What is intussusception?

Intussusception is the telescoping of one segment of intestine into another adjacent distal ("downstream")
segment of the intestine. (The term "intussusception" is pronounced "in-tuh-suh-sep-tion" with the accent
on the "in." It comes from the Latin "intus", within + "suscipere", to receive = to receive within). Common
mispellings of intussusception include: intususception, intussuseption, intersusception.

Intussusception is the most common cause of intestinal obstruction in children between 3 months and 6
years of age. It is extremely rare in children under 3 months of age or in older children and adults.

What happens during intussusception?

During intussusception, a segment of bowel (intussusceptum) telescopes into a more distal segment

The compression of blood vessels in the involved intestine reduces the supply of blood to the affected
intestine. If the blood supply is greatly reduced, the involved intestine may swell, causing an obstruction,
or even die (become gangrenous) and bleed. It also may rupture and lead to abdominal infection
and shock.

Is intussusception an urgent problem?

Intussusception is an emergency and requires immediate attention

Who is at greatest risk for intussusception?

Most cases of intussusception occur in children between 5 months and 1 year of age. Boys develop the
condition two times more often than girls. Intussusception can also occur in adults and older children,
although it is uncommon.

What causes intussusception?

The causes of intussusception are not fully known. Most cases in young children are idiopathic, (meaning
the cause is unknown), although some viral and bacterial infections of the intestine may possibly
contribute to intussusception in infancy.

Intussusception is very rare in older children and adults. In this population, the causes are believed to be
due to polyps or tumors, which are often referred to as the "lead point" of the intussusception.

Why is rapid diagnosis of intussusception important?

Early diagnosis and treatment of intussusception is essential in order to prevent injury to the intestine and
the associated sequelae, including surgical removal of the bowel, sepsis, and even death.
What are the symptoms of intussusception?

Most describe the symptoms of intussusception as a triad of colicky abdominal pain, bilious vomiting, and

The primary symptom of intussusception is described as intermittent crampy abdominal pain. This is often
called "colicky pain." Intussusception in an infantusually starts with the infant suddenly crying very loudly,
as if in great pain. The infant intermittently draws the knees up to the chest while crying. This reaction is
caused by the abdominal pain which recurs frequently and increases in intensity and duration. These
intermittent painful episodes are believed to be caused by the telescoping of the bowel and resultant
compression of blood vessels and nerves.

In addition to the abdominal pain, most children will also have episodes of vomiting associated with the
pain. This vomiting is usually not associated with eating and may be bilious (yellow-green colored)

Some affected individuals who do not seek early medical attention may pass "currant jelly stool". This is
stool that is bloody and mucousy and may be a sign that the affected bowel has lost its blood supply and
that the bowel may be necrotic(non-viable).

As the condition progresses, the infant becomes may become weaker and develop additional symptoms,
including those associated with shock, such as paleness,lethargy, and even fever, though these are not
an integral part of the associated "triad."

Thankfully, most cases are diagnosed early, and some studies describe the development of the bloody
stools as occurring in only one-third of the cases diagnosed.

How is intussusception diagnosed?

The history of abdominal pain and vomiting as described above, may suggest the diagnosis of
intussusception. Additionally, the examining doctor may feel an abdominal "sausage-shaped" mass (the
intussusception itself) or upon auscultation with a stethoscope, may hear diminished or absent bowel
sounds. Lab tests are usually not helpful, although plain abdominal X-rays can reveal signs of an
intestinal obstruction, including air-fluid levels, decreased gas, and unexplained masses, usually seen in
the right lower quadrant of the abdomen. Ultrasound andCT scans are generally not required to make the
diagnosis.

A barium, water-soluble contrast or air enema is considered both diagnostic and therapeutic in the
management of intussusception. This radiologic procedure involves the introduction of the contrast into
the lower intestine. If an intussusception is present, it will be seen during the imaging. Often just the
introduction of the contrast will reduce the telescoped bowel to its normal position and shape. In these
cases there is a high risk of for re-intussusception in the first 24 hours following the enema.

Is it necessary to operate when there is intussusception?

The treatment of intussusception may or may not require surgery. In some cases, the intestinal
obstruction can be reversed with an enema. The enema carries a risk of intestinal rupture and cannot be
done if the bowel has already perforated. The procedure also requires the availability of a surgeon, in
case the patient's bowel ruptures or the intussusception cannot be reduced.
 If the intestinal obstruction cannot be reversed by a barium enema, surgery is necessary to reverse the
intussusception and relieve the obstruction. If a portion of the intestine has become gangrenous, it must
be removed. After surgery,intravenous feeding and fluids are continued until normal bowel movements
resume.

What is the prognosis (outlook) for patients with intussusception?

The outlook for intussusception is usually good with early diagnosis and treatment. Early detection and
treatment are paramount.

Intussusception At A Glance

 Intussusception is the infolding (telescoping) of one segment of the intestine within another. 

 Intussusception usually results in a blockage of the intestine. 

 Intussusception occurs primarily in infants (boys more often than girls) but can also occur in
adults and older children. 

 The primary symptoms of intussusception include abdominal pain and vomiting.

 Early diagnosis and treatment of intussusception are essential to save the intestine and the
patient.

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