The constellation of signs and symptoms of intussusception represents one of the most classic presentations of any pediatric illness; however, the classic triad of vomiting, abdominal . National Library of Medicine doi:10.7759/cureus.26551. 378 (16):1521-1528. Available at http://www.medscape.com/viewarticle/843091. HHS Vulnerability Disclosure, Help Symptoms. In adults, intussusception may seem like a stomachache at first, with symptoms of nausea and . And some older children have pain but no other symptoms. The American Journal of Surgery, 131(6), 758-761. Although intussusception is a rare cause of abdominal pain in adults, it is an important diagnosis to consider in patients with recurrent abdominal pain because it may be a harbinger of malignancy. Centers for Disease Control and Prevention. If the bowel is unable to be successfully reduced (put back into place), or part of it has developed gangrene, the affected section will be removed and the two remaining healthy sections are sewn back together. Intussusception is far more common in children, which account for 95% of all cases 2022 Jul 4;14(7):e26551. For example, connections have been made between sigmoid volvulus and people born with a congenital disorder called Hirschsprung's disease. The flow of fluids and food through the bowel can get blocked. Insomnia, sleep issues hit young adults the worst, health survey finds 2023 WebMD, LLC. Hospitalizations for Intussusception Before and After the Reintroduction of Rotavirus Vaccine in the United States. Intussusception in Adults - PubMed The American Journal of Surgery, 121(5), 531-535. 2016 Jan. 51 (1):179-82. In about 10% of cases, intussusception returns within 72 hours after a procedure, regardless of whether it was an enema or surgery. Accessibility Matson DO. It often affects people living with underlying neurologic or psychiatric conditions. Complications of intussusception if it is not treated include injury or death of the intestine which can result in surgical removal of the bowel, life-threatening infection (sepsis), and death. The patient was discharged home on postoperative day 2. Please remove adblock to help us create the best medical content found on the Internet. [QxMD MEDLINE Link]. Rotavirus infections. The diagnosis and management of adult intussusception. Findings consistent with volvulus include a distended large bowel. Adult intussusception - PubMed Volvulus treatment focuses on two goals: Fixing the currently twisted intestine and preventing future episodes. Small bowel intussusception in adults is rare and often challenging to diagnose owing the elusive, non-specific symptoms. A rotavirus infection usually starts within two days of exposure to the virus. Lancet Global Health. The U.S. Food and Drug Administration recommends that the vaccine not be given to children who have a history of intussusception. Random biopsies of the stomach showed mild chronic inflammation without evidence of Helicobacter pylori. Arch Pediatr Adolesc Med. Results: By Lyndsey Garbi, MD Sixteen percent of small-bowel and 5% of large-bowel intussusceptions are idiopathic. The prognosis in such cases is good, Once an individual has a blockage, there is always a risk that it might recur, A quick diagnosis and surgical treatment are the most important factors in dealing with intussusception. Epub 2005 Jun 11. Contopoulos-Ioannidis DG, Halpern MS, Maldonado Y. It's the most common abdominal emergency in early childhood. Adult Intussusception - PMC - National Center for Biotechnology Information Asian J Surg. Older adults and adults caring for young children have an increased risk of infection as well. 2017 Jun 1. 2009 Oct. 39(10):1075-9. HHS Vulnerability Disclosure. Weakness or lack of energy. Presentation often includes colicky abdominal pain, flexing of the legs, fever, lethargy, and vomiting, with blood in the stool in some cases. Trends in Hospitalizations for Intussusception in California in Relationship to the Introduction of New Rotavirus Vaccines, 1985-2010. Bottom: coronal view with jejunum-jejunal intussusception again seen in the left upper quadrant. 43(7):1249-53. Volvulus symptoms usually occur over time and gradually get worse. Symptoms are usually of long duration (several weeks to several months), although the patient may occasionally present with an acute abdomen [ 4 ]. 