Intussusception Flashcards

1
Q

Define intussusception

A

Invagination of the proximal bowel into a distal segment (prolapse of one part into the lumen of the adjoining distal part)
Most commonly involves the ileum passing into the caecum through the ileocaecal valve

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2
Q

What is the aetiology of intussusception

A

The intussusceptum telescopes INTO the lumen of the intussuscipiens

The lead point of the intussusception is most often an enlarged mesenteric lymph node (Peyer’s patch) in the terminal ileum
Viral infection → hyperplasia of the Peyer’s patches and lymphoid tissue in the intestinal wall
Idiopathic

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3
Q

Why can intussusception lead to ischaemia

A

The mesentery is dragged alongside the proximal bowel wall into the distal lumen → obstruction of venous return → oedema, muscosal bleeding, increased pressure
Arterial compromise → ischaemia, necrosis, perforation

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4
Q

What may act as the pathological lead point for intussusception

A

Luminal polyps
Malignant tumours
Benign mass lesions e.g. lipomata
Meckel’s diverticulum
Henoch-Schonlein purpura (intestinal wall haematoma)
Enteric duplication cysts
Appendix
Hypertrophies mucosal glands (cystic fibrosis)

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5
Q

What are the risk factors for intussusception

A

6-12 months
Male sex
Antecedent viral illness
First-generation rotavirus vaccination (RRV-TV)

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6
Q

What are the symptoms of intussusception

A

Abdominal pain
- Paroxysmal, severe colicky pain
- 1-3- minutes
- Episodes of pain: child becomes pale, draws up legs, pain around the mouth
- Infant is normal between episodes
- >3 months (rule out colic)
Lethargic
Poor feeding
Vomiting (may be bile-stained depending on the site of intussusception)
Redcurrant jelly-like stools (blood-stained mucous) - represents mucosal oedema/ulceration
Abdominal distension

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7
Q

What are the differentials for intussusception

A

Gastroenteritis
incarcerated inguinal hernia
Appendicitis
Mesenteric adenitis
Meckel’s diverticulum
Colic
Pyloric stenosis
Urinary tract infection

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8
Q

What are the signs of intussusception on examination

A

Obs: shock (from intestinal ischaemia, gangrene, perforation)

General
Pale, draws legs up
Lethargic

abdominal
Sausage-shaped mass in the RUQ or epigastrum
Abdominal distension
Dance’s sign (emptiness on palpation of RUQ)

DRE
Blood on gloves

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9
Q

What investigations should be done for intussusception

A

Urine dip
Blood glucose

FBC, CRP, LFTs, blood gas

Abdo US: Target/doughnut sign (single hypoechoic ring with hypoechoic centre)
AXR: distended small bowel, absent gas in distal colon or rectum, assess for perforation/obstruction
Diagnostic enema: meniscus sign

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10
Q

What is the management for intussusception in a patient who is stable

A
  1. IV fluid resuscitation
  2. Contrast (barium/Gastrograffin) or air enema reduction

Second line: Surgical reduction + Abx (clindamycin, gentamycin)

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11
Q

What is the management for intussusception in a patient who is unstable

A
  1. A-E assessment
  2. Contact paed surgeons
  3. IV fluid resuscitation
  4. NBM + NG feeds
  5. Rectal air insufflation by the radiologist - CI in peritonitis, perforation, shock

Second line: surgical reduction

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12
Q

What is the management for recurrent intussusception

A

Assess for a potential pathological lead point → CT abdomen

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13
Q

What are the complications of intussusception

A

Bowel perforation
Peritonitis
Gut necrosis

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14
Q

What is the prognosis for intussusception

A

Success rate of rectal air insufflation is about 75%
Recurrence of the intussusception occurs in less than 5% but is more frequent after hydrostatic/contrast enema reduction (10%)
Mortality in intussusception is related to delay in presentation, septic shock, and inadequate fluid resuscitation

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