Symptoms of intussusception in infants

Written by Hu Qi Feng
Pediatrics
Updated on September 22, 2024
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The clinical manifestations of intussusception mainly include abdominal pain, vomiting, bloody stools, and an abdominal mass. The abdominal pain is often spasmodic and regular, manifesting as sudden severe colicky pain. The child appears to be crying and restless, with knees drawn up to the abdomen, pale complexion, and the pain lasts for several minutes or longer but lessens after; it recurs every ten to twenty minutes, accompanied by intestinal movements. Vomiting is an early clinical symptom, initially consisting of milk curds or food residue, and later may include bile and fecal-like liquid. Bloody stool is an important symptom, appearing within the first few hours; initially, the stools can be normal, with about 85% of cases excreting jam-like mucoid bloody stools within six to twelve hours of onset. The abdominal mass is often located in the upper right abdomen below the costal margin, where a slight, tender mass can be palpated.

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Written by Hu Qi Feng
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Does intussusception require a CT scan?

Intussusception is commonly diagnosed through routine abdominal ultrasound examinations, which have a positive rate of over 90%. In the ultrasound, the transverse section of the intussusception can show concentric circles or target ring-shaped mass images, and the longitudinal section may reveal the sleeve sign. Additionally, a barium enema can be employed, along with X-ray imaging. Under X-ray, the lead point of intussusception appears as a mass shadow, and air enema reduction treatment can be performed concurrently. Generally, CT is not used as a routine diagnostic tool.

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Caused by infantile intussusception

Intussusception is divided into primary and secondary types, with 95% being primary cases, most commonly seen in infants and young children. This is due to the fact that the mesentery of the ileocecal part in infants and young children is not yet fully fixed and has a greater degree of mobility, which are structural factors that facilitate the occurrence of intussusception. The remaining 5% are secondary cases generally occurring in older children, where the affected intestines often have a clear organic cause, such as a Meckel's diverticulum turning into the ileal lumen, serving as the starting point for intussusception. Other causes like intestinal polyps, tumors, duplications, or abdominal purpura can cause the intestinal wall to swell and thicken, which can also trigger intussusception.

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Can intussusception heal itself?

Once intestinal intussusception occurs, only a small part can be spontaneously reduced. In most cases, urgent reduction treatment is required, including non-surgical and surgical treatments. Non-surgical treatment mainly involves enema therapy. Within 48 hours of the intussusception, if the overall condition is good, the abdomen is not distended, and there are no obvious signs of dehydration or electrolyte imbalance, barium enema treatment can be applied. If the duration of the intussusception exceeds 48 to 72 hours, or if the condition is severe with intestinal necrosis or perforation, surgical treatment is necessary.

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Can intussusception in children cause fever?

In the early stages of intussusception, the child generally remains in good condition, with normal body temperature and no symptoms of systemic poisoning. As the disease progresses and worsens, complications such as intestinal necrosis or peritonitis may develop, leading to deterioration of the overall condition. At this point, severe dehydration, high fever, lethargy, coma, and shock, among other symptoms of poisoning, can occur. Therefore, fever can indeed appear in the later stages of intussusception.

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Causes of intussusception in children

The etiology of intussusception is divided into primary and secondary types, with 95% being primary, which is common in infants and young children. In infants, the mesentery of the ileocecal region is not yet fully fixed and has a larger degree of mobility, which is a structural factor conducive to the occurrence of intussusception. Secondary cases account for about 5%, often secondary to Meckel's diverticulum, intestinal polyps, intestinal tumors, intestinal duplications, and abdominal purpura causing swelling and thickening of the intestinal wall, which can lead to intussusception. Certain factors may cause a change in the rhythmic movement of the intestines leading to disorder, thereby inducing intussusception, such as changes in diet, viral infections, and diarrhea.