Intussusception
<B>Intussusception:</B> Telescoping (prolapse) of a portion of the intestine within another immediately adjacent portion of intestine.
This decreases the supply of blood to the affected part of the intestine, and frequently leads to intestinal obstruction.
The pressure created by the two walls of the intestine pressing together causes inflammation, swelling, and reduces the blood flow.
Death of bowel tissue can occur, with significant bleeding, perforation, abdominal infection, and shock occurring very rapidly.
Most cases of intussusception occur in children between five months and one year of age.
Boys are affected three times more often than girls.
The cause of intussusception is not known, although viral infections of the intestine may contribute to intussusception in infancy.
In older children or adults, the presence of polyps or a tumor may trigger the intussusception.
Early diagnosis is very important.
Symptoms begin with sudden, loud crying in an infant, with the baby drawing the knees up to the chest while crying.
This reaction is caused by abdominal cramping.
The pain and crying is intermittent, but recurs frequently, and increases in intensity and duration.
Fever is common.
As the condition progresses, the infant becomes weak and then shows signs of shock, including pale color, lethargy, and sweating.
About half of afflicted infants pass a bloody, mucousy ('currant jelly') stool.
On examining the abdomen, the doctor may feel a mass.
Abdominal X-rays may suggest intestinal obstruction, but a barium enema is needed to show the characteristic telescoping of the bowel.
Treatment may or may not require surgery.
In some cases, the intestinal obstruction can be reduced with a barium enema by a radiologist.
(There is a risk of bowel perforation with this procedure, so it cannot be performed if perforation has already occurred).
If the obstruction cannot be reduced by a barium enema, surgery is needed to reduce the intussusception, relieve the obstruction, and remove any dead tissue.
Intravenous feeding and fluid are continued until a normal bowel movement has passed.
Although intussusception is life-threatening, the outlook is good with early treatment.