pediatric intussusception according to nelson 20th edition

1. Intussusception
Zinash Demissie(CII)
by zinash demissie

2. • Intussusception occurs when a portion of the
alimentary tract is tele-scoped into an adjacent
segment.
• most common cause of intestinal obstruction
between 5 mo and 3 yr of age and the most
common abdominal emergency in children
younger than 2 yr.80% of the cases occur before
age 24 mo
• if left untreated, ileal–colonic intussusception
may lead to intestinal infarction, perforation,
peritonitis, and death
by zinash demissie

3. ETIOLOGY AND EPIDEMIOLOGY
• Approximately 90% of cases of intussusception in
children are idio-pathic
• prior or concurrent respiratory adenovirus (type C)
infection
• After rotavirus vaccine within 2 wk of immunization
• introduction of new food proteins results in swollen
Peyer patches in the terminal ileum
• Intrauterine intussusception may be associated with
the development of intestinal atresia
by zinash demissie

4. Recognizable lead points for the
intussusception
• Meckel diverticulum,
• intestinal polyp,
• neurofibroma,
• inverted appendix stump,
• leiomyomas and hamarto-mas,
• ectopic pancreatic tissue,
• anastomotic suture line,
• posttransplant lymphoproliferative disease,
• hemangioma, or
• malignant conditions such as lymphoma, or Kaposi sarcoma.
by zinash demissie

5. • Intussusception can complicate mucosal
hemorrhage, as in HSP,ITP, or hemophilia.
• Postoperative intussusception Cystic fibrosis,
celiac disease, and Crohn disease are other
risk factors.
by zinash demissie

6. PATHOLOGY
• Intussusceptions are most often ileocolic, less
commonly cecocolic, and occasionally ileal. Very
rarely, the appendix forms the apex of an
intussusception
• Intussusceptum invaginates into the lower the
intussuscipiens pulling its mesentery along
→obstructs venous return →edema, and
bleeding from the mucosa → blood and mucus in
stool
• Most intussusceptions do not strangulate the
bowel within the 1st 24 hr but can eventuate in
intestinal gangrene and shock.
by zinash demissie

7. CLINICAL MANIFESTATIONS
• Typical:-sudden onset, in previously well child,
severe paroxysmal colicky pain at frequent
intervals with straining efforts with legs and
knees flexed and loud cries.
• infant play normally between the paroxysms of
pain but if the intussusception is not reduced, the
infant becomes progressively weaker and
lethargic.abdominal signs. Eventually, a shock-like
state, with fever and peritonitis.
by zinash demissie

8. • Then weak pulse
• shallow respirations and grunting
• Abd pain
• Vomiting in the early phase later becomes bile
stained
• 60% of infants pass a stool containing red
blood and mucus, the currant jelly stool
by zinash demissie

9. • The combination of paroxysmal pain, vomiting
and a palpable abdominal mass has a positive
predictive value of >90%; the presence of
rectal bleeding increases this to approximately
100%.
by zinash demissie

10. • Palpation of the abdomen reveals a slightly
tender sausage-shaped mass, sometimes
ilincrease in size and firmness during a
paroxysm of pain and is most often in the
right upper abdomen in long axis, at epigas-
trium, the long axis is transverse
by zinash demissie

11. • rarely, the advancing intestine prolapses
through the anus This prolapse can be
distinguished from prolapse of the rectum by
the separation between the protruding
intestine and the rectal wall, which does not
exist in prolapse of the rectum.
• Recurrent intussusceptionis in 5-8% and is
more common after hydrostatic than surgical
reduction.
by zinash demissie

12. DIAGNOSIS
• Abd ultrasound:- tubular mass in longitudinal
views and a doughnut or target appearance in
transverse
• Ultrasound has a sensitivity of approximately
98-100% and a specificity of approximately 98%
 Air, hydrostatic (saline), and, less often,
water-soluble contrast enemas have replaced
barium examinations
by zinash demissie

13. DIFFERENTIAL DIAGNOSIS
• Gastroenteritis(but the pattern of illness,the
character of pain, or in the nature of vomiting
or the onset of rectal bleeding should alert the
physician)
• Meckel diverticulum (Bleeding is usually
painless)
• Henoch-Schönlein purpura (Ileoileal disease
common )
by zinash demissie

14. TREATMENT
• Spontaneous reduction in 4-10% of patients
• In patients with prolonged intussusception and
signs of shock, peritoneal irritation, intestinal
perforation, or pneumatosis intestinalis, multiple
recurrences (suspected lead point) hydrostatic
reduction should not be attempted
• hydrostatic reduction under fluoro-scopic or
ultrasonic guidance is approximately successful in
80-95% in patients with ileocolic intussusception.
by zinash demissie

15. • If manual operative reduction is impossible or
the bowel is not viable, resection of the intus-
susception is necessary, with end-to-end
anastomosis
by zinash demissie

16. PROGNOSIS
• Untreated intussusception in infants is usually
fatal. Recovery fast if reduced in 24 hrs.
mortality rate rises rapidly after the 2nd day.
• recurrence rate 10%Most recurrences occur
within 72 hr of reduction. Corticosteroids may
reduce recurrency
by zinash demissie