Intussusception

Background/Pathophysiology

  • Intussusception is the invagination of one segment of the intestine within a more distal segment
    • usually ileum invaginating through the ileocaecal valve into the caecum
    • As the bowel intussuscepts, it pulls the blood supply with it which can lead to vascular compromise, ischaemia and possibly necrosis and perforation (can be fatal)
  • Most common cause of bowel obstruction in infants (commonly between 4 and 10 months old)
  • Occurs in around 30/100,000 children in the first year of life.
  • Often follows a period of the child being unwell e.g. infection (more common if caused diarrhoea/vomiting e.g. rotavirus

Risk Factors/Aetiology

  • Meckel’s diverticulum predisposes to intussusception
  • Henoch Schonlein purpura– there is a small association
  • Rotavirus infection (occasionally rotavirus vaccination)

Presentation

  • Severe abdominal pain that comes and goes (episodes lasting 2-3 minutes, in between times the child will usually appear pale, floppy, lethargic)
  • After 6-12 hours, pain can become more constant; vomiting may occur (may be bile-stained green
    • Stool may contain blood and mucus (classic ‘red currant jelly stool’)
    • There may also be a tender abdominal mass (may be sausage shaped)

Investigation

  • An USS can usually confirm the diagnosis
    • Barium studies may be done if suspected volvulus
    • AXR may show
      • soft tissue mass; ‘target sign’ (caused by overlapping bowel and mesenteric fat); absence of bowel gas/stool; meniscus sign (crescent of gas outlining the intussusception; loss of visualisation of the tip of the liver
  • U&Es, FBC, LFTs etc

Management

  • IV fluids
  • Nasogastric tube for suction
  • Radiological
    • Air enema
  • Laparotomy reduction if there are any signs of peritonitis/perforation, prolonged history, pathological lead-point (i.e. structural cause that would require surgery); failed enema

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