Site icon almostadoctor

Intussusception

Introduction

Intussusception is a condition affecting children where-by one section of bowel will ‘telescope’ inside an adjacent section, resulting in bowel obstruction, and if left untreated – bowel ischaemia.

It classically presents with intermittent abdominal pain – with periods of acute severe pain and an inconsolable child, interspersed with periods where the child appears completely well.

The classical sign is “redcurrant jelly” stool caused by bleeding of the affected part of bowel.

Imaging may be with x-ray, USS or barium enema – with USS becoming the more preferred first option.

Treatment of choice is “insufflation” whereby gas is blown up the anus to inflate and stretch out the bowel. This is usually done with USS monitoring to confirm resolution. This is successful in 75% of cases. The remainder require surgery

 

The pathology of intussusception

Epidemiology and aetiology

Risk factors

There is a very long list of factors that are though to precipitate intussusception although in many cases no obvious cause can be found. Most causes are thought to be related to some sort of mass around which the intussusception can start (the “lead site”).  For example, in inflammatory causes (e.g. recent gastroenteritis) there is thought to be a lump of inflamed lymphoid tissue on the mucosa called a Peyer’s patch. Or, after blunt trauma there may be a haematoma, or in appendicitis there is an inflamed appendix.

Some causes that are thought to be more common include:

Pathophysiology

Presentation

Diagnosis

Treatment

The earlier treatment is initiated, 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. It is important to provide fluid resuscitation before other treatments are attempted.
Insufflation

The medium used for “insufflation” appears to be not important. Previously barium enema was used, but air or saline are just as effective. The pressure is what is important. 60mmHg will reduce most cases and 100mmHg is considered a definitive reduction. Pressures of 120mmHg or higher are associated with increased perforation risk.

Surgery

References

Read more about our sources

Related Articles

Exit mobile version