Intussusception

DEFINITION

Intussusception (in-tuh-suh-SEP-shun) is a serious disorder in which part of the intestine slides into an adjacent part of the intestine. This “telescoping” often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that’s affected. Intussusception can lead to a tear in the bowel (perforation), infection and death of bowel tissue.

Intussusception is the most common cause of intestinal obstruction in children younger than 3. Intussusception is rare in adults. Most cases of adult intussusception are the result of an underlying medical condition, such as a tumor. In contrast, the cause of most cases of intussusception in children is unknown.

In children, the intestines can usually be pushed back into position with an X-ray procedure. In adults, surgery is often required to correct the problem.

CAUSES

Your intestine is shaped like a long tube. In intussusception, one part of your intestine — usually the small intestine — slides inside an adjacent part. This is sometimes called telescoping because it’s similar to the way a collapsible telescope folds together.

In some cases, the telescoping is caused by an abnormal growth in the intestine, such as a polyp or a tumor (called a lead point). The normal wave-like contractions of the intestine grab this lead point and pull it and the lining of the intestine into the bowel ahead of it. In most cases, however, no cause can be identified for intussusception.

Children

In the vast majority of cases of intussusception in children, the cause is unknown. Because intussusception seems to occur more often in the fall and winter and because many children with the problem also have flu-like symptoms, some suspect a virus may play a role in the condition. In a few instances, a lead point is identified as the cause of the condition — most frequently Meckel’s diverticulum (a pouch in the lining of the small intestine).

Adults

In adults, intussusception is usually the result of a medical condition, such as:

• A tumor
• Scar-like tissue in the intestine (adhesions)
• Surgical scars in the small intestine or colon
• Hematoma
• Inflammation, such as from Crohn’s disease

SYMPTOMS

The first sign of intussusception in an otherwise healthy infant may be sudden, loud crying caused by abdominal pain. Infants who have abdominal pain may pull their knees to their chests when they cry. The pain of intussusception comes and goes, usually every 15 to 20 minutes at first. These painful episodes last longer and happen more often as time passes.

Other frequent signs and symptoms of intussusception include:

• Stool mixed with blood and mucus (sometimes referred to as “currant jelly” stool because of its appearance)
• Vomiting
• A lump in the abdomen
• Lethargy

Less common signs and symptoms include:

• Diarrhea
• Fever
• Constipation

Some infants have no obvious pain, don’t pass blood or have a lump in the abdomen. Some older children have pain but no other symptoms.

Adults

Because intussusception is rare in adults and symptoms of the disorder are often nonspecific, it is more challenging to identify. Abdominal pain is the most common symptom, followed by nausea and vomiting and diarrhea. A significant percentage of people have no signs and symptoms.

When to see a doctor

Intussusception requires emergency medical care. If you or your child develops the signs or symptoms listed above, seek medical help right away.

In infants, remember that signs of abdominal pain may include recurrent bouts of pulling the knees to the chest and crying.