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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Causes of intussusception in children

The causes of intussusception are divided into primary and secondary types, with 95% being primary, commonly seen in infants and young children. In infants, the mesentery of the ileocecal area is not yet fully fixed and has greater mobility, which is a structural factor prone to intussusception. Secondary cases account for 5%, where intussusception occurs. Some intestines show clear organic changes, such as Meckel's diverticulum, intestinal polyps, intestinal tumors, intestinal duplication anomalies, abdominal purpura, and thickening of the intestinal wall, which can cause intussusception of the intestines. Certain triggers, including dietary changes, viral infections, and diarrhea, can induce intussusception.

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Intestinal intussusception described by ultrasound.

The appearance of intussusception under ultrasound shows concentric or target ring-shaped mass images on a transverse section scan, and a sleeve sign on a longitudinal section scan. For an ultrasound-guided hydrostatic reduction, a balloon is inserted through the anus and inflated, connecting a T-tube to a Foley catheter with a side tube connected to a sphygmomanometer to monitor water pressure. Isotonic saline at a temperature of thirty to forty degrees is injected, and the target ring-shaped mass image can be seen retracting to the ileocecal region. The disappearance of the concentric circles or sleeve sign under ultrasound indicates the completion of this therapeutic diagnosis.

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Is intussusception in children serious?

Intussusception is a life-threatening emergency, and its reduction is an urgent medical treatment that must be performed immediately once diagnosed. Generally, in the early stages of intussusception, the general condition is still good, with normal body temperature and no symptoms of systemic toxicity. As time progresses, the condition worsens, and there may be necrosis of the intestines or peritonitis, with overall health deteriorating. Common severe symptoms include dehydration, high fever, lethargy, coma, and shock from toxicity.

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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.

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Does infant intussusception require surgery?

Intussusception lasting between forty-eight and seventy-two hours, or if the duration is shorter but the condition is severe, including cases with intestinal necrosis or perforation, as well as those involving small intestine type intussusception, all require surgical treatment. Depending on the overall condition of the child and the pathological changes in the intussuscepted bowel, options include reduction of intussusception, intestinal resection and anastomosis, or enterostomy, etc.