Intussussception

Dr. Kolachalam, Intussusception

 

 

What is Intussusception?

 

Intussusception is a process in which a segment of intestine invaginates (moves inwards) into the adjoining intestinal lumen (opening), causing bowel obstruction. With early diagnosis, appropriate fluid resuscitation, and therapy, the mortality rate from intussusception in children is less than 1%. If left untreated, however, this condition is uniformly fatal in 2-5 days.

 

What are the symptoms of Intussusception?

 

Early symptoms can include:

  • Nausea
  • Vomiting- sometimes bile stained (green color)
  • Pulling legs to the chest area
  • Intermittent moderate to severe cramping abdominal pain.
  • Pain is intermittent not because the intussusception temporarily resolves, but because the intussuscepted bowel segment transiently stops contracting.

Later signs include:

  • Rectal bleeding, often with “red currant jelly” stool (stool mixed with blood and mucus)
  • Lethargy.
  • Physical examination may reveal a “sausage-shaped” mass felt upon palpation of the abdomen.

In children or those too young to communicate their symptoms verbally:

  • May cry
  • Draw their knees up to their chest
  • Experience dyspnea (difficult or painful breathing)
  • Sporadic Pain

Fever is not a symptom of intussusception. However, intussusception can cause a loop of bowel to become necrotic (tissue death), secondary to decreased blood supply due to compression. This leads to the formation of a small hole then infection, which causes fever.

 

How is this diagnosed?

 

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, though, less commonly, recurrence may be seen several days and even months later.

 

Does Intussusception require surgery?

 

If the intestinal obstruction cannot be reversed by an 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.

Because of the risk of recurrence, patients who are successfully reduced by enema usually are admitted for observation during the first 24 hours post procedure, and have no ill effects.

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