Causes of intussusception in children

Written by Hu Qi Feng
Pediatrics
Updated on September 23, 2024
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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.

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Written by Hu Qi Feng
Pediatrics
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Infant intussusception symptoms

Intussusception clinically presents with abdominal pain, which occurs in fits and starts and has a regular pattern. This manifests as sudden spasmodic colic; the child cries and is restless, drawing the knees up to the belly and turning pale. The pain lasts for several minutes or longer, then eases off, allowing the child to fall asleep quietly. These episodes recur every 10 to 20 minutes as intestinal movements provoke further attacks. Vomiting occurs, initially consisting of curdled milk or food residues and later containing bile-stained, feculent fluid. Moreover, blood in stools is an important symptom. Symptomatically, stools may appear normal for a few hours, but within six to twelve hours, 85% of affected children might pass jelly-like mucus blood stools. A palpable lump can be detected in the upper right abdomen, indicative of the point of intussusception. As for general symptoms, the child may appear well early on, but as the condition worsens, intestinal necrosis or peritonitis may occur, leading to severe dehydration, high fever, lethargy, coma, shock, and other signs of systemic toxicity.

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How to treat intussusception in infants

The treatment of intussusception mainly includes non-surgical and surgical methods. The non-surgical method involves enema treatment. Within 48 hours of the onset of intussusception, if the overall condition is good, there is no abdominal distension, no apparent dehydration, and no electrolyte disorders, ultrasound-guided hydrostatic enema, air enema, or barium enema can be performed. If the intussusception lasts more than 48 to 72 hours, or if the duration is shorter but the condition is severe, with intestinal necrosis or perforation, surgical treatment is required.

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How to treat intussusception in children?

Intussusception is a life-threatening emergency that requires urgent reduction once diagnosed. Reduction methods include non-surgical and surgical therapies. Within forty-eight hours of intussusception, if the overall condition is good, there is no abdominal distension, and no significant dehydration or electrolyte imbalance, reduction can be attempted under ultrasound guidance using hydrostatic enema, air enema, or barium enema. If the intussusception has lasted beyond forty-eight to seventy-two hours, or if there is severe abdominal distention, intestinal necrosis, or perforation, surgical treatment is necessary.

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How is intussusception in infants caused?

Intussusception is divided into primary and secondary types, with 95% being primary, commonly seen in infants. This is due to the fact that the mesentery at the ileocecal region in infants is not fully fixed and has greater mobility, which are structural factors that facilitate intussusception. For the 5% of secondary cases, these are more common in older children, whose intestines often have clear organic causes for intussusception. These causes include the inversion of a Meckel's diverticulum into the ileal lumen serving as a lead point; intestinal polyps, intestinal tumors, intestinal duplications, and abdominal purpura can cause thickening and swelling of the bowel wall leading to intussusception. Additionally, certain facilitating factors can disrupt the rhythm of intestinal peristalsis, thereby inducing intussusception. Changes in diet, viral infections, and diarrhea are among the factors that can trigger intussusception.

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Written by Yao Li Qin
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Intussusception: How to Diagnose

Intussusception is one of the most common acute abdominal conditions in infants and toddlers, primarily seen in children under one year old. It refers to the condition where part of the intestine and its mesentery slip into an adjacent intestinal lumen, causing obstruction at the root of the intestine. The diagnosis of intussusception in children is mainly based on clinical symptoms. A previously healthy child may suddenly experience an episode of severe, regular, intermittent colicky pain. The child may appear restless, crying, with knees bent, a reduced amplitude of movement, and a pale complexion, with the abdominal pain easing after 10 to 20 minutes. The child may also vomit and pass bloody stools. Bloody stools are a very important symptom; approximately 85% of cases will pass jelly-like, mucousy bloody stools within 6 to 12 hours of onset, or even if there is no bloody stool visible, rectal examination can reveal its presence. A sausage-shaped mass can be felt in the abdomen. Furthermore, an ultrasound can show a typical image of a concentric circle or target-sign mass. Under ultrasound monitoring, procedures such as air or hydrostatic enema can be performed, which help in the early diagnosis of intussusception.