Intussusception in Children: Symptoms, Emergency Signs & Treatment

What Is Intussusception and How Does It Affect Children?

Intussusception occurs when one segment of the intestine telescopes into an adjacent segment, much like a collapsing telescope. This creates a blockage that prevents food and fluid from passing through the intestine normally. It also compresses blood vessels, which can lead to swelling, inflammation, and potentially serious damage to the intestinal tissue if not treated promptly.

The intestines in the body move food along through rhythmic, wave-like contractions called peristalsis. In intussusception, something disrupts this normal movement, causing one section of bowel to slide inside the section immediately following it. This "telescoping" effect traps the inner bowel segment and pulls its blood supply along with it, compressing the vessels and reducing blood flow to the affected area.

The most common type of intussusception in children is ileocolic intussusception, where the last part of the small intestine (ileum) slides into the first part of the large intestine (colon). This accounts for approximately 90% of cases in children. Less commonly, small bowel intussusception can occur, where one part of the small intestine telescopes into another part of the small intestine.

Intussusception causes the intestine to swell and eventually creates a complete blockage, known medically as a bowel obstruction. This prevents the child from passing stool or gas normally. If the blood supply remains compromised for too long, the trapped intestinal tissue can become damaged (necrosis) and may even develop a hole (perforation), which can lead to life-threatening infection.

Who Gets Intussusception?

Intussusception primarily affects infants and young children, with most cases occurring between 3 months and 3 years of age. The peak incidence is between 5 and 9 months, making it one of the most common causes of bowel obstruction in infancy. Boys are affected slightly more often than girls, at a ratio of approximately 3:2.

While intussusception can occur at any age, it becomes increasingly rare after age 3. When it does occur in older children or adults, there is usually an underlying anatomical cause, such as a polyp, tumor, or Meckel's diverticulum, that acts as a "lead point" triggering the telescoping.

What Are the Symptoms of Intussusception in Children?

The hallmark symptoms of intussusception include sudden, severe abdominal pain that comes and goes in waves, causing the child to cry intensely and pull their legs toward their abdomen. Between episodes, children often appear unusually tired, pale, or lethargic. Vomiting typically begins early, and later symptoms may include bloody or jelly-like stool and abdominal distension.

Intussusception typically begins suddenly in an otherwise healthy child. Parents often describe their child as being completely fine one moment, then suddenly screaming in pain the next. The pain is caused by the intestine trying to push past the blockage, creating intense cramping that comes in waves.

One of the most distinctive features of intussusception is the intermittent nature of the pain. Episodes of severe pain typically last 15-20 minutes, during which the child may scream, draw their knees up to their chest, and appear inconsolable. Then the pain subsides, and the child may seem relatively comfortable or even playful - only to have another episode begin minutes later.

However, it is important to understand that children can react differently to the pain of intussusception. Some children cry loudly and are clearly distressed, while others become unusually quiet, limp, or unresponsive. The child's response partly depends on their age and temperament, which is why recognizing the overall pattern of symptoms is so important.

The Classic Triad of Symptoms

Medical textbooks traditionally describe a "classic triad" of intussusception symptoms: intermittent abdominal pain, vomiting, and bloody stool. However, research shows that only about 20-30% of children present with all three symptoms at once. Many children, especially those caught early, may only show one or two of these signs.

• Intermittent abdominal pain: Severe, colicky pain that comes and goes, often causing the child to pull their legs up toward their abdomen. Present in about 80-90% of cases
• Vomiting: Initially may contain food, but later can become green (bile-stained) as the obstruction worsens. Present in about 70-80% of cases
• Bloody or "currant jelly" stool: A mixture of blood and mucus that resembles red currant jelly. This is typically a late sign and present in only 30-60% of cases at initial presentation

Behavior Changes Between Pain Episodes

One of the most concerning features of intussusception is how children behave between pain episodes. Rather than returning to normal, many children become increasingly lethargic, pale, and weak. Some parents describe their child as "not themselves" - unusually quiet, limp, or difficult to engage. This lethargy can be mistaken for tiredness, but it actually reflects the ongoing physiological stress on the child's body.

