Intussusception

Question 1

What is intussusception?

Answer 1

It is defined as a condition in which a section of the bowel telescopes into its neighbouring distal section, causing bowel obstruction

Question 2

Which region of the bowel does intussusception tend to occur?

Answer 2

Ileocecal valve

Question 3

Which seven risk factors are associated with intussusception?

Answer 3

Infants, 6 – 18 Months Old

Male Gender

Viral Infection

Meckel’s Diverticulum

Intestinal Polyps

Cystic Fibrosis

Henoch-Schoenlein Purpura

Question 4

What are the ten clincical features of intussusception?

Answer 4

Generally Unwell

Inconsolable Crying

Lethargy

Pallor

Bilious Vomiting

Intermittent Abdominal Pain

Red Currant Jelly Stools

Sausage Right Upper Quadrant Mass

Sunken Eyes

Dry Lips

Question 5

Describe the abdominal pain associated with intussusception

Answer 5

The abdominal pain episodes result in the child becoming inconsolable and drawing their knees up to their chest

The child may appear well between episodes, however will become more lethargic over time as dehydration worsens

Question 6

What three investigations are used to diagnose intussusception?

Answer 6

Blood Tests

Abdominal X-Rays

Ultrasound Scans

Question 7

What two blood test results indicate intussusception?

Answer 7

Increased Neutrophil Levels

Increased CRP Levels

Question 8

What are the two features of intussusception on abdominal x-ray scans?

Answer 8

Distended Proximal Bowel Loops

Decreased Distal Bowel Gas

Question 9

What is the gold standard investigation used to diagnose intussusception?

Answer 9

Ultrasound Scans

Question 10

What is the feature of intussusception on ultrasound scans?

Answer 10

A target-like mass in the right upper quadrant

Question 11

What are the four immediate management options of intussusception?

Answer 11

IV Analgesia

Fluid Resuscitation

Nasogastric Tube Insertion

Nil By Mouth

Question 12

What is the most important immediate management option of intussusception?

Answer 12

Fluid Resucitation

Question 13

What is the non-surgical management option of intussusception?

Answer 13

Enema Administration

Question 14

When are enemas used to manage intussusception?

Answer 14

They are the first line definitive management option

Question 15

Name two enemas used to manage intussusception

Answer 15

Water

Air

Question 16

How is enema administration conducted?

Answer 16

It involves the introduction of air or water into the gut via a foley catheter in the rectum under pressure, in order to force the folded bowel out of the bowel and into the normal position

This is usually conducted under fluoroscopic guidance

Question 17

What are the two surgical management options of intussusception?

Answer 17

Surgical Reduction

Bowel Resection

Question 18

When is surgical reduction used to manage intussusception?

Answer 18

It is the second line definitive management option, which is recommended when there is evidence of bowel perforation/peritonitis or when non-surgical management is deemed ineffective

Question 19

What is surgical reduction?

Answer 19

It involves manual reduction of intussusception, in which the bowel is moved back into its normal position

Question 20

When is bowel resection used to manage intussusception?

Answer 20

When there is evidence of bowel perforation or bowel necrosis

Question 21

What five complications are associated with intussusception?

Answer 21

Bowel Obstruction

Bowel Perforation

Bowel Necrosis

Peritonitis

Sepsis