Intussusception

I was told my child has an intussusception (intus). What is it?

Intus occurs when a segment of bowel (the intussusceptum) telescopes into the lumen of another segment of bowel (the intussuscipiens). It is the most common cause of tummy pain in children aged 3 months to 3 years old. It is most commonly idiopathic. It can happen after a viral infection, or after rotavirus vaccination, or due to a lead point. When untreated, intussusception decreases the blood supply to the bowel or causes a perforation. Children become very sick when that happens. It is diagnosed using an ultrasound and treated with air or liquid reduction enema.

How does intussusception present in a child?

A child classically presents with tummy pain and updrawing of legs. There can be vomiting, no passage of stools or gas, or blood passed from the bottom. He / she becomes lethargic between the bouts of pain or develops a fever. The child needs to be examined by a pediatric surgeon or paediatrician. Other causes of tummy pain are varied and include diarrhoea, constipation, appendicitis, Meckel’s diverticulitis, etc.

How is the treatment for pediatric intussusception?

An intravenous cannula is set and blood tests are drawn to detect any abnormality. Your child should have nothing by mouth. Fluids and nutrients will be given via the cannula. I accompany your child to the Radiology department for the reduction enema. A reduction enema is first line treatment (1), failing which I perform a laparoscopic reduction of intussusception. When there is an intraluminal lead point for e.g. a polyp, I will bring the section of intestine out through the keyhole incision. Excision and anastomosis will then be performed and the intestine replaced into the tummy.

During the procedure, what happens?

A tube is placed into your child’s bottom. Either the radiologist or myself will hold the tube in place and restrain your child to prevent tube displacement. Enema reduction is performed. The progress is monitored with a type of X-ray with as minimal radiation as possible, or an ultrasound. This is needed to determine complete reduction of the intussusception. Your child cries during the procedure due to discomfort and anxiety. In a safely performed reduction enema, there is a less than 0.5% risk of bowel perforation due to the insufflation of air or liquid (2). I have not had this happen to my patients before, because the radiologist or myself will ensure that the pressure and attempts at reduction are not excessive. If the intussusception is not reduced or there is a bowel perforation, your child requires surgery.

After the procedure, can my child eat?

After successful enema reduction, your child will be monitored for symptoms of recurrence. The rate of recurrence is up to 20% post reduction (3), and treatment will be a repeat reduction enema or operation depending on the individual patient. He/she can have clear fluids, which will be advanced to food by the next day when there is no recurrence.

References

(1) Plut D, Phillips GS, Johnston PR, et al. Practical Imaging Strategies for Intussusception in Children. AJR Am J Roentgenol. 2020 Dec;215(6):1449–63.

(2) Gluckman S, Karpelowsky J, Webster AC, et al. Management for intussusception in children. Cochrane Database Syst Rev. 2017 Jun 1;6:CD006476.

(3) Carol WY Wong, Ivy HY Chan, Patrick HY Chung, et al. Childhood intussusception: 17-year experience at a tertiary referral centre in Hong Kong. Hong Kong Med J 2015 Dec;21(6):518-23.

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