intussusception

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Intussusception

 

Definition

Intussusception is the enfolding of one segment of the intestine within another. It is characterized and initially presents with recurring attacks of cramping abdominal pain that gradually become more painful.

Description

Intussusception occurs when part of the bowel or intestine is wrapped around itself producing a masslike object on the right side of the abdomen during palpation (a procedure used during a physical examination, when the examiner touches the abdomen with his/her hand, usually feeling for mass, pain, or discomfort). The number of new cases of intussuscetion is approximately 1.5 to four cases per 1,000 live births. The onset of abdominal pain is usually abrupt and severe. Just as fast as the onset of pain appears, it disappears and the child resumes activity normally. This process of sudden severe abdominal pain appearing out of the blue then disappearing is repeated with duration of painful attacks. The pain usually increases after approximately five hours of recurrent cycles of severe abdominal pain followed by relaxation. Vomiting and diarrhea occur in about 90% of cases with six to 12 hours after initial onset of symptoms.
Physical examination and palpation usually reveal a sausage shaped mass of enfolded bowel in the right upper mid portion of the abdomen. Within a few hours approximately 50% of cases have bloody, mucus filled bowel movements. At about this time the child is visibly very ill with fever, tenderness, and distended abdomen. Intussusception is the most frequent cause of intestinal obstruction during the first two years of life and commonly affects children between three to 12 months of age. The disease is three times more common in males than in females. In about 85% of cases the cause is idiopathic (meaning unknown). The remaining 15% of cases can be caused by a variety of other diseases such as tumors of the lymph nodes (lymphoma), fat tumors (lipomas), foreign bodies/objects, or from infections that mobilize immune cells to the area causing and an inflammatory reaction and intestinal blockage. Most cases of intussusception do not strangulate the affected bowel within the first 24 hours. If the disease is not treated after this time, the possibility of intestinal gangrene, shock, and death increases.

Causes and symptoms

The major symptom of intussusception is when a healthy child suddenly and without warning experiences severe abdominal pain that subsides and usually results in continuation of normal activities such as playing. The duration of the painful attacks increases as the hours go by. Usually, the child develops nausea, vomiting, and diarrhea soon afterwards in about 90% of all cases. The child becomes weak, exhausted, and develops a fever. The affected child may also expel bloody, mucus-like bowel movements. These blood filled bowel movements are usually due to impaired blood flow to the obstructed area. During palpation there may be a sausage-shaped mass located on the upper right mid portion of the abdomen. If the disease progresses and is undetected, the child may develop necrosis death of cells within the affected area. Additionally, there may be perforation or hole in the intussusception bowel that can cause a life threatening infection in the peritoneum (a layer of tissue that protects the organs and intestines within the abdominal cavity). This infection of the peritoneum is called peritonitis. Some patients may exhibit altered states of consciousness or seizures.

Diagnosis

A presumed diagnosis can be made by history alone. If the clinician suspect's intussusception x-ray films should be performed, which may reveal a mass in the right upper mid abdominal region. Two classical clinical signs are mucus-blood filled stools and a "coiled string" appearance in the affected bowel as visualized during an x ray with a barium enema. Blood chemistry analysis is not specific for intussusception. Depending on vomiting and blood loss through the stools, blood chemistry may reflect signs of dehydration and anemia.

Key terms

Barium — A chemical used in certain radiological studies to enhance visualization of anatomical structures.
Obstruction — A blockage that prevents movement.

Treatment

Treating intussusception by reduction (alleviating the source of blockage) is an emergency procedure. The barium examination is not only the diagnostic tool of choice, but also frequently curative. Infusion by gravity from a catheter placed in the rectum will tend to relieve pressure buildup. If this does not relieve the area, then air can be pumped into the colon to clear blockage. If these procedures are unsuccessful then surgery is required. Approximately 25% of affected children require surgical intervention. Surgery in the affected bowel is advantageous since the actual cause can be removed, and the procedure decreases the possibility of recurrences. In general without surgical correction of the affected bowel, there is a 5-10% chance of recurrence. Recurrence usually appears within the first 24 to 48 hours after barium procedure.

Prognosis

The outcome of intussusception depends on the duration of symptoms before treatment initiation. Most infants will recover if treatment is initiated within the first 24 hours. Untreated intussusception is almost always fatal. Overall even with treatment, approximately 1-2% of affected children will die.

Prevention

Prevention of death can be accomplished with immediate medical care, within the first 24 hours. Once intussusception is suspected, emergency measures should be initiated. Untreated intussusception is almost always fatal. There is an increased chance for death if the disorder is not treated within 48 hours.

Resources

Books

Behrman, Richard E., et al, editors. Nelson Textbook of Pediatrics. 16th ed. W. B. Saunders Company, 2000.
Townsend, Courtney M., et al. Sabiston Textbook of Surgery. 16th ed. W. B. Saunders Company, 2001.

