Intussusception is a serious disorder in which one part of the intestine slides into another, cutting off blood supply and frequently blocking food or liquid from progressing through the digestive tract. Left untreated, intussusception can result in perforation of the intestine that may cause infection and necrosis (tissue death). Intussusception is the most common cause of intestinal blockage in patients under the age of 3. Although rare in adults, when it does occur, it is typically caused by an underlying condition, such as a tumor.
Risk Factors for Intussusception
There are several risk factors for developing intussusception. The condition is much more likely to develop in children than in adults and affects more boys than girls. It may result from a congenital malformation or from an abnormal development of the intestine as it grows (malrotation). Some research exists pointing to a correlation between patients with acquired immune deficiency syndrome (AIDS) and the development of intussusception. Individuals who have experienced one episode of intussusception are at elevated risk of having another.
Causes of Intussusception
While most cases of intussusception in children are of unknown origin, because the condition occurs more frequently in the fall and winter and many children who are affected have flu-like symptoms, it is suspected that a virus may be a precipitating cause. In some cases a diverticulum, or pouch in the lining of the small intestine, may be a weakness that precipitates the disorder.
In adults, intussusception typically results from an underlying condition in the intestinal tract, such as:
- Adhesions (scar tissue)
- Hematoma (swelling filled with blood)
Inflammation as an underlying cause of intussusception may occur because of a disease process, such as Crohn's disease or ulcerative colitis, from a previous surgical procedure, or from radiation therapy.
Symptoms of Intussusception
The symptoms of intussusception are different in children and adults.
Symptoms in Intussusception in Children
The first symptom of intussusception in infants is severe abdominal pain, accompanied by loud crying and pulling the knees up to the chest. The pain is usually episodic, recurring every 15 to 20 minutes. As time passes, the episodes occur more frequently and last longer. Other symptoms include:
- Bloody stool or stool containing mucus
- Lump in the abdomen
- Diarrhea, fever, constipation (more rarely)
In some cases, infants may only have vague symptoms without abdominal pain. In others, older children may experience abdominal pain as their only symptom.
Symptoms of Intussusception in Adults
A noteworthy number of adults who have intussusception have no symptoms of the disorder at all. Those who do, most commonly experience abdominal pain, but may also have nausea, vomiting or diarrhea.
Diagnosis of Intussusception
Several means are used to diagnose intussusception. Diagnostic imaging, using X-rays, CT or ultrasound scans may be performed so the doctor can visualize the intestine coiled within another part of itself and determine whether there has been a perforation of the intestinal wall. Another important diagnostic procedure is a barium or an air enema during which the barium or air is inserted into the rectum to help to make X-ray images more visible. The enema cannot be administered, however, if the intestine has been perforated.
Treatment of Intussusception
Although in some situations intussusception is temporary and resolves without treatment, in many cases medical or surgical intervention is necessary. Fortunately, the barium or air enema, in addition to being diagnostic, corrects the problem of intussusception in 90 percent of children with the disorder. In the 15 to 20 percent of cases in which the condition recurs, the procedure will have to be repeated. Since for most adults, there is an underlying cause of intussusception, adults must usually undergo corrective surgery. The surgery may be performed to:
- Close a tear in the intestinal wall
- Free the part of the intestine that is trapped
- Clear the intestine of a blockage
- Remove necrotic (dead) intestinal tissue
Surgery for intussusception is typically performed for children whose enema treatment is ineffective and for adult patients who are acutely ill.