Intussusception Flashcards
Define Intussusception
A paediatric emergency where a segment of bowel telescopes into an adjacent section, causing obstruction.
Most common type/location of an intussusception
ileocaecal 90%, ileocaecal junction
What are the classic symptoms of intussusception?
- Intermittent colicky abdominal pain (child draws knees to chest).
- Bilious vomiting (later stages).
- Redcurrant jelly stool (blood/mucus mix, late sign).
- Lethargy.
intussusception exam stem
- Viral URTI preceeding to intussusception
- Bowel bostruction features: Abdo distention, constipation, vomiting
What is the gold-standard investigation for diagnosis?
Abdominal ultrasound
intussusception Mx
Fluid resus if signs of shock/dehydration +/- NG tube if obstructed bowel
1. Theraputic enema: Contrast, water or air are pumped into the colon forcing the intussusception back into position
2. Surgical reduction
3. if bowel gangrene / perforation: Surgical resection
intussusception complications
- Bowel obstruction
- Gangrene bowel
- Peroforation
- Dehydration and shock
- Death
intussusception Risk factors
- 2-12 months
- Male
- Recent viral infection
intussusception USS distinctive feature
Target/Doughnut sign
How do intussusception lead to dehydration and shock?
Fluid and bowel contents can collect within the intussusception
Risk of therapeutic enema Mx for intussusception
Bowel perforation
Intussusception causes
Idiopathic
Meckel diverticulum (most common)
Polyps
Henoch-Schönlein purpura
Lymphoma and other tumors
Post-operative
Intussusception peak age prevalence
2-12 months of age
What is the first-line treatment for uncomplicated intussusception?
Contrast or Air enema reduction (successful in ~80% of cases). Contraindicated if perforation/peritonitis is suspected
When is surgery required?
If enema fails, perforation occurs, or signs of peritonitis/necrosis (laparotomy or laparoscopic reduction)
when to refer for intussusception
All suspected cases require urgent hospital assessment
Inssusception examination findings
Palpable “sausage” mass
