Intussusception

Question 1

What is intussusception?

Answer 1

Intussusception = invagination (telescoping) of proximal bowel into a distal segment (commonly ileum) passing into the caecum through the ileocaecal valve.

=> The most common cause of intestinal obstruction in children

Question 2

Intussusception affects children between 3 months to 2 years old.

Boys > Girls [3:1]

Answer 2

INFO CARD

Question 3

What are the features of intussusception?

Answer 3

1. Paroxysmal abdominal colic pain
   => during paroxysm the infant will characteristically draw their knees up and turn pale
   => child recovers but becomes increasingly lethargic
2. Vomiting
3. Blood-stained stool
   => red-currant jelly sign is a late sign
4. Sausage shaped mass in the right upper quadrant
5. Abdominal distension
6. May refuse feeds
7. Episodic intermittent inconsolable crying

Question 4

How is intussusception diagnosed?

Answer 4

Ultrasound

=> shows classic target sign (concentric echogenic and hypoechogenic bands)

=> shows complications of disease i.e. free abdominal air or presence of gangrene

Any necrotic bowel should be resected

Question 5

How is intussusception managed?

Answer 5

1. Rectal air insufflation under radiological control (more widely used vs traditional contrast enema) => only performed if child is stable
2. Operative reduction indicated if:

=> failure of non-operative management
=> peritonitis or perforation is present
=> haemodynamically unstable