Intussusception
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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-raydistended 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

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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