Intussusception Definition
It is an emergency condition in which a part of the colon or small intestine turns back into itself. It is rare in adults but is a most common type of intestinal blockage in children.
Types of Intussusception
Know about the different types of Intussusception:
- Cystic fibrosis
- Cystic fibrosis associated Intussusception
- Familial occurrence of intussusception
- Hematologic dyscrasias
- Hematologic dyscrasias associated Intussusception
- Henoch- Schlonlein purpura associated Intussusception
- Meckel diverticulum associated with intussusception
- Mesenteric or duplication cysts associated Intussusception
Intussusception Age
This problem affects children as well as adults, though it is rare in the latter. In children, most cases of this condition occur in those aged between 6 months and 2 years. It is seen to affect male infants more than females.
Intussusception in adults
Intussusception is rare in fully grown individuals and accounts for only 1% of all cases of bowel obstructions. Approximately 90% cases of this condition in adults are the result of a postoperative condition or an underlying ailment such as a neoplasm. Neoplasm, however, is the most common causative factor and is found responsible in about 65% cases of this condition in adults.
This problem is rarely found to be a cause of abdominal pain in adults. Due to the varied range of symptoms arising from this emergency situation, it poses diagnostic challenges for doctors. It is due to this reason that Intussusception diagnosis often gets delayed. It leads to the development of Bowel Ischaemia and results in surgical intervention.
Intussusception in Children
In children, the problem is generally caused due to introversion of a part of the intestine which can result in blocking blood supply as well as the passage of food.
Physical observation as well as air or contrast enema and abdominal x-ray are generally enough to diagnose an Intussusception. Insertion of nasogastric tube, use of intravenous fluids and air or contrast enema are usually effective in curing the condition. If these fail to improve the problem, a surgical operation may be needed. The prognosis is usually good with early treatment. Unless treated in time, the condition can lead to infections and even fatal complications for suffering children.
Intussusception Symptoms
Know about the major signs and symptoms of Intussusception in adults as well as children.
Intussusception Symptoms in Adults
The symptoms of this condition can be intermittent or chronic in adults. They include discomforts like:
- Abdominal pain
- Abdominal inflammation (swelling)
- Nausea
- Vomiting
- Rectal bleeding
- Changes in frequency of bowel movements
- Changes in urgency of bowel movements
Intussusception Symptoms in Children
A sudden onset of abdominal pain is the primary symptom of this problem in kids. The pain usually arises periodically. Both infants and young children generally cry as the pain starts becoming more severe. During an intense abdominal ache, they may draw up their knees to the chest. Suffering children may display extreme irritability and fatigue between episodes of pain. Some of them may also recover and show normal behavior until the start of the next painful episode.
During painful episodes, the condition may lead to intense abdominal pain. There may as well be other signs of Intussusception like
- Fever
- Bloody or mucus-filled stool
- Shock
- Yellow-green vomit
- Swollen abdomen, due to the development of a lump in the abdomen
In the later stages, lack of treatment can make an affected child turn pale and experience weakness. He or she may also go into shock and become feverish.
Intussusception Diagnosis
The diagnosis of Intussusception is carried out by physical examination and consideration of the medical history of the sufferer. Doctors also look for Dance’s sign or retraction of the abdomen for a proper diagnosis. Per rectal examination as well as experiencing part of the intussusceptum is especially helpful in case of children.
Diagnostic methods used for determination of this condition involve imaging studies like
- X-ray of the abdomen
- Ultrasound examination of the abdomen
Some healthcare providers also use Air Enema for a proper diagnosis.
Intussusception Treatment
The condition may be cured with either an air-contrast enema or barium enema (water-soluble contrast enema). Both of these procedures help confirm the diagnosis of intussusceptions. These successfully reduce the problem in over 80% of cases. Unfortunately, the problem tends to recur within 24 hours in about 5–10% of sufferers.
Air Enema Intussusception
Air enema is the initial choice of treatment for Intussusception. Air Enema forces back the telescoped portion of the intestine which comes out and enters into a normal position. Normalcy is restored in 75-90% pediatric cases. Occasionally, antibiotics are needed for cure. A surgical correction may be necessary if the condition fails to resolve or if the intestine is damaged. Intestinal damage occurs if an intestinal portion ruptures or dies due to lack of blood supply. A surgical reduction is also needed if an enema is found insufficient in reducing the problem.
Barium Enema Intussusception
A barium enema is the name given to an X-ray examination of the large intestine (rectum and colon). It is also known as lower gastrointestinal (GI) examination. The test helps diagnose disorders and other problems affecting the large intestine. It is used to correct a condition known as Ileocolic Intussusception.
