Intussusception is a condition in which part of the intestine moves inside itself in a telescoping effect. This causes abdominal pain and other symptoms. It can lead to a lack of blood flow to the intestine and blockages so that food and fluids can’t move through the intestine normally. It is more common in babies and children than others but can also occur in adults.
In children, intussusception is often treated with an air or water enema that pushes the intestine back into place. Children may also need surgery, but this is more common in adults. Left untreated, intussusception can be life-threatening.
This article will explore intussusception symptoms, diagnosis, emergency treatment, and outlook in children and adults.
Complete List of Intussusception Symptoms
The symptoms of intussusception can vary between people and also between kids and adults.
Intussusception Symptoms in Children
Making a diagnosis might be more challenging in babies and small children because they can’t tell adults and healthcare providers about their symptoms. Babies, in particular, may have signs of illness that are nonspecific, such as inconsolable crying, fussiness, and lethargy.1 About 1 to 2 per 1,000 babies and children younger than 3 years develop intussusception.2
About half of all children have symptoms of what’s considered the “classic triad” of intussusception: vomiting, intermittent abdominal pain, and bloody stool that looks like currant jelly. In a retrospective study of almost 600 children with intussusception, the most common symptoms were identified as:3
- Abdominal pain (described as moderate in about half of all cases)
- Irritable or inconsolable crying in babies
- Vomiting
- Bloody stool
- Fever
Intussusception Symptoms in Adults
In adults, the signs and symptoms of intussusception may be nonspecific,meaning they are similar to those from several other digestive problems. The most common symptom is abdominal pain. It can take time to rule out various other disorders and get the correct diagnosis.4
Symptoms in adults may include:5
- Abdominal pain
- Constipation
- Nausea
- Vomiting
- Diarrhea
- Rectal bleeding
- Mass in the abdomen
- Bowel obstruction
Challenges of Identifying Intussusception in Infants and Adults
For both children and adults, diagnosing intussusception can be difficult. This is because the symptoms aren’t the same from person to person and can be similar to many other conditions.
Intussusception in Children
The signs and symptoms of intussusception are variable in babies and kids. This can make it difficult for healthcare providers to know which patients should be evaluated for intussusception. The age of the child also makes a difference (such as infants vs. teens).3
Some of the other conditions that might be considered along with intussusception—a process of elimination called differential diagnosis—include the following.1
Infants and toddlers less than 2 years old:
- Gastroenteritis ("stomach flu")
- Constipation
- Urinary tract infection
- Hernia: A weakened spot in the abdominal wall
- Pyloric stenosis: A narrowing in the opening to the stomach
- Malrotation, or midgut volvulus: When the intestine loops around itself
Preschoolers between 2 and 5 years old:
- Appendicitis
- Intestinal malrotation
- Volvulus
- Hepatitis (a disease of the liver)
- Hemolytic anemia: A blood disorder in which red blood cells are destroyed
- Henoch-Schönlein purpura: Acute inflammation of the blood vessels, including those in the gut)
Kids between 5 and 12 years old:
- Appendicitis
- Gastroenteritis
- Testicular or ovarian torsion
- Gynecologic conditions (such as dysmenorrhea, ectopic pregnancy, and miscarriage)
Intussusception in Adults
In adults, intussusception is rare. For people who seek care from a healthcare provider for a bowel obstruction, only about 1% are diagnosed with intussusception.4
Of adults that have intussusception, many are first misdiagnosed with another condition or have a delayed diagnosis. About half are not diagnosed until they have surgery and the condition is found.4
The reason for the delay or the misdiagnosis could be because the symptoms of intussusception in an adult are similar to many other more common digestive problems. The list of other conditions that might be ruled out might include:5
- Appendicitis: An inflammation of the appendix
- Crohn’s disease: A chronic condition that causes inflammation in the digestive tract
- Leiomyosarcoma: A rare type of cancer
- Lymphomas: A type of cancer in the lymphatic system
- Meckel's diverticulum: A bulge in the small intestine
- Peutz–Jegher syndrome: A condition that causes polyps to grow
- Hypertrophied Peyer patch: An overgrowth of a normally occurring group of cells in the intestine
- Polyps: Growths in the intestine
- Lipomas: Benign tumors
- Infections (such as from adenovirus, rotavirus, or parasites)
- Bleeding disorders (such as hemophilia)
- Henoch-Schönlein purpura: Inflammation caused by the collection of immunoglobulin A in the blood vessels
- Leukemia: A type of cancer that affects the bone marrow or the lymphatic system
- Neuronal intestinal dysplasia: Causes a lack of peristalsis (muscle contractions that move material through the digestive tract)
- Celiac disease: An intolerance to gluten protein
- Cystic fibrosis: Causes excess mucus in the body
Risks of Untreated Intussusception Symptoms
If intussusception goes undiagnosed and untreated, it could lead to serious outcomes. One of the potential complications is a lack of blood getting to the intestines. Without blood flow, the intestinal tissue may start to die.4
A section of the intestine that has died might tear, creating a hole (perforation). If the contents of the intestine (stool) get into the abdomen, it can cause a serious infection called peritonitis.
