Intussusception Flashcards
Define intussusception.
Invagination of proximal bowel (intussuscepian) into distant component (intussusceptum).
Explain the aetiology for intussusception.
90% idipathic.
Physiological lead point: Peyer’s patch (gastroenteritis enlarges)
Pathological lead point: malignancy, Meckl’s diverticulum, Henoch-Schonlein purpura
Summarise the epidemiology of intussusception.
Most common cause of SBO in 3m-2y
Rare <3m
M > F 2:1
What are the presenting symptoms of intussusception?
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
What are the signs of intussusception?
Abdo distention with sausage shaped mass in RUQ
Emptiness on palpation in RLQ (Dance’s sign)
What are appropriate investigations for intussusception?
- Abdo USS: may show donut sign/ target mass (think: intUSSusception)
- AXR (paucity of air in RUQ + large bowel, thickened wall, poorly defined liver edge, dilated small bowel loops)
- Barium/ gastrogaffin enema if have 1 of 3 Ps: Perforation, Peritonitis, Pale complexion
What is the management plan for intussusception?
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
What are complications associated with intussusception?
Shock
Peritonitis
Intestinal perforation
What should be done if there is recurrent intussusception?
Recurrence risk 5%
Investigate for a lead point
(Meckel’s diverticulum, Polyps, Appendix)
What is the most common site of intussusception?
Ileum into caecum through ileocaecal valve
Describe the pathophysiology of intussusception
- Stretching + constriction of mesentery
- Venous return obstruction
- Engorgement + bleeding from mucosa, fluid loss
- Bowel perforation, peritonitis + gut necrosis
What are Peyer’s patches?
Oval/ round lymphoid follicles located in lamina propria layer of mucosa + extending into submucosa of ileum.