Intussusception

Question 1

What is intussusception?

Answer 1

Intussusception is a condition where the bowel “invaginates” or “telescopes” into itself. Picture the bowel folding inwards. This thickens the overall size of the bowel and narrows the lumen at the folded area, leading to a palpable mass in the abdomen and obstruction to the passage of faeces through the bowel.

Question 2

Who is commonly affected by intussusception?

Answer 2

It typically occurs in infants 6 months to 2 years and is more common in boys.

Question 3

What other conditions are associated with intussusception?

Answer 3

It is associated with various conditions:

• Concurrent viral illness
• Henoch-Schonlein purpura
• Cystic fibrosis
• Intestinal polyps
• Meckel diverticulum

Question 4

What are the clinical features of intussusception?

Answer 4

• Severe, colicky abdominal pain
• Pale, lethargic and unwell child
• “Redcurrant jelly stool”
• Right upper quadrant mass on palpation
  
  • This is described as “sausage-shaped”
• Vomiting
• Intestinal obstruction

Question 5

What is the initial investigation for intussusception?

Answer 5

ltrasound is the initial investigation of choice.

Contrast enema can also be used for diagnosis.

Question 6

Briefly describe the management of intussusception

Answer 6

Therapeutic enemas can be used to try to reduce the intussusception. Contrast, water or air are pumped into the colon to force the folded bowel out of the bowel and into the normal position.

Surgical reduction may be necessary if enemas do not work.

If the bowel becomes gangrenous (due to a disruption of the blood supply) or the bowel is perforated, then surgical resection is required.

Question 7

What are the complications of intussusception?

Answer 7

• Obstruction
• Gangrenous bowel
• Perforation
• Death