Intussusception

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Intussusception is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction. With early diagnosis, appropriate fluid resuscitation, and therapy, the mortality rate from intussusception in children is less than 1%. If left untreated, however, this condition is uniformly fatal in 2-5 days.

Air contrast enema shows intussusception in the cecum.

History The patient with intussusception is usually an infant, often one who has had an upper respiratory infection, who presents with the following symptoms: Vomiting: Initially, vomiting is nonbilious and reflexive, but when the intestinal obstruction occurs, vomiting becomes bilious Abdominal pain: Pain in intussusception is colicky, severe, and intermittent Passage of blood and mucus: Parents report the passage of stools, by affected children, that look like currant jelly; this is a mixture of mucus, sloughed mucosa, and shed blood; diarrhea can also be an early sign of intussusception Lethargy: This can be the sole presenting symptom of intussusception, which makes the condition’s diagnosis challenging Palpable abdominal mass 

Physical examination The hallmark physical findings in intussusception are a right hypochondrium sausage-shaped mass and emptiness in the right lower quadrant (Dance sign). This mass is hard to detect and is best palpated between spasms of colic, when the infant is quiet. Abdominal distention frequently is found if the obstruction is complete. 

Diagnosis Imaging studies used in the diagnosis of intussusception include the following:

Radiography: Plain abdominal radiography reveals signs that suggest intussusception in only 60% of cases:

Ultrasonography: Hallmarks of ultrasonography include the target and pseudokidney signs

Contrast enema: This is the traditional and most reliable way to make the diagnosis of intussusception in children .

Management Nonoperative reduction Therapeutic enemas include the following:

Hydrostatic: With barium or water-soluble contrast
Pneumatic: With air insufflation; this is the treatment of choice in many institutions, and the risk of major complications with this technique is small Surgical reduction Traditional entry into the abdomen is through a right paraumbilical incision. The intussusception is delivered into the wound, and manual reduction is attempted. It is important that the intussusception be milked out of the intussuscipiens. If manual reduction is not possible or perforation is present, a segmental resection with an end-to-end anastomosis is performed.

Laparoscopy has been added to the surgical armamentarium for intussusception and can be performed in all cases of intussusception.
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