What is Intussusception?
Intussusception is a condition where the proximal part of the intestine is swallowed into the distal part. The intestine that is swallowed inside is called the Intussusceptum, and the outer intestine is called the Intussuscipiens. The most common site is the Terminal Ileum, which is swallowed into the large intestine. It is also a common cause of abdominal emergencies in children aged 3 months to 2 years.
Symptoms of Intussusception that Parents Should Watch for in Their Child
Children with intussusception often have cramping abdominal pain that comes and goes, with periods of relief alternating with pain. In young children, parents may notice the child crying out, tensing up, and drawing their legs up. This lasts for a while, then the child stops crying and calms down. Other symptoms of bowel obstruction may include vomiting bile, abdominal distension, and if left untreated, passing stool mixed with mucus and blood (Currant jelly stool). Therefore, it should not be ignored. If the child shows initial symptoms or suspicion, it is better to take them to see a doctor promptly.
Diagnosis of Intussusception
Doctors diagnose intussusception using the following methods:
1. Plain abdominal film is an X-ray of the abdomen, used as an initial radiological examination to diagnose causes of acute abdominal pain, abdominal trauma, and foreign body ingestion. It can show signs of bowel obstruction, such as dilation of the small intestine proximal to the obstruction, absence of air in the colon, and soft tissue shadows commonly found in the right upper abdomen.
2. Ultrasonography is an examination using high-frequency sound waves emitted from a transducer. The sound waves reflect differently depending on tissue density and depth. The transducer receives these signals and processes them into images. This method has the advantage of no direct radiation exposure to the patient. Typical ultrasound findings include the target sign or bull’s eye sign in the transverse view and the pseudokidney sign in the longitudinal section.
Treatment Guidelines for Intussusception
1. Patients should receive intravenous fluid resuscitation because they often have dehydration from vomiting, bowel obstruction (small bowel obstruction), or fasting (NPO).
2. In patients with normal blood pressure and no signs of bowel ischemia, non-surgical treatment is considered. Currently, pneumatic reduction using air pressure is preferred due to its safety and relatively high success rate.
3. Surgery is performed if pneumatic reduction fails or if there are signs of bowel gangrene or perforation. During surgery (laparotomy), the surgeon manually reduces the intussusception by gently pushing the intussusceptum back to its normal position (manual reduction). The surgeon should also look for a pathologic leading point, such as a congenital diverticulum of the small intestine (Meckel’s diverticulum). If manual reduction is not possible or bowel gangrene is found, bowel resection should be considered.
Intussusception in Children and the Risk of Recurrence
Intussusception in children has a recurrence rate of 15% in those treated with pneumatic reduction and 5% in those treated surgically. Recurrence most commonly occurs within the first 24 hours. Frequent recurrences should raise suspicion of a pathologic leading point.
Phyathai 2 Hospital is equipped to treat pediatric intussusception with an experienced team of surgeons, radiologists, and care providers, and has internationally standard operating rooms. If parents are concerned, they can consult a doctor beforehand because proper and timely treatment improves outcomes and effectiveness.
Assoc. Prof. Dr. Chonsak Thiraphatpan
Consultant Pediatric Surgeon
Child and Adolescent Health Center, Phyathai 2 Hospital
