Pediatric Intussusception

What is pediatric intussusception?

Intussusception happens when a section of the bowel (intestine) slides into the next section, like a telescope. This telescoping causes a blockage that can prevent fluids and food from passing through the intestine. Intussusception can cause swelling and bleeding inside the bowel. It can also reduce the blood supply to the affected parts of the bowel.

Without treatment, intussusception can lead to possibly life-threatening health problems. These include a tear or hole in the intestine, infection and damage or even death of bowel tissue. That’s why it’s important to get emergency medical care for your child as fast as possible.

What are the signs and symptoms of pediatric intussusception?

The first sign of intussusception in babies and children may be sudden, loud crying caused by severe belly pain. The belly pain may:

• Begin suddenly

• Cause them to pull their knees to their chest as they cry

• Come and go about every 15 to 20 minutes at first

• Last longer and get worse with time

Other signs and symptoms of intussusception include:

• Swelling or a lump in the belly

• Nausea and vomiting

• Stool (poop) mixed with blood and mucus, sometimes called currant jelly stool

• Diarrhea

• Weakness

• Dehydration

• Fever

How is pediatric intussusception diagnosed?

If your child has any of these signs and symptoms, they need emergency medical care. They’ll likely see the specialists in our pediatric emergency rooms (ER) first. We work quickly to confirm a diagnosis so that your child can start treatment right away.

Our team will ask you about your child’s symptoms and medical history. We’ll do a physical exam, paying special attention to your child’s belly to check for tenderness, swelling and other signs.

As we confirm a diagnosis, your child may need one or more tests, such as:

• Ultrasound: This is the first test we use to diagnose intussusception. This imaging test uses sound waves to create images of the inside of the body. An ultrasound can show a blockage or tear in the intestine. At Children’s Health, our ultrasound technicians are experienced in getting accurate ultrasound images. Accurate ultrasounds can help your child avoid other unneeded tests, such as enemas or imaging with radiation.

• Air-contrast enema: This test can help diagnose and treat intussusception at the same time. Our doctors place a small tube into your child’s rectum (end of the intestines where poop comes out). Through the tube, we inject liquid with barium contrast, which shows up in X-ray imaging. We also put air through the tube to expand the intestine for better images. An air-contrast enema with imaging shows a blockage or tear in the intestine. The air pressure may also help push the telescoped part of the intestine back into place.

• X-ray: This imaging uses radiation beams to make pictures of the inside of the body. We sometimes use X-ray with an air-contrast enema to see bowel blockages for treatment.

• Computed tomography (CT) scans: This imaging test takes X-rays from many angles to create 3D images of the inside of the body. We sometimes use CT scans with air-contrast enemas to show bowel blockages for treatment.

• Fluoroscopy: This imaging test provides real-time videos using X-ray beams. We may use fluoroscopy with air-contrast enemas to see bowel blockages for treatment.

What causes pediatric intussusception?

Most of the time, the cause of pediatric intussusception is unknown. It’s the most common cause of bowel blockages in children between the ages of 6 months to 3 years.

Certain factors can increase the risk of intussusception. In babies and children, these risk factors include:

• Cystic fibrosis

• Hemophilia

• Immunoglobulin A (IgA) vasculitis (Henoch-Schönlein purpura)

• A problem with the way the intestines developed in a baby before birth, such as intestinal malrotation and Meckel's diverticulum

• Unusual growths in the intestines, such as colon (large intestine) polyps or tumors

How is pediatric intussusception treated?

If your child has intussusception or its symptoms, take them to the nearest emergency room for immediate treatment.

When you come to Children’s Health, we quickly diagnose your child and begin treatment right away. Our ER specialists work with surgeons in our General and Thoracic Surgery program to provide care. Our treatment options for intussusception include:

Air-contrast enema

We often use this procedure to diagnose and treat intussusception at the same time. Most of the time, an air-contrast enema is successful, and children don’t need further treatment.

Surgery to treat intussusception

A child may need surgery if intussusception has created a tear in the bowel or if the enema doesn’t work. Whenever possible, we do minimally invasive laparoscopic surgery. This technique uses two to three small cuts (incisions) instead of one large cut.

Our surgeons insert a small camera and surgical tools through the cuts to move the affected parts of the intestine into the right position. If the intestine is torn or damaged, we remove that section and connect the healthy sections back together. Minimally invasive procedures help reduce your child’s pain and recovery time.

Follow-up care after intussusception treatment

Whether your child has an enema or surgery, they’ll need to stay in the hospital after treatment. The length of hospital stay is different for each child, from one to several days.

While in the hospital:

• Your child will get nutrition through an IV (tube going into a vein) at first. They can gradually start drinking fluids first, then eating.

• Your child will get medicines, as needed, to relieve pain and fever and prevent infection.

• Our care team will watch your child as they begin drinking and eating in case they vomit. We also watch them closely for signs of intussusception coming back.

Your child can go home once they can drink, eat and have a bowel movement as usual. Our care team will tell you how to watch for signs of problems, which may include:

• Vomiting

• Fever over 101 degrees

• Signs of infection near incisions, such as redness, swelling, warmth or excessive drainage

• Diarrhea or jelly-like stool (poop)

• Belly pain