Intussusception (medical disorder)
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| ICD-10 | K38.8, K56.1 |
|---|---|
| ICD-9 | 543.9, 560.0 |
| OMIM | 147710 |
| DiseasesDB | 6913 |
| MedlinePlus | 000958 |
| eMedicine | emerg/385 |
An intussusception is a situation in which a part of the intestine has prolapsed into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another.[1] The part which prolapses into the other is called the intussusceptum, and the part which receives it is called the intussuscipiens. The most frequent type of intussusception is one in which the ileum enters the cecum, however other types are known to occur, such as when a part of the ileum or jejunum prolapses into itself. Almost all intussusceptions occur with the intussusceptum having been located proximally to the intussuscipiens. The reason for this is that peristaltic action of the intestine pulls the proximal segment into the distal segment. There are, however, rare reports of the opposite being true.
Intussusception in humans is almost exclusively a disease of the young, usually those between 2 months and 36 months old. It occurs more frequently in boys than in girls, with a ratio of approximately 3:1.[2]
In adults, intussusception represents the cause of approximately 1% of bowel obstructions and is frequently associated with neoplasm, malignant or otherwise.[3]
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[edit] Symptoms
Early symptoms can include nausea, bilious vomiting, and intermittent moderate to severe crampy abdominal pain. Later signs include rectal bleeding, often with red currant jelly stool (stool mixed with blood and mucus), and lethargy. Physical examination may reveal a sausage-shaped mass felt upon palpation of the abdomen.
In children too young to communicate their symptoms verbally, they may cry, draw their knees up to their chest or experience dyspnea with paroxsyms of pain.
Fever is not a symptom of intussusception, per se. However, intussusception can cause a loop of bowel to become necrotic. This leads to perforation and sepsis, which causes fever.
[edit] Diagnosis
Intussusception is often suspected based on history and physical exam, including observation of Dance's sign. Per rectal examination is particularly helpful in children as part of the intussusceptum may be felt by the finger. An x-ray, ultrasound, or computerized tomography of the abdomen may demonstrate the problem, or in the most critical cases the child may be taken to the operating room immediately to repair whatever is causing the problem, be it intussusception or some other problem.
[edit] Treatment
When the condition is not immediately life-threatening, the intussusception is usually treated with either a barium enema or an air-contrast enema, which both confirms the diagnosis of intussusception, and in most cases successfully reduces it. The success rate is over 80%. However approximately 10% of these recur within 24 hours.
If it cannot be reduced by an enema or if the intestine is damaged, then a surgical reduction is necessary. In a surgical reduction, the abdomen is opened and the part that has telescoped in is pulled out manually by the surgeon or if the surgeon is unable to successfully reduce it or the bowel is damaged, the affected section will be resected. Often, the intussusception can be reduced by laparoscopy, whereby the segments of intestine are pulled apart by forceps.
[edit] Prognosis
Intussusception is a medical emergency, as it will eventually cause death if not reduced. When an intussusception or any other severe medical problem is suspected, the person must be taken to a hospital immediately, or if that is not possible a call for help must be made.
The outlook for intussusception is excellent when treated quickly, and when untreated it leads to death within 2–5 days. Fast treatment is a necessity, because the longer the intestine segment is prolapsed the longer it goes without bloodflow, and the less effective a non-surgical reduction will be. Prolonged intussusception also increases the likelihood of bowel ischemia and necrosis, requiring surgical resection.
Intussusception has been recorded with porphyria. Since neurovisceral porphyrias (acute intermittent porphyria, hereditary coproporphyria and variegate porphyria) have been associated with severe gut dysmotility and vasospastic bowel infarction physicians should be on high alert for porphyrias in cases of intussusception.
[edit] Footnotes
- ^ Gylys, Barbara A. and Mary Ellen Wedding, Medical Terminology Systems, F.A. Davis Company, 2005.
- ^ Lonnie King, M.D., FACEP (2006). Pediatrics: Intussusception. Retrieved on June 5, 2006.
- ^ Gayer G, Zissin R, Apter S, Papa M, Hertz M (2002). "Pictorial review: adult intussusception--a CT diagnosis.". Br J Radiol 75 (890): 185-90. PMID 11893645. Free Full Text.
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| esophagus - stomach: | Halitosis | Nausea | Vomiting | Heartburn | GERD | Achalasia | Esophageal cancer | Esophageal varices | Peptic ulcer | Abdominal pain | Stomach cancer | Non-ulcer dyspepsia | Gastroparesis |
| liver - pancreas - gallbladder - biliary tree: | Hepatitis | Cirrhosis | NASH | PBC | PSC | Budd-Chiari | Hepatocellular carcinoma | Acute pancreatitis | Chronic pancreatitis | Hereditary pancreatitis |
| small intestine: | Peptic ulcer | Intussusception | Malabsorption (e.g. coeliac, lactose intolerance, fructose malabsorption, Whipple's) |
| colon: | Diarrhea | Appendicitis | Diverticulitis | Diverticulosis | IBD (Crohn's, Ulcerative colitis) |