2011 Feb. 127(2):e296-303. Shekherdimian S, Lee SL, Sydorak RM, Applebaum H. Contrast enema for pediatric intussusception: is reflux into the terminal ileum necessary for complete reduction?. How Diverticulitis Affects the Sigmoid Colon, Understanding Diverticulitis vs. Appendicitis, Small Intestine: Function, Anatomy, and More, Colon Cancer and Poop: Signs to Watch Out For, Comparing Ileostomy vs. Colostomy Surgery, The Link Between Endometriosis and Bloating, Importance of Second-Look Surgery in a Newborn Presenting With Early Malrotation, Clinical outcomes of sigmoid colon volvulus: identification of the factors associated with successful endoscopic detorsion, A digital audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting, The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction, Congenital anomalies of the tubular gastrointestinal tract, Laparotomy surgery in the treatment of congenital gastroschisis with intestinal malrotation and atresia in newborns, Management of colonic obstruction: a review, Colonic volvulus in the United States: trends, outcomes, and predictors of mortality, A "whirl pattern" caused by sigmoid colon dilation, wrapped around the mesentery and vessels, A "bird-beak" appearance, where a contrast dye is blocked and cannot pass through. When to see a . Bookshelf For children, a main symptom is vomiting with what looks like bile, a yellow-green fluid produced by the liver. Mesenteric fat and vessels are often visible within the bowel lumen, and varying degrees of proximal bowel dilatation may be present.7,8 In a retrospective review of 33 adult patients with intussusception, 30 were diagnosed by CT, and those caused by neoplastic processes were more likely to be associated with other signs and symptoms of obstruction.9 Other imaging modalities include plain abdominal films that can provide clues regarding site of obstruction but are neither sensitive nor specific in terms of diagnosis. The virus can remain infectious on surfaces that haven't been disinfected for weeks or months. This site needs JavaScript to work properly. 2023 Apr 27;15(4):e38230. Federal government websites often end in .gov or .mil. [1] The usual age of occurrence is six to eighteen months old. What Is the Recovery Time and Success Rate for Intussusception Surgery? American College of Gastroenterology (ACG)4900 B South, 31st St. Arlington, VA 22206Phone: (703) 820-7400Fax: (703) 931-4520Website: http://www.acg.gi.org, American Gastroenterological Association (AGA)4930 Del Ray Avenue Bethesda, MD 20814Phone: (301) 654-2055Fax: (301) 652-3890Email: member@gastro.orgWebsite:http://www.gastro.org, In-depth - Intussusception - Mayo Clinic (2015). 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. Blood in stools. Adult Intussusception: An Uncommon Condition and Challenging Management Review of systems was negative for fevers, weight loss, ocular symptoms, oral ulcers, skin lesions, joint pain, or diarrhea. As a library, NLM provides access to scientific literature. A child may take a bath or shower two days after surgery, and a follow-up with the doctor is usually scheduled for 2-3 weeks later. The CT scan showed a nonobstructive small-bowel intussusception within the proximal small bowel (Figure 1). The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colonic Volvulus and Acute Colonic Pseudo-Obstruction. Predictive factors of malignancy in adults with intussusception. Early in the disease process, occult blood in the stools is the first sign of impaired mucosal blood supply. Intussusception: Practice Essentials, Background, Etiology and If too much tissue damage has occurred, a colostomy may be necessary. [QxMD MEDLINE Link]. N Engl J Med. It is a common finding at evacuation proctography in patients with disordered anorectal function 1; the bowel wall is seen to descend and infold by varying degrees, and may eventually protrude through the anus.The pathophysiology of the condition is poorly understood. Adult intussusception: a retrospective review. Abdominal distention frequently is found if obstruction is complete. Volvulus in children is often first diagnosed as a disorder in newborns, or even before birth. Radiology. J Pediatr Surg. Approved by: Krish Tangella MD, MBA, FCAP. 2006 Dec;21(8):834-9. doi: 10.1007/s00384-005-0789-3. Wang N, Cui XY, Liu Y, Long J, Xu YH, Guo RX, Guo KJ. The reason lethargy occurs is unknown, because lethargy has not been described with other forms of intestinal obstruction. Intussusception is a type of bowel blockage that rarely occurs and is most likely to happen during a baby's the first year. The most common symptoms of intussusception are abdominal pain, nausea, and vomiting; less frequent symptoms are melena, weight loss, fever, and constipation [ 4 ]. