Intussusception

Question 1

What is intussusception?

Answer 1

1. Telescoping of a segment of intestine into an adjacent distal segment, causing bowel obstruction
2. MC in infants 6–36 months

Usually, the ileum is telescoped back into the caecum

Question 2

MC cause of what?

Answer 2

Intestinal obstruction in 6-18 months

Question 3

5 close associations - pathological lead points

Answer 3

1. HSP (Henoch-Schonlein Purpura)
2. Concurrent viral illness
3. CF
4. Intestinal polyps - key
5. Meckel’s diverticulum - key

Often idiopathic

Question 4

4 RF

Answer 4

1. Male (3:1)
2. Recent viral infection - adenovirus
3. Hx of constipation or diarrhoea
4. Lead points (MC < 6 months or > 3 yrs)

Question 5

Sx

Answer 5

1. Paroxysmal, intermittent abdominal pain (child draws knees up, cries, then may appear well)
2. Vomiting (initially non-bilious, then bilious)
3. Red currant jelly stools (late sign)
4. Lethargy between episodes

Sign - PALPABLE SAUSAGE-SHAPED MASS IN RUQ + tender & distended abdomen

Question 6

3 Ix

Answer 6

1. Abdominal US → GS (“target” or “doughnut” sign)
2. Abdominal XR → may show obstruction or mass, sometimes used if US is not immediately available
3. U&Es - if dehydrated or vomiting

US - concentric echogenic and hypoechogenic bands
Air/contrast enema - GS

Question 7

Mx

Answer 7

1. Stabilisation with IV fluids + monitor vital signs
2. Air or contrast enema reduction - definitive
3. Surgical referral

Consider an NG tube or analgesia alongside IV fluids.

Question 8

4 indications for surgical referral

Answer 8

1. Perforation suspected
2. Peritonitis
3. Failed enema/reduction
4. PATHOLOGICAL LEAD POINT PRESENT

Question 9

4 complications

Answer 9

1. Bowel necrosis/perforation if untx
2. Peritonitis
3. Recurrence after enema reduction (5-10%)
4. Shock from dehydration

Gradually resume oral feeds once STABLE