How to treat intussusception in children?

Written by Hu Qi Feng
Pediatrics
Updated on September 03, 2024
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Intussusception is a life-threatening emergency that requires urgent reduction once diagnosed. Reduction methods include non-surgical and surgical therapies. Within forty-eight hours of intussusception, if the overall condition is good, there is no abdominal distension, and no significant dehydration or electrolyte imbalance, reduction can be attempted under ultrasound guidance using hydrostatic enema, air enema, or barium enema. If the intussusception has lasted beyond forty-eight to seventy-two hours, or if there is severe abdominal distention, intestinal necrosis, or perforation, surgical treatment is necessary.

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Written by Yao Li Qin
Pediatrics
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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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Written by Hu Qi Feng
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Symptoms of recurrent intussusception in children

5-8% of the children may experience recurrent intussusception. Enema reduction has a higher recurrence rate than surgical reduction. The manifestations of recurrence are similar to the initial episode, primarily presenting as abdominal pain, vomiting, bloody stools, or a palpable intussusceptum-like mass in the abdomen. The abdominal pain is mainly intermittent, and can last for several minutes or longer, accompanied by pale complexion. The vomitus may include curds or food residues, possibly containing bile; in later stages, it may resemble fecal matter. Bloody stools may appear as jelly-like mucoid blood.

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Written by Hu Qi Feng
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Infant intussusception typical symptoms

The typical clinical manifestations of intussusception are as follows: Firstly, abdominal pain, which occurs in paroxysmal, regular episodes, characterized by sudden onset of severe colicky pain. The child appears restless and cries, with knees drawn to the abdomen, pale complexion, and relief coming after several minutes or longer; the pain reoccurs every ten to twenty minutes. Secondly, vomiting is an early symptom, initially reflexive containing milk curds or food residues, later possibly containing bile, and in the late stage, fecal-like liquid may be vomited. Thirdly, bloody stools are a significant symptom, appearing within the first few hours; initially, stools may appear normal, later becoming scanty or absent. In about 85% of cases, a jam-like mucousy bloody stool is passed within six to twelve hours of onset, or bloody stools are found upon rectal examination. Fourthly, abdominal mass is often found in the right upper quadrant just below the ribs, where a slight movable intussusception mass can be palpated, resembling a sausage.

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Causes of intussusception in children

The etiology of intussusception is divided into primary and secondary types, with 95% being primary, which is common in infants and young children. In infants, the mesentery of the ileocecal region is not yet fully fixed and has a larger degree of mobility, which is a structural factor conducive to the occurrence of intussusception. Secondary cases account for about 5%, often secondary to Meckel's diverticulum, intestinal polyps, intestinal tumors, intestinal duplications, and abdominal purpura causing swelling and thickening of the intestinal wall, which can lead to intussusception. Certain factors may cause a change in the rhythmic movement of the intestines leading to disorder, thereby inducing intussusception, such as changes in diet, viral infections, and diarrhea.

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Written by Yan Xin Liang
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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.