Intussusception

Question 1

definition of intussusception

Answer 1

Condition in which one part of the intestine folds into the other part causing obstruction in a process called TELESCOPING

Question 2

how many cases occur in infants under one

Answer 2

2/3rd of all cases of intussusception

Question 3

intussusception

Answer 3

is the most common cause of intestinal obstruction in infants and young children

Question 4

nearly all cases occur at

Answer 4

the ileo-caecal region where the ileum folds into the caecum

Question 5

most common cause

Answer 5

most cases are idiopathic but are associated with risk factors such as having previous intussusception, having a sibling who has had intussusception or intestinal malrotation

Question 6

if babies the most common cause

Answer 6

lymphoid hyperplasia, when a baby gets a GI infection (rotavirus, norovirus), the peters patches in the intestine enlarge and can serve as a leading point

Question 7

other cause is

Answer 7

mockers diverticulum which is an abnormal out pouching of GI tissue from the ileum into the perineum, occasionally the diverticulum can invert and become a leading point

Question 8

symptoms of intussusception

Answer 8

• colicky abdominal pain which worsens on peristalsis
• abdominal guarding
• on palpation a hard sausage shaped mass can be palpated in the right hypochondriac and there is emptiness in the right lower quadrant (dance sign)
• initially causes non-billuos vomiting, but when obstruction occurs it becomes billous
• red current jelly like stool

Question 9

why does the classical stool occur

Answer 9

there is increased pressure on the walls of the trapped bowel which causes ischaemia and then infarction, the infarction causes the sloughing off of the intestinal mucosa, blood and mucous causing the classic red current jelly like stool

Question 10

diagnosis

Answer 10

• ultrasonography is used as screening as it has a false negative rate close to zero however, if it is positive you still require a contrast enema

Question 11

signs on ultrasonography

Answer 11

• target sign

- psuedokidney sign

Question 12

gold standard diagnostic investigations

Answer 12

contrast enema

Question 13

management of intussusception

Answer 13

• IV fluids and nasogastric decompression for all
• therapeutic enema (hydrostatic or pneumatic), the only absolute contra-indication is intestinal perforation which requires surgery