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. Kapadia MR. Volvulus of the small bowel and colon. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). The records of all patients 18 years and older with the postoperative diagnosis of intussusception at the Massachusetts General Hospital during the years 1964 through 1993 were reviewed retrospectively. Abdominal CT is now widely regarded as the modality of choice for diagnosing intussusceptions in adults. Cochrane Database Syst Rev. Adult bowel intussusception: presentation, location, etiology If any symptoms are suspected, an individual should contact a healthcare provider immediately. 2022 Feb;114(1):40-54. doi:10.32074/1591-951X-553. Gilmore AW, Reed M, Tenenbein M. Management of childhood intussusception after reduction by enema. Takeuchi K, Tsuzuki Y, Ando T, et al. Verywell Health's content is for informational and educational purposes only. Intussusception in adults: Clinical characteristics, diagnosis and Donhauser, J. L., & Kelly, E. C. (1950). 354(1):11-22. He also reported one episode of dark tarry stools 4 months earlier. J Pediatr Surg. The goal of this study was to review retrospectively the symptoms, diagnosis, and treatment of intussusception in adults. 2009 Jul-Dec. 6(2):131. There's a risk of perforation with this procedure, so it shouldn't be done if your healthcare provider suspects you may have peritonitis, an inflammation of tissues in the abdominal cavity. Preoperative reduction by barium or air, or manually in the operating room is generally not recommended owing to theoretical risks of perforation, seeding of microorganisms or tumor cells, and increased surgical complications of manipulated friable and edematous bowel.3,9 However, preoperative reduction can be considered in consultation with a surgeon in cases where a diagnosis of benign lesion has previously been established and the bowel involved is viable, or where resection may result in short gut syndrome.10,11 Of note, nonobstructing intussusception detected incidentally on CT in an otherwise asymptomatic patient does not require intervention. Indications for laparoscopy in the management of intussusception: A multicenter retrospective study conducted by the French Study Group for Pediatric Laparoscopy (GECI). eMedicineHealth does not provide medical advice, diagnosis or treatment. 2017;15(2):215-220. doi:10.5217/ir.2017.15.2.215. Dis Colon Rectum. 2020; doi:10.1016/S2214-109X(20)30262-X. Both times he had CT scans that did not show recurrent intussusception or other acute pathology, and he was discharged home after symptoms were controlled. [QxMD MEDLINE Link]. The most common symptom is belly pain that comes and goes. Lethargy is a relatively common presenting symptom with intussusception. Felix, E. L., Cohen, M. H., Bernstein, A. D., & Schwartz, J. H. (1976). Baiu I, Shelton A. Sigmoid Volvulus. Abdominal ultrasonography reveals the classic target sign of an intussusceptum inside an intussuscipiens. Forty-eight percent of the enteric lesions were malignant and 52% were benign. MeSH [QxMD MEDLINE Link]. Rotavirus infections are common in children ages 3 to 35 months particularly those who spend time in child care settings. Hisham Nazer, MBBCh, FRCP, DTM&H is a member of the following medical societies: American Association for Physician Leadership, Royal College of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Royal Society of Tropical Medicine and Hygiene, Royal College of Physicians and Surgeons of the United KingdomDisclosure: Nothing to disclose. Intussusception (medical disorder) - Wikipedia -, Aust N Z J Surg. Unable to load your collection due to an error, Unable to load your delegates due to an error. Intussusception (in-tuh-suh-SEP-shun) happens when one part of the bowel slides into the next, much like the pieces of a telescope. It may be caused by: Risk factors for intussusception include age under 2 years (80% of cases are in children under 2 years) and being male (some estimates state males are two to four times more likely to develop the condition). Barussaud M, Regenet N, Briennon X, et al. 2019;321(24):2478. doi:10.1001/jama.2019.2349. A special type of postoperative intussusception: ileoileal intussusception after surgical reduction of ileocolic intussusception in infants and children. Severe diarrhea can lead to dehydration, particularly in young children. This study identified that age older than 5 months, male sex, and lethargy were 3 important clinical predictors of intussusception. 