Flashcards in Intussusception Deck (15):
What is intussusception?
= Invagination of proximal into distal bowel
Where is intussusception most common?
- commonest occurrence is ileum moving into the colon through the ileo-caecal valve
Peak incidence (and why) and age bracket of intussusception
• Can occur 3m to 3y
• Peak incidence at 5-7 months
• Due to change in immune system and antigenic exposure
Explain how idiopathic intussusception occurs.
• Most likely due to change in immune system and antigenic exposure -> inflamed Peyer’s patches in terminal ileum -> gut tries to push that along -> small to large bowel intussusception
What are some causes of pathological intussusception.
Less commonly due to a pathological lead point:
• Meckel’s diverticulum
• Polyp (look for circumoral freckling – Peutz- Jegher’s syndrome)
• Vascular malformation
• Duplication cyst
Which is more common in paeds: idiopathic or pathological intussusception?
Symptoms of intussusception
• Crampy episodic abdominal pain
• 3-4 minutes between waves of severe pain (waves of small bowel obstruction)
• Episodes typically 2-3 times/hour
• Sympathomimetic response - pallor while crying, sweating
• Vomiting and fever
• Faeculant vomiting is very late sign, uncommon
• Pallor and lethargy
• Bowel motions
○ blood and/or mucus
○ classic red currant jelly stool is a late sign
○ Diarrhoea is quite common and can lead to a misdiagnosis of gastroenteritis
How can intussusception lead to perforation?
Venous obstruction → oedema → obstruction → ischaemia → perforation → peritonitis
What is a classic behavioural sign of intussusception?
🐝Children tend to pull legs up towards buttocks to relieve pressure on abdominal wall
What will the intussusception feel like on examination?
Abdominal mass - sausage shaped mass RUQ or crossing midline in epigastrium or behind umbilicus, palpable in about two thirds of children.
What Ix are done for intussusception, and which is the most relevant?
• Exclude perforation or bowel obstruction
• A normal AXR does not exclude intussusception
2. US (Dx Ix of choice, but not needed if high suspicion)
3. Air enema (initial if high suspicious)
What are classical signs of intussusception on AXR?
1. Target sign - 2 concentric circular radiolucent lines usually in the right upper quadrant
2. Crescent sign - a crescent shaped lucency usually in the left upper quadrant with a soft tissue mass
What risks are there when doing an air enema?
- Bowel perforation
Mx of intussusception
• Supportive: analgesia, IV fluids
• Correct electrolyte abnormalities
• Nil orally, NGT if bowel obstruction/perforation on AXR/for decompression
• Simple (= <48h, no peritonitis, stable child)
• Air enema reduction successful in 80-90%, repeat in 6h if doesn’t work
• Complicated (=>48h, peritonitis and/or septicaemia)
• Laparotomy (10-15%)