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Definition
Intussusception is the enfolding of one segment of the intestine within another. It is characterized by and initially presents with recurring attacks of cramping abdominal pain that gradually become more painful.
Description
Intussusception occurs when part of the bowel or intestine is wrapped around itself, producing a mass-like object on the right side of the abdomen during palpation (a procedure used during a physical examination, when the examiner touches the abdomen with his/her hand, usually feeling for mass, pain, or discomfort). The number of new cases of intussusception is approximately 1.5 to four cases per 1,000 live births. The onset of abdominal pain is usually abrupt and severe. Just as fast as the onset of pain appears, it disappears and the child resumes activity normally. This process of sudden severe abdominal pain appearing out of the blue, then disappearing, is repeated with duration of painful attacks. The pain usually increases after approximately five hours of recurrent cycles of severe abdominal pain followed by relaxation. Vomiting and diarrhea occur in about 90% of cases within six to 12 hours after initial onset of symptoms.
Physical examination and palpation usually reveal a sausage-shaped mass of enfolded bowel in the right upper mid-portion of the abdomen. Within a few hours approximately 50% of cases have bloody, mucus-filled bowel movements. At about this time the child is visibly very ill with fever, tenderness, and distended abdomen. Intussusception is the most frequent cause of intestinal obstruction during the first two years of life and commonly affects children between three to 12 months of age. The disease is three times more common in males than in females. In about 85% of cases the cause is idiopathic (meaning that it is unknown). The remaining 15% of cases can be caused by a variety of such other diseases as tumors of the lymph nodes (lymphoma), fat tumors (lipomas), foreign bodies/objects, or from infections that mobilize immune cells to the area causing and an inflammatory reaction and intestinal blockage. Most cases of intussusception do not strangulate the affected bowel within the first 24 hours. If the disease is not treated after this time, the possibility of intestinal gangrene, shock, and death increases.
— Laith Farid Gulli, M.D.
