Intussusception

Treatment Overview

Ideally, treatment for intussusception begins within 24 hours after the onset of symptoms. Normally, a child is treated in the hospital with either an enema or surgery. The type of treatment varies depending on the age of the child and the extent of the problem in the intestine.

Enemas

• An enema usually consists of air, although barium (a milky-white liquid) may also be used. This procedure can also confirm a diagnosis. The enema increases the pressure in the child's intestine, which can often cause the affected area to return to its normal position. This process is called reduction.
• Enemas to treat intussusception are done in the X-ray department of a hospital. During the enema, an X-ray or ultrasound is used to check the condition of the intestine.
• An air enema is successful 75% to 94% of the time, and a barium enema is successful 50% to 78% of the time.³ However, the longer the symptoms have been present, the less likely it is that an enema reduction will be successful.
• Sometimes more than one enema is needed. However, an enema should not be used more than 2 or 3 times.
• An enema should not be used if there is evidence of an infection in the lining of the abdominal wall (peritonitis), a ruptured intestine, a severe reaction to an infection that has spread throughout the blood and tissues (sepsis), or the death and decay of tissue (gangrene) in the bowel.

Surgery

Sometimes surgery is needed for intussusception. Surgery may be needed if:

• Enemas have not corrected the problem after two or three attempts.
• Health professionals suspect that the intestine has been damaged and needs to be repaired.
• The child is very ill or the intestine has ruptured, leaking stool into the abdomen.

During surgery to correct intussusception:

• An incision is made through the skin into the abdomen.
• In children, the affected part of the intestine is stretched out and returned to its usual position. Any damaged part is removed. The appendix is usually removed as well.
• The incision through the skin into the abdomen is closed.

If a large portion of the intestine is removed during surgery or the intestine has developed a serious infection, the child may need an ileostomy. This is an opening in which waste leaves the small intestine and collects in an odor-proof plastic pouch fastened to the skin.

If intussusception is not treated, the affected part of the intestine will be blocked and may then rupture. This can cause serious infection and possibly death.

Sometimes intussusception recurs.

• Between 5% and 11% of the time, intussusception recurs in children after it has been treated with enemas.³ If intussusception recurs after it has been treated with enemas, additional enemas or surgery may be needed.
• Between 1% and 4% of the time, intussusception recurs in children after it has been treated with surgery.³ If intussusception recurs after surgery, another surgery of the abdomen is usually needed to correct it again, to look for other conditions that may be causing the condition, or to remove the portion of the intestine that is involved.

Most adults with intussusception need surgery.

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Author:	Amy Fackler, MA Debby Golonka, MPH	Last Updated: August 22, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics Brad W. Warner, MD - Pediatric Surgery
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