Intussusception

Causes of Intussusception:

1. Idiopathic (unknown cause):
   • In most cases in children, the exact cause is unknown. It may be related to viral infections, which cause swelling of the lymphatic tissue in the intestines.
2. Lead Point (more common in adults):
   • Meckel’s diverticulum: A congenital abnormality of the small intestine can act as a lead point.
   • Polyps or tumors: In adults, tumors or masses in the intestine are more likely to be the cause.
   • Inflammation: Conditions like Crohn’s disease can cause swelling that leads to intussusception.
   • Post-surgery: Some cases may occur after abdominal surgery due to adhesions or scarring.

Types of Intussusception:

1. Ileocolic: The most common type, where the ileum (the end of the small intestine) telescopes into the colon.
2. Ileoileal: Involves the small intestine telescoping into itself.
3. Colocolic: A rare type in which one part of the colon folds into another part of the colon.

Symptoms of Intussusception:

The symptoms of intussusception can come on suddenly and may vary between children and adults. In children, the symptoms are often more dramatic.

1. Classic Triad of Symptoms in Children:

   • Sudden, severe abdominal pain: Often intermittent and may cause the child to cry, draw their legs up to their chest, or appear very irritable.
   • Vomiting: Early vomiting may be non-bilious (without bile), but as the obstruction progresses, bile-stained vomiting may occur.
   • “Currant jelly” stools: Stools mixed with blood and mucus, giving them a red jelly-like appearance. This is a later sign and suggests bowel damage.

2. Other Symptoms:

   • Lethargy or weakness: Children may appear unusually tired or listless.
   • Palpable abdominal mass: A sausage-shaped mass may be felt in the abdomen, especially in children.
   • Fever: May occur if infection or inflammation sets in.

3. Symptoms in Adults:

   • Intermittent abdominal pain: The pain may be less acute and more chronic, often mistaken for other gastrointestinal conditions.
   • Nausea and vomiting: These may occur due to bowel obstruction.
   • Changes in bowel habits: Diarrhea, constipation, or bloody stools can occur.

Diagnosis of Intussusception:

1. Physical Examination:

   • Doctors may palpate a mass in the abdomen, particularly in children, which can suggest intussusception.

2. Imaging Tests:

   • Ultrasound: The preferred diagnostic tool in children, showing the characteristic “target sign” or “doughnut sign” on cross-sectional views. Ultrasound is non-invasive and effective.
   • Abdominal X-ray: May show signs of bowel obstruction, but is less definitive than ultrasound or other imaging methods.
   • Contrast Enema: This is both diagnostic and therapeutic in children. A barium or air enema can reveal intussusception and, in many cases, the pressure from the enema can reduce the intussusception.
   • CT scan: More often used in adults to diagnose intussusception and to check for any underlying causes, such as tumors.

Treatment of Intussusception:

1. Non-surgical Treatment:

   • Air or Barium Enema: In children, the first line of treatment is often a contrast enema (barium or air). The pressure from the enema can unfold the telescoped part of the intestine in up to 90% of cases, particularly if it’s caught early.

2. Surgical Treatment:

   • Surgery: Required if the enema is unsuccessful, if the intestine is perforated, or if the intussusception is due to an underlying pathology (like a tumor in adults). Surgery involves manually reducing the intussusception or removing the affected segment of the bowel if it has become necrotic.
   • Laparoscopy: Minimally invasive surgery may be used in some cases to correct the intussusception.

Complications of Intussusception:

1. Bowel necrosis: If the blood supply to the affected bowel segment is cut off for too long, tissue death can occur, which can lead to perforation, peritonitis (infection of the abdominal lining), and sepsis.
2. Recurrence: In children, intussusception can recur after non-surgical reduction with an enema, though this is relatively uncommon.
3. Obstruction: Prolonged intussusception can lead to a bowel obstruction, causing severe pain, vomiting, and bloating.

Prognosis:

• In children, the prognosis is generally good if treated promptly. Non-surgical reduction via enema is successful in the majority of cases.
• Adults tend to have a more complicated prognosis, especially if the intussusception is due to an underlying condition like cancer. Surgery is often required in these cases.

When to Seek Medical Attention:

Immediate medical attention is required if a child shows symptoms like severe abdominal pain, vomiting, lethargy, or passing blood-stained stools. Early intervention is crucial to prevent serious complications such as bowel perforation or necrosis.

Conclusion:

Intussusception is a potentially life-threatening condition where early diagnosis and treatment are critical to preventing complications. While most cases in children can be successfully treated with non-surgical methods, adults often require surgery due to underlying causes. Awareness of the symptoms and quick medical intervention can lead to a favorable outcome, especially in children.