Intussusception: Difference between revisions
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**Sudden colicky pain | **Sudden colicky pain | ||
**Palpable sausage shaped mass on right | **Palpable sausage shaped mass on right | ||
**Currant jelly stool (only 50% of cases) | **Currant jelly stool (only 50% of cases; late manifestation of the disease) | ||
*Intermittent episodes of pain | *Intermittent episodes of pain | ||
**Child pulls up knees | **Child pulls up knees | ||
| Line 23: | Line 23: | ||
*Vomiting, rectal bleeding, constipation | *Vomiting, rectal bleeding, constipation | ||
*Distended | *Distended | ||
*Late Stage: sepsis | *Late Stage: sepsis | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 02:06, 20 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; late manifestation of the disease)
- 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
- Emergent
- Nonemergent
3 mo–3 y old
- Emergent
- Nonemergent
3 y old–adolescence
- Emergent
- Nonemergent
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
- ↑ Marinis A et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009 Jan 28; 15(4): 407–411.