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

References

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