Name
INTUSSUSCEPTION
DESCRIPTION
DETAIL
CAUSES . Children . Marked hypertrophy of Peyerfs patches (92-98%) . Lead point in 2%-8% (polyp, Meckel diverticulum, duplication cyst, ectopic pancreas, lymphoma, Henoch-Schonlein purpura, lipoma, carcinoma) . Allergic reactions, diet changes, changes in intestinal activity may be other causes . Possible adenovirus or rotavirus infection . Adults . Virtually always associated with lead point -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS • Adhesive band small bowel obstruction • Appendicitis • Gastroenteritis* ULTRA SOUND WHOLE ABDOMEN : CHARACTERISTIC BULLS EYE PICTURE IS SEEN SOMETIMES LABORATORY • Electrolytes • CBC • Urinalysis • Stool guaiac IMAGING • Ultrasound • Plain film - flat and upright abdominal films may suggest the diagnosis DIAGNOSTIC PROCEDURES • Contrast enema (barium, water soluble contrast or air) • Abdominal ultrasound
TYPENOTES
RISK FACTORS: Henoch-Schönlein purpura, Leukemia, Lymphoma, Cystic fibrosis, Recent upper respiratory infection (21%), Recent operation (1-24 days previously), Recent viral gastrointestinal illnessGENERAL MEASURES . IV fluid resuscitation . Foley catheter (if child severely dehydrated) . Nasogastric tube . Antibiotics useful only if necrotic bowel present . Non-operative care: . Hydrostatic/pneumatic reduction of intussusception (50-80% success) . Barium column should be 40-42 inches high . Enema continued as long as progress is made. Bowel may be drained and the enema repeated. . Pneumatic reduction pressure should not exceed 120-140 mm Hg (16-18.6 kPa) SURGICAL MEASURES . Right lower quadrant incision . Gentle manipulation by pushing intussusception (not pulling) . If unable to reduce or non-viable bowel, segmental resection with re-anastomosis . Enterotomy if lead point suspected . Incidental appendectomy commonly done ACTIVITY As tolerated after reduction DIET Liquids started after abdominal distension resolves and bowel function returns PATIENT EDUCATION . Instruct family on possibility of recurrence (5-13%) . Most recurrences occur in first 24 hours postreduction PATIENT MONITORING Office visit one week after discharge POSSIBLE COMPLICATIONS • Bowel perforation during attempted reduction • Prolonged ileus • Adhesions with intestinal obstruction • Incisional hernia • Ischemic intestine requiring second operation • Electrolyte abnormality • Anemia • Pleural effusion • Sepsis • Recurrence EXPECTED COURSE/PROGNOSIS • Mortality should not exceed 1-2% • Possible recurrence (5-13%) after hydrostatic reduction • Possible recurrence (3%) after operative reduction
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
STOOL ROUTINE, X-RAY ABDOMEN ERECT VIEW, ULTRA SOUND WHOLE ABDOMEN - MALE, COMPLETE BLOOD COUNT, SIGMOIDOSCOPY, COLONOSCOPY