Intussusception
Definition
Epidemiology
Clinical Features
Investigations
Treatment
Source
Toronto Notes 2012
OHCM 9th Ed 2014
- Telescoping of segment of bowel into distal segment → ischemia and necrosis
- Usual site: ileocecal junction; jejunum in children with GJ tubes
- Lead point of telescoping segment may be swollen Peyer's patches, Meckel's diverticulum, polyp, malignancy, Henoch-Schonlein Purpura
Epidemiology
- 2mo-2y
- F>M
- 90% idiopathic, children with CF or GJ tube at significantly increased risk
- 50% between 3-12 months, 75% before 2 yrs of age
Clinical Features
- "classic triad"
- Abdominal pain
- Palpable sausage-shaped mass: upper to mid-abdomen
- "Red currant jelly" stools (only in 10-15% of patients)
- Colicky periumbilical pain
- Drawing up of legs
- Later vomiting and rectal bleeding
- Shock and dehydration
Investigations
- Imaging: U/S
Treatment
- Resus if shocked
- NGT
- Air enema diagnostic, can be therapeutic (reduce intussusception in 75% of cases)
- Reduction under hydrostatic pressure
- Surgery rarely needed
Source
Toronto Notes 2012
OHCM 9th Ed 2014