Intussusception

 

Intussusception is a common cause of bowel obstruction in the pediatric population, in which a part of the intestine telescopes into the other intestine. The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscipiens. Intussusception is a medical emergency and a patient should be seen immediately to reduce risk. Its incidence begins to rise at about 2 to 3 months of life, peaks at 4 to 9 months of age, and then gradually declines at around 18 months.

Children usually present with periodic abdominal pain nausea, vomiting (sometimes bile stained), pulling legs to the chest area, and intermittent moderate to severe cramping abdominal pain. Pain is intermittent because the intussuscepted bowel segment transiently stops peristalsing. Later signs include rectal bleeding, often with “red currant jelly” stool (stool mixed with blood and mucus), and lethargy. Physical examination may reveal a “sausage-shaped” mass felt upon palpation of the abdomen. The most frequent type of Intussusception is one in which the ileum enters the cecum called ileo-colic intussusception.

An Intussusception is often suspected based on history and physical exam. Ultrasound is today considered the imaging modality of choice for diagnosis and exclusion of Intussusception due to its high accuracy and lack of radiation. A target-like mass, usually around 3 cm in diameter, confirms the diagnosis

Traditionally, Intussusception can be treated with ultrasound guided saline reduction. The success rate is over 80%. However, approximately 5–10% of these recur within 24 hours. Unsuccessful hydrostatic reduction has been followed by laparotomy. With the advent of minimally invasive surgery, centers have adopted laparoscopic reduction as a surgical option.for cases which have failed hydrostatic reduction. 

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