In most children (2 months to 2 years) the intussusception is ileocaecal with small bowel obstruction as a right iliac fossa mass as ileum goes into caecum and colon.
- From the Latin intus (within) and suscipere (to receive).
- Invagination of a proximal piece of bowel into a distal segment
- Telescoping of the bowel - like closing a telescope
- Infant age 6-18 months previously well
- There is telescoping of bowel within itself
- May be caused by an area of inflammation or lymphoid hyperplasia
- Can lead to oedema, vascular insufficiency, Gut necrosis and death
Intussusception is the most common cause of bowel obstruction in patients aged less than 2 years.
- Fever, Apathy, listlessness, pallor
- Intermittent colicky abdominal pain with screaming child
- Sausage shaped mass in the abdomen
- Red current jelly like stools (bloody mucus)
- Vomiting develops later
- Right iliac fossa mass proximal to the ileocaecal valve
- Gastroenteritis, Pneumonia, Appendicitis
- FBC: raised WCC. U&Es: dehydration.
- Abdominal X-ray: may be dilated gas-filled proximal small bowel, paucity of gas distally, multiple fluid levels (but may be normal in the early stages). A normal AXR does not exclude intussusception
- Ultrasound: may identify doughnut or target sign or mass
- Bowel enema - barium has been gold standard (crescent sign, filling defect) but air and water-soluble double-contrast are now available.
- Urgent Air-contrast enema is needed which causes reduction and relieves the problem. X-rays may be normal in 30%.
- Bowel obstruction
- Bowel gangrene
- Bowel perforation
- Sepsis, Death
- Involve the surgical team early and keep nil by mouth. ABC, Fluid Resuscitation: NG tube and IV fluids 20 ml/kg N-Saline and start Antibiotics if obstructed or peritonitis. Keep under constant observation as patients can rapidly deteriorate so provide medical or nursing escorts.
- Rectal air insufflation may be considered or Barium enema is usually tried several times if there is no sign of peritonitis, perforation or shock.
- Surgery if any signs of peritonism with laparotomy is performed with operative reduction and resection of gangrenous bowel. Careful observation post-op as it can recur