Intussusception

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

Diagnosis

• 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
• 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
• All labs nonspecific

Treatment

1. NPO/NG tube
2. Surgery consult
3. Air-contrast enema (reduces 80%)
   1. 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

Disposition

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

Source

Uptodate