Intussusception: Smart Treatment & Care Must Meet

May 2021

Intussusception occurs when one of the loops of the intestine is drawn into the other, creating a "telescoping" effect. Intussusception can be caused by infection with rotavirus or by another GI tract disease such as intestinal polyposis, Meckel's diverticulum, lymphoma or leukemia.

Children who are under two years old and have distal ideal intussusception usually experience a painless passage of bloody stool followed one to two weeks later by severe abdominal pain. They may also have fever and vomiting. Less common symptoms include constipation, diarrhea, irritability and feeding problems that typically worsen with activity.

Intussusception is considered a surgical emergency, and a bowel resection may be required to remove the intussusceptum (or part of it). Antibiotics are not used in the treatment of intussusception because it is believed that this can make recovery more difficult or cause intussusception to occur in the opposite direction. Instead, pain medication such as morphine may be used.

One in ten infants with Intussusception will have a period of normal bowel movements between episodes. Mild intussusception tends to be more common in girls, while severe intussusception tends to occur more frequently in boys.

Rotavirus infection is the most common cause of intussusception. Rotavirus promotes hypertrophy of the intestinal villi, leading to enterocyte cell death and mucosal ulceration. Loss of enterocytes leads to occlusion of the microvasculature and subsequent thrombosis. The resulting hypoxia promotes synthesis and release of transforming growth factor-beta (TGF-β), which stimulates smooth muscle proliferation surrounding regions adjacent to the dead enterocytes.

Due to increased smooth muscle tone, blood vessels become compressed and are unable to deliver the oxygen required for healing. The process is further exacerbated with each cycle of cell death and regeneration. Continued cycles of hypoxia, thrombosis, infiltration of inflammatory cells and smooth muscle proliferation results in the development of intussusception.

The second leading cause of intestinal intussusception is lymphoma or leukemia. The formation of a tumor within the intestinal wall can cause it to bulge outward into an adjacent loop, leading to intussusception. Intussusception is a condition in which part of the intestine slides into an adjacent part of the intestine. The word is derived from Latin, where intrusa means "slide into" and sectio means "section, cut".

Symptoms include abdominal pain, vomiting, and constipation. Without treatment it can lead to bowel obstruction or peritonitis leading to death. In children it is a common cause of abdominal pain that may resolve without specific treatment. In adults it is often caused by some type of intestinal infection or condition interfering with peristalsis such as Crohn's disease or scleroderma. Treatment may involve surgery or observation with intravenous fluids if needed.

Intussusception occurs in up to 2 per 1000 live births. It affects males and females equally, and is most common in children under the age of five years, with an average age of six months at diagnosis. Approximately 1% to 6% of cases are familial or inherited.

Intussusception occurs when one segment of intestine (the intussusceptum) invaginates into a segment next to it (the intussuscipiens). The invaginating segment is called the "leading point". Intussusception can extend from the proximal end (duodenum) or middle (jejunum) of the bowel.

The most common configuration is "transverse intussusception" in which the intussusceptum (the leading point) extends laterally across the lumen of the intussuscipiens. This configuration is commonly seen in children younger than 6 months, but may occur in older children and adults.

Other configurations include "anterior intussusception" and "posterior intussusception". In anterior intussusception, the leading point extends into the intestine (intussusceptum), not through it; and the intussuscipiens is only partially involved. The anatomic term for this condition is "simplex anterior intestinal intussusception".

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