see also [[Volvulus]], [[Paeds#Abdominal pain|Abdominal pain in paeds]] [RCH Intussusception](https://www.rch.org.au/clinicalguide/guideline_index/Intussusception/) - most common cause of bowel obstruction btwn ==2 months and 6 years== - USS is dx method of choice Intussusception is the invagination (telescoping) of a proximal segment of bowel into the distal bowel lumen. ==The commonest site is a segment of ileum moving into the colon through the ileo-caecal valve==. This process leads to bowel obstruction, venous congestion and bowel wall ischaemia. Perforation can occur and lead to peritonitis and shock. - The triad of intermittent abdominal pain, palpable abdominal mass and red currant jelly stools occurs in only 1/3 of children - May occur at any age, but most commonly between 2 months and 2 years of age - Most cases are idiopathic (90%) - In older children, a pathological lead point may be the cause # Clinical features - sudden pain with sudden relief → child can appear very well in between episodes - vertically oriented mass in right abdomen or epigastrium - "current jelly" stools is a late finding - pallor, especially during episodes - lethargy may be profound, episodic, or persistent - vomiting -- bile-stained is late feature of bowel obstruction - diarrhoea common, can lead to misdiagnosis of gastroenteritis. rectal bleeding or "red currant jelly" are late signs of bowel ischemia and infarction - palpable abdominal pass **additional risk factors** - recent intussusception - potential lead point: eg meckel's diverticulum, [[Henoch-Schonlein Purpura|HSP]], lymphoma, polyps (eg Peutz Jegher Syndrome) - recent bowel surgery - recent rotavirus **Complications** - fluid depletion and electrolyte imbalance - bowel wall necrosis - bowel perforation - sepsis # Investigations ## ultrasound intussusception #pocus - \>98% sensitive and specific when formal ; POCUS does not exclude dx - use linear probe - start at hepatic flexure, identify transverse and ascending colon. trace ascending colon down lateral abdomen towards cecum in RLQ. identify active peristalsis of terminal ileum - ileocolic intussusception most commonly found in RUQ - segment of walls may have multiple thick hyoechoic layers or general appearance of a kidney "*pseudokidney sign*" - sonodense centre (bowel contents) surrounded by a sonolucent ring (bowel wall) "*target sign*" seen on transverse views of bowel. - typical intussusception is 3-5 cm in diameter, nearly fill image on US display ![[Pasted image 20240724150626.png]] A - longitudinal image demonstrating "*pseudokidney sign*" . hypodense areas of intussusception are oedematous bowel wall. hyperechoic central area is caused by bowel contents, and possibly intussuscepted mesenteric fat B - transverse scan through ascending colon demonstrates the "donut" or "*target sign*" appearance of intussusception. the outer ring is the intussuscipiens, while central echoes are the intussusceptum. ![[Pasted image 20240724150611.png]] ## AXR - only if signs of obstruction or perforation - sensitivity <50%; does not exclude intussusception - signs: - empty right lower quadrant and visible soft tissue mass in upper abdomen - soft tissue mass surrounded by a crescent lucency of bowel gas - lack of faecal material in the large bowel - signs of SBO - pneumoteritoneum indicates bowel perforation ![[Pasted image 20240515185109.png]] ## contrast / gas enema - can be used diagnostically and therapeutically in consultation w/ surgical team - small risk of bowel perf and bacteraemia during gas enema - contraindicated if peritonitis, shock, perforation, or unstable pt # Treatment - air enema (as above) - laparotomy ![[Pasted image 20230818192418.png]] # Related Questions ## abdominal pain - [ ] 2Q: [Child with Abdominal Pain](x-devonthink-item://C88FD92C-E0CB-48A1-8D73-F20489FA4E6C?page=12) -- [Answer](x-devonthink-item://98D17FA0-225B-4E94-B21C-4E36D5C76A7C?page=37) ## abdominal pain in child - [ ] 4Q: [Child with Abdominal Pain](x-devonthink-item://D6654B01-83AA-4553-94F0-791FD96A636D?page=7) -- [Answer](x-devonthink-item://00427DF6-6D28-4FEB-A0CA-DF96DBBBCE97?page=3) -- [prop](x-devonthink-item://AB9BDA6D-9CA8-4E73-9D15-B6105225A1B4?page=3) ## bowel obstruction - [ ] 5Q: [Abdominal Pain in 2y Old](x-devonthink-item://93BBB26D-55F3-43AF-A3B9-F829BE210561?page=9) -- [Answer](x-devonthink-item://E3D816B5-653D-4DC6-A389-8C69022A6062?page=8) -- [prop](x-devonthink-item://42954006-1F26-4D23-93DB-6738A8FA6D94?page=4) ## intussception - [x] 7Q: [Paeds Abdominal Pain](x-devonthink-item://5DC0999B-D537-4002-86AF-FD7B54B45E2E?page=66) -- [Answer](x-devonthink-item://406AF611-5CD4-4B3B-9795-327E8F4E3626?page=32) - [x] 8Q: [Paeds Abdominal Pain](x-devonthink-item://7FCD3940-4BB4-45FE-86A6-E5707E82D5B5?page=55) -- [Answer](x-devonthink-item://3263A68A-96A6-43EC-985B-43260C3509BF?page=20) - [x] DUPLICATE Q: [Child with Abdominal Pain](x-devonthink-item://D6654B01-83AA-4553-94F0-791FD96A636D?page=7) -- [Answer](x-devonthink-item://00427DF6-6D28-4FEB-A0CA-DF96DBBBCE97?page=3) ## volvulus - [ ] 19Q: [Bowel obstruction](x-devonthink-item://554C45F7-8661-4467-BD61-8A79B6ECABF4?page=85) -- [Answer](x-devonthink-item://554C45F7-8661-4467-BD61-8A79B6ECABF4?page=87)