2013 Feb. 23(2):166-9. Garry Wilkes, MBBS, FACEM Emergency Physician, Echuca Regional Health, Victoria; Clinical Associate Professor, University of Western Australia, AustraliaDisclosure: Nothing to disclose. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea#children. Importance of Second-Look Surgery in a Newborn Presenting With Early Malrotation. Abdominal radiograph shows small bowel dilatation and paucity of gas in the right lower and upper quadrants. Careers. Intestinal Intussusception: Etiology, Diagnosis, and Treatment An open procedure, which involves a large incision. Is There a Connection Between Intussusception and the Rotavirus Vaccine? Begos, D. G., Sandor, A., & Modlin, I. M. (1997). Given his persistent discomfort on serial exams unrelieved by antiemetics and narcotics, an abdominal CT was performed. It also may become dilated, or widen. Volvulus. If you have rotavirus and you don't wash your hands after using the toilet or your child has rotavirus and you don't wash your hands after changing your child's diaper or helping your child use the toilet the virus can spread to anything you touch, including food, toys and utensils. An X-ray or ultrasound accompanies the enema procedure so the doctor can visualize the area of the intussusception. 2023 Mar 28;15(3):e36798. Rarely, intussusception also can occur in older children and adults. Management is often surgical, and delays in diagnosis can lead to complications such as bowel obstruction, ischemia, or undiagnosed malignancy. American College of Emergency Physicians. Adenocarcinoma is the most common malignant lead point in the colon, whereas metastasis is the most common malignant lead point in the small intestine.3,4 Other etiologies include benign tumors (adenomatous polyps, lipomas, fibromas, leiomyomas, hamartomas), adhesions, lymphoid hyperplasia, cystic fibrosis, scleroderma, celiac disease, inflammatory bowel disease, appendicitis, pancreatitis, and rectal foreign bodies. Accessed Jan. 30, 2021. Xie X, Wu Y, Wang Q, Zhao Y, Xiang B. Symptoms in children Because intussusception is most common. There are two vaccines available: The vaccines are considered safe and effective, and studies show that they prevent thousands of children from developing rotavirus every year. If left untreated, it can cause serious damage to the intestines, intestinal . Volvulus treatment with surgery will depend on the extent of bowel injury to help determine whether reconnecting the bowel or a colostomy is needed. A significant proportion of these lead points are malignant neoplasms, accounting for 66% of colonic intussusceptions and 30% of cases in the small intestine. It's possible to be infected with rotavirus more than once, even if you've been vaccinated. Early symptoms are a fever and vomiting, followed by three to seven days of watery diarrhea. Recurrent abdominal pain is a common and challenging presenting chief complaint in the Emergency Department. Warshauer DM, Lee JK. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Agha, F. P. (1986). Intussusception only accounts for 1-5% of individuals with an intestinal blockage, but the cases can be very severe. Abdominal radiography is not necessary in children with intussusception. There were 44 enteric and 14 colonic intussusceptions. 