Intussusception

Question 1

Key points Intussusception

Answer 1

The diagnosis of intussusception requires a high index of suspicion. Consider intussusception in infants and children with intermittent distress, vomiting or isolated unexplained lethargy
Delayed presentation of intussusception can manifest as small bowel obstruction, bowel perforation, peritonitis and/or shock
Ultrasound is the initial study of choice

Question 2

Commonest site for Intussusception

Answer 2

segment of ileum moving into the colon via ileo cecal valve

Question 3

MC age for Intussusception

Answer 3

2mo-2yo

Question 4

Clinf for Intussusception

Answer 4

Intermittent pain/distress- episodes recurr but increase in frequency
Well between episodes
Pallor, lethargy, vomits
Diarrhea - PR bleeds/red currant jelly

Abdominal mass may be felt – typically a sausage shaped mass in the right abdomen, crossing the midline in the epigastrium or behind umbilicus (in 2/3 of children). The abdominal mass may be subtle and examination is best performed when the child is settled in between episodes
Abdominal distension suggests bowel obstruction
Tenderness or guarding may suggest perforation and peritonitis
Inspection of the nappy and perianal region should be done. A rectal examination is rarely indicated
Infants may present with Hypovolaemic shock

Question 5

RFs for Intussusception

Answer 5

Recent intussusception (may present with more subtle symptoms)
Potential lead point – eg Meckel’s diverticulum, Henoch Schonlein Purpura, lymphoma, luminal polyps (eg Peutz Jegher Syndrome)
Recent bowel surgery
Recent rotavirus vaccination