Intussusception Flashcards
What is intussusception?
When part of the intestine folds into the section next to it
Does intussusception affect the large or small bowel?
Usually the small but can involve the large
How common is intussusception compared to other causes of neonatal intestinal obstruction?
It’s the most common
What is the most common type of intussusception?
The ileum folding into the caecum
Where else can small intestine intussusception occur?
- Jejunum into jejunum
- Jejunum into ileum
- Ileum into ileum
In almost all cases of intussusception, does the bowel prolapse proximal into distal or distal into proximal?
Proximal into distal
Why are most cases of intussusception proximal into distal?
Due to peristalsis pulling the proximal segment
What is the main risk of intussusception?
The trapped bowel may become ischaemic
How does the gut mucosa respond to ischaemia?
It is very sensitive and can slough off into the lumen
How can mucosal ischaemia present?
Redcurrant jelly stool
What is the underlying cause of intussusception?
Unknown
How is viral infection thought to be linked to intussusception?
Can lead to enlargement of Peyer’s patches creating a lead point of the intussusception
What are some risk factors for intussusception?
- Certain infections
- Diseases such as CF
- Intestinal polyps
How does intussusception present?
- Abdominal pain
- Lethargy
- Refusal of feeds
- Vomiting
- Redcurrant jelly stool
- Abdominal mass
- Abdominal distension
Describe the abdominal pain usually seen in intussusception
- Paroxysmal
- Severe
- Colicky
What happens to the child during episodes of pain?
Becomes pale, especially around the mouth and draws legs up
How may vomit appear in intussusception?
Bile stained (depending on the site of intussusception)
What shape is an abdominal mass in intussusception usually?
Sausage shaped
What imaging can be used in intussusception?
- AXR
- Abdo USS
What might an AXR show in intussusception?
- Distended small bowel
- Absent gas in distal colon/rectum
Sometimes the intussusception itself can be visualised
What may be seen on USS in intussusception?
- Target/doughnut sign
What is a USS used for?
Confirming diagnosis and checking treatment response
What is a differential diagnosis of intussusception?
Pyloric stenosis
How should intussusception be managed?
- IV resuscitation
- Rectal air insufflation
When should rectal air insufflation not be performed?
In the presence of peritonitis
Who carries out rectal air insufflation?
Radiologist in the presence of a paediatric surgeon
Why is a paediatric surgeon required in rectal air insufflation?
In case of procedure failure or perforation
If rectal air insufflation is unsuccessful what is needed?
Operative reduction
What treatment may be useful in reducing the risk of a further episode?
Dexamethasone
What is the most serious complication of intussusception?
Stretching and constricting of the mesentery
What can constriction if the mesentery cause?
Venous obstruction
What can mesenteric venous obstruction due to mesenteric constriction lead to?
Engorgement and bleeding from the mucosa, fluid loss and subsequently bowel perforation, peritonitis and necrosis
