Intussusception

Question 1

What is intussusception?

Answer 1

Invagination of proximal bowel into a distal segment.

Question 2

Where is intussusception most common?

Answer 2

Most commonly involves ileum passing into caecum through ileocaecal valve.

Question 3

What is the peak age of presentation of intussusception?

Answer 3

3 months - 2 years.

Question 4

What serious complication is a concern in intussusception?

Answer 4

Stretching and constriction of the mesentery can lead to venous obstruction which in turn can cause engorgement and bleeding from bowel mucosa, fluid loss and subsequently bowel perforation, peritonitis and gut necrosis.

Question 5

What may be seen on an AXR in intussusception?

What other investigation will confirm diagnosis?

Answer 5

Distended small bowel and absence of gas in distal colon/rectum.

Abdominal ultrasound

Question 6

What is the treatment of intussusception?

Answer 6

Reduction by air insufflation.

Question 7

What is the common presentation of intussusception? (5 features)

Answer 7

• Paroxysmal, severe colicky pain and pallor (pale during episode of pain, especially around mouth, draw legs up).
• May refuse feeds/vomit (vomit may become bile-stained)
• Sausage-shaped mass, often palpable in abdomen.
• Passage of characteristic redcurrent jelly stool comprising blood-stained mucus = characteristic but late sign.
• Abdo distension and shock