PAEDIATRIC CONDITION

1. INTUSSUSCEPTION

2. INTRODUCTION
• Intussusception is a condition
where the bowel “invaginates”
or “telescopes” into itself. This
thickens the overall size of the
bowel and narrows the lumen at
the folded area, leading to a
palpable mass in the abdomen
and obstruction to the passage
of faeces through the bowel.

3. EPIDEMIOLOGY
• It typically occurs in infants 6
months to 2 years
• Affects approximately 1 in every
500 children under the age of 5
years.
• more common in boys.

4. CLASSIFICATION

5. RISK FACTORS
1. Age:
2. Previous episodes:
3. Gastrointestinal infections:. Rotavirus, a common cause of gastroenteritis in infants and young.
4. Structural abnormalities
5. Meckel's diverticulum
6. Celiac disease
7. Intestinal polyps
8. Henoch-Schönlein purpura:
9. Family history

6. PATHOPHYSIOLOGY
• The exact cause of intussusception is not fully understood, but it is believed to be
multifactorial. One of the primary contributing factors is thought to be an abnormality
in the peristaltic movements of the intestine, which could result from changes in the
lymphatic tissue within the intestine, a viral infection or certain medical conditions
such as polyps or tumors in the intestine.
• As the invagination progresses, it leads to obstruction of the intestinal lumen, impairing
the passage of food and waste material causing symptoms such as severe abdominal
pain, vomiting, and bloody stools.
• Furthermore, the invagination can compromise blood flow to the affected segment of
the intestine, leading to ischemia and tissue necrosis. If left untreated, this can result in
perforation of the intestine and peritonitis (inflammation of the abdominal cavity). The
compromised blood flow can also lead to secondary complications such as infection
and sepsis

11. CLINICAL PRESENTATION
• Severe, colicky abdominal pain
• Pale, lethargic and unwell child
• “Redcurrant jelly stool”
• Right upper quadrant mass on palpation. This is described as “sausage-
shaped”
• Vomiting
• Intestinal obstruction

13. DIAGNOSIS
Diagnosing intussusception involves a combination of
• clinical evaluation
• imaging studies: ultrasound and sometimes CT scan or X-ray
• diagnostic procedures: barium enema or air enema

14. Clinical Evaluation
- Medical History: inquire about the patient's symptoms, including
abdominal pain, vomiting, bloody stools, and changes in bowel
movements.
- Physical Examination: perform a thorough physical examination,
paying particular attention to the abdomen. a mass or signs of
tenderness or distension may be noticed

15. Imaging Studies
- Ultrasound: Ultrasonography is the primary imaging modality used to
diagnose intussusception in children. It is non-invasive and does not
involve exposure to ionizing radiation. Ultrasound can visualize the
telescoped bowel segments and identify characteristic features such as
the "target sign" or "doughnut sign."
- X-ray: Abdominal X-rays may be performed to evaluate for signs of
bowel obstruction or air-fluid levels. However, X-rays alone are not
sufficient for confirming the diagnosis of intussusception.
- Computed Tomography (CT) Scan: In certain cases where ultrasound
results are inconclusive or unavailable, a CT scan may be used to aid in
diagnosis

17. Diagnostic Procedures
- Barium Enema: This procedure involves introducing a contrast
material (barium) into the rectum through a small tube. X-rays are
then taken to visualize the movement of the contrast material
through the intestines. Barium enema can both diagnose and treat
intussusception in some cases.
- Air Enema: Similar to a barium enema, air enema involves introducing
air instead of contrast material into the rectum. The air helps to push
the telescoped bowel segments back into their normal position.

19. TREATMENT
• Therapeutic enemas can be used to try to reduce the intussusception.
Contrast, water or air are pumped into the colon to force the folded
bowel out of the bowel and into the normal position.
• Surgical reduction may be necessary if enemas do not work.
• If the bowel becomes gangrenous (due to a disruption of the blood
supply) or the bowel is perforated, then surgical resection is required.

20. DIFFERENTIAL DIAGNOSIS
1. Gastroenteritis
2. Appendicitis
3. Meckel's diverticulum
4. Hirschsprung's disease
5. Volvulus
6. Intestinal obstruction
7. Meconium ileus
8. Henoch-Schönlein purpura

21. COMPLICATIONS
• Obstruction
• Gangrenous bowel
• Perforation
• Death

22. REFERENCES
• 1. Mayo Clinic - www.mayoclinic.org
• 2. MedlinePlus - medlineplus.gov