Intussusception: Difference between revisions

Revision as of 21:46, 8 October 2015

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

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
Guaiac-positive stool (~50%)
Adults
- Typically have partial/SBO symptoms
- Vomiting, rectal bleeding, constipation
- Distended
- Late Stage: sepsis
- Large bowel obstruction associated with malignancy

Stable patients with a high clinical suspicion and/or radiographic evidence of intussusception and no evidence of bowel perforation should be treated with nonoperative reduction.
1. NPO/NG tube
2. Air-contrast enema (reduces 80%)

Surgery consult
1. Surgery is indicated when nonoperative reduction is incomplete.
2. 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

Uptodate

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

Authors:

@@ Line 33: / Line 33: @@
 ***Diagnostic and frequently curative
 ***Prior to procedure, IV hydration, NG tube decompression, surgery consult
-**CT for adults
+**CT for adults (air contrast or barium enemas not sufficient)<ref>Marinis A et al. Intussusception of the bowel in adults: A review. World J Gastroenterol. 2009 Jan 28; 15(4): 407–411.</ref>
 ***Up to 20% of cases don't have lead point
 ***70% risk of malignancy