INTUSSUSCEPTION Flashcards
Facts: Pathophysiology, Epi
6 Mo - 6 Yrs
Segment of bowel (MC ileocolic) telescopes into the distal bowel -> venous congestion + edema -> bowel ischemia -> necrosis + perforation
Clinical Features
Ask about:
TRIAD (1/3 of cases):
- colicy abdominal pain: severe, episodic, symptom free periods
-currant jelly stool (late)
-vomit
a/w:
+/- vomit
+/- lethargy
Recent viral or diarrheal illness
Look for:
- sausage shaped mass
-abdominal distension
Investigations
CBC, comprehensive metabolic panel, and type and screen
U/S: Test of Choice
Sensitive 98-100%
-Doughnut Sign
Plain XRAY:
-if concern for obstruction /perforation
-Supine, upright / cross-table lateral views
- Target Sign
- Crescent Sign or Meniscus Sign
- Soft Tissue Mass RUQ
- Obscured Liver Edge
- Signs of Obstruction
- Free Air
Management
IVF: 20 cc/kg bolus of NS
Maintenance Fluid
NPO
Surgical Consult if signs of perforation, shock or peritonitis
Non-surgical reduction by radiologist with air or contrast enema. Success > 90%