Intussusception

Question 1

What is Intussusception?

Answer 1

• This is a condition where the bowel invaginates/ telescopes into itself
• 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

What are the Associated conditions for Intussusception?

Answer 2

• Concurrent Viral illness
• Henoch-Schonlein Purpura
• Cystic Fibrosis
• Intestinal Polyps
• Meckel Diverticulum

Question 3

How does Intussusception typically present?

Answer 3

• Severe colicky abdominal pain
• Pale, lethargic and unwell child
• Redcurrant jelly stool
• RUQ mass on palpation - sausage shaped
• Vomiting
• Intestinal obstruction
• Classical OSCE question: Redcurrant jelly stool, sausage- shaped mass, recent upper viral respiratory tract infection, features of intestinal obstruction (vomiting, absolute constipation and abdominal distention)

Question 4

What is the gold standard investigation for Intussusception?

Answer 4

• USS scan or a contrast enema

Question 5

What is the Management for Intussusception?

Answer 5

• Therapeutic enemas can be used to try and reduce the intussusception
• Contrast, water or air are pumped into the colon to force the folded bowel out of the bowel and into 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 6

What are the complications of Intussusception?

Answer 6

• Obstruction
• Gangrenous bowel
• Perforation
• Death