intussusception

Intussusception is a rare but dangerous condition in young children, generally ages 3 months to 6 years - more often in the first couple of years of life. It involves a sudden onset of severe abdominal pain that comes in waves. The child strains and cries loudly, and characteristically wants to lie very still during the attack of pain. At first the child may act normally between the episodes of pain, but if the diagnosis is delayed, may become progressively more sick.

The bowel is a long tube. What happens is that a portion of the bowel folds in on itself (see illustration). This most commonly happens when the valve from the small bowel to the large bowel gets pulled through into the large bowel.

The tissues around the bowel (called the mesentery) contain the blood vessels that support the bowel and these get trapped and strangulated. As the tissue of the bowel wall and the mesentery becomes strangled, it begins to swell, worsening the constriction and hastening the whole process. Bloody mucus may appear in the stool, and vomiting may develop. If the diagnosis isn't made quickly, the section of bowel and tissue dies and the child will go into shock.

The treatment is often surprisingly easy. If early intussusception is suspected, a barium enema will usually be done to confirm it, and often cure it. The pressure of the barium containing fluid used to do the test is often just the trick to reduce (pop back out) the intussusception. If that doesn't work, it will have to be surgically fixed.

If your child gets a tummy ache, that doesn't mean she has an intussusception. But abdominal pain in an infant or toddler that alarms you with its sudden onset and severe nature, with intervening periods of apparent well-being, especially if you see anything abnormal in the stool, or if there is vomiting with the abdominal pain, means call your doctor right away.

There was an advisory issued on July 15, 1999 concerning a possible increased risk of intussusception in the first three weeks after administration of the Rotashield® rotavirus vaccine. Distribution of the vaccine was suspended until further studies have been completed to see if there is truly an association with increased risk, and if so, whether the benefit of the vaccine still outweighs the risk. The number of cases reported was 23 cases out of about 1.5 million doses of vaccine given. The highest risk seemed to be in the first week after administration of a dose of Rotashield® and was most likely in the youngest recipients. To be clear, if your child had the vaccine while it was being administered, any increased risk of problems is long since past and you need not worry about it.

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