Intussusception

Question 1

What is an intussusception?

Answer 1

Invagination (telescoping) of a segment of the proximal bowel into a distal bowel segment.
The most common scenario is the ileum passing into the caecum through the ileocaecal valve.

Question 2

What is the relevant epidemiology of bowel intussusception?

Answer 2

Infants - 3m to 2yrs
More common in males

Question 3

What is the aetiology of intussuscpetion?

Answer 3

Majority idiopathic
Inc risk with:
Viral infections of GIT - peyers patch enlargement lead point for intussusception
Lymphoid hyperplasia - lymphomas or infections
Meckels diverticulum -
Polyps - consider Peutz-Jeghers syndrome and FAP
CF - inc intestinal secretions
Henoch-schonlein purpura - vasculitis
Vaccination - rotavirus

Question 4

What are the typical signs and symptoms of intussusception?

Answer 4

Paroxysmal, severe colicky pain - draw up legs - constant after 12hrs
Lethargy
Refusal of feeds
Vomitinh - bile standing
Passage of a red-currant jelly stool - blood stained mucus is a late feature
Abdominal distention
Palpation may reveal a sausage shaped mass in the abdomen.

Question 5

What is the key diagnostic test for bowel intussusception?

Answer 5

Target sign - concentric echogenic and hypoechogenic bands on ultrasound.
May also show complications such as free abdominal air or the presence of gangrene.

Question 6

What is the acute management for a bowel intussusception?

Answer 6

IV fluids
NG tube to decompress the stomach
Rectal air insufflation or a contrast enema

Question 7

When might operative reduction be required for an intussusception in a child?

Answer 7

Non-operative management has failed
Peritonitic or perforation
Child is hemodynamically unstable

Question 8

What are the common complications of a bowel intussusception?

Answer 8

Necrosis of the bowel requiring surgical intervention
Sepsis and associated infections
Perforation and peritonitis