Intussusception

Intussusception-a "telescoping" of intestine usually occurring at the junction of the terminal ileum and ileocecal valveoccurs most commonly in children under 2 years. Approximately 5% of cases occur in adults. Less than 50% of patients have the classic clinical triad of abdominal pain, currant jelly stools, and a palpable abdominal mass. Lethargy may be a predominant finding in some patients.

Causes

The causes of intussusception are not fully known although viral infections may be responsible in some cases.

Intussusception is very rare in older children in whom the presence of a polyp or a tumor may trigger the intussusception. A tumor is a common cause of intussusception in adults.

Symptoms

• Episodic colicky abdominal pain ++++ in an otherwise healthy child (90% to 95% of cases) or in an adult (5% to 10% of cases)
• Nausea and vomiting ++++
• Bloody stool +++
• Diarrhea ++
• Poor oral feeding by a child and episodes of crying and drawing up the legs

Signs

• Palpable abdominal mass +++ classically described as sausage shaped
• Abdominal tenderness +++
• Dehydration and lethargy between episodes of pain may be
  the only signs of intussusception in young children.
• Occult blood in stool +++
• Currant jelly (bloody, mucoid) stool ++

Treatment

An experienced radiologist often can unfold the intussusception using an 'enema' of air or fluid under pressure to push the enfolded intestine back into its normal position. When this does not work, surgery is required to unfold the intestine. In a small percentage of children, it is necessary to remove the section of intestine that is causing the blockage.