[80] Intussusception

Question 1

What is intussusception?

Answer 1

When part of the intestine folds into the section next to it

Question 2

Does intussusception affect the large or small bowel?

Answer 2

Usually the small but can involve the large

Question 3

How common is intussusception compared to other causes of neonatal intestinal obstruction?

Answer 3

It’s the most common

Question 4

What is the most common type of intussusception?

Answer 4

The ileum folding into the caecum

Question 5

Where else can small intestine intussusception occur?

Answer 5

• Jejunum into jejunum
• Jejunum into ileum
• Ileum into ileum

Question 6

In almost all cases of intussusception, does the bowel prolapse proximal into distal or distal into proximal?

Answer 6

Proximal into distal

Question 7

Why are most cases of intussusception proximal into distal?

Answer 7

Due to peristalsis pulling the proximal segment

Question 8

What is the main risk of intussusception?

Answer 8

The trapped bowel may become ischaemic

Question 9

How does the gut mucosa respond to ischaemia?

Answer 9

It is very sensitive and can slough off into the lumen

Question 10

How can mucosal ischaemia present?

Answer 10

Redcurrant jelly stool

Question 11

What is the underlying cause of intussusception?

Answer 11

Unknown

Question 12

How is viral infection thought to be linked to intussusception?

Answer 12

Can lead to enlargement of Peyer’s patches creating a lead point of the intussusception

Question 13

What are some risk factors for intussusception?

Answer 13

• Certain infections
• Diseases such as CF
• Intestinal polyps

Question 14

How does intussusception present?

Answer 14

• Abdominal pain
• Lethargy
• Refusal of feeds
• Vomiting
• Redcurrant jelly stool
• Abdominal mass
• Abdominal distension

Question 15

Describe the abdominal pain usually seen in intussusception

Answer 15

• Paroxysmal
• Severe
• Colicky

Question 16

What happens to the child during episodes of pain?

Answer 16

Becomes pale, especially around the mouth and draws legs up

Question 17

How may vomit appear in intussusception?

Answer 17

Bile stained (depending on the site of intussusception)

Question 18

What shape is an abdominal mass in intussusception usually?

Answer 18

Sausage shaped

Question 19

What imaging can be used in intussusception?

Answer 19

• AXR

- Abdo USS

Question 20

What might an AXR show in intussusception?

Answer 20

• Distended small bowel
• Absent gas in distal colon/rectum

Sometimes the intussusception itself can be visualised

Question 21

What may be seen on USS in intussusception?

Answer 21

• Target/doughnut sign

Question 22

What is a USS used for?

Answer 22

Confirming diagnosis and checking treatment response

Question 23

What is a differential diagnosis of intussusception?

Answer 23

Pyloric stenosis

Question 24

How should intussusception be managed?

Answer 24

• IV resuscitation

- Rectal air insufflation

Question 25

When should rectal air insufflation not be performed?

Answer 25

In the presence of peritonitis

Question 26

Who carries out rectal air insufflation?

Answer 26

Radiologist in the presence of a paediatric surgeon

Question 27

Why is a paediatric surgeon required in rectal air insufflation?

Answer 27

In case of procedure failure or perforation

Question 28

If rectal air insufflation is unsuccessful what is needed?

Answer 28

Operative reduction

Question 29

What treatment may be useful in reducing the risk of a further episode?

Answer 29

Dexamethasone

Question 30

What is the most serious complication of intussusception?

Answer 30

Stretching and constricting of the mesentery

Question 31

What can constriction if the mesentery cause?

Answer 31

Venous obstruction

Question 32

What can mesenteric venous obstruction due to mesenteric constriction lead to?

Answer 32

Engorgement and bleeding from the mucosa, fluid loss and subsequently bowel perforation, peritonitis and necrosis