Intussusception: Difference between revisions

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**Rare
**Rare
**80% involve small bowel
**80% involve small bowel
**70% risk of malignancy


==Diagnosis==
==Clinical Features==
*Classic Triad:
*Classic Triad:
**Sudden colicky pain
**Sudden colicky pain
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**May be asymptomatic between episodes
**May be asymptomatic between episodes
**Later stages may be associated with lethargy
**Later stages may be associated with lethargy
*Guaiac-positive stool (~50%)
===Adults===
*Adults
*Typically have partial/SBO symptoms
**Typically have partial/SBO symptoms
*Vomiting, rectal bleeding, constipation
**Vomiting, rectal bleeding, constipation
*Distended
**Distended
*Late Stage: sepsis  
**Late Stage: sepsis  
**Large bowel obstruction associated with malignancy
 
*Imaging
**[[Ultrasound: Abdomen|Ultrasound]]
***Sensitivity and specificity approach 100%, but operator dependent
***Classically see bulls eye lesion
**Air contrast enema
***Diagnostic and frequently curative
***Prior to procedure, IV hydration, NG tube decompression, surgery consult
**CT for adults (air contrast or barium enemas not sufficient)<ref>Marinis A et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009 Jan 28; 15(4): 407–411.</ref>
***Up to 20% of cases don't have lead point
***70% risk of malignancy
*All labs nonspecific


==Differential Diagnosis==
==Differential Diagnosis==
{{Pediatric abdominal pain DDX}}
{{Pediatric abdominal pain DDX}}


==Treatment==
==Diagnosis==
#Stable children with a high clinical suspicion and/or radiographic evidence of intussusception and no evidence of bowel perforation should be treated with nonoperative reduction
*Classic Triad
##NPO/NG tube
*All labs nonspecific
##Air-contrast enema (reduces 80%)
*Guaiac-positive stool (~50%)
 
===Imaging===
*[[Ultrasound: Abdomen|Ultrasound]]
**Sensitivity and specificity approach 100%, but operator dependent
**Classically see bulls eye lesion
*Air contrast enema
**Diagnostic and frequently curative
**Prior to procedure, IV hydration, NG tube decompression, surgery consult
*CT for adults (air contrast or barium enemas not sufficient)<ref>Marinis A et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009 Jan 28; 15(4): 407–411.</ref>
**Up to 20% of cases don't have lead point


#Surgery consult
==Management==
##Surgery is indicated when nonoperative reduction is incomplete.
*Stable children with a high clinical suspicion and/or radiographic evidence of intussusception and no evidence of bowel perforation should be treated with nonoperative reduction
##In stable, asymptomatic patient with ileo-ileo intussusception, short length of intussusception <2.3 cm, expectant management is reasonable as many of these cases will resolve spontaneously
**NPO/NG tube
##In all adults with intussusception due to high incidence of malignancy
**Air-contrast enema (reduces 80%)
*Surgery consult
**Surgery is indicated when nonoperative reduction is incomplete.
**In stable, asymptomatic patient with ileo-ileo intussusception, short length of intussusception <2.3 cm, expectant management is reasonable as many of these cases will resolve spontaneously
**In all adults with intussusception due to high incidence of malignancy


==Disposition==
==Disposition==
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*[[Ultrasound: Abdomen]]
*[[Ultrasound: Abdomen]]


== Source ==
==References==
Uptodate
<references/>
<references/>
[[Category:Peds]]
[[Category:Peds]]
[[Category:GI]]
[[Category:GI]]

Revision as of 19:40, 10 October 2015

Background

  • Most common cause of intestinal obstruction in 3mo-6yr
    • Usually occurs in 3-36 months
  • Due to telescoping of one part of intestine into another
    • Mesentery involvement > ischemia, bloody/mucous stool
  • Peds - typically no pathological lesions
  • Adults
    • Rare
    • 80% involve small bowel
    • 70% risk of malignancy

Clinical Features

  • Classic Triad:
    • Sudden colicky pain
    • Palpable sausage shaped mass on right
    • Currant jelly stool (only 50% of cases)
  • Intermittent episodes of pain
    • Child pulls up knees
    • May be asymptomatic between episodes
    • Later stages may be associated with lethargy

Adults

  • Typically have partial/SBO symptoms
  • Vomiting, rectal bleeding, constipation
  • Distended
  • Late Stage: sepsis

Differential Diagnosis

Pediatric Abdominal Pain

0–3 Months Old

3 mo–3 y old

3 y old–adolescence

Diagnosis

  • Classic Triad
  • All labs nonspecific
  • Guaiac-positive stool (~50%)

Imaging

  • Ultrasound
    • Sensitivity and specificity approach 100%, but operator dependent
    • Classically see bulls eye lesion
  • Air contrast enema
    • Diagnostic and frequently curative
    • Prior to procedure, IV hydration, NG tube decompression, surgery consult
  • CT for adults (air contrast or barium enemas not sufficient)[1]
    • Up to 20% of cases don't have lead point

Management

  • Stable children with a high clinical suspicion and/or radiographic evidence of intussusception and no evidence of bowel perforation should be treated with nonoperative reduction
    • NPO/NG tube
    • Air-contrast enema (reduces 80%)
  • Surgery consult
    • Surgery is indicated when nonoperative reduction is incomplete.
    • In stable, asymptomatic patient with ileo-ileo intussusception, short length of intussusception <2.3 cm, expectant management is reasonable as many of these cases will resolve spontaneously
    • In all adults with intussusception due to high incidence of malignancy

Disposition

  • Admit
  • Recurrence occurs in ~10% of cases reduced by enema
    • initial management same

See Also

References

  1. ↑ Marinis A et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009 Jan 28; 15(4): 407–411.
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