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Intussusception
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What is it?
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Intussusception occurs when a portion of the intestine folds like a telescope, with one segment slipping inside another segment. It can occur anywhere in the intestines. This causes an obstruction, preventing the passage of food that is being digested through the intestine.
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Etiology
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The cause of intussusception is not known. Though rare, an increased incidence of developing intussusception may be seen in children:
· Who have abdominal or intestinal tumors or masses
· Who have appendicitis
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Occurrence/Epidemiology
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Children less than 3 years old, can also occur in older children, teenagers, and adults.
· Intussusception occurs more often in boys than girls.
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Clinical Presentation
(subjective and physical examination)
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Subjective: Pain, Sudden loud crying, Straining, Draw knees up, Irritable.
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Objective: red mucus or jelly like stool, fever, lethargic, vomiting bile, diarrhea, sweating, dehydration, abdominal distention or lump.
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Diagnostic Testing
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X-Ray: may demonstrate an elongated soft tissue mass with a bowel obstruction proximal to it.
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Ultrasound: ‘Target Sign’
also known as the doughnut sign or bull’s eye sign. appearance is generated by concentric alternating echogenic and hypoechogenic bands.
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Upper & Lower GI Series (Barium Swallow & Enema): giving the “coiled spring” appearance
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3 Differential Diagnosis
(include difference between each differential diagnosis & the main diagnosis)
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Intussusception:
Pain, sudden crying, red mucus or jelly like stool, fever, lethargic, vomiting bile, diarrhea, sweating, dehydration, abdominal distention or lump.
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Gastroenteritis: vomiting that are typically nonbilious, often with anorexia, fever, lethargy, and diarrhea.
No jelly like stool
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Gastric Volvulus: Epigastric pain tenderness and distention, vomiting, bloody diarrhea
No jelly like stool
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Appendicitis: abdominal pain that has migrated from a periumbilical position to the right lower quadrant.
No jelly like stool or masses.
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Non-Pharmacologic Management
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There are currently no nonpharmacological treatments.
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Pharmacologic Management
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May fix itself while being diagnosed with barium enema. Air enema (aids in moving intestines back).
Antibiotics if infection present
Surgery: push the telescoped intestine back out. Rare cases a resection of intestines may happen, and stoma created.
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Follow Up
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With toleration of diet, patients treated with nonoperative reduction are usually discharged 12-18 hours after the therapeutic enema. After operative reduction, postoperative progress dictates the length of stay.
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References
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Blanco, F. C., Chahine, A. A., King, L., & Wilkes, G. (2017, July 3). Intussusception: Practice Essentials, Background, Etiology and Pathophysiology. Retrieved from
Crawford, E. (2015). NP-Family Specialty Review and Study Guide: A Series from StatPearls. Retrieved from
Epocrates. (2017). Intussusception Differential Diagnosis – Epocrates Online. Retrieved from
Shah, V., & Amini, B. (2017). Intussusception | Radiology Reference Article | Radiopaedia.org. Retrieved from
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