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Intussusception Note

Intussusception is a condition where a part of the intestine telescopes into an adjoining segment, most commonly affecting children aged 3 months to 3 years. Diagnosis can be confirmed through abdominal ultrasound or enema, with immediate surgical consultation required for signs of peritonitis or shock. Early treatment leads to an excellent prognosis, while delayed diagnosis may result in severe complications such as bowel ischemia and sepsis.

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Dr Himanshu Meena
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12 views1 page

Intussusception Note

Intussusception is a condition where a part of the intestine telescopes into an adjoining segment, most commonly affecting children aged 3 months to 3 years. Diagnosis can be confirmed through abdominal ultrasound or enema, with immediate surgical consultation required for signs of peritonitis or shock. Early treatment leads to an excellent prognosis, while delayed diagnosis may result in severe complications such as bowel ischemia and sepsis.

Uploaded by

Dr Himanshu Meena
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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INTUSSUSCEPTION

PRESENTATION
Intussusception is
defined as a HISTORY PHYSICAL EXAM
telescoping of a Epidemiology General Exam
part of the intestine
q Male > female q Tachycardia, hypertension, pallor
into the lumen of
q 3 months to 3 years old q Patient is uncomfortable & unwell
adjoining intestine.
(peak 6 to 12 months) q Late sign: hypovolemic shock
This most often q Recent viral illness (tachypnea, tachycardia,
occurs idiopathically; lethargy)
however, a lead Clinical Symptoms
point may be q Episodic abdominal pain Abdominal Exam
implicated (e.g. q Lethargy q May be normal
enlarged Peyer’s q Vomiting q Palpable abdominal mass
patches or sites of q Red “currant jelly” stools q Abdominal distension
anatomic (uncommon) q Late sign: peritonitis (rigidity,
abnormality) guarding, rebound tenderness)
q Poor feeding

DIAGNOSIS
Abdominal Ultrasound
q Can be used as quick initial diagnostic test if diagnosis is uncertain
q Look for 3-5cm mass deep to abdominal wall with target sign appearance

Enema (Liquid Contrast or Air)


q Most sensitive and specific test that is both diagnostic and therapeutic
q Look for meniscus sign or filling defect
Abdominal Plain-Film X-Ray
q Poor sensitivity and specificity for diagnosis of intussusception
q Useful to rule out suspected obstruction or perforation of bowels

CONSULT SURGERY IMMEDIATELY if suspected peritonitis, shock or free intra-abdominal air


(note: enema is contraindicated in these cases)

MANAGEMENT PROGNOSIS

q Fluid resuscitation (isotonic IV) Excellent prognosis if


treated early
Enema Reduction Surgical Reduction
q Best option for clinically q Best option for unstable patients Late diagnosis can lead to
stable patients (hypovolemic shock, peritonitis) bowel ischemia, sepsis
q Enema can be air, saline, OR q Laparoscopic or open surgery and risk of mortality
water soluble contrast, or to milk out the intussusception Intussusception reoccurs
ultrasound-guided q If reduction fails or bowel is after ~10% of enema
(note: no clear advantage non-viable, resection of bowel reductions, 2-5% of
among enema modalities) area is performed surgical reductions

November 2023
Jonah Isen (Medical Student, Queen’s University), Dr. Andrea Winthrop (Pediatric Surgeon, Queen’s
University) for www.pedscases.com

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