Intussusception in Infants

1. Overview

Intussusception is a common medical emergency in infants, particularly those under the age of 2.

2. Causes

• Thin infants: Thin infants are more susceptible to intussusception due to their thinner intestinal walls, which are more prone to spasms.

• Well-nourished infants: Breastfed infants may have a higher risk due to the nutrient-rich nature of breast milk, which stimulates strong intestinal motility.

• Formula-fed infants: Formula-fed infants can also experience intussusception, but at a lower rate than breastfed infants.

• Summer: Intussusception is more prevalent in summer due to hot and humid weather, which intensifies intestinal motility.

3. Symptoms

3.1 Clinical Symptoms

• Currant jelly stool: The infant cries, draws their legs towards their abdomen, then extends them and draws them back again.

• Palpable intussusception mass: The intussusception mass can often be felt in the lower right abdomen, with the right iliac fossa being empty.

• Constipation: The infant may not have a bowel movement or have infrequent stools, which may contain blood.

• Vomiting blood: Vomiting blood can be a sign of intestinal obstruction or necrosis.

3.2 Functional Symptoms

• Vomiting milk: Vomiting milk usually occurs early, and the infant is not feverish.

• Vomiting bile: Vomiting bile occurs later and may be accompanied by brown, bloody stools.

• Bright red blood in the stools: Bright red blood in the stools typically occurs late and may be accompanied by high fever.

• Brown blood in the stools: Brown blood in the stools typically occurs late and may be accompanied by vomiting bile.

3.3 Physical Symptoms

• Palpable intussusception mass: Palpating the intussusception mass is a late sign, often accompanied by rectal bleeding.

• Abdominal distention: Abdominal distention is a late sign, and the intussusception mass may be palpable.

• Rectal examination reveals the leading edge of the intussusception: Rectal examination revealing the leading edge of the intussusception is a late sign.

• Brown blood in the rectal examination: Brown blood in the rectal examination is a late sign and may be accompanied by vomiting bile.

4. Differential Diagnosis

• Congenital megacolon: This condition presents with bloody stools but differs from intussusception.

• Rectal polyps: This condition also presents with bloody stools but typically lacks other symptoms of intussusception.

• Enteritis: This condition also presents with bloody stools but is usually accompanied by high fever and abdominal pain.

• Dysentery: This condition also presents with bloody stools but is typically accompanied by diarrhea and high fever.

5. Treatment

• Pneumatic reduction: Pneumatic reduction is an effective treatment method for intussusception.

• Indications: Pneumatic reduction should be performed when the infant presents to the hospital early.

• Contraindications: Pneumatic reduction should not be performed when the infant arrives at the hospital more than 48 hours after onset or shows signs of peritonitis.

• Barium enema: Barium enema is now commonly used as a replacement for pneumatic reduction.

• Surgery: Surgery is indicated when pneumatic reduction is not feasible or fails.

6. Underlying Causes

• Intestinal polyps: Intestinal polyps can be a cause of secondary intussusception.

• Meckel’s diverticulum: Meckel’s diverticulum can be a cause of secondary intussusception.

• Mesenteric lymphadenitis: Mesenteric lymphadenitis can be a cause of secondary intussusception.

• Duplication of the bowel: Duplication of the bowel can be a cause of secondary intussusception.

7. Associated Viruses

• Rotavirus: Rotavirus is considered to be associated with acute intussusception in infants.

8. Underlying Causes Not Leading to Secondary Intussusception

• Intestinal adhesions: Intestinal adhesions do not cause secondary intussusception.

9. Type of Intussusception in Breastfed Infants

• Acute intussusception: Intussusception in breastfed infants is generally classified as acute intussusception.

10. Components of the Intussusception Mass

• Intussusceptum: The intussusceptum is the primary cause of complications.

11. Reasons for Intussusception in Breastfed Infants Occurring Often in the Ileocecal Region

• This is a region rich in lymphatic tissue and is sensitive to infection: This region contains abundant lymph nodes and is prone to infections.

• This is the boundary between the mobile and fixed segments of the intestine: This region is susceptible to spasms.

• This region often exhibits motility responses from the terminal ileum: This region exhibits significant motility.

12. Earliest Functional Symptom

• Colic: Colic is the earliest functional symptom of acute intussusception.

13. Location Where the Intussusception Mass Can Be Felt

• Lower right abdomen: The intussusception mass is often felt in the lower right abdomen.

14. Findings on Rectal Examination

• Blood-tinged stool: This is a common finding during rectal examination in intussusception.

15. Most Important Clinical Symptom Indicating Late-Presenting Intussusception

• High fever: High fever is the most important clinical symptom indicating late-presenting intussusception.

16. X-ray Findings Indicating Intestinal Necrosis

• Crescent sign: The crescent sign is an X-ray finding indicating intestinal necrosis.

17. Most Important Sign Indicating that the Intussusception Mass Has Been Reduced

• The intussusception mass is no longer palpable: This is the most important sign indicating that the intussusception mass has been reduced.

18. Most Common Age Group

• 4-8 months: This is the most common age group for infants with intussusception.

19. X-ray Findings of Late-Presenting Intussusception

• Crescent sign: The crescent sign is an X-ray finding of late-presenting intussusception.

20. Typical Ultrasound Imaging of Intussusception

• Sandwich sign: The sandwich sign is a typical ultrasound image of intussusception.

21. Characteristic Feature of Vomiting in Late-Presenting Intussusception

• Vomiting bile: Vomiting bile is a characteristic feature of vomiting in late-presenting intussusception.

22. Clinical Symptoms of Late-Presenting Intussusception

• Abdominal distention with no palpable intussusception mass: This is a clinical symptom of late-presenting intussusception.

Case 3:

• An 8-month-old boy, weighing 12 kg, was admitted to the hospital with a high fever of 39-40°C, lethargy, a drawn appearance, a rapid pulse of 140 bpm, significant abdominal distention, vomiting bile, and brown, bloody stools.

1. First step to take:

• Fluid and electrolyte replacement: The infant is dehydrated and requires immediate fluid and electrolyte replacement.

2. Possible diagnosis:

• Late-presenting intussusception: The boy exhibits classic symptoms of late-presenting intussusception, including high fever, lethargy, abdominal distention, vomiting bile, and brown, bloody stools.

3. To confirm the diagnosis:

• Abdominal ultrasound: Abdominal ultrasound is the most effective diagnostic method for intussusception.

Note:

• Intussusception is a medical emergency and requires prompt treatment to prevent serious complications.

• If you suspect intussusception in an infant, immediately take the infant to the hospital.