Intussusception: Difference between revisions

Revision as of 09:10, 21 August 2016

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
  - If > 6 years old, more likely to have a lead point
- Slight male predominance - 3:2
Adults
- Rare
- 80% involve small bowel
- 70% risk of malignancy

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
  - May be completely benign, smiling, playful
- Suspect if recurrent brief pain episodes, especially if wake child from sleep
- Later stages may be associated with lethargy
May have vomiting (non-bilious, late stages bilious)
May present as lethargy alone, without any of the classic triad

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 do not have lead point

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

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

Authors:

@@ Line 21: / Line 21: @@
 **Child pulls up knees
 **May be asymptomatic between episodes
+***May be completely benign, smiling, playful
+**Suspect if recurrent brief pain episodes, especially if wake child from sleep
 **Later stages may be associated with lethargy
+*May have vomiting (non-bilious, late stages bilious)
+*May present as lethargy alone, without any of the classic triad
 ===Adults===
 *Typically have partial/SBO symptoms