Gastrointestinal System >
Intussusception

“The prolapse of one part of the intestine into the lumen of the adjoining distal part, most often occurring in the ileocaecal region”

Risk Factors
  • Male sex
  • Age 6-12 months
Aetiology
  • Usually unclear but likely related to hyperplasia of Peyer’s patches and lymphoid tissue in the intestinal wall
Pathophysiology
  1. One portion of the intestine is telescoped into the lumen of the intestine immediately distal to it
  2. The mesentery is dragged into the distal lumen, becoming compressed
  3. Venous and lymphoid flow is obstructed
  4. Bowel wall becomes oedematous and increases lumen pressure
  5. Peristalsis is disrupted causing colicky abdominal pain
  6. Arterial blood flow may become compromised
  7. Ischaemia, necrosis and perforation may develop
Clinical Presentation
  • Colicky abdominal pain – every 10-20 minutes, lasting 1-3 minutes
  • Vomiting
  • Lethargy/irritability between waves of pain
  • PR bleeding/redcurrant jelly stool
  • Palpable abdominal mass (RUQ/epigastrium)
  • Signs of hypovolaemic shock – dehydration, pallor, hypotension, tachycardia
Investigations
  • Bloods: n/a
  • Imaging:
    • Abdominal X-Ray
      • May be normal early-on
      • Dilated gas-filled proximal bowel
      • Paucity of gas distally
      • Multiple fluid levels
    • Abdominal Ultrasound
      • Visible mass
      • Rduced mesenteric blood flow
      • Target/doughnut sign
      • Psuedokidney/sandwich appearance
    • CT Scan
      • Target sign
      • Dilated loops of bowel
  • Special:
    • Diagnostic Enema
      • Meniscus sign
      • Coiled spring sign
Management
  • Urgent referral to hospital
  • “Drip and suck” (IV fluids and nasogastric tube)
  • Broad-spectrum antibiotics where there is a risk of perforation
  • Radiological reduction (air or liquid contrast enema)
  • Surgical reduction
Complications
  • Bowel ischaemia and necrosis
  • Perforation
  • Peritonitis
  • Sepsis

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