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Intussusception

Definition
  • An intussusception is a medical condition where a part of the intestine (intussusceptum) telescopes into another section (intussuscipiens), often leading to bowel obstruction.
Etiology
  • 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.
Demographics
  • 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.
Clinical Presentation
  • “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.
Investigations
  • 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.
Management
  • 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.
Complications
  • Bowel ischemia and necrosis due to compromised blood flow.
  • Peritonitis if the bowel perforates.
  • Recurrence after non-surgical treatment.

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