1) This case report describes the presentation and management of a 10-month-old boy with recurrent intussusception who presented with abdominal pain and vomiting. 2) Ultrasound was used to diagnose intussusception and showed characteristics of a "pseudokidney". 3) The patient underwent pneumatic reduction which was successful in treating the recurrent intussusception. Close monitoring was required after the procedure.

1. RECURRENT INTUSSUSCEPTION
IN AN INFANT
Dr. Rashidi Ahmad
Emergency Department
HUSM

2. OBJECTIVES
• Incidence of recurrent intussusceptions
• Radioimaging diagnosis and
therapeutics
• The best option of intussusceptions
management in ED

3. INTRODUCTION
• The commonest cause of intestinal
obstruction among infant and young
childhood
• Leading cause of mortality of GI
emergencies
Jay L Grosfeld. Intussusception Then and Now: A historical Vignette.
J Am Coll Surg, 2005:830-832

4. MANAGEMENT OPTIONS
• Management option
surgical non-surgical
pneumatic barium
● Non-surgical reduction proves to be
superior to surgery
Eur J Pediatr 1999;158:707- 710.

5. 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

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

7. 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

8. 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

9. Supine abdominal
radiograph

10. 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

11. SIEMENS Elegra MEDISonoline

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

15. 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

17. 1st trial 2nd trial

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

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

20. FINAL DIAGNOSIS
RECURRENT INTUSSUSCEPTION

21. 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

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

23. 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