first birthday. Intussusception is the leading cause of
abdominal surgery in children age 5 and younger.
In infants, 3 boys develop intussusception for
every 2 girls that do, but as children age, the rate
changes sharply and the disorder becomes much
more common in boys. By age 4, the boy:girl ration
is 8:1. There is no difference in the rate of intussuscep-
tion among races or ethnic groups. Internationally,
although few statistics are available, the rate seems to
be about the same as in the United States.
Adults can develop an intussusception, but the
condition is rare.Causes and symptoms
The cause of most cases of intussusception cannot
be identified (idiopathic intussusception). In general,
researchers believe that uneven forces on the wall of
the intestine start the process. In some cases, a spot
called a lead point develops. This seems to be a heavy
spot or pocket on the wall of the intestine that then
’’leads‘‘ the slide of one section of intestine into
another. Some lead points develop around surgical
scar tissue, tumors, polyps, collections of blood or
fluid in the intestinal wall, or, in the case of cystic
fibrosis, the accumulation of sticky mucus on the
wall of the intestine. However, a lead point is identified
in less than 12% of cases in children.
Another theory on why intussusception develops
suggests that the process is set off by uncordinated
bowel contractions (peristalsis). Viral infection may
also play a role. There is an association between recent
viral infection and intussusception, but no clear cause
and effect relationship has been determined. At one
time, it appeared that vaccination for rotavirus, a virus
that causes severe diarrhea in young children,
increased the rate of intussusception. The vaccine in
question was withdrawn from the U. S. market. As of2007, a new vaccine used in the United States against
rotavirus, RotaTeq, has shown no association with
increased intussusception.
Intussusception is a medical emergency. Symp-
toms of intussusception usually appear suddenly in
an otherwise healthy child. The classic symptoms of
intussusception are abdominal pain, vomiting, and
passing reddish, jelly-like stools called ‘‘current jelly’’
stools. The jelly-like material comes from shedding of
mucus from the intestinal wall, and the red is from
fresh blood. However, this constellation of three
symptoms is present in only about 20% of children.
About 50% of children have abdominal pain and
current jelly stools without vomiting.
Normally an infant who appears healthy suddenly
draw up his or her legs and scream or cry frantically in
pain. The child may vomit. This is followed by a
period when the pain disappears and the child appears
normal. Painful episodes return, however, at roughly
10–20 minute intervals. The child may have loose
watery stools at first. Over time, the stools become
reddish and jelly-like. Eventually the child becomes
lethargic between bouts of pain and may develop a
swollen abdomen and fever. If left untreated, intussus-
ception is fatal.
Adults can also experience intussusception,
although the disorder is uncommon to rare. In adults,
the cause is often an unsuspected tumor or polyp
growing in the intestine. Symptoms often appear
much more gradually in adults and may come and go
over a long period. Adult symptoms of intussuscep-
tion include changes in bowel frequency, urgent desire
to have a bowel movement, abdominal cramps, pain in
a single area of the abdomen, rectal bleeding, nausea
and vomiting. These symptoms resemble the symp-
toms of other gastrointestinal disorders complicating
diagnosis.DiagnosisDiagnosis is made on the basis of patient history
and imaging studies. X ray images of the abdominal
region will show a mass orobstruction in the bowels.
Computed tomography (CT) scans or ultrasound
maybedoneinadditiontoxrays.Ifthereisnosign
that the bowel has torn (perforated) or ruptured, a
contrast x ray is done on the large intestine. In a
contrast colon x ray, a liquid containing barium is
inserted through the rectum and into the colon. The
barium contrasts with thesurrounding tissue to pro-
vide clearer x ray images of the affected area.KEY TERMS
Gangrene—death of body tissue due to a cutting off
of the blood supply
Idiopathic—occurring from unknown causes
Perforation—a whole in the wall of an organ in the
body
Polyp—a tissue growth that extends out into the
hollow space of an organ such as the intestine or
uterus.
Rectum—the last few inches of the large intestineIntussusception