- What is intussusception?
- How common is intussusception?
- What causes intussusception?
- What are the risk factors of developing intussusception?
- Does the rotavirus vaccine cause intussusception?
- What are the symptoms of intussusception?
- How is intussusception diagnosed?
- How is intussusception treated?
- What are the long-term effects of intussusception?
- What are the complications of untreated intussusception?
- How to prevent intussusception?
Gastrointestinal problems in infants are often complicated. But one issue that leads to severe outcomes is intussusception, a condition where the small intestine collapses, affecting the baby’s ability to digest food and derive nourishment from it. But what causes intussusception in the first place and how can you prevent it?
What Is Intussusception?
Intussusception is a condition where one section of the small intestine folds and collapses over the next section. The intestine is like a tube. So when one part folds over the other, it slips into another segment, creating a very deep fold akin to the folding of a collapsible telescope (1).
In medical terms, the condition is described as an invagination of the bowel (2). Intussusception narrows down the channel inside, constricting the flow of blood, and inhibiting the movement of the lymphatic fluids. It also impairs the exterior muscles’ ability to push food, leading to complications and infection. All this make intussusception a life-threatening disease.
How Common Is Intussusception?
The condition is the most common cause for intestinal blockage among children aged between three months and three years, although it can affect children as old as six years too. About 80% of cases occur among infants younger than two years. Intussusception is rare among babies under three months of age, while those aged between five and nine months are at the highest risk.
In the US, about two cases of intussusception in 1000 births are reported. The condition is more common in males than in females. 80% of cases are ileocolic intussusception, which is when the ileum (the last part of the small intestine) collapses on cecum (the first section of the large intestine).
[ Read: Blood in baby stool ]
What Causes Intussusception?
The exact cause of intussusception is not known (3). Medical experts believe that intussusception is genetic and runs in families. Some diseases and scenarios may also increase the chances of developing a collapsed intestine.
What Are The Risks Of Developing Intussusception?
Babies are at a higher risk of developing intussusception if they have any of the following problems:
- Viral gastrointestinal infection
- An intestinal or an abdominal tumor and polyps
- Gastrointestinal parasitic disease
- Celiac disease
- Crohn’s disease
- Cystic fibrosis
- A side effect of recent intestinal surgery
The above problems only increase the risk of intussusception and do not necessarily always cause it. But you should be more vigilant about intussusception symptoms when the baby has any of the above conditions.
Does The Rotavirus Vaccine Cause Intussusception?
The current rotavirus vaccine seldom causes intussusception as a side effect. An older version of rotavirus vaccine introduced in the year 1998 was found to be associated with intussusception in one among 10,000 pediatric recipients of the vaccine. The vaccine was discontinued in the year 1999 (4).
Newer versions of the vaccine, which were tested to check for intussusception side effect and licensed in the year 2006 and 2008 (5). The risk with the new rotavirus vaccine reduced to one in 100,000, which medical experts state is the same risk of a baby developing intussusception without getting the rotavirus vaccine.
What Are The Symptoms Of Intussusception?
A baby with intussusception will display the following symptoms:
- Bloody, jelly-like stools with a lot of mucus. Your baby may alternate bloody stools with normal stools that contain blood spots.
- Severe abdominal pain.
- Colic and irritability due to pain in the stomach. The baby will draw their feet up, curl them up, or rub their hand on their belly indicating discomfort.
- Frequent vomiting, especially after a feed or meal. Vomiting usually follows abdominal pain.
- Swollen and bloated abdomen.
- Malnutrition and dehydration. It happens because the baby’s intestine is unable to absorb sufficient food and water.
- Extreme lethargy and drowsiness.
- Fever, in case the baby develops an infection in the intussuscepted part of the intestine.
Intussusception is a medical emergency. Book a doctor’s appointment right away if your baby displays any of the above symptoms.
[ Read: How To Relieve Stomach Pain In Infants ]
How Is Intussusception Diagnosed?
