How to treat intussusception in children?

Written by Quan Xiang Mei
Pediatrics
Updated on February 02, 2025
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Intussusception in children is a common surgical condition. The treatment approach depends on the severity of the child's clinical symptoms. If the intestines have not been telescoped for long, and the intestinal mucosa has not suffered ischemic necrosis, and if the clinical symptoms are mild, air enema can be used to relieve the intussusception without the need for surgery. However, if the clinical symptoms are severe and necrosis has been prolonged, meaning the intestinal mucosa has reached a state of ischemia and necrosis that is irreparable, surgical treatment in a surgical setting is definitely required. Whether surgery or air enema is needed should be decided based on the actual color ultrasound results and a comprehensive diagnosis by the clinician.

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Written by Yan Xin Liang
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Early symptoms of intussusception in children

Intussusception in children refers to a segment of the intestine telescoping into the adjoining lumen, causing an obstruction to the passage of intestinal contents. Intussusception accounts for 15%-20% of intestinal obstructions and can be primary or secondary. Generally, primary intussusception is more common in infants and young children. Early symptoms may include bloating, abdominal pain, vomiting, possibly accompanied by bloody stools, and a palpable mass in the abdomen. Moreover, intussusception can occur in multiple locations, such as jejunum into jejunum, jejunum into ileum, ileum into ileum, ileum into cecum, ileum into colon, colon into colon, etc. Among these, ileo-cecal intussusception is the most common, while small intestine into small intestine and colon into colon are relatively rare.

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Causes of Intussusception in the Elderly

Intussusception refers to an obstruction caused by one segment of the intestine entering an adjacent segment, which can occur at any age. In adults, over 85% of intussusception cases can be attributed to organic lesions, typically tumors, but also possibly due to polyps or diverticula in the intestines. Typical symptoms of intussusception may include abdominal pain, an abdominal mass, and jelly-like bloody stool. In adults, intussusception is generally treated surgically. The surgical approach often involves exploratory laparotomy, possibly involving intestinal resection and anastomosis. For the resected part, reinforced suturing is usually required. If a primary anastomosis cannot be tolerated, procedures such as creating a stoma or exteriorizing the intestine may be performed, awaiting stabilization of the condition before further treatment.

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Can intestinal intussusception have bowel movements?

After the occurrence of intussusception, the patient's symptoms often manifest as those of intestinal obstruction, causing significant abdominal pain, cessation of gas and stool passage through the anus, and a palpable abdominal mass can be felt. Imaging studies can clearly indicate signs of intussusception. Once intussusception occurs, the patient stops passing stool, and symptoms such as vomiting and nausea also occur. Once diagnosed, it is crucial to treat promptly, including air enema reduction or surgical treatment, to promptly address the symptoms of intussusception, prevent the worsening of intestinal obstruction symptoms, and avoid severe complications such as intestinal necrosis, which can endanger the patient's life.

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Symptoms of intussusception in infants

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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How is intussusception diagnosed?

Intussusception is one of the common acute abdominal conditions in infants and young children. The primary clinical symptoms include abdominal pain, vomiting, and "jam-like" stools, with a mass often palpable in the abdomen. Initially, the overall condition of the child is generally fine, but in the later stages, symptoms such as dehydration, lethargy, coma, and shock can appear. Any healthy infant or young child who suddenly experiences episodic abdominal pain or periodic, regular bouts of crying, accompanied by vomiting, bloody stools, and a sausage-shaped mass in the abdomen, should be highly suspected of having intussusception. Once intussusception is confirmed, timely enema treatment should be administered to the child, and if the opportunity for an enema has passed, surgical treatment should be considered.