intestinal intussusception in infants

1. INTUSSUSCEPTION IN AN
INFANT

2. INTRODUCTION
• The commonest cause of intestinal
obstruction among infant and young
childhood
• Leading cause of mortality of GI
emergencies

3. ISSUES
• Risk of recurrence is 0-5.4% (post
surgery)
• The recurrence may be overlooked by
junior or inexperienced doctors
Koh C-C, Sheu J-C, Wang N-L, et al. Pediatr Surg Int 2006
September);22:725- 728

4. Recurrent intussusception post
surgical reduction
• What is the best tool to detect
intussusceptum and intussuscepient
• Conservative (barium or pneumatic
reduction) versus surgical reduction

5. CASE PRESENTATION
CHIEF COMPLAINT
10/12 old boy with acute onset of abdominal pain and
vomiting
PRESENTING ILLNESS
abdominal pain and vomiting since early morning
NBO and crying throughout the day
Less active and poor oral intake

6. PAST MEDICAL HISTORY
Intussusception at 8/12 old –underwent surgical reduction
(? type of surgery)
(? reason for failed non-surgical reduction)
CLINICAL FINDINGS
Vitals sigs:Normal
Afebrile
Fairly hydrated
Abdomen: soft, no palpable mass
Other systems unremarkable

7. Supine abdominal
radiograph

8. Plain abdominal radiograph
• Normal radiograph does not exclude the
diagnosis
• Significant signs:
- target sign
- paucity of air in the bowel
- little or no stool in the colon or small
- bowel soft tissue mass in the RUQ (50%)
- SBO
James D’Agostino, 2002

9. SIEMENS Elegra MEDISonoline

12. Color Doppler USG
• Estimate the reducibility
- color signal within intussususceptum
• Predicts bowel ischemia
- does not always true

13. MANAGEMENT OPTIONS
• Management option
surgical non-surgical
pneumatic barium
● Non-surgical reduction proves to be
superior to surgery

14. Urgent pneumatic reduction
• Patient was sedated
• Prone position
• Foley’s catheter sized 22F inserted into
the rectum
• Air inflated till 120 mmHg and sustained at
about 80 mmHg for 30 min

16. 1st trial 2nd trial

17. PSEUDOKIDNEY?
• Thick-walled “doughnut” (intussuscepiens)
with inner echogenic mesenteric fat
(intussusceptum)

18. CLINICAL PROGRESSION
• Close observation in pediatric surgical
ward
• Discharged well on the second day of
pneumatic reduction

19. FINAL DIAGNOSIS
RECURRENT INTUSSUSCEPTION

20. RECURRENT
INTUSSUSCEPTION
• Early diagnosis is crucial
• Index of suspicious
• Ultrasonography has a high diagnostic accuracy
rate for intussusception and safer than x-rays
• Pseudokidney? S & S (94%)
• Suggestion: NO MORE x-ray in suspected
intussusception
Harrington et al. Ultrasonography and Clinical Predictors
of Intussusception. Journal of Paed 1997;132:836-839

21. • Factors affecting the successfulness
of pneumatic reduction
–Coexisting intestinal pathology
–Delay in diagnosis
Journal of Pediatric Surgery 2007;42:1504-1508

22. CONCLUSION
• Ultrasonography is the best diagnostic
method of intussusception
• A successful pneumatic reduction of
intussusception require a multidisciplinary
approach
Harrington et al. Journal of Pediatrics 1997;132:836-838
K Rosenfeld, K McHugh. Clinical Radiology
1999;54:452-458