Other

University of Maryland. 2001. http://www.umm.edu.

intussusception

 [in″tŭ-sŭ-sep´shun]
1. prolapse of one part of the intestine into the lumen of an immediately adjacent part, causing intestinal obstruction.
2. the reception into an organism of matter, such as food, and its transformation into new protoplasm.

Intussusception is one of the most common causes of intestinal obstruction in infancy. Most cases occur in children during the first year of life, and some cases occur in the second year, but very few thereafter. The condition may be caused by a growth in the intestine or by any condition that causes the intestine to contract strongly. Usually, the cause is not known. The condition becomes apparent when a healthy, thriving infant suddenly experiences paroxysms of abdominal pain, with vomiting and restlessness. The infant usually cries out with pain and draws the knees up to the chest. The abdomen becomes tender and distended as the obstruction progresses and a sausage-shaped mass is felt in the upper right quadrant. Stools appear red and jellylike due to the presence of blood.

Diagnosis is confirmed by barium enema, which in about 75 per cent of uncomplicated cases has a therapeutic effect, reducing the invagination by hydrostatic force. Surgical intervention involves manual reduction and, if a portion of the intestine has been irreparably damaged, bowel resection.
Intussusception. From McKinney et al., 2000.

in·tus·sus·cep·tion

(in'tŭs-sŭs-sep'shŭn), [MIM*147710] Avoid the misspellings intususception, intussuseption, intersusception, and other variants.
1. The taking up or receiving of one part within another, especially the enfolding of one segment of the intestine within another.
See also: introversion, invagination.
2. Often, specifically, the process of incorporation of new material in the growth of the cell wall.
Synonym(s): introsusception
[L. intus, within, + sus-cipio, to take up, fr. sub + capio, to take]

intussusception

/in·tus·sus·cep·tion/ (in″tah-sah-sep´shun) prolapse of one part of the intestine into the lumen of an immediately adjacent part.

intussusception

(ĭn′tə-sə-sĕp′shən)
n.
1. Medicine Invagination, especially an infolding of one part of the intestine into another.
2. Biology Assimilation of new substances into the existing components of living tissue.

intussusception

[in′təsəsep′shən]
Etymology: L, intus, within, suscipere, to receive
prolapse of one segment of bowel into the lumen of another segment. This kind of intestinal obstruction may involve segments of the small intestine, the colon, or the terminal ileum and cecum. Intussusception occurs most often in infants and small children and is characterized by abdominal pain, vomiting, and presence of bloody mucus in the stool (currant jelly stool). Barium enema is used to confirm the diagnosis, and surgery is usually necessary to correct the obstruction. See also intestinal obstruction.
enlarge picture
Ileocolic intussusception

intussusception

Pediatric surgery The telescoping of one segment of the intestine into another, which compromises the involved segment, causing intestinal obstruction and strangulation, especially of the distal segment, inflammation, swelling, ↓ blood flow and, if prolonged, necrosis accompanied by bleeding, perforation, infection, dehydration, shock Clinical ♂:♀ ratio, 3:1; common from 5 months and 1 yr of age; onset is often abrupt with intense colicky intermittent abdominal pain that ↑ in intensity and duration, accompanied by vomiting and fever, weakness and eventually, shock; half of infants pass bloody mucus popularly termed “currant jelly” stool; early diagnosis is critical to salvage the bowel and the baby Management Surgery. Cf Volvulus.

in·tus·sus·cep·tion

(in'tŭ-sŭ-sep'shŭn)
1. The taking up or receiving of one part within another, especially the enfolding of one segment of the intestine within another.
See also: introversion, invagination
2. The incorporation of new material in the growth of the cell wall.
Synonym(s): introsusception.
[L. intus, within, + sus-cipio, to take up, fr. sub + capio, to take]

intussusception

The movement of a length of bowel into an adjacent segment in the manner of a telescope. Invagination of a bowel segment. The condition is commonest in children. Once started, intussusception rapidly progresses until the supplying blood vessels are also drawn in and become obstructed. GANGRENE may result. Urgent surgical correction is required.

intussusception

the growth in the surface area of a cell wall by the inclusion of additional particles in the wall.

intussusception

1. prolapse of one part of the intestine into the lumen of an immediately adjacent part, causing intestinal obstruction.
2. the reception into an organism of matter, such as food, and its transformation into new protoplasm.
Intestinal obstruction due to intussusception occurs sporadically in all species, and in series in cattle associated with intestinal polyposis and in sheep with esophagostomiasis. The intussusception may be of the small intestine into itself or into the colon through the ileocecal valve, and in cattle into the spiral colon.

cecocolic intussusception
cecal inversion occurs uncommonly in dogs, with clinical signs of blood-stained feces and sometimes vomiting and weight loss. With a barium enema, radiographs may show a filling defect and 'accordion pleating' of the proximal colon.
gastroesophageal intussusception
inversion of the stomach, and occasionally spleen and pancreas, into the esophagus. Occurs most commonly with megaesophagus.
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