Elective Diaries: What is intussusception?
The Medics Abroad summer electives are currently underway in Malindi, Kenya. Our medical students have been there for just under a week and have seen a whole lot of medical conditions that they have only ever encountered in textbooks. The opportunities for hands-on clinical experience have been endless. From scrubbing in for a hemicolectomy in a rare case of intussusception in an elderly female to stitching up lacerations in the Emergency department. It has been nothing short of fulfilling for them.
Samaher, who is one of the medical students, got to scrub in for a right hemicolectomy (partial resection of the colon) and ileo-transverse anastomosis (attachment of the ileum to the transverse colon) in a 60-year-old female with ileocecal intussusception. Here, she sheds some light on what the condition is all about.
What is intussusception?
A potentially serious condition in which a segment of intestine invaginates into the adjoining intestinal lumen. Although it can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestine. This ‘telescoping’ causes bowel obstruction and ischemia which can result in perforation, infection, and death of tissue if not addressed promptly.
What are the causes of intussusception?
Intussusception is the most common cause of intestinal obstruction in children younger than 3 years old.
It is usually preceded by a viral infection, however, it may be caused by a congenital anomaly such as Meckel’s diverticulum. Though rare in adults, most cases involve an abnormal growth such as a polyp or tumor (called a lead point). The normal peristaltic movements (wave-like contractions) grab this lead point and pull it along with the lining of the intestine into the bowel ahead of it.
What are the symptoms and signs of intussusception?
The first sign of intussusception in an otherwise healthy infant may be sudden, loud crying caused by abdominal pain. Infants who have abdominal pain may pull their knees to their chests when they cry. The pain initially occurs in 15 to 20-minute intervals. However, these painful episodes tend to increase in frequency and duration.
Other manifestations of intussusception include:
- Stool mixed with blood and mucus (“currant jelly” appearance)
- Abdominal mass
Since intussusception is rare in adults and might have symptoms that overlap with other conditions, it’s more challenging to diagnose. As a result, people sometimes have symptoms for weeks before seeking medical attention.
How is intussusception diagnosed?
- Presence of abdominal mass on physical examination
- Air/ barium enema
How is intussusception treated?
In children, the intestines can usually be pushed back into position with an X-ray procedure whereas adults often require surgery. This was the case for the 60-year-old female with ileocecal intussusception, as she had a right hemicolectomy (partial resection of the colon) and ileo-transverse anastomosis (attachment of the ileum to the transverse colon) done.
Samaher is a medical student at the Royal College of Surgeons in Bahrain (RCSI Bahrain).