Small Bowel and Colonic Intussusception
Intussusception means folding within and refers to one section of the intestine that collapses into another. When Intussusception or one intestine section collapses through folding (intussusceptum) into another intestinal section (intussuscipiens), it triggers an abnormal health condition requiring immediate medical treatment. Intussusception commonly occurs where the small intestine joins the large intestine.
Who is affected by Intussusception?
Children aged between three months to six years are more prone to developing intussusception, because their bodies are still developing and during this time intestinal obstruction may occur. Younger babies are not as much at risk. Children aged over six years and adults are less likely to experience Intussusception, unless caused by another medical condition.
What causes Intussusception?
The main trigger of Intussusception is a blockage in a section of the intestine and some causes are unknown (idiopathic); however, known causes include:
- Viral infections, such as rotavirus or adenovirus.
- Bacterial infections, such as bacterial meningitis.
- Polyps or tumours.
- Enlarged lymph gland.
- Whip worms and round worms.
What happens during Intussusception?
In intussusception, a section of the intestine or bowel with tissues, blood vessels and nerves collapses into another segment, sometimes referred to as distal. The folding causes compression and pressure to build up in the folded and receiving segments of the intestine, blocking the intestine and resulting in swelling and reduced blood flow. The condition is serious because it can result in infection, tearing or rupturing of the intestine and bleeding.
What are the symptoms of Intussusception?
There are initial and advanced symptoms that occur from intussusception. Initial symptoms may include abdominal pain and cramping, nausea and vomiting. Yellowy-green bile may be vomited, as fluids excreted through the liver into the intestine are blocked and move back up into the oesophagus. More advanced symptoms include increased pain in the abdomen when breathing, infection with fever, blood in stools, and fatigue. A natural reflex is to try and reduce the cramping and pain by bending the knees up to the chest. Weakness, fever and shock set in if left untreated.
When should medical attention be sought for Intussusception?
If left untreated severe life-threatening medical complications can arise with the spread of infection. Early intervention can be life-saving.
How is Intussusception diagnosed?
Initial diagnostic tests include a discussion of symptoms (with parents/guardians if affecting a child) and physical examination of the abdomen. If a solid lump is felt in the abdomen this can be a sign of obstruction caused by intussusception. A doctor may use a stethoscope to listen for bowel sounds that are usually not present if an obstruction exists. Other diagnostic tests include:
- Rectal examination.
- Abdominal X-ray.
- Imaging with ultrasound and/or computer tomography (CT) scans.
- Telescopic barium with radiographic contrast.
- Air enema.
What medical conditions or diseases are associated with Intussusception?
A diagnosis of intussusception may indicate three types of medical disorders:
- Rectal prolapsed.
- Henoch-Schönlein Purpura (HSP).
- Gastroenteritis.
Rectal prolapse is evident when part of the rectum's tissue lining extends out of the anus as a red mass with mucous. Henoch-Schönlein Purpura (HSP) is also termed Purpura Rheumatica and is a disease that causes skin or organ haemorrhaging, inflammation of blood vessels and infection resulting in joint and abdominal pain with a rash. Gastroenteritis is inflammation within the gastrointestinal tract, affecting both the stomach and small intestine. Vomiting and diarrhoea are symptoms.
How is Intussusception treated?
Depending on the severity of symptoms and how advanced the intussusception is before diagnosis, a range of treatments may be appropriate:
- Barium or water-soluble contrast enema: to reverse the obstruction.
- Air enema: to reverse the obstruction.
- Surgery: to squeeze out and resect the collapsed intestinal section.
- Laparoscopy: surgery using forceps to unfold and part the two intestinal sections.
After treatment the patient is given intravenous fluid and food until normal bowel peristalsis movement occurs.
What are long-term health implications of Intussusception?
If left untreated symptoms will worsen restricting blood flow and causing infection. Intussusception can become life-threatening, requiring medical emergency and immediate hospitalisation. Long-term health implications can be weakened organ function and gastrointestinal/bowel complications, such as rectal prolapse, Henoch-Schönlein Purpura (HSP), Gastroenteritis and Bacterial Meningitis.
How can Intussusception be prevented?
In children preventative measures such as early medical attention for symptoms or monitoring where viral and bacterial infections are identified. In adults, preventative measures may include both early intervention if symptoms occur and screening for polyps or tumours. Treatment for worms can also reduce the likelihood of developing intussusception.