In some cases, particularly when diagnosis is delayed, children may become so lethargic that they appear almost unconscious or unresponsive between pain episodes. This is a serious warning sign that requires immediate emergency care.

Less Common Symptoms

While the symptoms described above are most typical, intussusception can sometimes present in less obvious ways. Some children may have:

• Altered consciousness or extreme drowsiness without obvious pain
• A palpable sausage-shaped mass in the abdomen (felt by a doctor during examination)
• Diarrhea before the bloody stool develops
• Fever (though this is usually a late sign suggesting complications)
• Empty right lower abdomen on examination (called "Dance's sign")

What Causes Intussusception in Babies and Children?

In approximately 90% of cases in children under 3 years, the exact cause of intussusception is unknown (idiopathic). It often occurs following a viral infection that causes lymph node swelling in the intestinal wall. In older children, an identifiable "lead point" such as a polyp, Meckel's diverticulum, or tumor may trigger the condition. Intussusception cannot be prevented.

Understanding why intussusception happens can be frustrating for parents, because in most young children there is no clear, identifiable cause. Medical professionals believe that the normal wave-like movements of the intestine (peristalsis) somehow pull one segment of bowel into the next, but exactly why this happens in some children and not others remains unclear.

The most widely accepted theory relates to lymphoid hyperplasia - the swelling of lymph nodes (Peyer's patches) in the intestinal wall. These lymph nodes are part of the immune system and can enlarge in response to viral infections. When they swell, they may create a "lead point" that gets caught by the intestinal contractions and pulled into the adjacent bowel segment, initiating the telescoping.

This theory is supported by the observation that intussusception frequently occurs following or during viral infections, particularly:

• Gastrointestinal infections (stomach bugs, gastroenteritis)
• Upper respiratory infections (colds, flu)
• Adenovirus infections (which have been specifically linked to intussusception)

Anatomical Lead Points

In older children (typically over 3-5 years) and in cases of recurrent intussusception, doctors are more likely to find an identifiable anatomical abnormality acting as a "lead point." This lead point gets caught in the normal intestinal contractions and pulls the bowel along with it, creating the telescoping effect.

Common lead points include:

• Meckel's diverticulum: A small pouch on the intestinal wall present from birth, found in about 2% of people
• Intestinal polyps: Benign growths on the intestinal lining
• Lymphoma or other tumors: More common in older children
• Henoch-Schönlein purpura: A condition causing inflammation and bleeding in small blood vessels
• Cystic fibrosis: The thick mucus can create lead points
• Previous abdominal surgery: Scar tissue can act as a lead point

Rotavirus Vaccination and Intussusception

There is a small increased risk of intussusception in the 1-2 weeks following rotavirus vaccination. Studies estimate this risk at approximately 1-5 additional cases per 100,000 vaccinated infants. While this association is real, it is important to understand it in context.

Rotavirus itself causes severe gastroenteritis that leads to hundreds of thousands of hospitalizations and thousands of deaths in children worldwide each year. The benefits of rotavirus vaccination in preventing these serious outcomes far outweigh the very small risk of intussusception. Medical organizations worldwide continue to recommend rotavirus vaccination.

When Should You Seek Emergency Care for Intussusception?

Seek emergency medical care immediately if your child has episodes of severe abdominal pain that cause them to draw up their legs, especially if accompanied by vomiting, lethargy between pain episodes, or blood in the stool. Intussusception is a time-sensitive emergency - the sooner treatment begins, the better the outcome and the lower the risk of complications.

One of the most important things parents can do is recognize the warning signs of intussusception and seek help quickly. The condition can progress from early symptoms to serious complications within hours, so time matters.

You should go to the emergency department or call emergency services immediately if your child shows any of the following:

• Sudden episodes of severe abdominal pain that come and go in waves
• Crying episodes where the child pulls their knees to their chest
• Unusual lethargy, paleness, or unresponsiveness between pain episodes
• Vomiting, especially if it becomes green or bile-stained
• Blood or mucus in the stool, or "currant jelly" appearing stool
• A swollen or rigid abdomen
• Your child is very unwell or you are concerned something is seriously wrong

Trust your parental instincts. If something feels seriously wrong with your child, seek help immediately. It is always better to have a doctor evaluate your child and rule out intussusception than to wait and risk complications.

