Intussusception

Last updated 20.09.12

Features

-  Telescoping or prolapse of one portion of the bowel into an immediately adjacent segment

-  Most commonly occurs at the terminal ileum: ileocolic

-  Most common cause of bowel obstruction in 3 month to 6 year olds

-  Male 3:1 female

-  Uniformly fatal in 2-5 days if untreated

 

Diagram

 

Causes

-  90% idiopathic

-  2 months – 2 years most common

-  If > 2 years look for lead point

-  Recent URTI or recurrent diarrhoea --> mesesteric laympadenitis = lead point

-  Henoch-Schonlein purpura

-  CF

-  Chronic GI tubes

-  Meckels diverticulum

-  Intestinal polyp

-  Intestinal lymphosarcoma

-  Haemangioma

 

Associated S/S

-  Sudden onset of colicky abdo pain w vomiting

-  Episodes 10-20 minutes apart

-  Sausage shaped mass in epigastrium in 60%

-  Loose water stools --> blood or mucous

-  Compression of mesentry --> swelling --> obstruction

-  Venous engorgement + ischaemia --> mucous --> red current jelly stool (50% pts)

-  Fever suggests enteric sepsis

 

Complications

-  Intestinal haemorrhage

-  Necrosis & perforation

-  Shock & sepsis

-  Reoccurrence 3-10%

 

Ix

-  Barium contrast enema unless acute abdomen

-  Dx 95%

-  AXR: perforation, obstruction, soft tissue mass, paucity of gas

-  Ultrasound: target sign/bullŐs eye

-  FOBT: positive in 75%

 

X-ray

 

US

 

Mx

-  Fluid resuscitations

-  Air enema: 80% successful

-  Sx

-  20% pts

-  Manual reduction +/- resection of ischaemic bowel

-  Admission: 10% reoccur, usually within 24 hrs

 

 

 

References