Intussusception: Difference between revisions

Revision as of 09:20, 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
    - Lead points: Meckel diverticulum, duplication cyst, polyp, tumor, hematoma, vascular malformation, parasite (eg Ascaris), Henoch-Schonlein purpura
- 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
  - Some emergency departments have successfully implemented bedside point-of-care ultrasound
- Classically see bulls eye lesion
- Ultrasound can diagnose ileo-ileal intussusception, whereas contrast enema cannot
- Negative ultrasound = may still be intermittent intussusception
Air contrast enema
- Diagnostic and frequently curative
- Prior to procedure, IV hydration, NG tube decompression, surgery consult
Hydrostatic (saline or water-soluble contrast) enema also may be used
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
- Consider NG tube as indicated
- Air-contrast enema (reduces 80%)
- Hydrostatic (saline or water-soluble contrast) may also be used
Surgery consult
- Surgery is indicated when nonoperative reduction is incomplete, or patient is toxic, or has perforation or peritonitis.
- In stable, asymptomatic patient with ileo-ileal 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 45: / Line 45: @@
 *[[Ultrasound: Abdomen|Ultrasound]]
 **Sensitivity and specificity approach 100%, but operator dependent
+***Some emergency departments have successfully implemented bedside point-of-care ultrasound
 **Classically see bulls eye lesion
+**Ultrasound can diagnose ileo-ileal intussusception, whereas contrast enema cannot
 **Negative ultrasound = may still be intermittent intussusception
 *Air contrast enema