How Is Intussusception Diagnosed?

Intussusception is primarily diagnosed using abdominal ultrasound, which is fast, non-invasive, and highly accurate. The ultrasound shows a characteristic "target sign" or "doughnut sign" where the telescoped bowel appears as concentric rings. Abdominal X-rays may also be used to look for signs of bowel obstruction. The diagnosis can often be made within minutes of arrival at the emergency department.

When you bring your child to the emergency department with suspected intussusception, the medical team will work quickly to confirm the diagnosis and begin treatment. The evaluation typically includes a physical examination and imaging studies.

Physical Examination

The doctor will first take a detailed history of your child's symptoms and examine them thoroughly. During the examination, they will:

• Feel the abdomen for tenderness, distension, or masses - sometimes a sausage-shaped mass can be felt
• Check vital signs (heart rate, blood pressure, temperature)
• Assess the child's level of alertness and overall condition
• Perform a rectal examination to check for blood or mucus

While the physical examination can provide important clues, imaging is essential to confirm the diagnosis and guide treatment.

Abdominal Ultrasound

Ultrasound is the gold standard for diagnosing intussusception in children. It is non-invasive, does not use radiation, and can be performed quickly at the bedside. In experienced hands, ultrasound has a sensitivity of over 98% for detecting intussusception.

On ultrasound, intussusception produces characteristic findings:

• Target sign (doughnut sign): When viewed in cross-section, the telescoped bowel appears as multiple concentric rings, resembling a target or doughnut
• Pseudokidney sign (sandwich sign): When viewed lengthwise, the telescoped bowel resembles a kidney shape
• Assessment of blood flow: Doppler ultrasound can evaluate blood flow to the affected bowel, which helps predict the success of non-surgical treatment

Abdominal X-Ray

Plain abdominal X-rays may also be taken, particularly to look for signs of complications such as:

• Bowel obstruction (dilated loops of intestine, air-fluid levels)
• Perforation (free air in the abdominal cavity)
• Absence of gas in the right lower abdomen where the colon should be

However, X-rays alone cannot definitively diagnose intussusception and are less sensitive than ultrasound. A normal X-ray does not rule out intussusception.

Contrast Enema

In some cases, a contrast enema (using air or liquid contrast) may be used for both diagnosis and treatment. During this procedure, contrast material is introduced through the rectum under X-ray or ultrasound guidance. If intussusception is present, it will be visible as a "coiled spring" appearance where the contrast outlines the telescoped bowel. The advantage of this approach is that it can often treat the intussusception at the same time as diagnosing it.

Blood Tests

While blood tests cannot diagnose intussusception, they may be ordered to assess your child's overall condition, check for dehydration, and help plan treatment. Common tests include:

• Complete blood count (to check for infection or anemia from bleeding)
• Electrolytes and kidney function (to assess hydration)
• Blood type (in case blood transfusion is needed)

How Is Intussusception Treated?

Most cases of intussusception (80-95%) can be successfully treated without surgery using an air or hydrostatic enema, which uses pressure to push the telescoped bowel back into its normal position. This procedure is performed under X-ray or ultrasound guidance by a radiologist. Surgery is only needed when the enema is unsuccessful or if complications have occurred.

The treatment of intussusception has two main goals: first, to stabilize the child and address any dehydration or shock; and second, to reduce the intussusception (push the telescoped bowel back to its normal position).

Initial Stabilization

Before any specific treatment for the intussusception, your child will receive supportive care to stabilize their condition:

• Intravenous (IV) fluids: Children with intussusception are often dehydrated from vomiting and reduced fluid intake. IV fluids help restore hydration and support blood pressure
• Nothing by mouth: Your child will not be allowed to eat or drink in preparation for the procedure or potential surgery
• Pain relief: Medication to help manage pain and keep your child comfortable
• Nasogastric tube: In some cases, a thin tube may be placed through the nose into the stomach to decompress the intestines
• Antibiotics: May be given if there is concern about infection or perforation

Non-Surgical Reduction: Air or Hydrostatic Enema

The primary treatment for intussusception in stable children without complications is enema reduction. This non-surgical procedure is performed by a radiologist and has a success rate of 80-95% in most hospitals.