2022 Jul 14:S1015-9584(22)00969-1. doi:10.1016/j.asjsur.2022.07.023. Surgical resection of the intussusception without reduction is the preferred treatment in adults, as almost half of both colonic and enteric intussusceptions are associated with malignancy. Reuters Health Information. It is always important to discuss the effect of risk factors with your healthcare provider. Adult intussusception detected at CT or MR imaging: clinical-imaging correlation. Intussusception Symptoms: Bloody Stool, Pain, Fever - Verywell Health Later on, frank hematochezia and the classic currant jelly stools appear. He had a temperature of 98.8 F (37.1 C), pulse of 84 beats/min, blood pressure of 132/82, respiration of 20 breaths/min, and oxygen saturation of 97% on room air. Forty-three percent of the colonic lesions were malignant and 57% were benign. Intussusception is the most common cause of intestinal blockage in children between ages 3 months and 3 years. Intussusception in the adult. Some factors that may increase the risk of volvulus include: Volvulus also may be more likely in people with specific anatomical features. Clipboard, Search History, and several other advanced features are temporarily unavailable. Intussusception involves the telescoping of a segment of bowel into an adjacent segment, leading to obstruction, inflammation, and possible ischemia. The entire bowel was inspected from the ligament of Treitz to the terminal ileum. [QxMD MEDLINE Link]. Intussusception of the bowel in adults: a review. Intussusception Clinical Presentation - Medscape Before Symptoms can be nonspecific, and diagnosis is best made by CT imaging. government site. Summary Intussusception most commonly occurs in infants aged between 3 and 12 months, with a peak at the age of approximately 9 months. Disclaimer. J Laparoendosc Adv Surg Tech A. Computed tomography scanning proved to be the most useful diagnostic radiologic method. Symptoms and Causes What are the symptoms of intussusception? Intussusception Symptoms, Signs & Cause - MedicineNet Ann Surg. Can Intussusception Be Treated With Home Remedies? 2012;25(4):200-3. doi:10.1055/s-0032-1329533. Rotavirus. In a study of 745 surgically diagnosed adult intussusceptions, 52% were found in the small intestine (39% enteroenteric, 13% ileocolic) and 38% in the large intestine (17% ileocecal, 17% colocolic, 4% appendiceal).2. It often happens in the cecal and sigmoid colon sections of the intestines. However, rarely, they can cause a part of the intestine to fold back on itself (intussusception), resulting in possibly life-threatening intestinal blockage. Diagnosis and treatment of adult intussusception. The diagnosis and treatment of adult intussusception. The .gov means its official. In the beginning, episodes of pain occur approximately every 15 to 20 minutes, and over time they become more frequent. In 30 years at the Massachusetts General Hospital, there are 58 cases of surgically proven adult intussusception. Intussusception in adults: Institutional review - ScienceDirect Dexamethasone may decrease the risk of another episode. Management for intussusception in children. The hallmark physical findings in intussusception are a right hypochondrium sausage-shaped mass and emptiness in the right lower quadrant (Dance sign). The site is secure. A., Hearn, D., & Ogden, W. (1971). The infant can be pale, diaphoretic, and hypotensive if shock has occurred. Clin Colon Rectal Surg. The patient is usually an infant who presents with vomiting, abdominal pain, passage of blood and mucus, lethargy, and a palpable abdominal mass. Fever and leukocytosis are late signs and can indicate transmural gangrene and infarction. J Pediatr. The two types of procedures used for bowel reduction surgery are: The type of procedure will be dictated by the childs condition. People sometimes have symptoms for weeks before seeking medical attention. [QxMD MEDLINE Link]. 2010 Oct 25. Common symptoms of volvulus that may signal bowel obstruction include: Constipation and the inability to pass gas may occur together, leading to abdominal distention and possibly nausea and vomiting. eCollection 2023 May. Role of nitric oxide and cyclooxygenase pathway in lipopolysaccharide-induced intussusception. 