- Occurs when one part of bowel invaginates (intussusceptum) into an adjacent section
(intussuscipiens)
- Results in intestinal obstruction and venous compression
- If uncorrected it can result in arterial insufficiency and necrosis
Picture provided by Mr J C Campbell, Derriford Hospital, Plymouth
Picture provided by Brian Meade, Princess Alexandra Hospital, Brisbane, Australia
Picture provided by Gary Atkin, Mount Vernon Hospital, Northwood, Middlesex, United Kingdom
- It is the commonest abdominal emergency between 3 months and 2 years
- Peak incidence is between 6 and 9 months
- Most cases are idiopathic with the lead point due to enlarged Peyer's patches
- Usually due to a viral infection
- 5% are due to polyp, Meckel's diverticulum, duplication cyst or tumour
- Commonest site involved is the ileocaecal junction
Clinical features
- Intermittent colicky abdominal pain and vomiting
- Each episode classically last 1-2 min and recurs every 15-20 min
- Passage of blood - 'red currant jelly' per rectum
- Sausage shaped abdominal mass
- Diagnosis confirmed with water soluble contrast enema or ultrasound
Picture provided by Fahid Abu-Bent, Neblus Speciality Hospital, Neblus, Palestine
Treatment
- Resuscitation with intravenous fluids and nasogastric tube
- Attempt reduction with air or contrast enema under radiological guidance
- If peritonitis, shock or failed reduction requires surgery
- If bowel necrosis requires resection with primary anastomosis
Bibliography
Daneman A. Alton D J. Intussusception. Issues and controversies related to diagnosis and reduction. Radiol
Clin North Am 1996; 34: 743-756.
DiFiore J W. Intussusception. Semin Pediatr Surg 1999; 8: 214-220. |