Intussusception

What is Intussusception?

Intussusception is a condition where a section of the intestine slides into another intestinal section, similarly to the mechanism of telescope retraction. Intussusception causes obstruction because the interior of the intestine becomes too small and can easily collapse. The part that starts sliding is called the intussusceptum, and the part that receives it is called intussuscipiens.

Non-surgical repair can be done in children but not in adults. Recent advances in medical technology enable intussusception to be detected more easily. A barium X-ray and a more sophisticated computerized tomography (CT) scan can promptly reveal the intussusception.  These diagnostic tools are now used routinely for abdominal problems.

It is the second most common abdominal problem in children worldwide. It is a common abdominal disorder in children with a higher frequency in males. In most cases the causative agent is unknown. Intussusception can also occur in adults as a complication from surgery or with an underlying pathologic origin that can be benign or malign. In adults the condition accounts for only 1% of all bowel obstruction cases. Higher rates of this condition in developed countries are likely a result of increased detection rates among infants relative to developing countries, where it is thought that cases of intussusception might lead to an infant's death without ever being detected.

What Causes Intussusception?

Most cases of intussusception are of unknown etiology. However, several factors have been associated with the increased predisposition in children: hunger, viral or bacterial infections, recent respiratory illness, diarrhea, long-term use of indwelling gastro-intestinal tubes used for gavage and tube feeding. In adults, mechanical leads can cause intussusception and it is commonly associated with gastrointestinal tumors or polyps, Meckel's diverticulum, blunt abdominal traumas with hematoma, foreign bodies, intestinal lymphosarcoma and Kaposi's sarcoma.

Symptoms of Intussusception

Symptoms of intussusception vary between children and adults.

In children and infants:

• Vomiting, sometimes with green coloration, indicating the presence of bile.
• Abdominal pain, seen in children as crying and pulling their legs towards chest.
• Intermittent pain and crying.  If the pain is intense, difficulty in breathing might occur.
• Loose watery stool with a reddish substance, which is actually a mixture of blood and stool, both seen in infants and adults.
• Sausage-shaped mass palpable at the abdomen.

Symptoms in adults:

• Intermittent pain, nausea and vomiting green substance
• Weight loss
• Fever
• Anemia
• A small minority have a sausage-shaped abdominal mass

Diagnosis of Intussusception

The symptoms of intussusception are readily evident to the medical practitioner and in most cases are easily diagnosed. Intussusception is often suspected after a routine medical interview and physical exam. A rectal examination might confirm intussusception near the rectal area. Often, this evidence is enough to prove the diagnosis, but imaging modalities are usually ordered to be absolutely sure and are often used for adults.

A stool examination is ordered to check for intestinal bleeding and an x-ray (with barium for older children and adults) can show the Dance's sign which consists on a retraction of the right iliac fossa, a common site of intussusception. An ultrasound can detect intussusception if the mass is large enough. Another tool that is more advanced is the CT scan for infants which readily shows the affected area. The presence of free interperitoneal gas is a sign that the condition might evolved to a very serious level since it indicates that the intestine has already ruptured and released gas and contents into the peritoneal cavity.

Treatment of Intussusception

There is no one-fits-all approach for the treatment of intussusception. The treatment will depend on the doctor's judgment and age of the patient. In all cases, however, the condition must be treated immediately.

The non-surgical approach consists of administering barium contrast and water enema which can correct the involution of intestines. However, sliding of the affected area recurs in about 5 to 10% of the cases. The enema approach must be chosen criteriously, since it carries the risk for further rupture by increasing pressure in the intestines.

If there is a large risk of rupture, recurring intussusception, and in severe cases in adults, surgery is used as a last resort. In primary interventions the surgeon normally squeezes the involved intestine. However, in recurrent cases, resection of the affected area followed by connection of the two intestinal ends will likely be performed.

After the treatment or surgery, food is withheld and temporarily replaced by intravenous nutrition and fluids until the intestines resume normal activity and the wound has sufficiently healed.

Prognosis of Intussusception

The prognosis for an intussusception patient is good if the condition is detected early. At later stages, severe complications, such as intestinal perforation, malnutrition and anemia may arise.

Living with Intussusception

Because it is a condition that might develop dangerous complications, the individual must be moved into a medical facility. Meanwhile, withhold all food and fluids.

Current Research of Intussusception

More investigation is in place for the early detection of intussusception in children. In treatment, the introduction and improvement of laparoscopic surgery has led to reduced hospital stays because the incisions are generally small.