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.
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 6 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 declined by 25% from 1993 to 2004 but have remained stable since 2000 at 35 cases per 100,000 infants. In infants under 9 weeks of age, incidence is less than 5 per 100,000 infants.
Not every case of intusssuception can be avoided. But there are far too many serious, permanent injury and fatal cases result from the failure to diagnose intussusception, usually in the ER 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 other test that would have given the doctor the proper diagnosis on a silver platter. If you believe you or someone you care about has been injured or killed by medical malpractice, we will be glad to talk to you about what happened to you and figure out whether our attorneys think you may have a claim worth pursuing. Call 800-553-8082 or get a free online consultation for your malpractice case.Symptoms of Intussusception
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. An 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 1 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 then non-Hispanic white infants; however, ethnicity does not seem to have an association with intussusception infants less than 16 weeks of age.Treatment and Outcomes
In order to avoid dehydration and shock and prevent infection, emergency care is necessary to treat intussusception. Generally, 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 7 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 is 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 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.
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