Due to the “glove finger” turning of a portion of the intestine, intussusception is signaled by violent abdominal pain. It is a cause of medical and surgical emergency in young children, as it can lead to intestinal obstruction. In older children and adults, it can take a chronic form and signal the presence of a polyp or a malignant tumor.

Definition

Intussusception (or intussusception) occurs when a portion of the intestine turns like a glove and engages inside the intestinal segment immediately downstream. Following this “telescoping”, the digestive tunics which form the wall of the digestive tract interlock with each other, forming an invagination roll comprising a head and a neck.

Intussusception can affect any level of the intestinal tract. However, nine times out of ten, it is located at the crossroads of the ileum (the last segment of the small intestine) and the colon.

The most common form is acute intussusception of the infant, which can quickly lead to obstruction and interruption of blood supply (ischemia), with a risk of intestinal necrosis or perforation.

In older children and adults, there are incomplete, chronic or progressive forms of intussusception.

Causes

Acute idiopathic intussusception, without an identified cause, usually occurs in healthy young children, but in a context of viral or ENT infection with winter recrudescence that has caused inflammation of the abdominal lymph nodes.

Secondary intussusception is linked to the presence of a lesion in the wall of the intestine: a large polyp, a malignant tumor, an inflamed Merckel’s diverticulum, etc. More general pathologies may also be involved:

• rheumatoid purpura,
• lymphoma,
• hemolytic uremic syndrome,
• cystic fibrosis …

Postoperative intussusception is a complication of certain abdominal surgeries.

Diagnostic

Diagnosis is based on medical imaging. 

Abdominal ultrasound is now the exam of choice.

The barium enema, an x-ray examination of the colon performed after an anal injection of a contrast medium (barium), was once the gold standard. Hydrostatic enemas (by injection of barium solution or saline) or pneumatic (by insufflation of air) under radiological control are now used to confirm the diagnosis. These examinations have the advantage of allowing at the same time an early treatment of intussusception by promoting the replacement of the invaginated segment under the pressure of the enema.

The people concerned

Acute intussusception mainly affects children under 2 years of age, with a peak frequency in infants aged 4 to 9 months. Boys are twice as affected as girls. 

Intussusception in children over 3-4 years old and in adults is much rarer.

Risk factors

Congenital malformations of the gastrointestinal tract may be a predisposition.

A small increase in the risk of intussusception following the injection of a vaccine against rotavirus infections (Rotarix) has been confirmed by several studies. This risk occurs mainly within 7 days of receiving the first dose of vaccine.

In infants, very violent abdominal pain, of sudden onset, manifested by intermittent seizures lasting a few minutes. Very pale, the child cries, cries, gets agitated… Separated at the start by intervals of 15 to 20 minutes, the attacks are more and more frequent. In lulls, the child may appear serene or on the contrary prostrate and anxious.

Vomiting appears quickly. The baby refuses to feed, and blood is sometimes found in the stool, which looks “like gooseberry jelly” (the blood is mixed with the intestinal lining). Finally, stopping intestinal transit evokes intestinal obstruction.

In older children and adults, symptoms are mainly those of intestinal obstruction, with abdominal pain and cessation of stool and gas.

Sometimes the pathology becomes chronic: intussusception, incomplete, is likely to regress on its own and the pain manifests itself in episodes.

Acute intussusception in infants is a pediatric emergency. Serious or even fatal if left untreated due to the risk of intestinal obstruction and necrosis, it has an excellent prognosis when properly managed, with a very low risk of recurrence.

Global support

Infant pain and the risk of dehydration should be addressed.

Therapeutic enema

Nine times out of ten, pneumatic and hydrostatic enemas (see diagnosis) are sufficient to put the invaginated segment back in place. The return home and the resumption of eating are very quick.

surgery

In the event of late diagnosis, failure of the enema or contraindication (signs of irritation of the peritoneum, etc.), surgical intervention becomes necessary.

Manual reduction of intussusception is sometimes possible, by exerting back pressure on the intestine until the sausage disappears.

Surgical resection of the invaginated part can be performed by laparotomy (classic open stomach operation) or by laparoscopy (minimally invasive surgery guided by endoscopy).

In case of intussusception secondary to a tumor, this must also be removed. However, it is not always an emergency.