Intussusception is the infolding of one part of the intestine into another. Most cases occur in children during the first year of life.
Early symptoms of the condition include :
In children who are too young to communicate symptoms, major presentations include constant crying and pulling up of knees to the chest and paroxysms of pain .
Laboratory studies are often not helpful in the evaluation of patients with intussusception . However, leukocytosis may be present with gangrene in advanced cases of intussusception. Following persistent vomiting and fluid sequestration in obstructed bowels, dehydration and electrolyte imbalance often occur.
Ultrasonographic imaging has also been found to have a relatively high sensitivity and specificity when it comes to detection of ileocolic intussusception. Abdominal radiographs may also show diagnostic characteristics of intussusception but their specificity and sensitivity is still in doubt.
The treatment often recommended in this condition includes a barium or air enema and in some cases surgery .
A barium or air enema can be a diagnostic procedure and also a treatment. When this procedure works, there is usually no need to continue with further treatment. It is the treatment of choice in children as it is highly effective with them. It is rarely used in adults. Recurrence following barium or air enema is seen 15-20% of the time and when it happens, the treatment is often repeated.
Surgery is recommended when the intestine is torn or a lead point is suspected . Portion of the trapped intestine is freed, obstruction is cleared and dead intestinal tissues are also removed. This is the treatment used for most adult cases. In rare scenarios, intussusception is temporary without requiring medical intervention.
Prognosis is excellent in patients with this condition as long as it is diagnosed and treated early . Otherwise, severe complications and death may occur.
After non-operative reduction, the recurrence rate of intussusception is often less than 10% however it has been reported to be as high as 15% in other cases. Most intussusceptions recurrences happen after 72 hours of correction but there have been cases where it occurred 3 years down the line. When there is more than 1 recurrence, a lead point is suspected. A recurrence often starts with the same symptoms as the initial event. Except when lead point suggestion is very strong, treatment for recurrence is often same as treatment for initial event.
In a few cases, the condition is caused by abnormal growth in the intestine such as polyp or a tumor . This is known as the lead point. The normal wave-like contractions of the intestine may grab this lead point, pulling it into the lining of the intestine and then into the bowel that is ahead of it. In many cases however, there is no clear cause of intussusception.
It is difficult to determine the true prevalence of this disease due to the wide geographic variation in the incidence of the condition among countries and also in cities within countries . There are no official documents showing the prevalence of intussusception in the United States. It is believed though that incidence is 1 case for every 2000 live births. In Great Britain, incidence varies from 1.6 to 4 cases per 1000 live births.
On average, the male-female ratio is set at approximate 3:1. With advancing age, the gender difference becomes further clear. In patients older than 4 years, male-to-female ratio is 8:1. Two out of three children with intussusception are < 1 year old and the most common occurrence is in people aged 5 to 10 months. It is also the most common cause of intestinal obstruction in patients within the ages of 5 months to 3 years.
The pathogenesis of idiopathic intussusception is not clear . It is however, believed to follow an imbalance in the longitudinal forces along the walls of the intestine.
As a result of imbalance in the intestinal wall forces, an area of the intestine enters into the lumen of adjacent bowel. The invaginating portion of the intestine or the intussusceptum collapses into the receiving portion or the intussuscipiens. The process goes on and more proximal areas get involved.
The intussusceptum may proceed to the distal colon or sigmoid and even prolapse out of the anus in rare cases. The classic pathologic process seen with most bowel obstruction cases arises when the mesentery of the intussusceptum gets invaginated with the intestine.
There is no clear prevention path for this condition.
Intussusception refers to a situation where a part of the intestine invaginates into the bordering intestinal lumen bringing about an obstruction in the bowel . It is a well-known cause of abdominal pain in children. Intussusception is suspected in pediatric medicine when the 3 main symptoms (vomiting, abdominal pain, and passage of blood) are present.
There are two variants of intussusception, the idiopathic intussusception which often starts at the ileocolic junction (affects infants and toddlers mostly) and the enteroenteral intussusception which is jejunojejunal, jejunoileal or ileoileal (occurs in older children). The latter condition is seen in people with special medical conditions such as Henoch-Schönlein purpura (HSP), cystic fibrosis and hematologic dyscrasia. It may also be secondary to a lead point and often occurs in the postoperative period.
Intussusception refers to a serious disorder where part of the intestine enters into a nearby part of the intestine in a manner seen with the folding of a telescope. This mechanism leads to the blockage of food and fluid from getting through. The part of the intestine that is affected is also deprived of blood supply. The condition can bring about a tear in the bowel, infection, and death to tissues in the bowel.
It is the most common cause of intestinal obstruction in children younger than 3 years of age and it is rarely seen in adults. When it is seen in an adult, there is a high chance that it is as a result of a medical condition such as a tumor. In children on the other hand, there is no clear indication of what causes intussusception.
Treatment in children doesn’t require surgery most of the time but surgery is required to treat the condition in adults.