GI - Intussusception

Question 1

What is Intussusception? (2)

Answer 1

1. A condition where the bowel invaginates or telescopes into itself.
2. As a result, the overall size of the bowel will thicken and narrow the lumen at the folded area.

Question 2

Where does Intussusception most commonly occur?

Answer 2

Ileo-caecal region.

Question 3

Associations of Intussusception (5).

Answer 3

1. Concurrent Viral Illness.
2. Henoch-Schonlein Purpura.
3. Cystic Fibrosis.
4. Intestinal Polyps.
5. Meckel Diverticulum.

Question 4

Epidemiology of Intussusception (2).

Answer 4

1. 6 months to 2 years of age.

2. 2x commoner in boys.

Question 5

Clinical Features of Intussusception (6).

Answer 5

1. Severe Colicky Paroxysmal Abdominal Pain.
2. ‘Red-Currant Jelly’ Stool.
3. Sausage-Shaped Right Upper Quadrant Mass.
4. Vomiting (may be bile-stained, depending on site).
5. Intestinal Obstruction.
6. Refusing Feeds.

Question 6

Stereotypical Patient in Intussusception (4).

Answer 6

1. Pale, lethargic and unwell child.
2. Had a viral URTI preceding illness.
3. Features of Intestinal Obstruction.
4. During the paroxysm, the infant will characteristically draw their knees up and turn pale.

Question 7

Why is the stool described as ‘red-currant jelly’?

Answer 7

Stool is blood-stained; this is often a late sign.

Question 8

Investigations in Intussusception (4).

Answer 8

1. Investigation of Choice : Ultrasound.
2. Diagnosis : Ultrasound or Contrast Enema.
3. Finding : Target-Like Mass (Concentric, Echogenic and Hypoechogenic Bands).
4. Also useful : check for complications e.g. free abdominal air, gangrene.

Question 9

Management of Intussusception (3).

Answer 9

1. Reduction by Air Sufflation under Radiological Control (only if child is stable).
2. Therapeutic Enemas (contrast, water, air are pumped into colon to force folded bowel out of the bowel into normal position).
3. Operative Reduction (if enemas fail).

Question 10

Complications of Intussusception (4).

Answer 10

1. Obstruction.
2. Gangrenous Bowel.
3. Perforation.
4. Death.

Question 11

Indications of Operative Reduction in Intussusception (3).

Answer 11

1. Failure of Non-Operative Management.
2. Peritonitis or Perforation present.
3. Haemodynamically Unstable.