Intussusception Surgery
A surgical procedure is used only when a surgeon makes sure that obstruction is substantial enough to need an operative cure. During surgery, the telescoped bowel is gently cut open. The part that has folded inwards is manually squeezed out by a surgeon. In case of bowel damage or an unsuccessful surgical reduction, resection of the affected section may become necessary.
More frequently, laparoscopy is used to reduce the intussusceptions. This involves pulling the intestinal segments apart with the aid of forceps. If the condition goes undiagnosed for several days, a segment of the bowel may die. This is an emergency concern and requires surgical removal of the dead intestinal segment. The two parts of the intestine are surgically connected by sewing up the healthy ends of the intestine together. The process is known as Anastomosis.
Intussusception Causes
The causes of Intussusceptions are not understood very well. However, certain factors have been identified as causes of this condition. These include:
Heredity
Heredity is often supposed to be a causative factor for this disorder. Individuals with a family history of this disease are seen to be at higher risk of suffering from the condition.
Viral Infections
In some cases, viral infections are thought to be responsible for the development of this condition.
Cystic Fibrosis
Cystic Fibrosis is often blamed for the rise of this condition. This is due to the fact that people suffering from this condition are seen to be at greater risk of having Intussusception.
Tumors, polyps or lymph nodes are also supposed to act as triggers for the condition. The older the child, the higher is the chance of finding such a trigger.
What Does Intussusception Mean?
Intussusception is a very serious problem. During this condition, a segment of the intestine (intussusceptum) gets shortened into a more lateral section (Intussuscipiens). It drags the associated vessels, nerves and mesentery with it. This leads to a venous compression. It is followed by an inflammation of the area which leads to an obstruction and a consequent reduction in the flow of blood to the affected section of the intestine. Approximately 90% cases of the condition have an impact on the ileocolic area of the intestine. It is the region where the small intestine encounters the large intestine.
The compression of blood vessels in the affected intestine lowers the blood supply to it. If the supply of blood is greatly lowered, the affected intestine may suffer an inflammation. The swelling can cause an obstruction. The affected section can turn gangrenous, bleed or even die. It may also suffer a rupture and result in abdominal infection and shock.
Internal Intussusception
Internal Intussusception of the rectum is a medical symptom associated with straining to defecate, usually associated with chronic constipation and diagnosed by Defecography. Surgical interventions to correct the problem have exhibited limited success, usually treating the intussusception but not always relieving the patient’s symptoms.
Intussusception Reduction
It is a medical process used to prevent gangrene of the intestine due to Intussusception. Bowel gangrene may lead to problems like perforation of the intestine, acute infection and even death. The reduction is carried out in two ways, Manual and Surgical. In manual reduction, surgeons try reduce the intussusception by gentle application of pressure which aims to easily bring Intussusceptum out of the Intussuscipiens. If manual reduction fails to improve the condition, a surgical reduction may be required.
Intussusception reduction can give rise to associated complications like:
- Reactions to general anesthesia
- Infections due to bowel perforation
- Excessive bleeding
- Urinary tract infection
- Formation of adhesions (formation of scar tissue bands after surgery or due to abdominal injury)
Intussusception Recurrence
Intussusception tends to recur in around 1–4% of patients after surgical reduction. The chance of recurrence is 5–10% after nonsurgical reduction (manual reduction). Adhesion tends to form in up to 7% patients undergoing surgical reduction. Intussusception-related deaths are very rare and occur in less than 1% sufferers of the condition in Western countries.
Generally, Intussusception reduction is performed under general anesthesia in a hospital operating room. The surgery may be conducted by a general surgeon, a pediatric surgeon (if pediatric intussusception is the case) or a colorectal surgeon.
Ileocolic Intussusception
It is a type of Intussusception in which the lower section of the ileum, along with the caecum valve, extends into the ascending colon. In other words, it is a condition marked by the protrusion of the end of the small intestine into the large intestine of a child.
Chronic Intussusception
It is a condition characterized by the prolapse of an intestinal segment into the lumen of an immediately neighboring section of the bowel. It persists for two or more weeks.
The problem generally manifests itself in the form of nonacute abdominal pain. It is usually diagnosed with the aid of plain abdominal x-ray and Laparatomy. Computed tomography (CT) and Ultrasonography are found to be the most useful and effective diagnostic method. Surgical intervention is always necessary for cure in older kids as well as adults due to high incidence of underlying lesions.
If treated early, the prognosis for this condition can be good though there is a risk of recurrence of this disorder. In the absence of treatment, the disorder can turn fatal for infants and young kids. If you suspect this condition in yourself or any child in your family, seek immediate medical treatment. Timely cure can help avoid many complications and make a smoother, faster recovery.