Intussusception
Intussusception is the telescoping of one portion of the intestine into another, causing obstruction of the bowel and blockage of its blood flow.
Intussusception is an uncommon cause of abdominal pain that typically affects children between the ages of 6 months and 2 years. It can occasionally affect older children. In most cases, the cause is unknown. Rarely, thickening of the intestinal wall due to a diverticulum, polyp, or tumor may lead to intussusception.
Symptoms
Intussusception usually causes sudden pain in a child who is otherwise healthy. The pain initially comes and goes, and the child may pull his legs up to his trunk during pain spasms. The child may return to normal activities between episodes, but the pain eventually becomes constant. Some children simply become irritable or listless and apathetic between episodes of pain. After a time, the child may vomit, pass stools with blood and mucus ("currant jelly" stools), or develop a fever. If unrecognized and untreated, intussusception can cause death of bowel tissue, which spreads bacteria from the gut into the bloodstream.
Diagnosis and Treatment
A doctor may suspect intussusception based on the child's symptoms and a physical examination. X-rays may be useful, but results are normal about one third of the time. Ultrasound is better, but a barium enema can both diagnose and treat intussusception. With a barium enema, the doctor instills barium and air into the child's rectum and then takes x-rays. The pressure of the barium and air pushes the collapsed portion of the intestine back into place. Sometimes just air without barium is used. When this procedure is successful, the child can be sent home from the hospital after a short time. Parents are advised to watch for symptoms because intussusception can recur in the next 1 to 2 days.
Surgery is needed if the barium enema is not successful in correcting the intussusception, if the child is too ill to tolerate a barium enema, if the child has recurrences of the condition, or if complications occur. In the case of a recurrence, surgery is performed not only to correct the condition but also to look for a polyp, tumor, or other abnormality that could explain why the intussusception recurred.
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