Justin cried loudly and drew his tiny legs up to his chest as
his bewildered parents tried to soothe him. Their 7-month-old had
before, but this was something new - his crying was more urgent,
his mood much more irritable. As the afternoon wore on,
Justin's dad noticed that his son's small belly was
distended, and when it was time to change the baby's diaper, he
suspected that something was wrong.
After speaking with Justin's doctor, Justin's dad
bundled him up and took him to the emergency department, where he
was diagnosed with and successfully treated for intussusception
-shun), the most common abdominal emergency to affect children
under 2 years of age. Keep reading to learn about intussusception,
its symptoms, its treatment, and more.
What Is Intussusception?
Intussusception occurs when one portion of the bowel slides into
the next, much like the pieces of a telescope. When this occurs, it
creates an obstruction in the bowel, with the walls of the
intestines pressing against one another. This, in turn, leads to
swelling, inflammation, and decreased blood flow to the intestines
The most common cause of intestinal obstruction in children
between the ages of 3 months and 6 years, intussusception:
- occurs most often in children between 5 and 10 months of age
(80% occur before a child is 24 months old)
- affects between one and four infants out of 1,000
- is three to four times more common in boys than in girls
Signs and Symptoms
Children with an intussusception have intense abdominal pain,
which often begins so suddenly that it causes loud, anguished
crying and causes the child to draw the knees up to the chest. The
pain is usually intermittent, but recurs and becomes stronger. As
the pain subsides, a child with an intussusception may stop crying
and seem fine.
Other common symptoms include:
- abdominal swelling or distension
- passing stools (or poop) mixed with blood and mucus, known as
currant jelly stool (60% percent of infants with an
intussusception will pass currant jelly stool)
- vomiting up bile, a bitter-tasting fluid secreted by the
liver that's often golden-brown to greenish in color
- lethargy (i.e., drowziness or sluggishness)
- shallow breathing
As the illness progresses, a child will become progressively
weaker and may develop a fever and appear to go into shock.
Symptoms of shock include lethargy, rapid heartbeat, weak pulse,
low blood pressure, and rapid breathing.
In infants, the causes of intussusception are unknown, although
there are some theories about why it occurs. Because
intussusception is seen most often in spring and fall, this seems
to suggest a possible connection to the kinds of viruses that
children catch during these seasons, including upper respiratory
In some cases, intussusception may follow a recent bout of
gastroenteritis (sometimes called stomach flu). Gastrointestinal
infections may cause swelling of the infection-fighting lymph
tissue that lines the intestine, which may pull one part of the
intestine into the other. Intussusception is most common around the
age that infants are being introduced to solid foods. It has been
suggested that the introduction of new foods may also cause some
swelling of the lymph tissue in the intestines, increasing the
chance of developing an instussusception.
Usually when an adult or a child older than 3 develops an
intussusception, it's often the result of enlarged lymph nodes,
a tumor, or a polyp in the intestine.
Diagnosis and Treatment
The doctor will then perform a physical exam on the child,
paying special attention to the abdomen. Often, the doctor can feel
the part of the intestine that's involved, which is swollen and
tender and often is described as a "sausage-shaped mass."
Symptoms like pain, drawing up the legs, vomiting, lethargy, and
passing bloody or currant jelly stool are meaningful in helping the
doctor reach a diagnosis. In addition to doing a
, the doctor will ask the parent about any concerns and symptoms
their child has, the child's past health, your family's
health, any medications the child is taking, any allergies the
child may have, and other issues. This is called the
If the doctor thinks an intussusception may be the cause of the
child's pain, a pediatric surgeon will be consulted to examine
the child and decide about treatment. The doctor may order an
abdominal X-ray, which may or may not show an obstruction. An
ultrasound examination may also help make the diagnosis. If the
child appears very ill, suggesting damage to the intestine, the
surgeon may opt to take the child immediately to the operating room
to correct the bowel obstruction.
A barium or air enema is often used to both diagnose and treat a
suspected intussusception. During a barium enema, a liquid mixture
containing barium is given through a catheter tube into the
child's rectum, and special X-rays are taken. Barium outlines
the bowels on the X-rays and, if an intussusception is present,
shows the doctors the telescoping piece of intestine.
In many instances, the barium enema not only shows the
intussusception, but the pressure from putting it in the bowel may
also unfold the bowel that has been turned inside out, instantly
curing the obstruction. An air enema, given rectally in a similar
way as barium, can also be used to diagnosis and treat an
The radiologist usually decides which test is most appropriate
to perform. Both procedures are very safe and usually well
tolerated by the child, although there is a very small risk of
infection or bowel perforation. There's a 10% risk of
recurrence, which usually occurs within 72 hours following the
If the barium or air enema procedures aren't successful or
the child is too ill to attempt the enema, the child will undergo
surgery. Enemas are less successful in older children, and
they're more likely to require surgery to treat
intussusception. Surgeons will try to fix the obstruction but if
too much damage has been done, that part of the bowel will be
Some babies with intussusception may be given antibiotics to
prevent infection. Babies who have been treated for intussusception
will be kept in the hospital and given intravenous feedings until
they're able to eat and have normal bowel function.
If left untreated, intussusception can cause severe
complications. Complications are directly related to the amount of
time that passes from when the intussusception occurred until
it's treated. Most infants who are treated within the first 24
hours recover completely from an intussusception with no problems.
Further delay increases the risk of complication which include
irreversible tissue damage, perforation of the bowel, infection,
When to Call Your Child's Doctor
Intussusception is a medical emergency. If you're concerned
that your child has some or all of the symptoms of intussusception,
such as abdominal pain, vomiting, or passing of currant jelly
call your child's doctor
or emergency medical services immediately.
The outcome for most infants with intussusception is very good,
and with early treatment, complications are much less likely to
develop. Do not delay, though - in many cases, early diagnosis can
mean a child can be successfully treated without surgery.
Thom E Lobe, MD
Date reviewed: October 2007
Originally reviewed by:
Philip Wolfson, MD
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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