Intussusception Flashcards
What is the definition of intussusception?
Invagination of proximal bowel into a distal segment
What is the most common site of intussusception?
Ileum to caecum (through ileocaecal valve)
What is the epidemiology of intussusception?
Peak age = 3 months - 2 years
Male:female 3:2
Most common cause of intestinal obstruction in infants after neonatal period
What is the pathophysiology of intussusception?
One segment invaginates into another –> mesentery becomes compressed –> bowel wall distends and obstructs lumen –> disrupted peristalsis –> colicky pain + vomiting –> lymphatic + venous obstruction –> ischaemia
What are the possible theories for the aetiology of intussusception?
Viral infection -> enlargement of Peyer’s patches + lymphoid tissue –> formation of lead point
Anatomical abnormalities –> formation of pathological lead points
What are some anatomical abnormalities that may increase risk of intussusception? In what age of children are these likely to present?
Meckel’s diverticulum, luminal polyps, malignant tumours
Children > 2y/o
What are the symptoms of intussusception?
Colicky abdo pain + crying –> pale and draws legs up to chest
Early vomiting –> bile stained (depending on site)
Redcurrant jelly stool + blood-stained mucus (later
Dehydration, pallor, shock
Irritability, sweating
Lethargy, hypotonia, + sudden alterations of consciousness
What are the signs of intussusception?
Sausage-shaped mass (in RUQ)
Abdo distension
Dance’s sign
What is Dance’s sign?
Absence of bowel in RLQ
What is the general presentation of a child with intussusception?
Sudden onset (insidious in older children)
Episodes of 10-20 mins
Early on, may recover between these
What are the investigations for intussusception?
AXR - distended small bowel and absence of gas in distal colon/rectum + outline of intussusception
USS - ‘target/doughnut sign’ (= loop of bowel within another) + assess blood flow w/ Doppler + check response to treatment
Contrast enema - ‘meniscus sign’ (rounded apex of intussuscepted bowel into column of contrast
What is the gold standard imaging modality for intussusception?
Contrast enema
What is the immediate management of intussusception?
‘Drip and suck’
IV fluids (due to pooling of fluid in gut –> hypovolaemic shock)
NG tube
How is reduction of intussusception performed?
Rectal air insufflation
Barium enema
Laparotomy –> surgical reduction
What is rectal air insufflation?
When air is blown into the bowel and is performed radiologically, usually only once
