Intussusception is a disorder in which part of the intestine, most commonly the small intestine, slides into another part, much like a telescope. This often results in a blockage preventing fluids and food from passing through the intestine. It also results in a blockage of the blood supply to the affected part of the intestine. The result can be a birth injury that can significant harm the child.
Lack of blood to the intestine can cause necrosis (tissue death) which can then result in an intestinal tear (perforation) and lead to peritonitis and shock. Intussusception most commonly affects children between the ages of 3 months and six years, but can also occur in adults. Intussusception has a prevalence of 1.5-4 cases per 1000 live births. Prompt diagnosis and treatment, usually in the form of emergency care, are essential to successfully treat intussusception without chronic problems or mortality.
Hospitalization rates associated with intussusception have declined by 25% but have remained stable since 2000 at 35 cases per 100,000 infants. In infants under nine weeks of age, the incidence is less than 5 per 100,000 infants.
Not every case of intussusception can be avoided. But there are far too many serious, permanent injury and fatal cases result from the failure to diagnose intussusception. These are usually emergency room cases or by pediatricians, often because the doctors are too busy to order an ultrasound or CT scan or fail to perform a rectal exam or another test that would have given the doctor the proper diagnosis on a silver platter.
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Probably the most common symptoms are unexplained irritability, vomiting or abdominal pain in a child between the ages of about six months and six years. Unfortunately, these are unspecific in that they are also symptoms of many other child ailments. There are reported cases of intussusception up to at age 8. But it is rarely seen in children over six-years-old.
So if you expect intussusception, you to dig deeper. Intussusception is often diagnosed through a battery of examinations and tests. A physical examination may be performed by your physician to look for a lump in the abdomen when intestinal obstruction is suspected. Blood, urine and fecal tests may be ordered by your physician. The fecal occult blood test checks for blood in the stool. Abdominal imaging is often performed (ultrasound, X-ray, CT scans or MRI) to determine the presence of intestinal obstructions or perforations. Air or barium enema may be performed to clarify abdominal imaging, however, barium enemas cannot be used in cases where the intestine is perforated.Risk Factors for Intussusception
Children are at much higher risk than adults to develop intussusception, with the majority of cases occurring in children less than one year of age, with boys being more susceptible than girls in a ratio of 3:2. Children with congenital defects such as abnormal intestinal formation or malrotation are also at increased risk of intussusception.
Intussusception can recur and therefore a prior history of intussusception is a risk factor. Studies have found that intussusception is more prevalent in Hispanic infants followed by non-Hispanic black infants, and non-Hispanic white infants. But ethnicity does not seem to have an association with intussusception infants less than 16 weeks of age.Treatment and Outcomes
To avoid dehydration and shock and prevent infection, emergency care is necessary to treat intussusception. The patient will be provided IV fluids to prevent dehydration. A tube may also be inserted through the nose into the stomach to help decompress the intestines. Air or barium enemas will sometimes correct the intussusception. If an enema is unsuccessful in correcting the issue, or the intestine is perforated, surgery is required. Surgery involves freeing the portion of affected intestine and removing any tissue that has died.
It is important to note that some cases of intussusception will correct themselves without need for intervention, however, it is important to seek emergency care in all cases to prevent negative outcomes.Misdiagnosis of Intussusception
Successful management of intestinal obstructions occurring in the neonatal period depends on quick and accurate diagnosis and effective therapy. Intestinal obstructions in neonates may be due to several causes including stenosis, malrotation, meconium plug syndrome, anorectal malformations, and other rare disorders. Though intussusception is the leading cause of intestinal obstructions in children between 6 and 18 months, it is extremely rare in newborns and pre-term babies, which lends to misdiagnosis. Published case studies have demonstrated that intussusception may be misdiagnosed as necrotizing enterocolitis (NEC) as abdominal masses are rarely present, and symptoms are similar to NEC (abdominal distension, bloody stools, vomiting and feeding intolerance). Due to the higher prevalence of NEC in this age group, and similar symptoms, an estimated average seven-day delay occurs in proper diagnosis of intussusception.
Recent studies have reported that ultrasound scans can establish an early diagnosis of intussusception in newborns. The current mortality rate in children with intussusception is less than 1% and is usually related to delayed diagnosis, delay in recognizing recurring intussusception, inadequate IV fluid and antibiotic administration, and surgical complications.
Misdiagnosis and delayed diagnosis in children are common due to the high prevalence of presentation of atypical symptoms which can mimic more common entities, such as acute appendicitis or viral infections. Proper use and interpretation of laboratory and imaging tests are required to minimize misdiagnosis and false positive and false negative results. Surgical consultants are recommended in cases of pediatric patients presenting with significant abdominal symptoms or findings.
Intussusception is an extremely rare condition. Only five percent of cases involve adults. Only one percent of adult bowel obstruction cases involve intussusception. Radiologists may overlook potential signs. As a result, physicians may misdiagnose adult intussusception as abdominal pain.
Many pediatric intussusception cases typically have unknown causes. Some suspect that a virus plays a role because this condition usually occurs in the colder months and flu-like symptoms are associated with this condition. Healthcare professionals may also identify a lead point as the condition's cause. This lead point is usually Meckel's diverticulum.
