Intussusception

An intussusception is a medical condition where a part of the intestine (intussusceptum) telescopes into another section (intussuscipiens), often leading to bowel obstruction.

• Most cases in children are idiopathic.
• Possible triggers in children: Viral infection, Meckel’s diverticulum, or lymphoid hyperplasia post-viral infection.
• In adults: Often due to a structural lesion like a tumour, polyp, or post-surgical adhesion.

• Most common in infants and toddlers, especially between 6 months to 2 years.
• Rarer in adults, where it accounts for a minority of intestinal obstructions.

• “Triad” in children: Colicky abdominal pain, vomiting, and red “currant jelly” stools (blood and mucus mixed).
• Palpable sausage-shaped mass in right upper quadrant.
• Lethargy or altered consciousness due to shock or sepsis.

• Abdominal ultrasound: Most commonly used, shows a characteristic “target” or “doughnut” sign.
• Plain abdominal X-ray: May show signs of obstruction or a mass.
• Contrast enema: Both diagnostic and therapeutic, especially in children.

• Children:
  • Hydrostatic (saline) or air enema: Both diagnostic and therapeutic in uncomplicated cases.
  • Surgery: If enema is unsuccessful, or if there’s a lead point (e.g., Meckel’s diverticulum).
• Adults: Usually require surgery due to a higher likelihood of a pathological lead point.

• Bowel ischaemia and necrosis due to compromised blood flow.
• Peritonitis if the bowel perforates.
• Recurrence after non-surgical treatment.

• Intussusception is common in infants and toddlers, often leading to bowel obstruction.
• Early diagnosis and management is required to reduce complications, such as bowel strangulation.
• It presents as a “Triad” of colicky abdominal pain, vomiting, and red “currant jelly” stools (blood and mucus mixed) in children.
• Diagnosis commonly through the identification of the characteristic “target” or “doughnut” sign in abdominal ultrasound.
• Hydrostatic (saline) or air enema is both diagnostic and therapeutic in children, but patients require surgery if this is unsuccessful or if it occurs in adults.