Intussuception

1. Intussusception: Pathophysiology, Diagnosis,
and Management
• Fogooluwahan Osokoya

2. Learning Objectives
• 1. Define intussusception and its clinical significance.
• 2. Understand the functional anatomy of the bowel and
how it predisposes to intussusception.
• 3. Explain the pathophysiology and pathogenesis.
• 4. Recognize clinical presentation and diagnostic tools.
• 5. Compare non-surgical vs. surgical management.
• 6. Differentiate intussusception from volvulus.

3. What Is Intussusception?
• • Definition: Telescoping of a proximal bowel
segment (intussusceptum) into a distal
segment (intussuscipiens).
• • Clinical Impact:
• - Leading cause of intestinal obstruction in
infants (6–12 months).
• - Untreated can lead to ischemia, necrosis,
perforation.

5. Functional Anatomy of the Bowel
• • Layers: Mucosa, submucosa, muscularis
propria, serosa.
• • Blood Supply: Superior mesentric artery and
inferior mesenteric artery critical for
perfusion.
• • Innervation: Enteric Nervous System
(Auerbach’s and Meissner’s plexuses).
• • Peristalsis: Coordinated propulsion of
luminal contents.

6. Pathogenesis
• Pediatric:
• • Idiopathic (80–90%):
• Viral infections eg rota virus and adeno virus lead to
lymphoid hyperplasia (Peyer’s patches) which form a lead
point that anchors and drags the ileum into the cecum
• • Common at ileocecal junction.
• Adult:
• •causes: Tumors, polyps, adhesions,Meckel’s
diverticulum.

7. Pathophysiology
• 1. Lead point formation leading to telescoping.
• 2. Mechanical obstruction leading to colicky
pain/vomiting.
• 3. Venous congestion leading to edema and
red'currant jelly stools.'
• 4. Arterial insufficiency leading to necrosis and
perforation.

8. Clinical Presentation
• • Triad: Intermittent colicky pain, vomiting,
currant jelly stools.
• • Physical Exam: Sausage-shaped RUQ mass,
lethargy (infants).
• • Red Flags: Peritonitis, fever, hemodynamic
instability.

9. Diagnosis
• 1Clinical Diagnosis
• Based on history and physical exam findings:
• Classic triad (colicky pain, vomiting, currant
jelly stools).
• Palpable sausage-shaped mass in the right
upper quadrant (RUQ).
• Lethargy or irritability, especially in infants.

10. Diagnosis
• Imaging Studies
• Ultrasound (Best Initial Test)
• Shows the classic “target sign” or “doughnut sign”
(layers of telescoped bowel).
• High sensitivity and specificity.
• Abdominal X-ray
• May show air-fluid levels (suggesting obstruction).
• May indicate absence of gas in the RLQ (“Dance
sign”).

11. Target sign

12. • 3. Laboratory Tests (Supportive)
• FBC – May show leukocytosis
(infection/inflammation).
• Electrolytes – To assess dehydration from
vomiting.

13. Management Algorithm
• • Stable Patient: Air/contrast enema reduction
(80–90% success).
• • Unstable Patient or Failed Enema: Surgery
(manual reduction or resection).

14. Treatment
• Immediate IV fluid resuscitation to correct fluid
losses and restore fluid, electrolyte and acid base
balance
• Antibiotics to cover for translocation
• NG tube for transfer with IV fluid maintenance and
replacement of NG losses
• Reduction is only attempted once fluid balance is
restored
• Analgesia and sedation may aid process of reduction

15. Non-Surgical Reduction
• • Procedure: Fluoroscopic/ultrasound-guided
air enema.
• • Contraindications: Peritonitis, perforation,
prolonged symptoms.
• • Success Rate: 80–90% in early cases.

16. Surgical Management
• • Indications: Perforation, necrosis, lead point
(adults).
• • Procedures:
• - Manual reduction (intraoperative).
• - Resection + anastomosis (necrotic bowel).

17. Intussusception vs. Volvulus
• • Intussusception: Telescoping, affects infants,
treated with enema first.
• • Volvulus: Twisting, affects neonates/elderly,
requires surgery first.

18. Key Takeaways & Conclusion
• 1. Early diagnosis (ultrasound) and enema
reduction.
• 2. Pediatric: Idiopathic;
• Adult: Rule out malignancy.
• 3. Delay leads to ischemia and increases
necessity for surgery.
• 4. Differentiate from volvulus.

19. References
• Baja's principles and practice of surgery
• Short textbook of surgery
• Oxford handbook of clinical surgery 5th
edition