Intussusception Flashcards
An intussusception is when the bowel folds back on itself like in a telescope. This is most common in infants, with 2/3 occurring in infants under 1 years old. What is the incidence of this in infants?
1 - 1 in 2.5
2 - 1 in 25
3 - 1 in 250
4 - 1 in 2500
3 - 1 in 250
- more common in females
An intussusception is when the bowel folds back on itself like in a telescope. This is most common in infants, with 2/3 occurring in infants under 1 years old. What is the peak age when this tends to occur?
1 - 0-3 months
2 - 3-6 months
3 - 6-9 months
4 - >9 months
3 - 6-9 months
Although the exact cause of intussusception remains unknown. Which of the following is NOT typically a risk factor?
1 - bowel obstruction
2 - sibling who has experienced intussusception
3 - previous intussusception
4 - intestinal malrotation
1 - bowel obstruction
An intussusception is when the bowel folds back on itself like in a telescope. What % of adults with a large bowel obstruction does this occur in?
1 - 1%
2 - <5%
3 - <25%
5 - 50%
2 - <5%
The following are all common causes of intussusception. Which one is the most common?
1 - idiopathic
2 - enlarged lymphatic payers patches
3 - lymphoma
4 - polyps
5 - meckel’s diverticulum
1 - idiopathic
An intussusception is when the bowel folds back on itself like in a telescope. Which of the following is not a common cause of intussusception in adults?
1 - IBD
2 - meckels diverticulum
3 - large colonic polyp
4 - ileus
5 - colorectal cancer
4 - ileus
- treatment of intussusception is normally en bloc resection of whole intussusception
What is the most common site in the GIT where intussusception can occur?
1 - ileocolic
2 - colocolic
3 - ileeoileal
4 - colosigmoid
1 - ileocolic
- generally where the ileum folds into the caecum and ascending colon
There are a lot of potential clinical features of intussusception. Which of the following is not part of the classical triad?
1 - abdominal pain (pallor, restlessness, screaming and bending knees to chest)
2 -palpable sausage mass in RLQ
3 - chronic diarrhoea
4 - passage of redcurrant jelly
3 - chronic diarrhoea
- the passage of redcurrant jelly is due to ischaemia and/or infarction of blood vessels and death of tissue.
- epithelial cells are sloughed off with mucus looking like red current jelly
Patients with intussusception can have bowel obstruction symptoms such as vomiting and distension. This is because of narrowing of the lumen restricts food and fluids to pass causing a large mass in the intestines and can lead to what?
1 - ventral hernia
2 - volvulus
3 - inguinal hernia
4 - caecum rupture
2 - volvulus
What is the first imaging modality commonly used in a patient with suspected intussusception?
1 - CT
2 - MRI
3 - ultrasound
4 - X-ray
3 - ultrasound
- intussusception appears as the classical bulls eye
- X-ray can be useful to show soft tissue mass, obstruction, and free air suggesting perforation
The following are treatment of a patient with intussusception. What is the 1st treatment a patient will receive?
1 - nasal gastric tube (NGT)
2 - IV fluid and electrolyte resuscitation
3 - antibiotics
4 - analgesia
5 - reduction/reversal of intussusception
2 - IV fluid and electrolyte resuscitation
the following would likely be the correct order of treatment:
- IV fluid and electrolyte resuscitation
- antibiotics incase of translocation
- NGT for fluids and losses
- analgesia can aid reduction
- reduction/reversal of intussusception
Can the reduction/reversal of intussusception be conducted anytime?
- NO!
- only when fluid balance is restored
There are a number of different approaches to reverse/reduce an intussusception. Which one is performed the majority of the time?
1 - surgery
2 - air enema
3 - barium enema
4 - colonoscopy
2 - air enema
- used in 75% of cases
What is the recurrence rate in non-operative reversal of the intussusception?
1 - 0.5 - 0.7%
2 - 5 - 7%
3 - 15-27%
4 - >50%
2 - 5 - 7%
Although an air enema is the most commonly used method to reverse/reduce an intussusception, open surgery is also performed. When is surgery indicated?
1 - infant is >2 y/o
2 - air enema has failed 3 times
3 - signs of peritonitis or perforation
3 - signs of peritonitis or perforation