Intussusception

Intussusception is a condition in which a part of the intestine telescopes into another, causing decreased blood supply to that part. This results in a blockage of the intestine where it has telescoped. The part that has been pulled inside can die from a lack of blood supply. The pressure caused by the two walls of the intestine pressing against each other causes pain, swelling and decreased blood flow. When the part that has telescoped dies, bleeding or infection can occur. The child may go into shock or even die if he or she is not treated right away.

No one knows why this happens, but it could be caused by a viral infection. There is nothing a parent can do to prevent this disease, which happens more frequently in boys than in girls. The most common age group is five months old to one year of age.

Parents should be suspicious if they notice sudden loud crying and the child has abdominal pain. The crying and pain can be off and on – not all the time. When it comes, it gets worse each time. The baby can become very weak, pale and sweaty and usually will vomit and have a fever. Sometimes, the baby has a bloody, jelly-like stool.

It is very important that this be caught early to save as much of the bowel as possible and to save the infant’s life.

A doctor examining a baby with intussusception usually notices a hard mass in the abdomen. The doctor may order a barium enema to see the telescoping bowel. This means that the technician will give the baby an enema with barium in it, which helps “light up” the bowel so that a clearer picture can be seen when X-rays are taken. It’s uncomfortable to have the enema, but it is not painful. The doctor may order an X-ray of the abdomen to see the blockage. This, too, is painless.

As treatment, a radiologist sometimes can make the blockage smaller during the barium enema. There is a risk of bowel perforation (a hole in the wall of the intestine) when this happens. If this doesn’t work, or if the bowel is already perforated, surgery is necessary. The surgeon removes the obstruction, straightens out the bowel and closes the wound. Sometimes the doctor has to remove part of the bowel if it is already dying or if there is a hole in it. The biggest danger with this type of disease and with the surgery is the risk of infection if the bowel has already perforated.

After surgery, the child receives lots of fluid through an intravenous tube until a normal bowel movement happens.

With early treatment, the child usually is fine after surgery.

For an appointment with a Washington University pediatric surgeon, call (314) 454-6022, Monday-Friday, 8 a.m.-5 p.m.