids are administered for several days as the surgical procedure causes a temporary slowdown in intestinal function. The child is not fed immediately post-surgery. Most children can begin eating after three days of surgery.
What Are the Complications of Intussusception in Children?
The common complications include infection, tear in the bowel, death of bowel tissue, or perforation. Intussusception blocks blood flow to the affected intestinal tissues. Due to a lack of blood supply, the tissues within the intestinal wall tend to die. Some children with intestinal tissue death can develop perforation in the intestinal wall, which causes infection in the peritoneum (peritonitis). The infection is life-threatening and can progress into septicemia, chronic abdominal pain, swelling, fever, vomiting, and septic shock.
The symptoms of a child that develops septic shock due to peritonitis are cool, clammy skin that appears pale or grey, weak and rapid pulse, breathing could be shallow or rapid, anxiety or agitation, and extreme listlessness. The child with shock can be conscious or unconscious. Some children tend to develop post-operative intussusception following laparotomy. The incidence among the pediatric population to develop post-operative intussusception is 0.25 %.
Conclusion
Children with intussusception experience severe problems with their intestines. It results from one part of the intestine telescoping over the other, creating blockage. Some cases resolve on their own or are cured with diagnostic testing. Few cases require surgery. If untreated, the condition can be fatal or recur.
