Which description of a stool is characteristic of intussusception?

Etiology of Intussusception

Most cases are idiopathic. However, there is a slight male predominance as well as a seasonal variation; peak incidence coincides with the viral enteritis season. An older rotavirus vaccine was associated with a marked increase in risk of intussusception and was taken off the market in the US. The newer rotavirus vaccines, when given in the recommended sequence and timing, are not associated with any clinically significant increased risk.

In about 25% of children who have intussusception, typically very young and older children, a lead point (ie, a mass or other intestinal abnormality) triggers the telescoping. Examples include polyps Polyps of the Colon and Rectum An intestinal polyp is any mass of tissue that arises from the bowel wall and protrudes into the lumen. Most are asymptomatic except for minor bleeding, which is usually occult. The main concern... read more

Meckel Diverticulum Meckel diverticulum is a true diverticulum and is the most common congenital anomaly of the gastrointestinal tract, occurring in about 2% of people. It is caused by incomplete obliteration of... read more

Immunoglobulin A–Associated Vasculitis (IgAV) Immunoglobulin A–associated vasculitis (formerly called Henoch-Schönlein purpura) is vasculitis that affects primarily small vessels. It occurs most often in children. Common manifestations... read more

Cystic Fibrosis Cystic fibrosis is an inherited disease of the exocrine glands affecting primarily the gastrointestinal and respiratory systems. It leads to chronic lung disease, exocrine pancreatic insufficiency... read more

Symptoms and Signs of Intussusception

The initial symptoms of intussusception are sudden onset of significant, colicky abdominal pain that recurs every 15 to 20 minutes, often with vomiting. The child appears relatively well between episodes. Later, as intestinal ischemia develops, pain becomes steady, the child becomes lethargic, and mucosal hemorrhage causes heme-positive stool on rectal examination and sometimes spontaneous passage of a currant-jelly stool. The latter, however, is a late occurrence, and physicians should not wait for this symptom to occur to suspect intussusception. A palpable abdominal mass, described as sausage-shaped, is sometimes present. Perforation results in signs of peritonitis, with significant tenderness, guarding, and rigidity. Pallor, tachycardia, and diaphoresis indicate shock.

About 5 to 10% of children present without the colicky pain phase. Instead, they appear lethargic, as if drugged (atypical or apathetic presentation). In such cases, the diagnosis of intussusception is often missed until the currant-jelly stool appears or an abdominal mass is palpated.

Diagnosis of Intussusception

• Ultrasonography

Suspicion of the diagnosis must be high, particularly in children with atypical presentation, and studies and intervention must be done urgently, because survival and likelihood of nonoperative reduction decrease significantly with time. Approach depends on clinical findings. Ill children with signs of peritonitis require , broad-spectrum antibiotics (eg, ampicillin, plus gentamicin and clindamycin; metronidazole plus either cefotaxime or piperacillin-tazobactam), nasogastric suction, and surgery. Clinically stable children require imaging studies to confirm the diagnosis and treat the disorder.

Barium enema was once the preferred initial study because it revealed the classic coiled-spring appearance around the intussusceptum. In addition to being diagnostic, barium enema was also usually therapeutic; the pressure of the barium often reduced the telescoped segments. However, barium occasionally enters the peritoneum through a clinically unsuspected perforation and causes significant peritonitis. Currently, ultrasonography is the preferred means of diagnosis; it is easily done, relatively inexpensive, and safe; the characteristic finding is termed the target sign.

At times, an intussusception is seen incidentally on an imaging study, such as a CT scan. If children have no symptoms of intussusception, they can be followed and no intervention is required.

Pearls & Pitfalls

• Physicians should not wait for passage of a currant-jelly stool to suspect intussusception because it is a late occurrence.

Treatment of Intussusception

• Air enema

• Surgery if enema unsuccessful or if perforation present

If intussusception is confirmed, an air enema is used for reduction, which lessens the likelihood and consequences of perforation. The intussusceptum can be successfully reduced in 75 to 95% of children. If the air enema is successful, children are observed overnight to rule out occult perforation. If reduction is unsuccessful or if the intestine has perforated, immediate surgery is required.

When reduction is achieved without surgery, the recurrence rate is 5 to 10%.

Key Points

• Intussusception is telescoping of one segment of intestine into another, usually in children < 3 years of age.

• Children typically present with colicky abdominal pain and vomiting, followed by passage of currant-jelly stool.

  What does intussusception poop look like?

  Your child may pass a normal stool, but the next stool may look bloody. A red, mucus, or jelly-like stool is usually seen with intussusception.

  What is the clinical manifestation of intussusception?

  The main symptom of intussusception is severe, crampy abdominal pain alternating with periods of no pain. Painful episodes may last 10 to 15 minutes or longer, followed by periods of 20 to 30 minutes of no pain, after which the pain returns.

  Is diarrhea a symptom of intussusception?

  Prolonged intussusception increases bowel ischemia and necrosis, requiring surgical resection. The differential diagnosis of intussusception includes acute gastroenteritis and rectal prolapse. Abdominal pain, vomiting, and stool with blood and mucus occur in acute gastroenteritis, but diarrhea is the leading symptom.

  Why does intussusception cause currant jelly stools?

  Intussusception occurs when a part of the bowel is pulled back into itself or another piece of the bowel. This condition causes people to pass bloody stool that looks like currant jelly. Blood in the stool can also signify other conditions like inflammatory bowel disease (IBD).