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Intussusception (invagination)

Definition


Disease: Intussusception (invagination) Intussusception (invagination)
Category: Surgical diseases
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Disease Definition:

Intussusception is a rare but 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 among children. This case is rare in adults. Most cases of adult intussusception are the outcome of an underlying medical condition. Most cases in children doesn’t have demonstrable reason.


Intussusception can usually be successfully treated without lasting problems when prompt attention is given.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Children
The following are intussusception signs and symptoms:

 

 

  • Diarrhea
  • Lethargy
  • Severe abdominal pain that comes and goes (intermittent pain)
  • A lump in the abdomen
  • Dehydration
  • Swollen (distended) abdomen
  • Stool mixed with blood and mucus (occasionally known as “current jelly” stool due to its appearance)
  • Fever
  • Shallow breathing
  • Vomiting


Sudden, loud crying is often the first sign of intussusception in infants, resulting from abdominal pain. Infants who experience abdominal pain may pull their knees to their chests when they cry. The pain of intussusception comes and goes, often every 15 to 20 minutes at first. These painful episodes linger longer and happen more often as time passes.


Adults
Intussusception can occur in adults, even though it is rare. Signs and symptoms resulting from intussusception in adults may either linger for a long time (chronic symptoms), or they may come and go (intermittent symptoms). Signs and symptoms include:

 

 

  • Rectal bleeding
  • Vomiting
  • Changes in bowel movement frequency
  • Nausea
  • Crampy abdominal pain
  • The urge to have a bowel movement right away (urgency)
  • Swollen (distended) abdomen
  • Pain in one area of the abdomen.

 

Emergent medical care is required for intussusception. Medical help should immediately be looked for when developing the signs or symptoms listed above.
Signs of abdominal pain may include recurrent bouts of pulling the knees to the chest and crying in infants.

Causes:

Intussusception is a disorder in which one part of the 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.
Intussusception is much more common in children, especially in infants, than in adults.
Certain medical conditions may result in intussusception. But, doctors in several cases are unable to determine the exact reason behind its occurrence. The older the patient is when he/she develop intussusception, the more likely it is that an underlying medical condition is causing the problem.

Children
For most cases of intussusception in children, the cause is unknown. Viral infection or a growth in the intestine, such as lymph node, tumor or a polyp may trigger it.
Certain cases of intussusception appear to be related to a version of the rotavirus vaccine which is a childhood illness resulting in severe vomiting, diarrhea, dehydration and fever.
That vaccine was removed from the market in 1999. There's no evidence that the rotavirus vaccine currently available causes intussusception.  


Adults
The following result from intussusception when it affects adults:

 

 

  • Surgical scars in the small intestine or colon
  • Long-term (chronic) diarrhea
  • Noncancerous (beign) or cancerous (malignant) growths
  • Scar-like tissue in the intestine (adhesions)
  • Problems with the movement of food through the digestive tract (motility disorders, like irritable bowel syndrome, gastroparesis and Hirschsprung’s disease).


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 among children younger than 1 year. Intussusception affects boys twice as often as girls. Malrotation, a condition present at birth (congenital) in which the intestine doesn't develop correctly, also is a risk factor for intussusception. Once a person had intussusception, he/she is at increased risk to develop it again.

Complications

Complications:

Intussusception can cut off the blood supply to the affected part of the intestine. Lack of blood results in the death of the tissue of the intestinal wall when it isn’t promptly treated. Tissue death can cause tear (perforation) in the intestinal wall that can contribute to peritonitis, an infection of the lining of the abdominal cavity.
Peritonitis is a life-endangering condition that needs medical attention right away. Signs and symptoms of peritonitis include the following:

 

 

  • Fever
  • Low urine output
  • Abdominal pain
  • Thirst
  • Abdominal swelling

 

Peritonitis may cause the child to go into shock. The following are signs and symptoms of shock:

 

 

  • Dilated pupils in the eyes
  • Cool, clammy skin that may be pale or gray
  • Lackluster eyes that appear to be staring
  • Abnormal breathing that may be either slow and shallow or very rapid
  • A weak and rapid pulse

 

A child may either be conscious or unconscious while in shock. Emergency medical care should immediately be provided when there’s a suspicion of shock in a child.

Treatments:

Treating intussusception involves emergency medical care in order to avoid severe dehydration and shock, as well as prevent infection that can occur when a part of intestine dies because of the lack of blood.
The child’s medical condition will be stabilized primarily when he/she arrives at the hospital. This includes giving fluids through an intravenous (IV) line and putting a tube through the child’s nose and into the stomach (nasogastric tube) to allow the intestines to decompress.
 A barium or air enema is usually used to correct the telescoping intestine and successfully treat intussusception. No further treatment will be required in case an enema has been proved effective.
Surgery is required when the intestine is torn or an enema fails in correcting the problem. The surgeon will free the part 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.

Prognosis:

Not Available

Expert's opinion

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