68.Intussusception.

Question 1

Intussusception - Definition

Answer 1

“Telescoping” of one portion of intestine into the other

Question 2

Intussusception - Main Point

Answer 2

• Part of intestine invaginates Into another section of intestine

Question 3

Intussusception - Most common location

Answer 3

• Ileocecal junction most common location

Question 4

Intussusception - Etiology:

Answer 4

• In pediatrics cases – idiopathic (6 mnths at risk due to change from milk – food)
• In older children + adults = rare
• Is associated with: Meckel’s diverticulum, polyps, intestinal neoplasm

Question 5

Intussusception - Pathogenesis:

Answer 5

• Believed to be due to imbalance in longitudinal forces along intestinal wall.
• Imbalance can be caused by a mass acting as a lead point or by disorganized pattern of peristalsis thus imbalance in force = intussusception

Question 6

Intussusception - Clinical Presentation

Answer 6

• Severe, cramping ab pain – worsens with peristalsis
• Child draws legs up during episodes of pain
• Lethargy, N/V, stool with dark blood clots + mucus = “currant jelly stools”

Question 7

Intussusception - Diagnostic Investigations

Answer 7

• X-ray = mass. Sparse gas in colon. Complete distal S.I obstruction
• Ab.US = can show “Target sign” of intussuscepted layers of bowel on transverse view or “pseudo kidney” on longitudinal view

Question 8

Intussusception - Treatment - NonOperative

Answer 8

Hydrostatic reduction by enema using contrast or air is diagnostic + therapeutic

o Contraindicated if in S.I – as enema won’t reach there

o Success in reduction ≈ 80%

o In case of recurrence – another hydrostatic reduction attempt should be done – if fails then surgery

Question 9

Intussusception - Treatment - Operative

Answer 9

Laparoscopy to confirm dx + tx – avoids large incision

o Transverse incision on right side of abdomen, intussusception reduced by squeezing the mass retrograde from distally to proximally until completely reduced

o Bowel resection if cant surgically reduce