Intussusception: Difference between revisions

Revision as of 22:50, 22 June 2011

Background

Most common cause of intestinal obstruction in 3mo-6yr
- Usually occurs in 6-18mo
Due to telescoping of one part of intestine into another
- Mesentery involvement > ischemia, bloody/mucous stool

Diagnosis

Triad:
- Sudden colicky pain
- Vomiting (bilious)
- Currant jelly stool (only 50% of cases)
Intermittent pain
- Child pulls up knees
- May be asymptomatic between episodes
Imaging
- Ambiguous dx = Ultrasound
- Likely dx = air contrast enema
  - Diagnostic and frequently curative
All labs nonspecific

Treatment

NPO
Surgery consult
Air-contrast enema (reduces 80%)

Disposition

Admit

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-* d/t prolapse of part of intestine into the other
+*Most common cause of intestinal obstruction in 3mo-6yr
-* 90% occurs in childhood (ileocolic, ileocecal, or ileoileocolic), adults can occur (50% are small bowel)
+**Usually occurs in 6-18mo
-* Most common cause of intestinal obstruction in <2 y/o group (2nd cause in infants behind hernia)
+*Due to telescoping of one part of intestine into another
+**Mesentery involvement > ischemia, bloody/mucous stool
 ==Diagnosis==
-* Usually btwn 3-12 mos, peak at 10mos (range is 3mo- 2 yr)
+*Triad:
-* Classic triad (3 Sx in 21%, 2Sx in 70%): colicky abdominal pain 80%, vomiting (bilious), bloody stools (currant jelly like) 50%. Intermittent pain= child pulls up knees, then relief.
+**Sudden colicky pain
-* "Dance's sign"= sausage like RUQ mass with no bowel in RLQ 85%
+**Vomiting (bilious)
-* All labs nonspecific
+**Currant jelly stool (only 50% of cases)
-* AXR= signs of obst w/ AFL & no gas distal to obst. U/s gd screening: sensitivity 100% spec.93%
+*Intermittent pain
-* Air contrast enema (replaced barium) can Dx & Rx (do NOT use if pt has peritonitis and/or shock). See coiled spring appearance/cervix lke mass.
+**Child pulls up knees
+**May be asymptomatic between episodes
+*Imaging
+**Ambiguous dx = Ultrasound
+**Likely dx = air contrast enema
+***Diagnostic and frequently curative
+*All labs nonspecific
 ==Treatment==
-#npo
+#NPO
-#NGT
+#Surgery consult
-#IVF
+#Air-contrast enema (reduces 80%)
-#surgery consult
-#Air-Contrast enema (reduces 80%)
+==Disposition==
+Admit
 [[Category:Peds]]
 [[Category:GI]]