INTUSSUSCEPTION

Question 1

Facts: Pathophysiology, Epi

Answer 1

6 Mo - 6 Yrs

Segment of bowel (MC ileocolic) telescopes into the distal bowel -> venous congestion + edema -> bowel ischemia -> necrosis + perforation

Question 2

Clinical Features

Answer 2

Ask about:

TRIAD (1/3 of cases):

• colicy abdominal pain: severe, episodic, symptom free periods
  -currant jelly stool (late)
  -vomit

a/w:
+/- vomit
+/- lethargy

Recent viral or diarrheal illness

Look for:
- sausage shaped mass
-abdominal distension

Question 3

Investigations

Answer 3

CBC, comprehensive metabolic panel, and type and screen

U/S: Test of Choice
Sensitive 98-100%
-Doughnut Sign

Plain XRAY:
-if concern for obstruction /perforation
-Supine, upright / cross-table lateral views

• Target Sign
• Crescent Sign or Meniscus Sign
• Soft Tissue Mass RUQ
• Obscured Liver Edge
• Signs of Obstruction
• Free Air

Question 4

Management

Answer 4

IVF: 20 cc/kg bolus of NS

Maintenance Fluid

NPO

Surgical Consult if signs of perforation, shock or peritonitis

Non-surgical reduction by radiologist with air or contrast enema. Success > 90%