Intussusception in Infants – Signs, Causes, and Treatment

Painful abdominal problems are common in infants. However, there are some abdominal ailments like intussusception, which is not known to many and may need immediate medical attention. It is important to diagnose this problem in time for effective treatment, quick relief and prevention.

What is Intussusception

Intussusception is a condition in which a part of the intestine folds in, moves, and slides/slips into the next part just like you would see in a foldup telescope. This obstructs the movement of fluids, food, bowel etc. in the intestine.

This disease makes the walls of the affected part of the intestine come under great pressure. This results in bleeding, irritation, swelling, infection, tissue damage and reduced intestinal blood supply. The affected part of the intestine can die in acute cases.

Age Groups That are Susceptible to Intussusception

Intussusception occurs in 1 to 4 out of every 1,000 infants. Around 1 % of 0 to 1-month-old infants and 80% of 5 to 10-month-old infants suffer from intussusception. Older kids below 3 years can also get it. Boys are more prone to it than girls.

Symptoms of Intussusception in Infants

Some symptoms may confuse you as they are similar to other conditions. Yet, you must know the symptoms of intussusception in infants:

• Loud, sudden crying with colicky, cramps and intermittent pain because of the folded intestine presses against blood vessels, tissues, and nerves. The pain recurs every 15-20 minutes initially. The duration and attacks increase as the condition intensifies.
• The infant may pull up the knees towards the chest or bend over while crying hard when the pain recurs.
• Some children may resume normal activities when the pain subsides. While others may be fatigued by the pain and the crying.
• Normal vomiting or yellowish, greenish vomit because of bile in it. This occurs right after the pain begins and may not be associated with meals.
• Research suggests that half of the affected children pass stool with mucus and even blood at times. It is called ‘jelly currant’ stool because it looks like that.
• Tiredness, weakness, lethargy, sleepiness, inactivity especially after a bout of pain.
• Sausage-like abdominal swelling/lump usually in the middle upper portion or right side of the hard and bloated stomach.
• Fever, pale, sweaty skin and diarrhoea are common symptoms of the disease as it advances.
• Sunken eyes, dry/sticky mouth, less urination (dry diaper) due to dehydration.
• Inflammation, shock and sepsis in complicated cases.

Please note that every infant does not have all or the same symptoms. Some may just experience pain.

What Are the Causes of Intussusception in Infants

Some of the suspected causes of intussusception in infants are:

• Meckel’s diverticulum is an abnormal, benign intestinal growth like a pouch, mass, polyp or a tumour. This is called the lead point. The intestine normally contracts in wave-like motions. During this motion, it may grab this lead point and pull it in so that it slides into the intestinal part preceding it.
• Virus or bacteria is a suspected cause because infant Intussusception occurs more during autumn-winter, with flu-like symptoms.
• Gastroenteritis/stomach flu that occurred before may enlarge lymph nodes (that fight infection) or tissues lining the intestine. This may be why one part of the intestine is sucked into another.
• An intestinal malrotation at birth where it fails to develop or rotate properly during the fetal stage. There may be intestinal blood vessel abnormalities as well.
• A family history of intussusception.
• Appendicitis may cause Intussusception in some infants.

How is Intussusception Diagnosed

Early diagnosis is important for quick, easy treatment and to prevent complications and surgery. Your paediatrician will first ask some questions about the symptoms and medical history. This will be followed by a physical examination of the child. If intussusception is suspected any of the following four diagnostic imaging procedures may be suggested. All imaging may typically display the intestine coiled within the intestine.

1. Abdominal X-ray

This is an imaging technique to detect the intestinal in-folding, blockage, tumour, mass, etc.

2. Abdominal Ultrasound

This technique provides more detailed imaging of blood flow in intestinal vessels, tissues, and the state of the functioning organs.

3. Abdominal CT Scan

This imaging can display intestinal rupture if any.

4. Air or Liquid Barium

This is an even more advanced imaging technique that can also treat the initial stages of intussusception. This procedure is either for the upper or lower intestine. The doctor inserts an air or liquid barium enema via the rectum into the stomach. Barium is a metallic, chemical, chalky substance that coats the organs so that they are clearly visible during imaging. In Infants, the liquid barium is preferably swallowed. Air enema is done by passing air through a tube inserted into the rectum.

These procedures can also correct intussusception because in some cases the pressure created when air or barium is inserted unfolds the intestine automatically. Studies suggest that this happens in 90 percent of infant cases and no other treatment is required. However, this may not work in complicated cases.

Complications of Intussusception

In extreme cases there may be a number of complications, some life-threatening as well:

• Blood supply can be totally disrupted in the diseased intestinal section. If this is not treated in time, it could lead to tearing, perforation, destruction, and the death of tissues. The affected intestine may become totally dysfunctional. The abdominal lining may get peritonitis.
• Peritonitis is an inflammation of the abdominal lining with symptoms like abdominal pain, bloating and fever.
• Peritonitis, in turn, may cause a shock that could turn life-threatening. Symptoms of peritonitis include – cold, clammy, pale, grey skin; poor or rapid pulse; light, slow or rapid breathing; and restlessness or listlessness.

Treatment for Intussusception

Intussusception may not require treatment in some infants because it goes away on its own. Infants requiring treatment if attended within 24 hours recover fully.

The kind of treatment for intussusception in infants is decided by the doctor depending on the seriousness, the child’s condition, suggestions of the medical staff involved, and parent’s preferences.

1. Initial Care

Prope care must be taken to stabilize the medical condition and prevent life-threatening complications. This involves:

• Intravenous (IV) fluids to prevent dehydration.
• Inserting a nasogastric tube into the stomach through the nose to expand the intestine.

2. Treating the Problem

Here are some ways to treat this problem:

a) Air Enema or Barium

In infants, intussusception is self-corrected during these imaging tests. An air or liquid barium enema via the rectum into the stomach. Barium coats the organs so that they are clearly visible during imaging. In Infants, the liquid barium is preferably swallowed. Air enema is done by passing air through a tube inserted into the rectum. This procedure can cure the problem, however, it may not work in severe complications and may require surgery.

b) Surgery

Surgery (under anaesthesia) is required if enema treatment fails; or if the lead point is a cause. A surgery helps in re-positioning the folded intestinal section, removing obstructions, dead tissues, or damaged intestinal portions.

If a small part is removed, the leftover parts are stitched together. In rare cases, a large part is removed and the remaining parts cannot be stitched back. In these cases, Ileostomy maybe conducted to restore the digestive system. In an ileostomy, the 2 remaining functional ends of the intestine are connected to abdominal openings called stoma. Stool passes through these openings into a bag. An ileostomy may be temporary or permanent (very rare) depending upon the amount of intestine removed.

All procedures are safe. The child has to stay in the hospital for a day or two because of post-surgical discomfort and the possibility of relapse.

When to Consult a Doctor

Bowel intussusception in infants can be life-threatening if diagnosis and treatment are not done in time. If you see any of the symptoms mentioned above, consult a doctor immediately. Don’t give unprescribed OTC medicines yourself and food before that.

Once your child is fine, consult your doctor about future prognosis because intussusception may relapse and in rare cases even come back in adulthood.

The degree of damage/removal of the intestine also has long-term implications. The digestive system may be affected if a large part of the intestine is removed. The child will need ongoing care in such cases.