What is Intussusception?
Intussusception is one of the most common abdominal emergencies affecting children under 2 years of age. This serious condition typically occurs when one part of the intestine slides into an adjacent section of the intestine, causing a “telescoping” effect. This often will then block food or fluid from passing properly through the body. Intussusception can also cut off the blood supply to the area of the intestine that has been affected. Without treatment, this could then lead to a tear or perforation in the bowel, which may then lead to infection and even death of the bowel tissue.
What causes Intussusception?
The cause of intussusception in children is generally unknown, although in most cases of adult intussusception it is developed as a result of an underlying medical condition. This can include tumors, polyps, a viral infection, or even as a result of recent intestinal surgery. In general, it is mostly young boys, between 5 months and two years of age who are affected, as they are up to four times more likely to develop intussusception than girls.
What are the symptoms of Intussusception?
The biggest potential indication of a case of intussusception is intense abdominal pain. This will often begin suddenly and may cause a child to react by drawing their knees up towards the chest. It is highly likely that a child affected by intussusception will cry very loudly, as it is an extremely painful condition. This pain may be episodic and disappear, at which time the child may switch from extreme irritability to being calm or even playful in between bouts of pain. Other common symptoms of intussusception may include vomiting blood, red mucus or jelly-like stool. The physical examination of a child with intussusception may also reveal a sausage-shaped mass in the abdomen felt through palpation. Unfortunately, symptoms of intussusception may also resemble other medical conditions. If you believe your child is experiencing symptoms of intussusception it is critical that you consult a physician as soon as possible for a proper diagnosis.
How is Intussusception diagnosed?
Intussusception can be diagnosed through a variety of methods, including a physical examination. Typically imaging studies are done to examine the abdominal organ, as well as to make an accurate diagnosis. This may include:
Abdominal X-rays: An abdominal X-ray, which can help illustrate an intestinal obstruction, as the radiologist may see an area of increased density where the bowel has telescoped or other indications of bowel obstruction.
Ultrasound: Using an Ultrasound can help to identify abnormally dense areas in the intestine. Ultrasounds use sound waves to create full pictures of what is happening inside the body. In the case of intussusception, a radiologist may see a target-like sign, which is typically associated with the affliction.
Air Contrast Barium Enema: Another test to reveal the presence of intussusception in the body may be an air contrast barium enema. In this process, air and barium contrast fluid are used as an enema in combination with an X-ray to help reveal narrow areas, blockages, or other issues. In some instances, the pressure exerted within the body through the enema will allow the intestine to correct the intussusception. In other words, the enema may be both a diagnostic measure, as well as a method for treatment.
How is Intussusception treated?
Treatment of intussusception can be very straightforward. In some instances, even the diagnostic process of an air contrast barium enema can successfully treat an intussusception. In this instance, the pressure of the air or contrast fluid pushes the bowel back to its normal position, thereby undoing the telescoping issue. Unfortunately, in about 10 to 15% of cases the enema does not work, making surgery necessary. If this is the case, and depending on the nature of the intussusception and the patient’s condition, your surgeon may choose one of two options. A traditional open procedure called a laparotomy involving a large incision or a laparoscopy, a newer less invasive procedure involving tiny incisions and utilizing a camera. Regardless of which surgery is used, the goal is to gently return the intestine to its original position and prevent the bowel from telescoping again. If this is not possible, or the portion of intestine has been irrevocably damaged, then the affected section will most likely be removed. The treatment used and the severity of the intussusception determines the extent of the hospital stay and length of post-procedure recovery.
Recent studies have shown a link between the Rotavirus Vaccine and intussusception in young children, which usually occurs within a week of receiving a dose of the vaccine. Intussusception affects between 1 in 20,000 to 1 in 100,000 infants per year in the United States who receive the Rotavirus vaccine. Despite this reaction being quite rare, it is very serious and as such has been added to the National Vaccine Injury Compensation Program’s vaccine injury table. According to the vaccine injury table, if a child develops an intussusception between 1 and 21 days after receiving the rotavirus vaccine the intussusception is presumed to have been caused by the vaccine and, provided certain criteria are met, the child may be entitled to receive compensation for the vaccine related injury.