Definition

Intussusception is a medical condition characterized by invading one segment of the intestine into another, resulting in a telescopic appearance of the intestine. This circumstance is critical, as twisted intestines may lead to obstruction in the passage of food and impede blood circulation. Failure to promptly release the folds can lead to intestinal perforation, which can result in the death of some parts of the gastrointestinal tract due to the immediate restriction of blood supply. Intussusception might become worse within 2 to 5 days. Intussusception frequently develops in infants, particularly those with a prior medical record of upper respiratory tract infections.

Causes

Most intussusception cases (90%) are idiopathic and develop spontaneously. There are several known causes of intussusception, such as:

1. Infection
2. Anatomical defects or intestinal malformations
3. Changes in bowel movements
4. Meckel's diverticulum is a congenital defect characterised by the presence of a small cavity within the small intestine
5. Intestinal polyp
6. Appendicitis
7. Inflamed Peyer's Patch (intestinal immunity organ)
8. Idiopathic

Risk factor

Intussusception risk is increased with a history of gastroenteritis or acute diarrhoea. A swelling of the lymph tissue that lines the intestines can occur when an infection is present. This swelling can cause the intestines to pull on each other, causing pain. Intussusception has a higher incidence in males than females and is more prevalent in the pediatric population than in adults. Potential risk factors include:

1. Intestinal malformations
2. Medical history of diseases such as cystic fibrosis and autoimmune disorders Henoch-Schonlein Purpura, Crohn's disease, and Celiac disease

Symptoms

Infants suspected of intussusception may manifest symptoms, including:

1. Vomiting: initially, the vomit may consist of clear liquid, but when there is an intestinal blockage, it may become greenish
2. Intermittent and severe abdominal pain
3. Stool consistency changes, containing blood or jelly-like mucus
4. Lethargy
5. An abnormally large or rigid part of the stomach
6. Cranky
7. Tumor: frequently detected in adult individuals

Adult intussusception symptoms may vary from other disorders and can sometimes be confusing. Constant or intermittent nausea and vomiting are common symptoms of intussusception in adults. Complaints could remain for weeks before the pain becomes severe. 

Diagnosis

During the initial consultation, the doctor may inquire about the patient's medical history, which may include:

1. When do symptoms of abdominal pain begin?
2. Does the pain remain persistent or manifest intermittently?
3. Did the pain end all of a sudden?
4. Do you also have additional symptoms like diarrhoea, vomiting, or nausea?
5. How is the consistency of the stool? Is it sticky or bloody?
6. Are you experiencing the presence of a mass in your abdominal region?

During the physical examination of infants with intussusception, a particular indication known as the dancing sign is detected. In the upper right is a sausage-shaped mass, while in the lower right is an empty abdominal region. During gastric contraction, the mass will be more palpable. If the physical examination doesn't lead to a definitive assessment, the doctor may do additional examinations, such as:

1. Radiographic assessment (without contrast agents)
   X-rays have a diagnostic accuracy of 60% for identifying intussusception.
   
   
2. Ultrasonography (USG)
   During an ultrasound examination, the doctor will assess the intestinal lining for signs of intussusception. Typical indicators include the appearance of a target-shaped image and the presence of a pseudokidney sign.
   
   
3. Barium enema
   Administering enema fluid is a procedure that simultaneously serves therapeutic and diagnostic purposes.

Management

A barium enema is a recommended treatment for treating an intestinal obstruction. The use of enemas as a therapeutic intervention has been practiced for an extensive period of time. During barium enema therapy, a physician will introduce a slender tube via the anus into the large intestine. To relieve the constrictions within the gut, there are two options for substances that can be introduced through the tube: liquid or air. This procedure is not universally effective; in certain instances, surgical intervention is necessary to release the obstructions of the intestine.

The surgical intervention for infants with intussusception involves physical manipulation to release the invaginated folds. However, there are several complications, such as perforations in the intestinal lining, so it becomes necessary to excise the necrotic parts of the intestine surgically. The selection of treatment depends on the severity and the doctor's considerations.

Following the procedure, the patient will be discharged from the hospital only under the following conditions: restoration of normal food consumption, absence of fever, and cessation of fluid expulsion from the surgical incision. The next step is for the doctor to determine if the patient's bowel habits are normal. Upon arriving home, the patient still requires a rest period for several days. Patients can engage in intense workouts or physical activities for three to four weeks following surgery. The doctor typically schedules post-operative control between one week and four weeks after the procedure. Spontaneous resolution of intussusception may happen in certain instances where the invaginated folds can resolve without intervention.

Complications

A potential severe complication of intussusception is the occurrence of a rupture in the lining of the intestine, often known as perforation. Interruption of blood circulation to the intestine may result in necrosis of a section of the intestine. If the intestinal lining undergoes necrosis, it becomes more vulnerable to rupture, leading to the leakage of intestinal contents into the abdominal cavity. Intestinal contents can potentially induce infections in the abdominal wall, leading to peritonitis. Peritonitis is a critical condition that necessitates emergency medical intervention.

Prevention

Most intussusception cases develop spontaneously; hence, there is no recognised prevention method. There are some preventative measures regarding a folded intestine:

1. Observe a child with abdominal pain for danger signs, particularly if the pain persists for an extended period
2. Urgently visit a doctor if you experience intermittent, severe abdominal pain for which the cause remains unknown
3. Schedule regular check-ups with a doctor if you have a history of chronic conditions, such as autoimmune diseases, that increase the risk of intussusception

When to see a doctor?

Severe and prolonged abdominal pain can be a serious medical concern and could worsen quickly. One possible complication of intussusception is peritonitis, which you should be aware of. Watch out for the following symptoms of peritonitis in a child:

1. 1. Abdominal pain accompanied by an increase in the size of the abdomen
   2. Fever and recurrent vomiting
   3. A patient with a pale appearance and chilly sweat might be in shock
   4. Hypotensive and tachycardia
   5. Tachypnea
   6. Agitated

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