Abdominal pain in children - intussusception
Intussusception is the sliding of one part of the intestine into another.
This article focuses on intussusception in children.
Intussusception is caused by part of the intestine being pulled inward into itself.
The pressure created by the walls of the intestine pressing together causes:
- Decreased blood flow
Intussusception can block the passage of food through the intestine. If the blood supply is cut off, the segment of intestine pulled inside can die. Heavy bleeding may also occur. If a hole develops, infection, shock, and dehydration can take place very rapidly.
The cause of intussusception is not known. Conditions that may lead to the problem include:
- Viral infection
- Enlarged lymph node in the intestine
- Polyp or tumor
The reason for the problem is more likely to be found in older children.
Intussusception can affect both children and adults. However, most cases occur in children ages 6 months to 2 years. It affects boys 4 times as often as girls.
The first sign of intussusception is very often sudden, loud crying caused by abdominal pain. The pain is colicky and not continuous (intermittent), but it comes back often. The pain will get stronger and last longer each time it returns.
An infant with severe abdominal pain may draw the knees to the chest while crying.
Other symptoms include:
- Bloody, mucus-like bowel movement, sometimes called a "currant jelly" stool
- Shock (pale color, lethargy, sweating)
- Stool mixed with blood and mucus
Exams and Tests
Your doctor will perform a thorough exam, which may reveal a mass in the abdomen. There may also be signs of dehydration or shock.
Tests may include:
The child will first be stabilized. A tube will be passed into the stomach through the nose (nasogastric tube). An intravenous (IV) line will be placed in the arm, and fluids will be given to prevent dehydration.
In some cases, the bowel blockage can be treated with an air or contrast enema. This is done by a radiologist skilled with the procedure. There is a risk of bowel tearing (perforation) with this procedure.
The child will need surgery if these treatments do not work. The bowel tissue can very often be saved. Dead tissue will be removed.
Antibiotics may be needed to treat any infection.
Intravenous feeding and fluids will be continued until the child has a normal bowel movement.
The outcome is good with early treatment. There is a risk this problem will come back.
When a hole or tear in the bowel occurs, it must be treated right away. If not treated, intussusception is almost always fatal for infants and young children.
When to Contact a Medical Professional
Intussusception is an emergency. Call your doctor right away, then call 911 or go to the emergency room right away.
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Maloney PJ. Gastrointestinal disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 171.
Manning AT, Little DC. Intussusception in infants and children. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 5th ed. Philadelphia, PA: Elsevier; 2016:chap 51.