2011 Jan. 212(1):62-7. Volvulus often affects children because of an abnormality in the rotation of the gut as the fetus is developing in utero, something that happens in about one in 6,000 live births. The bowel is blocked or obstructed because the intestine overlaps itself, A blockage in the bowels leads to swelling, bleeding, and the inability of food to pass through the intestine. There were 44 enteric and 14 colonic intussusceptions. Intussusception evident during air contrast enema prior to reduction. But it can also occur in older children, teenagers, and adults. Can Intussusception In Babies, Children, and Adults Be Prevented? Intussusception in Adults is generally diagnosed in the following manner: Many clinical conditions may have similar signs and symptoms. Adult intussusception: diagnosis and clinical relevance. Intussusception is an emergency because it can cause compression of the blood vessels in the affected area, leading to swelling, bleeding, and even death of the intestinal tissue. Parents also report the passage of stools that look like currant jelly. Niramis R, Watanatittan S, Kruatrachue A, et al. The child is found to have periods of lethargy alternating with crying spells, and this cycle repeats every 15-30 minutes. Left untreated, dehydration can become a life-threatening condition regardless of its cause. 3 (AJR) . Picture of the lower digestive tract. If the surgical incision was closed with a gauze bandage, it is typically removed within a few days post-op. Bethesda, MD 20894, Web Policies eCollection 2023 Mar. Being sick ( vomiting ). Emergency Medicine Resident at the Stanford/Kaiser Emergency Medicine Residency Program in CA. Rotavirus - Symptoms & causes - Mayo Clinic During the following year, the patient returned to the Emergency Department two more times for cramping abdominal pain. How Do I Know If I Have Bowel Endometriosis? In adults, surgery is often required to correct the problem. Intussusception in adults. World J Gastroenterol. Soccorso G, Puls F, Richards C, Pringle H, Nour S. A ganglioneuroma of the sigmoid colon presenting as leading point of intussusception in a child: a case report. The parents or caregivers describe the child as drawing the legs up to the abdomen and kicking the legs in the air. Adult intussusception: a retrospective review of 41 cases. the contents by NLM or the National Institutes of Health. If left untreated, Intussusception in Adults can lead to infection, shock, and possibly death, Intussusception in Adults can occur at any age, but this condition is much more common in infants and young children, Cases of Intussusception in Adults are fairly rare; only 5% of intussusception cases are in adults, Only about 1% of bowel obstructions are due to Intussusception in Adults, Both males and females are affected, but males are more likely to be affected than females, Individuals who have had a previous episode of intussusception are at a higher risk of another one, If Intussusception is in a familys medical history, the family members are at a higher risk of developing a bowel obstruction, Colonic diverticulum (bulging pouches in intestines), Meckels diverticulum (abnormal pouch on intestinal wall at birth), Inflammatory bowel diseases, such as Crohns disease, Abdominal pain that comes and goes; abdominal cramping, Constipation; melena (dark feces containing traces of blood), First, a healthcare provider examines the individual to make sure their symptoms, medical history, and physical examination are suggestive of intussusception, Signs of intussusception that can lead to a diagnosis include abdominal distension, a palpable mass in the abdomen, and decreased abdominal sounds during an abdominal auscultation, Plain abdominal film X-rays may be used first to find a site of intestinal obstruction, An upper gastrointestinal contrast solution might be used to detect a coil-spring appearance of the intestines, An abdominal ultrasound can also be performed to help diagnose intussusception, An abdominal CT scan is used if other exams do not show signs of intussusception, because it has a higher rate of accurate diagnosis due to the fact that it can recognize intussusception without any pre-existing illness, An endoscopy may be performed of the lower gastrointestinal tract to find the cause of the bowel obstruction and look for any inversions of the intestines, The bowel obstruction can lead to a lack of blood supply to the intestine and the intestinal tissue can die, Intestinal tissue death can lead to tears in the wall of the intestines and infections can spread into the abdominal cavity, Peritonitis (inflammation of the peritoneum) can result and cause shock and unconsciousness, Often, adults with intussusception have large structural issues in the intestines and surgery is necessary. The causes of volvulus are not entirely known. 101(6):663-70.

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