Intussusception

Question 1

Define intussusception?

Answer 1

Intussusception is a type of bowel obstruction in which portion of bowel invaginates in to a distal portion of bowel.

This cuts off the venous supply, causing swelling and therefore obstruction.

It is a surgical emergency as the aa supply can be cut off causing necrosis.

Question 2

What age is intussusception most common?

Where is it most common? (part of the bowel)

Answer 2

3 months to 2 years
But can occur at any age

Ileum passing into caecum through ileocaecal valve

Question 3

Describe the signs and symptoms of intussusception?

Answer 3

Intermittent colicky pain lasting 10-20 mins (normal in between episodes)

Vomiting may become bile stained

Sausage shaped mass in the RUQ

Red currant jelly stool (late sign)

Lethargy and hypotonia (sign that the child is very unwell)

Shock

Question 4

What are the different causes of intussusception? (8)

Answer 4

Idiopathic *
Meckel's diverticulum *
Polyps *
Peutz-Jegher's (hereditary intestinal polyposis)
Neoplasms *
Inflammed appendix
Foreign body
Peyer's patch hypertrophy

• most common causes

Question 5

What conditions are associated with it?

Answer 5

Viral infection *
Henoch-schonlein purpura (HSP) *
Cystic fibrosis
Nephrotic syndrome
Obesity

*most common associations

Question 6

How do you manage a patient with intussusception?

Answer 6

Manage the situation aka resus if needed.

Once confirmed air enema reduction using a large bore catheter (essentially blow the bowel back).

If perforated will need a laparotomy