Intussusception

Intussusception (in-tuh-suh-SEP-shun) is a serious condition in which part of the intestine slides into an adjacent part of the intestine. This telescoping action often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected. This can lead to infection, death of bowel tissue or a tear in the bowel, called perforation.

Intussusception is the most common cause of intestinal obstruction in children younger than 3 years old. The cause of most cases of intussusception in children is unknown. Though intussusception is rare in adults, most cases of adult intussusception are the result of an underlying medical condition, such as a tumor.

In children, the intestines can usually be pushed back into position with a minor procedure. In adults, surgery is often required to correct the problem.

Children

The first sign of intussusception in an otherwise healthy infant may be sudden, loud crying caused by belly pain. Infants who have belly pain may pull their knees to their chests when they cry.

The pain of intussusception comes and goes, usually every 15 to 20 minutes at first. These painful episodes last longer and happen more often as time passes.

Other symptoms of intussusception include:

• Stool mixed with blood and mucus — sometimes referred to as currant jelly stool because of its appearance.
• Vomiting.
• A lump in the belly.
• Weakness or lack of energy.
• Diarrhea.

Not everyone has all of the symptoms. Some infants have no obvious pain. Some children don't pass blood or have a lump in the belly. And some older children have pain but no other symptoms.

Adults

Intussusception is rare in adults. Also, because symptoms of the disorder often overlap with the symptoms of other disorders, it's more challenging to identify. The most common symptom is belly pain that comes and goes. Nausea and vomiting also may occur. People sometimes have symptoms for weeks before seeking medical attention.

Intussusception requires emergency medical care. If you or your child develops the symptoms listed above, seek medical help right away.

In infants, pulling the knees to the chest and crying are often symptoms of belly pain.

Your intestine is shaped like a long tube. In intussusception, one part of your intestine — usually the small intestine — slides inside an adjacent part. This is sometimes called telescoping because it's similar to the way a collapsible telescope slides together.

In some cases in adults, the telescoping is caused by a growth in the intestine, such as a polyp or a tumor, called a lead point. The typical wavelike contractions of the intestine grab this lead point and pull it and the lining of the intestine into the bowel ahead of it. In most cases, however, no cause can be found for intussusception.

Children

In most cases of intussusception in children, the cause is unknown. Intussusception seems to occur more often in the fall and winter. And because many children with the problem also have flu-like symptoms, some suspect a virus may play a role in the condition. Sometimes, a lead point can be identified as the cause of the condition — most frequently the lead point is a pouch in the lining of the small intestine (Meckel's diverticulum).

Adults

In adults, intussusception is usually the result of a medical condition or procedure, including:

• A polyp or tumor.
• Scar-like tissue in the intestine, known as adhesions.
• Weight-loss surgery such as gastric bypass or other surgery on the intestinal tract.
• Swelling in the intestines due to diseases such as Crohn's disease.

Risk factors for intussusception include:

• Age. Children — especially young 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 6 months and 3 years.
• Sex. Intussusception more often affects boys.
• Irregular intestinal formation at birth. Intestinal malrotation is a condition in which the intestine doesn't develop or rotate correctly. This increases the risk of intussusception.
• Certain conditions. Some disorders can increase the risk of intussusception, including:
  • Cystic fibrosis.
  • Henoch-Schonlein purpura, also known as IgA vasculitis.
  • Crohn's disease.
  • Celiac disease.

Intussusception can cut off the blood supply to the affected portion of the intestine. If left untreated, lack of blood causes tissue of the intestinal wall to die. Tissue death can lead to a tear in the intestinal wall, called a perforation. This can cause an infection of the lining of the abdominal cavity, known as peritonitis.

Peritonitis is a life-threatening condition that requires immediate medical attention. Symptoms of peritonitis include:

• Belly pain.
• Swelling in the belly area.
• Fever.
• Vomiting.

Peritonitis may cause your child to go into shock. Symptoms of shock include:

• Cool, clammy skin that may be pale or gray.
• A weak and rapid pulse.
• Breathing that may be either slow and shallow or very rapid.
• Anxiety or agitation.
• Extreme listlessness.

A child who is in shock may be conscious or unconscious. If you suspect your child is in shock, seek emergency medical care right away.