When tummy pain is serious trouble

Parents soon become experts in interpreting their babies’ cries and are quick to note unusual behavior and symptoms. When intermittent loud crying is followed by symptoms including a bloody stool, vomiting, a lump in the abdomen, lethargy, diarrhea, fever or constipation, this may be a sign of a serious condition called intussusception.

If your child shows any of these symptoms, call your pediatrician or go to the nearest pediatric emergency department. Intussusception is when part of the child’s intestine folds in on itself, similar to closing of a telescope.  This can be a dangerous condition, so quick action is needed.

Most cases of intussusception occur in infants younger than 12 months old, but it can affect toddlers and older children. It affects boys three times as often as girls.

While the cause is unknown, a viral infection may trigger the condition, in which pressure created by the “folded” walls of the intestine causes intense pain, irritation and swelling, blocking the passage of food.  In some cases, the condition may cause a hole in the intestine, leading to bleeding and infection. Even if the intestine remains intact, the part of the organ’s blood supply may be cut off, causing permanent damage.

Usually, the first symptom of intussusception is sudden, loud crying that may stop and start every few minutes. In between these crying episodes, your child may look very tired and pale. After several hours, the crying from the pain may become more constant.  Other signs of intussusception include bloody, mucus-like stools (sometimes referred to as currant jelly stool), fever, vomiting or shock.

Diagnosis and treatment

Fortunately, intussusception can usually be quickly diagnosed. The doctor may press gently on the child’s abdomen for signs of swelling. An abdominal X-ray or ultrasound can confirm the diagnosis. Children who are dehydrated may be given fluids through an IV tube, and a nasogastric tube may be passed from the nose down into the stomach to vent any built-up air and make your child more comfortable.

The “gold standard” treatment for intussusception consists of an air or contrast enema given by a skilled radiologist. With this procedure, air is forced into the intestine to straighten out the folded area. If successful, the pain goes away almost immediately, and the gastrointestinal tract soon returns to normal.

If the telescoped area of the intestine is not corrected by the enema or if there is a hole in the intestine, your child will need laparoscopic or open surgery to repair the damage. The telescoped area of the intestine can be returned to a normal position, and any dead tissue will be removed.

With early diagnosis and treatment, the outcome for intussusception is very good. While intussusception is a very serious condition, prompt parental action and physician diagnoses are the two keys to successful treatment.

Dr. Santiago Medina is a pediatric radiologist at Miami Children’s Hospital.

 In a recent national intussusception study, Miami Children’s Hospital had the lowest rate of surgery following attempted enema reduction among 27 children’s hospitals – just 11 percent compared with a high of 62.8 percent. The results were published recently in an article in the “Journal of Pediatric Surgery.”

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