Intussusception
last authored: Oct 2009, Dave LaPierre
last reviewed:
Introduction
Intussusception is the invagination of one section of small bowel into another. Over 50% of cases ocur between 3-12 months, and 75% of cases before 2 years of age.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis. To get students thinking.
Causes and Risk Factors
The majority of cases are idiopathic.
Risk factors include:
- cystic fibrosis
- GJ tube placement
Pathophysiology
Telescoping into a distal segment can lead to ischemia and necrosis. The usualy site is the ileicecal junction.
Other areas of increased risk include:
- swollen Peyer's patches
- Meckel's diverticulum
- polyps
- malignancy
- Henoc-Schollein Purpura
Signs and Symptoms
- history
- physical exam
History
Intussusception is often announced by sudden onset, recurrent, severe periumbilical pain, with pain-free intervals.
Vomiting and rectal bleeding (often 'red currant jelly' stools) follow.
Physical Exam
classic triad
abdominal pain
palpable mass
red currant jelly stools
A palpable, sausage-shaped mass may be felt in the upper or mid-abdomen
Children may draw their legs up to their abdomen.
Shock and dehydration can follow.
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
ultrasound
air enema can be diagnostic and therapeutic in 75% of cases
Differential Diagnosis
Treatments
Air enema is usually therapeutic. Reduction under hydrostatic pressure can be carried out.
Surgery is rarely required.
Consequences and Course
Resources and References
Topic Development
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