Intussusception

Question 1

Definition

Answer 1

It is telescoping or invagination of one portion (segment) of bowel into the adjacent segment.

Question 2

General

Answer 2

😁 It can be ilea-colic (most common type, 75%), colocolic

🤨It is the commonest cause of intestinal obstruction in children of 6- 18 months age

Question 3

Aetiology

Answer 3

Idiopathic ISS is common in children, occurs in terminal 50 cm of ileum.

During weaning, change in diet causes inflammation and oedema of Peyer’s patches-may stimulate ISS.

Upper respiratory tract viral infection which causes oedema of Peyer’s patches is also thought as an aetiology for intussusception in children.

Other causes in adolescents and adults are submucous lipoma, leiomyoma, polyps in jejunum (Peutz-Jegher syndrome), other polyps and carcinomas with papillary projections.

Question 4

Pathology

Answer 4

😰Apex is the one which advances;
😭 lntussuscipiens is the one which receives (outer sheath);
😆 lntussusceptum are the tubes which advance (middle and inner sheath).

Apex and inner tubes will have compromised blood supply which leads to gangrene.

, Because of ischaemia, apex sloughs off and bleeds, which mixes with the mucus to produce the classic red-currant Jelly that is passed per anum.

Gangrene which sets in leads to perforation and peritonitis

Question 5

Clinical Features

Answer 5

Common in males (3:2).

Common in 6-9 months. But can also occur at later agegrouped children.

Common in spring and winter, coinciding with the gastroenteritis and respiratory infections in respective periods. Commonest cause of intestinal obstruction in infancy. Initial colicky abdominal pain (75%) which eventually becomes severe and persistent.

Sudden onset of pain in a male child, with progressive distension of the abdomen, vomiting, with passage of “ red-currantJel/y” stool. It is usually not found in adult ISS.

Often ISS is recurrent

Question 6

Examination

Answer 6

🧐• Palpable mass (85%)

• Sausage-shaped smooth, firm mass
• Mass does not move with respiration
• Mobile in all directions Resonant
• Mass contracts under the palpating fingers
• Mass appears and disappears
• Empty right iliac fossa
• Features of intestinal obstruction/peritonitis-later

Question 7

Investigations

Answer 7

Barium enema shows typical claw sign or coiled spring sign (Pincer end).

Ultrasound shows target sign or pseudokidney sign or bull’s eye sign, which is diagnostic.

Plain X-ray abdomen shows multiple air fluid levels.

CT abdomen is needed.

Question 8

Treatment

Answer 8

Initial management: Ryle’s tube aspiration; IV fluids; Antibiotics; Catheterisation.
🤬Nonoperative management Reduction by hydrostatic pressure
😗surgical reduction
😆surgical resection