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INTUSSUSCEPTION

Peresented by Hamed Hooshang malamiri2012/10/05

DEFINITION

Intussusception (in-tuh-suh-SEP-shun) is a serious disorder in which part of the intestine — either the small intestine or colon — slides into another part of the intestine. This "telescoping" often blocks the intestine, preventing food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected.

Intussusception is the most common cause of intestinal obstruction in children. Intussusception is rare in adults. Most cases of adult intussusception are the result of an underlying medical condition. In contrast, most cases of intussusception in children have no demonstrable cause.

With prompt attention, intussusception can often be successfully treated without lasting problems.

Symptoms

Signs and symptoms of intussusception in children include: Severe abdominal pain that comes and goes (intermittent

pain) Stool mixed with blood and mucus (sometimes referred to

as "currant jelly" stool because of its appearance) A lump in the abdomen Swollen (distended) abdomen Vomiting, possibly vomiting bile (yellow-brown or greenish

fluid) Diarrhea Fever Dehydration Lethargy

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

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

Your intestine is shaped like a long tube. Intussusception is a disorder in which one part of your intestine — usually the small intestine — slides inside another part. This is sometimes referred to as "telescoping" because it's similar to the way a collapsible telescope folds together.

For most cases of intussusception in children, the cause is unknown. Possible triggers may be: Viral infectionA noncancerous growth or a cancerous tumor in the intestineIn the past, some cases of intussusception seemed to be associated with a version of the rotavirus vaccine. Rotavirus is a childhood illness that causes severe diarrhea, vomiting, fever and dehydration. That vaccine was removed from the market in 1999. There's no evidence that a newer rotavirus vaccine (RotaTeq) causes intussusception.

Risk factors

Risk factors for intussusceptions include:

Age. Children are much more likely to develop intussusception than adults are. It's the most common cause of bowel obstruction in children between the ages of 3 months and 6 years, with the majority of cases occurring in children younger than 1 year.

Sex. Intussusception affects boys more often than girls.

Abnormal intestinal formation at birth. Malrotation, a condition present at birth (congenital) in which the intestine doesn't develop correctly, also is a risk factor for intussusception.

A prior history of intussusception. Once you've had intussusception, you're at increased risk to develop it again

Complications

Intussusception can cut off the blood supply to the affected portion of the intestine. If left untreated, lack of blood causes tissue of the intestinal wall to die. Tissue death can lead to a tear (perforation) in the intestinal wall, which can cause peritonitis, an infection of the lining of the abdominal cavity.

Peritonitis is a life-threatening condition that requires immediate medical attention.

Signs and symptoms of peritonitis include: Abdominal painAbdominal swellingFeverThirstLow urine outputPeritonitis may cause your child to go into shock. Signs and symptoms of shock include: Cool, clammy skin that may be pale or grayA weak and rapid pulseAbnormal breathing that may be either slow and shallow or very rapidLackluster eyes that seem to stare blanklyProfound listlessnessA child who is in shock may be conscious or unconscious. If you suspect your child is in shock, seek emergency medical care right away.

Tests and diagnosis

To confirm a diagnosis of intussusception, your child may need:

A physical exam. The doctor may suspect intussusception or another type of intestinal obstruction if your child has a lump in the abdomen, along with intermittent pain or inconsolable crying.

Blood or urine tests. Your child's doctor may order blood and urine tests, as well as a fecal occult blood test, which checks for blood in the stool.

Ultrasound or other abdominal imaging. Taking images of your abdomen or your child's abdomen with an ultrasound, X-ray or computerized tomography (CT) scan may reveal intestinal obstruction caused by intussusception. Abdominal imaging also can show if the intestine has been torn (perforated).

Air or barium enema. An air or barium enema is basically a colon X-ray. The doctor will likely use air first and use barium only if necessary as a second choice. During the procedure, the doctor will insert air or liquid barium into your colon or your child's colon through the rectum. This makes the images on the X-ray clearer. Sometimes an air or barium enema will correct intussusception, and no further treatment is needed. A barium enema can't be used if the intestine is torn.

Treatments and drugs Emergency medical care is required to

treat intussusception to avoid severe dehydration and shock, as well as prevent infection that can occur when a portion of intestine dies due to lack of blood.

Initial care When your child arrives at the hospital, the doctors will first stabilize his or her medical condition. This includes:

Giving your child fluids through an intravenous (IV) line.

Helping the intestines decompress by putting a tube through the child's nose and into the stomach (nasogastric tube).

Correcting the intussusception To treat the problem, your child's doctor may recommend:

A barium or air enema. This can correct the telescoping intestine and successfully treat intussusception. If an enema works, further treatment is usually not necessary.

Surgery. If the intestine is torn or if an enema is unsuccessful in correcting the problem, surgery is necessary. The surgeon will free the portion of the intestine that is trapped, clear the obstruction and, if necessary, remove any of the intestinal tissue that has died.

In some cases, intussusception may be temporary and improve on its own without treatment. If no underlying medical condition is found that caused the intussusception, no further treatment is necessary.

Prevention

Because its cause is unknown in most cases, intussusception generally can't be prevented.

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