Intussusception is the telescoping of one part of the intestine into another part and is most common in children under 2 years old. The classic presentation includes intermittent abdominal pain, a sausage-shaped abdominal mass, and currant jelly stools. Ultrasound is the preferred diagnostic method and shows a target or "doughnut" sign. Treatment involves rehydration and antibiotics if infected. Non-operative reduction using hydrostatic or pneumatic pressure is usually attempted first but surgery may be needed if reduction fails or there are signs of perforation or necrosis. With prompt diagnosis and treatment, mortality from intussusception is less than 1%.

1. RAJIV LAL
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Intussusception

3.  Intussusception – telescoping of a proximal
segment of the intestine(intussusceptum) into a
distal segment (intussuscipien).
 It is the most common abdominal emergency in early
childhood, particularly in children younger than two
years of age.
 The majority of cases in children are idiopathic.

4. Epidemiology
 Most common cause of intestinal obstruction in
infants between 6 and 36 months of age.
 Approximately 60% < 1 year old
80 to 90% <2 years old
 Intussusception is less common before three
months and after six years of age
 male: female ratio of approximately 3:2

5. INTUSSUSCEPTION
ANATOMIC LOCATIONS
 ILEOCOLIC
MOST COMMON IN CHILDREN
 ILEO-ILEOCOLIC
SECOND MOST COMMON
 ENTEROENTERIC
ILEO-ILEAL, JEJUNO-JEJUNAL
MORE COMMON IN ADULTS
 CAECOCOLIC, COLOCOLIC

6. Pathogenesis
The intussusceptum, telescopes into the intussuscipien →
dragging the associated mesentery with it.
 Venous and lymphatic congestion
 Edema
 Strangulated obstruction
 Ischemia….necrosis….perforation….peritonitis
sepsis….shock…death

7. Lead point
A lead point is a lesion or variation in the intestine
that is trapped by peristalsis and dragged into a
distal segment of the intestine, causing
intussusception.
A Meckel diverticulum, intestinal polyp,
intestinal duplication, hemangioma, tumor
(lymphoma), appendix, ectopic pancreas can
act as a lead point for intussusception.
25% of cases have pathological lead point.

8. Aetiology
 Approximately 75% of cases are idiopathic
because there is no clear disease trigger or
pathological lead point.
 Viral infections can stimulate lymphatic tissue in
the intestinal tract, resulting in hypertrophy of
Peyer patches in the lymphoid rich terminal ileum,
which may act as a lead point for ileocolic
intussusception
 Postoperative- The intussusception is thought to
be caused by uncoordinated peristaltic activity
and/or traction from sutures or devices such as a
gastrojejunal feeding tube.

9. CLINICAL MANIFESTATIONS
History
Early
 Patients with intussusception typically develop the sudden onset of intermittent,
severe, crampy, progressive abdominal pain, accompanied by inconsolable
crying and drawing up of the legs toward the abdomen.
 Between symptoms child will be playing and doing normal activity.
 Vomiting
Later
 Continuous abdominal pain
 The stool may contains gross or occult blood or be a mixture of blood and
mucous and sloughing mucosa, giving it the appearance of currant jelly.
 Lethargy
 Palpable abdominal mass.
Physical
 A sausage shaped abdominal mass.
 Abdominal distension
 Dehydration

10.  Classic triad ( <15% of cases)
 Intermittent colicky abdominal pain
 RLQ sausage shaped abdominal mass
 currant jelly stool is seen in less than 15% of patients at
the time of presentation.
 Occasionally, the initial presenting sign is
lethargy or altered consciousness alone, without
pain, rectal bleeding, or other symptoms that
suggest an intra-abdominal process and is often
confused with sepsis.

11. Diagnosis
Ultrasonography — Ultrasonography is the method of choice to detect
intussusception. A Doughnut or ‘target sign’ is seen, representing
layers of the intestine within the intestine
Dx accuracy is approx 85%. May also be visible on abdo CT with IV
contrast.

12. Abdominal plain film – low sensitivity and specificity
 Signs of intestinal obstruction
 Pneumoperitoneum

13. Contrast x-ray Patients with typical presentation can proceed
directly to contrast study (enema) advantage of being diagnostic
(barium will outline a concave ‘meniscus’) and therapeutic.

14. Treatment
 Stabilize and resuscitate with intravenous fluids
 Hydration, electrolyte, acid-base balance.
 NBM and Stomach should be decompressed with a
nasogastric tube
 Antibiotics- if signs of infection (fever, peritonitis)
 Ampicillin 50mg/kg IM/IV 4x per day
 Gentamycin 5mg/kg IM/IV OD
 Metronidazole 7.5mg/kg IV TDS
Duration – uncomplicated reduced with air enema 24-48 hrs
- perforated bowel with resection 1 week post-op

15. Non-operative treatment
 Stable patients and no evidence of bowel perforation
should be treated with Non-operative reduction
 Non-operative reduction using hydrostatic or pneumatic
pressure by enema
 Risk of perforation – adv in pneumatic technique.
Surgical treatment
 Indicated for patients with peritonitis or evidence of
perforation or in whom non-operative reduction is
unsuccessful.
 Manual reduction at operation is attempted
 If manual reduction fails or in case of perforation,
necrosis, pathological lead point – bowel resection and
primary anastomosis is performed.
 The risk of recurrence is approximately 1 percent after
manual reduction and virtually nonexistent after surgical
resection

16. Complications - Rarely occur when diagnosis is prompt.
 Necrosis and bowel perforation from strangulated
intussusception
 Peritonitis and Sepsis
 Hypovolaemia and circulatory shock
 Electrolyte imbalance
 Perforation during non operative reduction.
 Wound infection.
 Adhesions causing bowel obstruction.
 Recurrence.
 10% after successful non-operative reduction
With early diagnosis, appropriate fluid resuscitation and
therapy, the mortality rate from intussusception in children is <
1%. If left untreated, this condition is uniformly fatal in 2-5
days.

17. Reference
 Lloyd DA, Kenny SE. The surgical abdomen. In:
Pediatric Gastrointestinal Disease: Pathopsychology,
Diagnosis, Management, 4th, Walker WA, Goulet O,
Kleinman RE, et al (Eds), BC Decker, Ontario 2004.
p.604.
 Rudolph’s peadiatrics 22nd edition
 Mandeville K, Chien M, Willyerd FA, et al.
Intussusception: clinical presentations and imaging
characteristics. Pediatr Emerg Care 2012; 28:842.
 Buettcher M, Baer G, Bonhoeffer J, et al. Three-year
surveillance of intussusception in children in
Switzerland. Pediatrics 2007; 120:473.