Intussusception

Background

• 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

Diagnosis

• 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

• Imaging
  • 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
• All labs nonspecific

Treatment

1. 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%)

1. 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

Disposition

• Admit
• Recurrence occurs in ~10% of cases reduced by enema
  • initial management same

See Also

Abdominal Pain (Peds)

Source

Uptodate