Contents
Introduction
This is a condition where-by one piece of bowel will ‘telescope’ inside another piece, resulting in obstruction, and sometimes ischaemia.
- Usually it is a piece of proximal bowel passing inside a more distal piece
- Most commonly, the distal ileum passing through the ielocaecal valve into the colon
- Requires urgent treatment
Epidemiology and aetiology
- Usually occurs between 3 months and 3 years
- 65% of cases occur <1 year
- Usually idiopathic
- The most common cause of intestinal obstruction after the neonatal period
Risk factors
- CF
- Some sort of intestinal mass, e.g.:
- Polyp
- Lymphoma
- Meckel’s diverticulum – a congenital diverticulum present in the distal ileus in 2% of children. Only 2% of those cases are symptomatic, and this is not always intussusception (e.g. could be rectal bleeding, or obstruction instead).
Presentation
- Abdo pain – colicky periodic severe pain. During the periods of pain, the child is often pale, and may curl up into a ball.
- Examination – a sausage shaped mass is often palpable
- Redcurrant jelly stools – very characteristic, blood-stained mucus in the stool. Usually occurs late in the presentation, and more likely to be passed after a PR exam.
- Abdominal distension
- Shock
- Peritonitis – may occur if there is perforation. Signs include: tenderness, guarding and rigidity
Diagnosis
- Abdominal X-ray – distended small bowel ± absence of gas in large bowel. Rarely, the actual intussusception itself may be visible
Treatment
The early treatment is initiatied, the greater the survival, and greater the change of non-surgical reduction.
IV fluids – should be administered rapidly after diagnosis. The intussusception can cause local pooling of fluids, and reduce IV volume.
Insufflation
- The first attempted treatment if peritonitis is not present
- Air is pumped into the anus, in an attempt to stretch the walls of the bowel and reduce the intussusception
- Often conducted under USS guidance to view if the technique is being successful
- This is successful in 75% of patients
Surgery
- The remaining 25% will require surgery, wither as insufflation is not effective, or peritonitis is present
- If peritonitis is present, patients will also require antibiotic therapy (a broad spec, usually gentamicin, ampicillin or clindamycin)
- Recurrence is 5-10%, slightly higher in non-operative treatments
