An intussusception is a situation in which a part of the intestine has prolapsed into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another. The part which prolapses into the other is called the intussusceptum, and the part which receives it is called the intussuscipiens. The most frequent type of intussusception is one in which the ileum enters the cecum, however other types are known to occur, such as when a part of the ileum or jejunum prolapses into itself. Almost all intussusceptions occur with the intussusceptum having been located proximally to the intussuscipiens, however in certain, very rare cases the intussusceptum was originally distal to the intussuscipiens. The reason for this is that peristaltic action of the intestine "pulls" the proximal segment into the distal segment.

Intussusception in humans is almost exclusively a disease of the young, usually those between 2 months and 36 months old. It occurs more frequently in boys than in girls, with a ratio of approximately 3:1.

Symptoms

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The symptoms can include rectal bleeding, currant jelly stool (stool mixed with blood and mucus), sudden moderate to severe abdominal pain, a mass felt upon palpation of the abdomen, swelling of the abdomen, nausea and vomiting.

In children too young to communicate their symptoms verbally, they may cry, draw their knees up to their chest or experience dyspnea.

Fever usually does not present as a direct result of the intussusception itself, but rather is caused by a complication such as sepsis.

Diagnosis

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Intussusception can be diagnosed by observation of Dance's sign, an x-ray of the abdomen, an ultrasound of the abdomen, or in the most critical cases the child may be taken to the operating room immediately to repair whatever is causing the problem, be it intussusception or some other problem.

Treatment

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When the condition is not immediately life-threatening, the intussusception is usually treated with either a barium enema or an air-contrast enema, which both confirms the diagnosis of intussusception, and in most cases successfully reduces it, however approximately 10% of these recur within 72 hours.

If it cannot be repaired by an enema or if the intestine is damaged, then a surgical reduction is necessary. In a surgical reduction, the abdomen is opened and the part that has telescoped in is pulled out manually by the surgeon or if the surgeon is unable to successfully reduce it or the bowel is damaged, the affected section will be removed.

Prognosis

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Intussusception is a medical emergency, as it can cause death if untreated. When an intussusception or any other severe medical problem is suspected, the person must be taken to a hospital immediately, or if that is not possible a call for help must be made.

The outlook for intussusception is excellent when treated quickly, and when untreated it leads to death within 2–5 days. Fast treatment is a necessity, because the longer the intestine segment is prolapsed the longer it goes without bloodflow, and the less effective a non-surgical reduction will be.

Footnotes

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Gastroenterology | Surgery | Invagination intestinale aiguë du nourrisson