Gastroenterology: Intussusception Flashcards
What is intussusception?
The invagination of proximal bowel into a distal segment
What region is most commonly involved?
The ileum passing into the caecum through the ileocaecal valve
Is it the most common cause of intestinal obstruction after the neonatal period?
Yes
What is the peak age of presentation?
3 months to 2 years
Does it affect more boys or girls?
Boys twice as often affected
What features are associated?
Paroxysmal, severe colicky pain with pallor
- during episodes of pain, child becomes pale, especially around mouth and draws up legs
Vomiting - may become bile stained depending on site
Feed refusal
Sausage shaped mass in RUQ
Characteristic red current jelly stool - comprising blood stained mucus
Abdominal distension
Shock
When does the passage of red current jelly stool occur?
Tends to be late in the illness and may be first seen after rectal examination
What is the most serious complication?
Stretching and constriction of the mesentery resulting in constriction of venous drainage resulting in further swelling and interruption of arterial supply.
Bleeding from the bowel mucosa, fluid loss and subsequent bowel perforation, peritonitis and gut necrosis can occur
Is an underlying intestinal cause of the intussusception often found?
No
What theories are there regarding the cause?
Viral infection - enlargement of Peyer’s patches, which may form the lead point of the intussusception
Meckel’s diverticulum - can invert and stick back into intestine. Can then act as a lead point and drag ileum into caecum.
Why is IV fluid resuscitation likely required immediately?
Often pooling of fluid in gut
Why may hypovolaemic shock occur?
Due to pooling of fluid in the gut
What investigations should be done?
USS - may show target like mass
How is it managed?
Reduction by air insufflation under radiological control - only once child resuscitated and supervision of surgeon in case of perforation (not if peritonitis)
If this fails or signs of peritonitis - surgical reduction
What is another term for intussusception?
Telescoping
What risk factors are there?
Previous intussusception
Sibling with intussusception
Having intestinal malrotation
Why can ischaemia occur?
Due to pressure on the wall of the trapped section of bowel - squeezes shut the small vessels running in wall of bowel. This can cause lack of blood flow to the tissue (ischaemia) and eventually infarction (death of tissue).
Ischaemia leads to…
Sloughing off of intestinal mucosal tissue, blood and mucus into the gut - leading to red current jelly stool
What can fever suggest?
The intestines perforated and leaking bacteria into the cavity - causing sepsis
Why can volvulus occur as a result of intussusception?
The blockage prevents food passing, leading to a large mass, which can potentially cause intestine to become twisted
What may an AXR show?
Distended small bowel and absence of gas in the distal colon
