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Intussusception (cont.)

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How is intussusception diagnosed?

The history of abdominal pain and vomiting as described above, may suggest the diagnosis of intussusception. Additionally, the examining doctor may feel an abdominal "sausage-shaped" mass (the intussusception itself) or upon auscultation with a stethoscope, may hear diminished or absent bowel sounds. Lab tests are usually not helpful, although plain abdominal X-rays can reveal signs of an intestinal obstruction, including air-fluid levels, decreased gas, and unexplained masses, usually seen in the right lower quadrant of the abdomen. Ultrasound and CT scans are generally not required to make the diagnosis.

A barium, water-soluble contrast or air enema is considered both diagnostic and therapeutic in the management of intussusception. This radiologic procedure involves the introduction of the contrast into the lower intestine. If an intussusception is present, it will be seen during the imaging. Often just the introduction of the contrast will reduce the telescoped bowel to its normal position and shape. In these cases there is a high risk of for re-intussusception in the first 24 hours following the enema, though, less commonly, recurrence may be seen several days and even months later.

Is it necessary to operate when there is intussusception?

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The treatment of intussusception may or may not require surgery. In some cases, the intestinal obstruction can be reversed with an enema. The enema carries a risk of intestinal rupture and cannot be done if the bowel has already perforated. The procedure also requires the availability of a surgeon, in case the patient's bowel ruptures or the intussusception cannot be reduced.

If the intestinal obstruction cannot be reversed by an enema, surgery is necessary to reverse the intussusception and relieve the obstruction. If a portion of the intestine has become gangrenous, it must be removed. After surgery, intravenous feeding and fluids are continued until normal bowel movements resume. Because of the risk of recurrence, patients who are successfully reduced by enema usually are admitted for observation during the first 24 hours post procedure, and have no ill effects. Recently, research has suggested that a select population of the children may be observed for shorter periods of time (6 hours) after undergoing reduction of the intussesception by enema, but currently, most patients stay the full 24 hours.

Medically Reviewed by a Doctor on 10/18/2012

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