The doctor will diagnose the condition using the following diagnostic tools and measures:
- Tactile examination: Intussusception forms a distinctive sausage-like lump inside the abdomen that a doctor can feel on touching a baby’s belly.
- Abdominal X-ray: An X-ray film can display intestinal blockage.
- Ultrasound: Abdominal ultrasounds give better imagery than an X-ray, and let the doctor examine the intensity of intestinal collapse.
- Barium tests: The doctor will give a barium metal fluid to the baby either to drink or through an enema. Once inside the gastrointestinal tract, barium creates a detailed image of the intestines in the X-ray. It helps in an accurate diagnosis of the problem and its extent.
Treatment depends on the severity of the condition.
How Is Intussusception Treated?
There are two ways of treating intussusception among infants:
Enema: Enema treatment, which is usually combined with the barium diagnosis test, is effective in 80% of cases. Barium is given through the anal opening with a high-pressure nozzle that can often force the fold of the intestine open. Other types of enema used include saline enema and air enema.
A saline enema has saline water while the air enema is when a rectal nozzle pumps air at high pressure to unfold the intestine. The doctor will not use air enema in case the intussusception is infected, since the pressurized air may force pathogens further up into the bowel.
Surgery: Severe, infected intussusception cases and those that do not respond to enema will require surgical intervention. The surgeons will manually unfold the overlapped part of the intestine. Any infected part of the fold is removed, and the rest of the intestine is stitched back. The aim would be to retain as much intestine as possible and treat the mildly infected intestine with oral medications. Removal of large sections of the intestine is rare.
The enema treatment has a 10% recurrence rate of intussusception. Surgery may offer a permanent cure, but involves higher risk and has a lasting impact on the functioning of the gastrointestinal tract of the baby. Post-operative care depends on the age of the baby but mostly involves giving intravenous fluids and sticking to a liquid diet.
The recovery time depends on the severity of intussusception and the method of treatment. Surgery can push the recovery by several weeks while the baby may have to go for a doctor checkup for many months after the procedure.
What Are The Long-term Effects Of Intussusception?
The long-term effects depend on the extent of the condition. Babies who have a section of their intestine removed during surgery could make it vital for the baby to eat and drink fluids more frequently than usual. Your child’s pediatrician can provide a diet plan that provides adequate calories and nutrition for such a baby. However, the majority of cases that are treated early will have no long-term effects.
[ Read: Signs Of Dehydration In Babies ]
What Are The Complications Of Untreated Intussusception?
It is highly unlikely the condition will get unnoticed, but if you significantly delay the treatment, intussusception can lead to the following complications:
- Infection of the intestine
- Bleeding across the entire abdominal cavity
- Peritonitis, a severe infection where a pathogen invades all organs of the abdomen
- Sepsis in case a pathogen passes into the bloodstream and reaches different parts of the body
- Death of the intestinal tissue
All the above complications are fatal but highly unlikely to occur since you would notice the symptoms of the condition and proceed to treatment even before a complication sets into action.
How To Prevent Intussusception?
There is no way to prevent intussusception since there is no single fundamental cause for it. Staying vigilant in case of high-risk babies is the only way to catch the condition early and prevent the onset of any complications.
Intussusception is a rare condition but can cause severe misery when it happens. It is quite likely that you will pick up the symptoms easily at home. In the majority cases of intussusception, a minimally invasive treatment with negligible impact on the gastrointestinal tract is enough, so that the baby can eat, thrive, and live a healthy life.
[ Read: Signs Of Appendicitis In Infants ]
Do you have any suggestions on how to care for a baby with this condition? Share your experiences in the comments section below.
2. Intussusception; The University of Chicago
3. Intussusception in Children; University of Rochester Medical Center
4. A Look at Each Vaccine: Rotavirus Vaccine; Children’s Hospital of Philadelphia
5. Rotavirus; University Of Colorado Denver
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