intussusception

Question 1

7 m.o. infant suddenly became irritable

mum noticed he was drawing his legs up when in pain and had passed “red currant jelly” stools in the nappy

he was otherwise well but had intermittent colic

you suspect that he may have intussusception

(a) describe, in one sentence, the abnormality that occurs in intussusception

Answer 1

telescoping (invagination) of one part of the intestine into another

Question 2

(b) list 3 physical signs that may be present

Answer 2

1. redcurrant jelly stools
2. palpable sausage-shaped mass typically in RUQ or epigastric region
3. blood on PR exam
4. episodes of pallor and screaming
5. billious vomiting
6. positive Dance’s sign (retraction of RIF)
7. signs of dehydration (e.g. reduced skin turgor, dry mucous membranes)

Question 3

(c) what 2 ix could you perform to help establish the dx?

Answer 3

1. US ⇒ target / donut sign
2. AXR ⇒ might show edge of intussusception

Question 4

(d) list 3 complications of this condition

Answer 4

1. intestinal perforation +/- ischaemia +/- necrosis
2. hypovolaemic shock
3. sepsis

Question 5

(e) how can this condition be treated? give one example

Answer 5

fluid resuscitation + air/barium enema

OR

pneumatic reduction under fluoroscopic guidance

OR

surgery