Medical conditions or surgical procedures typically cause adult intussusception. They include:
- A tumor or polyp
- Intestinal adhesions
- Weight loss surgery or other intestinal tract procedures
- Inflammation caused by certain diseases including Crohn's disease
Adult intussusception is an emergency. Treatment delays significantly increase the mortality risk. Once the physician diagnoses adult intussusception, they must immediately resuscitate the patient and prepare them for surgery. Close monitoring is also necessary because patients may experience severe complications if they have other comorbidities.
Healthcare professionals use ultrasounds, X-rays, and CT scans to confirm intussusception. Imaging usually shows a "bull's-eye" or a donut-like shape that may indicate intussusception-caused intestinal obstruction. It can also identify perforations.
- 2019, South Carolina: $1,000,000 Settlement. A 7-month-old girl suffered bloody stool and vomiting. She was diagnosed with viral gastroenteritis and nausea. The girl was then discharged home. Her condition failed to resolve. Two days after being discharged, she became unresponsive while on her way to her pediatrician. The girl died hours later. Her autopsy showed that she died from intussusception-caused sepsis. The girl's family alleged negligence against the hospital. They claimed its staff failed to rule out intussusception, failed to order an ultrasound, and prematurely discharged her. This case settled for $1,000,000.
- 2018, Pennsylvania: $6,500,000 Settlement. A 10-month-old boy suffered diarrhea, vomiting, and a fever over three days. His parents brought him to the emergency room. The boy was admitted. His ultrasound revealed intussusception. However, the boy was transferred to another hospital for "abdominal pain." He suffered from lethargy, sinus tachycardia, and dehydration. However, the hospital staff failed to hear any bowel sounds. The boy's condition declined. He was pronounced dead hours later. The boy's cause of death was septic shock from dehydration and intussusception. His parents alleged negligence against the hospital. They claimed failed to timely perform diagnostic studies and diagnose an obstructed bowel. This case settled for $6,500,000.
Kelley-Quon, L. I., et al. (2021). Management of intussusception in children: A systematic review. Journal of pediatric surgery, 56(3), 587-596.
This systematic review looked at the treatment options for pediatric intussusception. The researchers evaluated 83 articles. They concluded that pre-reduction antibiotics were unnecessary, healthcare providers should maximize non-operative outpatient management, and that minimally invasive techniques were an effective alternative to laparotomies.
Kim, P. H., et al. (2021). Predictors of failed enema reduction in children with intussusception: a systematic review and meta-analysis. European Radiology, 31(11), 8081-8097.
This meta-analysis identified the potential signs of failed enema reductions in pediatric intussusception. The researchers evaluated 38 studies. They found that shorter symptom durations and abdominal pain were associated with successful reductions. By contrast, the researchers found that being less than a year old, fever, vomiting, rectal bleeding, left-sided intussusception, ascetics, and trapped fluid were associated with failed reductions. They concluded that their evidence would help distinguish potential surgical candidates from patients who were likely to have a failed procedure.
Kotb, M., et al. (2021). Intussusception in preterm neonates: A systematic review of a rare condition. BMC pediatrics, 21(1), 1-8.
This study looked at neonatal intussusception's clinical features and how to distinguish it from necrotizing enterocolitis (NEC). The researchers looked at 52 cases. They found that 85 percent of cases involved abdominal distensions, 77 percent involved bilious gastric residuals, and 43 percent involved bloody stools. However, the researchers found that only one-third of cases involved all three symptoms. Two-thirds of cases took place in the ileum. Seven cases involved pathological lead points, four of which were related to Meckel's diverticulum. Only nine cases involved death. The researchers concluded that it was "crucial" to timely detect intussusception clues because it does not respond well to conservative treatments like NEC does.
Li, X. Z., et al. (2021). Ultrasonographic Diagnosis of Intussusception in Children: A Systematic Review and Meta‐Analysis. Journal of Ultrasound in Medicine, 40(6), 1077-1084.
This meta-analysis and systematic review evaluated whether ultrasonography could accurately diagnose pediatric intussusception. The researchers looked at 14 studies. They found that ultrasonography diagnosed pediatric intussusception with 94 percent sensitivity and 96 percent specificity.
Lyons, D., & Sidhu, S. (2019). Missed case of intussusception, a rare cause of abdominal pain in adults: A case report emphasizing the imaging findings and review of the literature. Radiology case reports, 14(8), 906-910.
This case study involved a 50-something man whose intussusception was misdiagnosed as a suspected passed kidney stone. It found that the radiologist failed to recognize subtle intussusception signs in the man's CT imaging. The researchers concluded that healthcare providers should consider intussusception as a differential diagnosis for abdominal pain in adults. They further concluded that radiologists must better familiarize themselves with clearer and subtler radiological signs of intussusception.Intussusception and Other Medical Malpractice Claims in Maryland
If you or someone you love has suffered as the result of a medical misdiagnosis or failure to diagnose intussusception, call at 800-553-8082 or get a free on-line no obligation consultation.