Some of the possible complications of untreated intussusception include:6
- Bowel obstruction
- Dehydration
- Lack of blood flow to the intestine
- Death of intestinal tissue
- Bowel perforation: A tear in the wall of the intestine
- Peritonitis: An infection of the lining of the abdominal cavity
- Sepsis: An immune system reaction to infection
- Shock: A sudden drop in blood flow throughout the body
When to Seek Care for Abdominal Pain
Abdominal pain is a reason to seek care from a healthcare provider. Severe abdominal pain or pain that is also accompanied by diarrhea or vomiting that won’t stop or bleeding from the rectum are reasons to get care in the emergency department.
Emergency Treatment for Intussusception Symptoms
The most common treatment for intussusception in children is the use of an enema. This can take different forms and could use air or saline (salt water). The movement of the air or fluid through the intestine can reverse the telescoping and push the tissue back into place.5
In cases in which there is tissue death, surgery might be used to remove that section of the bowel and repair any other damage.5
The most common treatment for intussusception in adults is surgery. Which type of surgery will depend on whether a cause is found and if the situation is an emergency.
For people who are medically stable, time can be taken to run some tests and consider options. In a person who is very ill or whose life is threatened because they are experiencing complications such as shock or sepsis, surgery might be done quickly.7
An enema may or may not be used in adults, either alone or before surgery. It is a controversial topic because, in adults, there may be a growth or abnormality in the area of intussusception that needs surgical removal. If surgery is not done, an underlying problem (which could be life-threatening) might not be addressed.8
Whether surgery should be done using minimally invasive techniques (laparoscopic) is still debated. Some research has shown that laparoscopic surgery can be effective and lead to shorter recovery times. The type of surgery will depend on a number of factors, but ultimately, the surgeon will try to save as much bowel as possible.9
What Causes Intussusception Symptoms?
Intussusception may be caused by one of several other conditions, some that are digestive and others that are not. There are also some conditions that increase the risk of intussusception.
Causes of Intussusception in Children
It’s not always known what causes intussusception in children. However, there are some risk factors that may increase the likelihood of intussusception:1
- Viral gastroenteritis
- Recent rotavirus vaccine
- Meckel's diverticulum
- Duplication cysts (lesions in the digestive tract)
- Lymphomas
- Henoch-Schönlein purpura
- Cystic fibrosis
- Celiac disease
- Crohn's disease
Causes of Intussusception in Adults
Intussusception in adults most commonly happens after surgery or because there is another condition present. However, sometimes a cause is never found, which is called idiopathic intussusception.5
The intussusception may be because part of the intestine catches onto a growth or abnormality (called a lead point) in the intestine and causes the telescoping effect.
Some of the causes of intussusception include:5
- Adhesions: Internal scar tissue such as from prior surgery
- Adenoma: A noncancerous tumor
- Cantor tubes: A tube inserted into the intestine for decompression
- Celiac disease
- Crohn's disease
- Endometriosis: The growth of tissue that closely resembles uterine tissue outside of the uterus
- Hamartoma: A noncancerous growth
- Hemangioma: A group of blood vessels
- Polyp (inflammatory polyp, inflammatory pseudopolyp, or Peutz–Jegher polyp)
- Kaposi's sarcoma: Cancer that forms in the lining of blood and lymph vessels
- Lipoma: A fatty tumor under the skin
- Meckel's diverticulum
- Neurofibroma: A benign tumor in nerve cells
- Tuberculosis: A bacterial infection that mainly affects the lungs
- Bleeding (hemorrhages) from a lack of blood clotting
- Cancers such as adenocarcinoma, carcinoid tumor, leiomyosarcoma, lymphoma, metastatic carcinoma, malignant gastrointestinal stromal tumor (GIST), neuroendocrine tumor, and sarcoma
Some of the conditions that may put an adult at risk of intussusception include:5
- Anorexia nervosa: An eating disorder
- Endometriosis: When tissue resembling tissue inside the uterus grows outside the uterus
- Malabsorption syndromes: A lack of the ability to absorb nutrients from foods
- Personal or family history of intussusception
Outlook of People Treated for Intussusception Symptoms
Most adults who have surgery for intussusception have a good outcome and recovery. This is especially true as laparoscopic surgery, which can lead to less pain and shorter recovery times, becomes more common.9
One large analysis of several studies of people undergoing surgery for intussusception showed that 22% had a complication after surgery. The most common complication was an infection at the surgery site. It was also shown that about 5% died after surgery.7
The most important thing related to outcomes is what may have caused the intussusception in the first place. For instance, if the cause was related to cancer, the prognosis may change because that underlying condition will also need to be treated.
Summary
Intussusception is an emergency that can be life-threatening. Abdominal pain is a common symptom in both adults and children. Getting a diagnosis can take time because the signs and symptoms could also be caused by many other conditions. Severe abdominal pain and rectal bleeding are reasons to seek care in an emergency department.