Intussusception

Question 1

What is intussusception?

Answer 1

• where a section of the bowel ‘invaginates’ or ‘telescopes’ into itself
• often the ileum enters the caecum
• this thickens the overall size of the bowel and narrows the lumen at the folded area, leading to a palpable mass in the abdomen
• it leads to obstruction to the passage of faeces through the bowel

Question 2

Who is intussusception more common in?

Answer 2

Infants aged 6 months to 2 years, more common in boys.

Question 3

What is intussusception often associated with?

Answer 3

• Concurrent viral illness
• Henoch-Schonlein purpura
• cystic fibrosis
• intestinal polyps
• and Meckel diverticulum.

Question 4

How does intussusception present?

Answer 4

• intermittent, severe, colicky abdominal pain
• episodic severe abdominal pain
• pale, lethargic and unwell child
• ‘redcurrant jelly stool’ (blood in stool is a late sign)
• RUQ mass on palpation: sausage shaped
• drawing up of legs
• vomiting
• intestinal obstruction
• (can have viral URTI preceding the illness)

Question 5

What investigations are used for intussusception?

Answer 5

• ultrasound
• doughnut sign/target like mass
• or contrast enema

Question 6

What is the management for intussusception?

Answer 6

• NBM and NG tube (drip and suck)
• IV fluids
• therapeutic enema: used to try and reduce the intussusception, contrast, water or air are pumped into the colon to force the folded bowel out of the bowel and into the normal position
• surgical reduction if enema doesn’t work
• if the bowel becomes gangrenous or perforated, surgical resection is needed

Question 7

What are the complications of intussusception?

Answer 7

Obstruction, gangrenous bowel, perforation, and death.