What is intussusception?
Intussusception (pronounced in-tuss-uss-EPP-shun) is a condition that occurs when 1 segment of the intestine slides inside the segment next to it, like the segments of a telescope do. When this happens, the walls of the intestine press against each other. This blocks the flow of stool (feces).
The area that is blocked can cause symptoms such as pain and swelling. Pressure cuts off blood flow to the intestine, which can damage the tissue. Intussusception needs treatment right away to prevent serious health problems.
Intussusception causes pain in the belly for almost all children who have the condition. In many cases, the pain:
- Is intense.
- Starts suddenly.
- Comes and goes.
- Tends to get worse each time it returns.
- Children with pain from intussusception may cry and draw their knees up to their chest. When the pain is gone, the child may seem fine.
Your child may also have any of these symptoms:
- Swelling in the belly
- Blood and mucus in the stool, which may look purple
- Sluggishness (lethargy)
The doctor will ask about your child’s symptoms. The doctor will also ask you about your child’s medical history. Often, children with intussusception have had a recent history of stomach pain and swelling, constipation and bleeding where the stool leaves the body (anus).
The doctor will also give your child a physical exam. They will check your child’s belly and feel for swollen, blocked sections of intestine. The doctor will also look for signs of dehydration and shock. So your child’s doctor can see the intestine, your child may have an X-ray or ultrasound exam of their belly.
Once intussusception is confirmed by ultrasound, your child will need an X-ray and then a procedure called a contrast enema. This is used to treat the intussusception and can be done either using air or a liquid. The radiologist will decide which one is best for your child.
Putting the air or liquid in the intestine usually makes the telescoped section open up. If the intestine opens up, your child doesn’t need surgery. At Seattle Children’s, doctors usually use air when they do this test. This type of enema sends air into the intestine through a tube placed in your child’s anus. They may use liquid if the air enema did not work or if doctors cannot tell if the intussusception was opened up.
Contrast enemas done with either air or liquid are useful even if they don’t push your child’s intestine into place. The X-rays made during the process help doctors see where the blockage is. These images can help our doctors plan for surgery, if needed.
If enema treatment works, your child may be discharged from the emergency department if they are able to drink liquids. This way, we can make sure your child is able to eat food and pass stool (have a bowel movement).
Surgery for Intussusception
If the enema doesn’t work, your child will need surgery right away. Your child may have surgery before having an enema if the doctor thinks the intestine has been damaged by the intussusception. This is not common, though.
At the time of surgery, we will give your child medicine (general anesthesia) to make them sleep without pain. The doctors at Seattle Children’s who give your child anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to give anesthesia to children safely.
The surgeon will make a cut (incision) in your child’s belly. The surgeon may do this surgery:
- Through 3 or 4 tiny cuts (laparoscopic surgery)
- Through 1 larger incision (open surgery)
Your child’s surgeon will talk with you about which option may be best for your child. Then the surgeon will squeeze the telescoped intestine back into place, if possible.
If the intestine is severely damaged or cannot be squeezed back into place, the surgeon will cut out the damaged section and sew the loose ends together. Sometimes, surgeons remove the child’s appendix during this surgery. They may remove the appendix because it may act as a starting point for intussusception to happen again. Your doctor will discuss this with you before surgery.
The length of the surgery depends on what your child needs. It takes 30 minutes to 1 hour, sometimes longer. Your child will be in the recovery room for another hour.
After surgery, we will give your child pain medicine to make them comfortable. It takes some time for the intestine to recover after surgery. You can expect your child to stay in the hospital at least overnight. They may need to stay for up to a week. How soon your child can eat or drink will depend on the type of surgery they had.
After your child goes home, you’ll need to keep the incision clean and dry until it heals. The surgery team will:
- Teach you how to care for the incision
- Explain what kinds of food or medicine to give your child
- Tell you if you need to limit your child’s activity for a while
Between 1% and 5% of children get intussusception again, so you will need to watch for symptoms.
Your child will need to see the surgeon for a follow-up visit about 2 to 3 weeks after surgery. The surgeon will make sure the incision is healing and your child is recovering well.