Intussusception: How to Diagnose

Written by Yao Li Qin
Pediatrics
Updated on January 19, 2025
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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.

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Intussusception earliest symptoms

The earliest symptoms of intussusception are primarily abdominal symptoms, including mild abdominal distension, abdominal pain, with pain mainly around the navel. This pain generally does not show significant relief and tends to intensify. There may also be cessation of passing gas and stool, and the patient might sometimes experience nausea and vomiting. If the symptoms of intussusception do not alleviate, we carry out an abdominal imaging examination, which may reveal fluid levels, indicating intestinal obstruction, and the intussuscepted bowel can be found. At this point, early air enema reduction can be performed. If the condition is not treated timely, it can lead to aggravated symptoms of intestinal obstruction, and even require surgical treatment.

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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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Written by Bai Yan Hui
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How to check for intussusception?

Intussusception is primarily diagnosed based on medical history, symptoms, physical signs, and auxiliary examinations. Medical history is mainly gathered by asking the parents, which is very important. Physical signs involve the doctor performing an abdominal palpation, where generally a mass can be felt on the abdominal wall. Auxiliary examinations usually include abdominal ultrasonography and upright abdominal plain films. For more complicated cases or when the location is unique and difficult to detect, a CT scan of the intestines may be performed to make the final diagnosis.

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Written by Yan Xin Liang
Pediatrics
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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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Does intussusception cause diarrhea?

Intussusception is a common surgical condition in infants and young children, characterized primarily by symptoms such as abdominal pain, crying, abdominal distension, the passage of jelly-like stools, and vomiting. Some children may also experience diarrhea and frequent passage of jelly-like stools, where the symptoms of intussusception may not be particularly noticeable, leading parents to possibly overlook them. Therefore, if a child has diarrhea accompanied by jelly-like stools, it is crucial to take the child to the hospital for a consultation and an ultrasound to confirm whether it is caused by intussusception. If left untreated for a long time, it can lead to ischemic necrosis of the intestinal mucosa, necessitating surgical treatment.