Intussusception

By: Erin C. Rauch


Description

Intussusception is a telescoping of one part of the intestine into another.   Peristalsis forces the proximal portion of the bowel back into itself.  A bowel obstruction will occur at this point.  This can lead to a decreased blood supply to the affected portion of the bowel, which can cause death of the bowel tissue.  This condition occurs most often in children, and is most common at the ileocecal valve.  Early diagnosis is critical in order to save the bowel and the infant.  The mortality rate of children with intussusception is less than 1% (Eisenberg & Dennie, 1995).


Etiology

The specific cause of intussusception is unknown.  It is possible that is caused by viral infections (Adam.com, 1999).  In adults, intussusception can be caused by a neoplasm (tumor), celiac disease or diarrheal diseases. It can also be caused by blunt abdominal trauma. (Warshauer & Lee, 1999).  It occurs most often in children who are between the ages of 5 months and one year.  It occurs in boys three times as often as it does in girls (Adam.com, 1999).


Signs & Symptoms

The pressure of the two walls of the intestine pressing against each other can cause inflammation & swelling.  This can lead to a decreased blood flow to that area.  As previously mentioned, this can cause that portion of the bowel to die.  This in turn can cause bleeding, perforation, and infection (Adam.com, 1999).

In infants, the first sign of intussusception is pained crying.  This is caused by abdominal pain.  Other symptoms include abdominal tenderness, dehydration, vomiting, fever, restlessness, diarrhea and bloody stool.  The child can even go into shock, turn pale, and sweat (Gorenstein et al., 1998).


Diagnosis

A plain abdominal x-ray could show a bowel obstruction that can be caused by this condition.  A barium enema can show the telescoping of the bowel.  Radiographically, a coiled-spring appearance of trapped barium will be seen (Eisenberg & Dennie, 1995).



The abdominal x-ray (left) shows intussusception 

Treatment

In some cases, the pressure of the barium going through the bowel, during the enema, can cause it to un-telescope itself, curing the patient.  However, this increases the risk of bowel perforation.  Insufflation of air into the bowel, has also been an effective technique in children.  In adults, a repeat barium enema should be done after treatment in order to determine the original underlying cause (Eisenberg & Dennie, 1995).

If either barium or air is unsuccessful then surgery is needed.  Usually the bowel can be saved.  If there is dying tissue present, then it is surgically removed and the bowel will be resected.   Intravenous feeding will be done until a normal bowel movement has passed (Adam.com, 1999).


Prognosis

The outcome for infants is good if they were treated early.  Older children or adults will need to further investigate the original cause of their intussusception in order to prevent another occurrence or other health problems (Adam.com, 1999).


References

Adam.com. (1999). Intussusception (children). [online] Available:
     http://my.webmd.com/content/asset/adam_disease_intussusception_(children) [2001, March 18].

Eisenberg, R., & C. Dennie (1995). Comprehensive Radiographic Pathology (2nd ed.). St. Louis: Mosby.

Gorenstein, A., Raucher, A., Serour, F., Witzling, M., & Katz, R. (1998). Intussusception in Children: Reduction with
     Repeated, Delayed Air Enema. Radiology, 206, 721-724.

Warshauer, D., & Lee, J. (1999). Adult Intussusception Detected at CT or MRI Imaging: Clinical-Imaging Correlation.
     Radiology, 212, 853-860.


Graphics

Adam.com. (1999). Intussusception-X-ray. [online] Available: http://my.webmd.com/content/asset/adam_imagepage_1172
     [2001, April 10].

Adam.com. (1999). Normal Anatomy. [online] Available:
     http://my.webmd.com/content/asset/adam_presentations_100116_12681 [2001April 10].