Intussusception

Intussusception is a condition in which a part of the bowel telescopes into the next part of the bowel further on. It usually occurs at the junction of the small bowel with the large bowel at an area called the ileocaecal valve.

Who gets it?

In the majority of cases, the cause of intussusception is never found. It is probably due to patches in the lining of the bowel which become large, in response to infection. In about 10-15% of cases, intussusception is caused by a polyp, a Meckel's diverticulum, a cyst in the wall of the bowel, or a small cancer.

Intussusception occurs in about 1 in 350 young children. It usually occurs between 4 and 10 months of age, but may occur at any age. If intussusception occurs in babies younger than 1 month of age, or children that are older than 3 years of age, there is an increased chance that it is caused by a cyst, a polyp, a Meckel's diverticulum or a cancer.

What are the symptoms?

The symptoms of intussusception often occur after 2-3 days of an associated illness with a temperature. The baby will develop spasms of pain in the abdomen and will draw up its legs in response to this. The child will become pale, will stop feeding properly and may even vomit once or twice in the early stages. As time goes by, the child may develop signs of a bowel obstruction with swelling of the abdomen, bile stained vomiting and a reduction in the number of normal bowel actions. At some stage the child may also pass a bowel action which is thick with mucous and blood. In over a third of cases, the Paediatric Surgeon will be able to feel a sausage shaped lump in the right side of the abdomen.

When to Refer?

Any child who is suspected of having an intussusception should be reviewed urgently by a Paediatric Surgeon. Investigations include, an ultrasound of the abdomen and sometimes a contrast enema.

Management

The child may need to be resuscitated with intravenous fluids and will be given medications to relieve the pain. In the majority of cases, the intussusception can be pushed back into place by performing an enema, in which air is pumped into the bowel from the bottom end. If the bowel does not pop back into place with the assistance of air pressure, the child will need an operation. In some cases when the intussusception has been present for some days, a portion of the bowel may need to be removed if it has become too badly damaged to survive.

Once the intussusception has been reduced, the prognosis is excellent. In those children whose intussusceptions were reduced using air pressure, the chance of intussusception occurring again is about 10%. In those children who have an operation, the chance of recurrence is about 2%. It is certainly preferable though to avoid an operation if possible.

What would happen if this condition was not treated?

If an intussusception is left too long without being treated, the child may become desperately unwell. The bowel may burst, causing peritonitis and septicaemia and sometimes death may ensue.