Intussusception

Question 1

An intussusception is when the bowel folds back on itself like in a telescope. This is most common in infants, with 2/3 occurring in infants under 1 years old. What is the incidence of this in infants?

1 - 1 in 2.5
2 - 1 in 25
3 - 1 in 250
4 - 1 in 2500

Answer 1

3 - 1 in 250

• more common in females

Question 2

An intussusception is when the bowel folds back on itself like in a telescope. This is most common in infants, with 2/3 occurring in infants under 1 years old. What is the peak age when this tends to occur?

1 - 0-3 months
2 - 3-6 months
3 - 6-9 months
4 - >9 months

Answer 2

3 - 6-9 months

Question 3

Although the exact cause of intussusception remains unknown. Which of the following is NOT typically a risk factor?

1 - bowel obstruction
2 - sibling who has experienced intussusception
3 - previous intussusception
4 - intestinal malrotation

Answer 3

1 - bowel obstruction

Question 4

An intussusception is when the bowel folds back on itself like in a telescope. What % of adults with a large bowel obstruction does this occur in?

1 - 1%
2 - <5%
3 - <25%
5 - 50%

Answer 4

2 - <5%

Question 5

The following are all common causes of intussusception. Which one is the most common?

1 - idiopathic
2 - enlarged lymphatic payers patches
3 - lymphoma
4 - polyps
5 - meckel’s diverticulum

Answer 5

1 - idiopathic

Question 6

An intussusception is when the bowel folds back on itself like in a telescope. Which of the following is not a common cause of intussusception in adults?

1 - IBD
2 - meckels diverticulum
3 - large colonic polyp
4 - ileus
5 - colorectal cancer

Answer 6

4 - ileus

• treatment of intussusception is normally en bloc resection of whole intussusception

Question 7

What is the most common site in the GIT where intussusception can occur?

1 - ileocolic
2 - colocolic
3 - ileeoileal
4 - colosigmoid

Answer 7

1 - ileocolic

• generally where the ileum folds into the caecum and ascending colon

Question 8

There are a lot of potential clinical features of intussusception. Which of the following is not part of the classical triad?

1 - abdominal pain (pallor, restlessness, screaming and bending knees to chest)
2 -palpable sausage mass in RLQ
3 - chronic diarrhoea
4 - passage of redcurrant jelly

Answer 8

3 - chronic diarrhoea

• the passage of redcurrant jelly is due to ischaemia and/or infarction of blood vessels and death of tissue.
• epithelial cells are sloughed off with mucus looking like red current jelly

Question 9

Patients with intussusception can have bowel obstruction symptoms such as vomiting and distension. This is because of narrowing of the lumen restricts food and fluids to pass causing a large mass in the intestines and can lead to what?

1 - ventral hernia
2 - volvulus
3 - inguinal hernia
4 - caecum rupture

Answer 9

2 - volvulus

Question 10

What is the first imaging modality commonly used in a patient with suspected intussusception?

1 - CT
2 - MRI
3 - ultrasound
4 - X-ray

Answer 10

3 - ultrasound

• intussusception appears as the classical bulls eye
• X-ray can be useful to show soft tissue mass, obstruction, and free air suggesting perforation

Question 11

The following are treatment of a patient with intussusception. What is the 1st treatment a patient will receive?

1 - nasal gastric tube (NGT)
2 - IV fluid and electrolyte resuscitation
3 - antibiotics
4 - analgesia
5 - reduction/reversal of intussusception

Answer 11

2 - IV fluid and electrolyte resuscitation

the following would likely be the correct order of treatment:

• IV fluid and electrolyte resuscitation
• antibiotics incase of translocation
• NGT for fluids and losses
• analgesia can aid reduction
• reduction/reversal of intussusception

Question 12

Can the reduction/reversal of intussusception be conducted anytime?

Answer 12

• NO!
• only when fluid balance is restored

Question 13

There are a number of different approaches to reverse/reduce an intussusception. Which one is performed the majority of the time?

1 - surgery
2 - air enema
3 - barium enema
4 - colonoscopy

Answer 13

2 - air enema

• used in 75% of cases

Question 14

What is the recurrence rate in non-operative reversal of the intussusception?

1 - 0.5 - 0.7%
2 - 5 - 7%
3 - 15-27%
4 - >50%

Answer 14

2 - 5 - 7%

Question 15

Although an air enema is the most commonly used method to reverse/reduce an intussusception, open surgery is also performed. When is surgery indicated?

1 - infant is >2 y/o
2 - air enema has failed 3 times
3 - signs of peritonitis or perforation

Answer 15

3 - signs of peritonitis or perforation

Question 16

What is the recurrence rate in operative reversal of the intussusception?

1 - 0.3%
2 - 3%
3 - 30%
4 - >50%

Answer 16

2 - 3%