Two main types of enema are used:

• Air (pneumatic) enema: Air is gently pumped into the rectum under controlled pressure. The air pressure pushes against the intussusception and gradually forces the telescoped bowel back into its normal position. This is monitored in real-time using fluoroscopy (continuous X-ray imaging)
• Hydrostatic (liquid) enema: A liquid contrast agent (saline or barium) is introduced through the rectum under gravity pressure. The liquid creates pressure that reduces the intussusception. This can be monitored with X-ray or ultrasound

Both methods are effective, and the choice often depends on the hospital's expertise and equipment. Air enema is generally preferred in many centers because it is associated with lower risk of complications if perforation occurs.

During the procedure, you as a parent can usually be present with your child, wearing a lead apron for radiation protection. The procedure typically takes 15-60 minutes, though it can take longer in difficult cases. Your child may receive sedation or pain medication to keep them comfortable.

What Happens After Successful Enema Reduction?

If the enema successfully reduces the intussusception, your child will be monitored in the hospital for several hours to ensure the bowel is functioning normally and the intussusception has not recurred. In many cases:

• Your child can start drinking clear fluids within a few hours
• If fluids are tolerated, a normal diet can resume
• Most children can go home the same day or after an overnight observation
• You will be given instructions on warning signs to watch for at home

Surgical Treatment

Surgery is needed in approximately 5-20% of cases, typically when:

• The enema reduction is unsuccessful after multiple attempts
• There are signs of complications (perforation, peritonitis, shock)
• The child is too unstable for enema reduction
• There is evidence of bowel necrosis (dead tissue)
• A lead point needs to be removed

During surgery, the surgeon will:

1. Make an incision in the abdomen (open surgery) or use small incisions with a camera (laparoscopic surgery)
2. Locate the intussusception and gently squeeze the telescoped bowel back into position (manual reduction)
3. Assess the viability of the bowel - if there is damaged or dead tissue, that portion will be removed (resection)
4. If bowel is removed, the healthy ends are sewn back together (anastomosis)
5. Remove any lead point if one is found

After surgery, your child will typically need to stay in the hospital for 1-5 days, depending on the extent of the procedure and whether bowel resection was required.

What Is the Long-Term Outlook for Children with Intussusception?

With prompt treatment, the prognosis for children with intussusception is excellent. Most children recover fully without any long-term complications. There is a 5-10% chance of recurrence, which can happen within days, weeks, or even months of the initial episode. Parents should remain alert to warning signs and seek immediate care if symptoms return.

The key to a good outcome in intussusception is early recognition and treatment. When treated promptly - ideally within 24 hours of symptom onset - the vast majority of children experience:

• Complete resolution of symptoms
• No lasting damage to the intestines
• Normal growth and development
• Normal digestive function

Even children who require surgery generally do well. Modern surgical techniques and pediatric anesthesia have made the procedure safe and effective. Most children who have bowel resection (removal of damaged intestine) do not experience long-term digestive problems, as the remaining intestine adapts well.

Risk of Recurrence

Intussusception can recur in approximately 5-10% of children. This risk is present regardless of whether the initial episode was treated with enema reduction or surgery. The recurrence risk is highest in the first 72 hours after treatment but can occur weeks or even months later.

If your child has had intussusception, watch for the same warning signs and seek immediate medical attention if they reappear. Most recurrences can also be treated successfully with enema reduction.

Children who have multiple recurrences (more than 2-3 episodes) may need additional investigation to look for an underlying lead point that is causing the repeated episodes.

When to Be Concerned After Treatment

After your child has been treated for intussusception, contact your healthcare provider or return to the emergency department if your child experiences:

• Return of severe abdominal pain in waves
• Vomiting that doesn't stop
• Blood in the stool
• Fever above 38.5°C (101.3°F)
• Signs of infection at any surgical incision sites
• Inability to tolerate food or fluids
• Progressive abdominal distension

Frequently Asked Questions About Intussusception