Intussusception Flashcards
Define intussusception.
Invagination or telescoping of part of the intestine (intussuscepian) into an adjacent intestinal lumen (intussusceptum).
Explain the aetiology/risk factors for intussusception.
90% idipathic. Most common site of invagination is the terminal ileum into the caecum.
Mesenteric constriction -> venous return obstruction -> engorgement and oedema -> bleeding -> prevention of arterial perfusion -> intestinal infarction and perforation.
Peyer’s patches: Oval or round lymphoid follicles located in the lamina propria layer of the mucosa and extending into the submucosa of the ileum.
What is intussusception associated with?
Adenovirus
HSP
FAP
Summarise the epidemiology of intussusception.
Most common cause of small bowel obstruction in infants. Rare in neonates.
What are the presenting symptoms of intussusception?
Triad: vomiting (initially non-bilious but becomes more bilious as intussusception more established) + colicky severe pain (can become inconsolable) + PR bleeding (red currant jelly stools – late signs as due to mucosal necrosis and sloughing).
What are the signs of intussusception?
Examination may reveal normal infant, signs of dehydration with shock, abdominal distension, ‘sausage-shaped, mass, blood PR.
What are appropriate investigations for intussusception?
Bloods: CRP(up), U&Es (dehydration), FBC(WCC up, Hb down), G&S. AXR: Dilated bowel may be present; ‘crescent sign’ – presence of a curvilinear mass on the right, especially in the transverse colon distal to the hepatic flexure, is pathognomonic.
USS: Confirmatory investigation, presence of a ‘donut’ or ‘target’ sign.
What is the management plan for intussusception?
General: IV access, fluid resuscitation (20 ml/kg/bolus), NGT placement, IV antibiotics for reduction and immediate confirmation of the intussusception with USS.
Therapeutic enema: Air, water or contrast enema for reduction. Usually three attempts as risk of perforation. Fluid between the bowel walls with a long-standing intussusception are poor prognostic factors for successful reduction. However, most centres will attempt a reduction as it is far less invasive.
Surgical reduction: If therapeutic air enema fails; may be by either the laparoscopic or open technique. Open access is through a right lower transverse incision. Reduction should be careful to avoid perforation and involve a retrograde milking technique. Laparoscopic reduction involves a gentle traction. Limited right hemicolectomy if the bowel is necrotic upon full reduction.
What are complications associated with intussusception?
Shock, peritonitis and intestinal perforation
What is the prognosis for intussusception?
Should be dealt with within 24 hrs.
