A Family Doctor's Tale - INTUSSUSCEPTION

DOC I HAVE INTUSSUSCEPTION

Intussusception is the telescoping of one part of the intestine into the distal(lower) part of the intestine.

Intussusception is most common in children between 3 months and 1 years of age.

Boys are affected 2 times more than girls.

It seldom occurs in children under 3 months of age or in older children.

It rarely occurs in adults.

The process of  intussusception involves a part of intestine (called the intussusceptum) telescopes into a more distal part (called the intussuscipiens) and pulls the accompanying mesentery, vessels, and nerves together into the intussuscipiens.


As a result the compression of the veins and swelling of the region results in blockage of the lumen of the intestine and reduce the blood flow to the affected part of the intestine.

Most cases affect the junction where the small intestine meets the large intestine.

Intussusception because of its obstruction effect on the intestine requires urgent attention and treatment.

The causes of of intussusception are not fully known although some viral and bacterial infections of the intestine may be a possible cause.

In older children and adults possible causes of intussusception may be due to polyps or tumors.

Typical Symptoms of intussusception are:
1.abdominal pain or cramps often with the baby drawing up its knees
when crying

2.vomiting episodes together with the abdominal pain.

The vomiting is not associated with food and may be  like bile in
color(yellow-green).

3.bloody and mucous stool(also called black currant jelly stools)may be present

Others symptoms are:
1.paleness,
2.lethargy,
3.fever
4.shock

Intussusception is diagnosed by:
1.history of abdominal pain, vomiting and black currant stools may suggest the diagnosis of intussusception.

2.On examination  an abdominal "sausage-shaped" mass (the intussusception itself) can sometimes be felt on palpation of the abdomen.
Diminished bowel sounds may suggest obstruction.

3.abdominal X-rays can show signs of an intestinal obstruction, with air-fluid levels, decreased gas, and unexplained masses, usually seen in the right lower region of the abdomen.

4.Ultrasound and CT scans are not necessary to make the diagnosis.

Early diagnosis and treatment of intussusception is essential in
order to prevent complications such as :
1.injury to the intestine from blockage


2.perforation of the  bowel,

3.sepsis

4.death.

The treatment of intussusception may not require surgery.

1.In some cases, the intestinal obstruction can be reversed using a barium enema.

The barium liquid enters the large intestine and pushes its way up to the small intestine. The pressure of the flow of the enema may push the telescoped small intestine out of its receptor and reverse the process of telescoping.


There is a risk of intestinal rupture.

2.If the above procedure is unsuccessful, surgery is necessary to reverse the intussusception and relieve the obstruction.

Any part of the intestine which has become gangrenous must be removed.

Intravenous feeding and fluids after surgery are continued until normal bowel movements returns.

The prognosis for intussusception is usually good with early diagnosis and treatment.