Intussusception is the most common cause of
bowel obstruction in patients aged less than 2 years.
Type Small Bowel Large Bowel Abdominal Pain Early and colicky and centrally abdominal Pain may not be colicky Vomiting Early Bilious vomiting and then faecalent due to bacterial overgrowth Vomiting late Constipation Late Early. May pass diarrhoea if partial obstruction Abdominal distension Less if high obstruction and vomits More severe if low Abdominal percussion May be resonant May be resonant Bowel sounds High pitched tinkling AXR Central small bowel valvulae coniventae across width of bowel visible. Distended small bowel. Usually centrally. Many short fluid levels on erect film. Often many loops of the small bowel. SB usually < 3 cm and up to 5 cm when obstructed. No gas in the colon. Peripheral large bowel and haustra do not cross the entire diameter of the wall. Gas in the large bowel. Few loops. Few long fluid levels. Transverse diameter < 10 cm. Causes Post surgical adhesions, herniae, volvulus, paralytic ileus, small bowel ischaemia, old irradiation damage , Crohn's disease Colorectal cancer, Sigmoid volvulus, Diverticular disease
Intussusception is the most common cause of bowel obstruction in patients aged less than 2 years.