Clinical Reference Systems: Pediatric Advisor 10.0

Description (Diagnosis must be confirmed by a physician.)

Intussusception occurs when one portion of the intestine folds in on itself, much like a collapsing telescope, and puts pressure on another part of the intestine.

The main symptom is sudden, severe abdominal pain. The pain comes and goes and lasts seconds to minutes. The waves of pain occur every 5 to 15 minutes. During attacks of pain the child will cry or scream. Between attacks of pain the child may appear to be well.

Other possible symptoms, in addition to pain, are:

• vomiting
• bloody stools
• pale skin.

Intussusception is most common between 6 months and 2 years of age, but it can occur at any age.

Cause

The exact cause of intussusception is not known. It sometimes happens when a child has a cold or other viral illness associated with swollen glands. There are glands located in the wall of the intestine and swelling of these glands can cause the bowel to telescope.

When the bowel telescopes, there is less blood flow to the intestine. The decreased blood flow causes pain and bloody stools. The intestine can also become blocked, which can cause the child to vomit.

Diagnosis

The doctor will ask a few questions about your child's medical history and recent symptoms. If he or she suspects intussusception, your child will be admitted to the hospital for treatment.

Treatment

1. Rehydration

   If your child's bowel is blocked, it may be difficult for your child to absorb fluids. Your child will be given some fluids intravenously (through a vein). Your child probably will have a tube placed through the nose down into the stomach to help control vomiting.

2. Barium or air enema

   The most important part of the treatment is getting your child's intestines back to their usual position. This can often be done by giving the child a special x-ray test called a barium enema or an air enema.

   During an enema a tube is put into into the child's rectum. A barium solution (and/or air, if it is an air enema) is passed through the tube while a technician takes several x-rays. This test does two things. It helps the doctor see what is wrong by showing an x-ray picture of exactly where the problem is in your child's intestine. It also treats the illness because the solution and/or air from the enema gently forces the telescoped part of the child's bowel back to where it belongs.

   The enema should take about only 10 minutes. During the test your child may feel some cramping pain.

   If the enema is successful, your child will not need further treatment. He or she will be observed for a short period of time in the hospital to make sure that the condition does not recur.

3. Surgery

   If the barium or air enema is not successful in fixing the problem, or if your child is extremely unwell because of the intussusception, your child will need surgery. During the operation the surgeon will gently unfold the telescoped bowel and return everything to its normal position.

Home Care

Once your child has been treated and discharged, there are no specific things that you have to do at home. Your child may eat and drink normally and should be encouraged to return to his or her usual level of activity. Although intussusception recurs in only 5% to 10% of all cases, it is important to watch for the return of any of the symptoms.

Call Your Child's Physician IMMEDIATELY If:

• Your child begins to have abdominal pain that comes and goes.
• Your child vomits.
• Your child becomes extremely lethargic (sluggish).
• Your child passes any bloody stools.
• Your child starts to act very sick.

Call Your Child's Physician During Office Hours If:

• You have other questions or concerns.