Last updated: 02/17/2009

Surgical correction of an intussusception is done with the patient under general anesthesia. The surgeon usually enters the abdominal cavity by way of a laparotomy, a large incision made through the abdominal wall. The intestines are examined until...

the intussusception is identified and brought through the incision for closer examination. The surgeon first attempts to reduce the intussusception by "milking" or applying gentle pressure to ease the intussusceptum out of the intussuscipiens; this technique is called manual reduction. If manual reduction is not successful, the surgeon may perform a resection of the intussusception. Resect means to remove part or all of a tissue or structure; resection of the intussusception, therefore, involves the removal of the area of the intestine that has prolapsed. The two cut ends of the intestine may then be reconnected with sutures or surgical staples; this reconnection is called an end-toend anastomosis.

More rarely, the segment of bowel that is removed is too large to accommodate an end-to-end anastomosis. These patients may require a temporary or permanent enterostomy. In this procedure, the surgeon creates an artificial opening in the abdomen wall called a stoma, and attaches the intestine to it. Waste then exits the body through the stoma and empties into a collection bag.

An alternative to the traditional abdominal incision is laparoscopy, a surgical procedure in which a laparoscope (a thin, lighted tube) and other instruments are inserted into the abdomen through small incisions. The internal operating field is then visualized on a video monitor that is connected to the scope. In some patients, the surgeon may perform a laparoscopy for abdominal exploration in place of a laparotomy. Laparoscopy is associated with speedier recoveries shorter hospital stays, and smaller surgical scars; on the other hand, however, it requires costly equipment and advanced training on the surgeon's part. In addition, it offers a relatively limited view of the operating field.

Diagnosis/Preparation

The diagnosis of intussusception is usually made after a complete physical examination, medical history, and series of imaging studies. In children, the pediatrician may suspect the diagnosis on the basis of such symptoms as abdominal pain, fever, vomiting, and "currant jelly" stools, which consist of blood-streaked mucus and pieces of the tissue that lines the intestine. When the doctor palpates (feels) the child's abdomen, he or she will typically find a sausage-shaped mass in the right lower quadrant of the abdomen. Diagnosis of intussusception in adults, however, is much more difficult, partly because the disorder is relatively rare in the adult population.

X rays may be taken of the abdomen with the patient lying down or sitting upright. Ultrasonography (an imaging technique that uses high-frequency sounds waves to visualize structures inside the body) and computed tomography (an imaging technique that uses x rays to produce two-dimensional cross-sections on a viewing screen) are also used to diagnose intussusception. A contrast enema is a diagnostic tool that has the potential to reduce the intussusception; during this procedure, x-ray photographs are taken of the intestines after a contrast material such as barium or air is introduced through the anus.

Children diagnosed with intussusception are started on intravenous (IV) fluids and nasogastric decompression (in which a flexible tube is inserted through the nose down to the stomach) in an effort to avoid surgery. An enema may also be given to the patient, as 40–90% of cases are successfully treated by this method. If these noninvasive treatments fail, surgery becomes necessary to relieve the obstruction.

There is some controversy among doctors about the usefulness of barium enemas in reducing intussusceptions in adults. In general, enemas are less successful in adults than in children, and surgical treatment should not be delayed.