Imagine you're holding a telescope. When you twist it one way, it extends fully. When you twist it back, the sections slide inside each other, making it smaller.
Your intestines are long and tube-shaped as well. But unlike a telescope, the sections are meant to stay extended. When one part of your intestine slides inside another, it causes a painful disorder called intussusception.
Intussusception can be a life-threatening condition. When one part of the intestine slides into another, food can't pass through. Blood can't get to the area either, which can cause a tear in the bowel, infection, and internal bleeding.
Who Gets It?
For children younger than 2, intussusception is the most common abdominal emergency. It can also happen in older children and teenagers. In rare cases, it can affect adults, though it's usually the result of another medical issue, like a tumor.
Other things that can affect who is more likely to get intussusception include:
Gender: Intussusception affects more boys than girls
Previous issues: Those who've had intussusception have a higher chance of getting it again.
Family history: Sisters and brothers of someone with intussusception are more likely to get it.
Adults with intussusception may have had one of the following:
- A polyp or tumor
- Adhesions, or scar tissue in the intestines
- Crohn's disease or other conditions that cause inflammation
- Surgery on the intestinal tract, such as gastric bypass (a surgery for weight loss)
Since intussusception can affect children who haven't begun to talk, they may express abdominal pain with a sudden, loud cry. They may also pull their knees up to their chests.
The pain happens occasionally at first, usually every 15 to 20 minutes. As time passes, the pain will happen more often and last longer.
Symptoms differ from child to child. Some have no pain at all. Look for these signs:
- A visible lump or swelling in the stomach
- “Currant jelly" stool, or stool mixed with blood and mucus
- Lack of energy
- Vomiting up bile, a yellow-green fluid
In adults, intussusception may seem like a stomachache at first, with symptoms of nausea and vomiting. Look out for stomach pain that comes and goes, getting stronger each time.
When Should I Call a Doctor?
Intussusception is a medical emergency. If you suspect your child has it, call a doctor right away. If you can't get an appointment at once, head to the emergency room.
When blood can't get to part of your intestines, the tissue in that area can die. If that happens, the lining of the abdominal cavity can become infected. This is a life-threatening condition called peritonitis.
If left untreated, your child may go into shock. Symptoms include:
- Abnormal pulse, either very slow or quick
- Abnormal breathing, either very shallow or rapid
- Cool, clammy, pale or gray skin
- Extreme lack of energy
- Loss of consciousness
Before You Go to the Doctor
This is an emergency, so things may move quickly. Do not give your child food, liquid, or over-the-counter medicine.
If you have time, prepare answers to the following questions so you can answer the doctor quickly:
- When did the symptoms, such as stomach pain, begin?
- Was the pain off and on, or consistent?
- Has there been nausea, vomiting, or diarrhea?
- Have you seen blood in the stool?
- Have you noticed swelling or a lump in the stomach area?
Diagnosis and Tests
Your doctor will ask questions about your child's medical history and symptoms. Your child may be stabilized with an IV line for fluids and a nasogastric tube. This tube is inserted into the stomach through the nose. It relieves pressure on the intestines.
In addition to a physical exam, your doctor will likely order imaging tests to get a better look inside. These may include:
Abdominal X-ray: This safe and painless test uses radiation to figure out whether your child has an obstruction in his intestines or bowel.
Air or contrast enema: A soft tube is placed in the rectum and air or a contrast fluid, such as barium, is passed through the tube and into the intestines and bowels. This highlights blocked areas on an X-ray. In some cases, an enema helps straighten out the intestine, fixing the intussusception.
Some cases of intussusception are temporary and don't need treatment. If an enema doesn't fix the intussusception, surgery is the next step.
Your surgeon may do this procedure by making a cut in the abdomen. This is called an open procedure. He may opt to do it laparoscopically, with tiny cuts and a camera.
Either way, the surgeon corrects the intussusception by lightly guiding the intestine back into place. If this doesn't work, she may remove the section and sew the intestine back together. She would do this with dissolvable stitches.
What Happens Afterward?
In one out of every 10 cases, intussusception returns within 72 hours of the procedure. Whether the treatment was an enema or surgery, your child will stay in the hospital overnight in case it happens again.
If an enema did the trick, expect the following:
- Air will continue to pass out of your child's body in the hours following the enema
- Acetaminophen may be given for fever
- No food or liquids will be given for the first 12 hours -- after that, clear liquids first, then solid food will be given
If your child had surgery, he'll likely spend a few hours in a recovery room before being moved to a hospital room. He'll get pain medication through an IV and may take acetaminophen for fever.
If the surgeon’s cut, or “incision,” was closed with a gauze bandage, it can be removed a few days after surgery. If it was closed with Dermabond or a clear dressing, it will dissolve on its own.
Your child can have sips of clear liquids to start, then can move on to solid food if the liquids stay down. Once he's eating well and feeling better, he can go home.
Two days after the surgery, your child can take a bath or shower. Make sure he stays away from contact sports until you have a follow-up appointment with the doctor. This usually happens within 2 to 3 weeks.