Intussusception Flashcards

1
Q

Define intussusception.

A

Invagination of proximal bowel (intussuscepian) into distant component (intussusceptum).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Explain the aetiology for intussusception.

A

90% idipathic.
Physiological lead point: Peyer’s patch (gastroenteritis enlarges)
Pathological lead point: malignancy, Meckl’s diverticulum, Henoch-Schonlein purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Summarise the epidemiology of intussusception.

A

Most common cause of SBO in 3m-2y

Rare <3m

M > F 2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the presenting symptoms of intussusception?

A

Triad:

Vomiting (May be bile stained depending on site)

Colicky severe pain (can become inconsolable)

Red currant jelly stool: late signs due to mucosal necrosis + sloughing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the signs of intussusception?

A

Abdo distention with sausage shaped mass in RUQ
Emptiness on palpation in RLQ (Dance’s sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are appropriate investigations for intussusception?

A
  1. Abdo USS: may show donut sign/ target mass (think: intUSSusception)
  2. AXR (paucity of air in RUQ + large bowel, thickened wall, poorly defined liver edge, dilated small bowel loops)
  3. Barium/ gastrogaffin enema if have 1 of 3 Ps: Perforation, Peritonitis, Pale complexion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management plan for intussusception?

A

EMERGENCY

If stable:

  • Fluid resus
  • NG tube insertion if repeatedly vomiting
  • Air insufflation under radiological control (traditionally barium enema: pneumatic forces bowel to un-telescope - take x rays throughout

If unstable/ perforated:

  • Surgical reduction with broad spectrum abx (clindamycin + gentamicin)
  • Remove non-viable bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are complications associated with intussusception?

A

Shock

Peritonitis

Intestinal perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should be done if there is recurrent intussusception?

A

Recurrence risk 5%

Investigate for a lead point

(Meckel’s diverticulum, Polyps, Appendix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common site of intussusception?

A

Ileum into caecum through ileocaecal valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the pathophysiology of intussusception

A
  1. Stretching + constriction of mesentery
  2. Venous return obstruction
  3. Engorgement + bleeding from mucosa, fluid loss
  4. Bowel perforation, peritonitis + gut necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are Peyer’s patches?

A

Oval/ round lymphoid follicles located in lamina propria layer of mucosa + extending into submucosa of ileum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly