TOPIC

INTUSSUSCEPTION

CASE
BABY : CINDY

DIKKI DRAJAT
GASTROINTESTINAL SYSTEM
Topic : Intussusception

Theme :

The week will center around the pathophysiology, management and complication of
intussusception.

Learning objectives

After completing Cindy’s case the students will be able to :

1. Describe the definition of intussusception and terminology of intussuscipient and

intussusceptum
2. Describe the etiologic factors of intussusception.
3. Describe the incidence of intussusception
4. Describe the pathogenesis of intussusception.
5. Describe the signs and symptoms of intussusception.
6. Describe diagnostic modalities of intussusception.
7. Discuss the differential diagnosis of intussusception.
8. Differentiate between dysentery and intussusception.
9. Describe the management plan for this case
10. Discuss the supportive treatments of intussusception.
11. Explain definitive treatments of intussusception
12. Describe the contra–indication of hydrostatic reduction.
13. Describe the complications of intussusception.
14. Describe post operative complications
15. Describe all informed consents should be given for such a patient.
Case Synopsis :

Page 1

Cindy, a 9 month old baby girl was admitted to Surgical E.R. Hasan Sadikin hospital
In Bandung with chief complaint of bloody and mucous stool .

History:
The baby have had bloody and mucous stool since two days ago.
Previously the mother noticed that her baby seemed restless, crying loudly &
intermittently paused by a periodic sleep. This complaint was noted a day before bloody
stool encountered. She also has got a greenish vomit.
The baby’s weight at the time is 10 kg.

Previously she was brought to local GP’s and she suggested to seek a medical care as
soon as possible at surgical emergency unit, unfortunately the referral letter was lost.

What seems to be Cindy’s problem ?

List your hypotheses and state the rastionale of each
 Page 2

After having the history taken, you examine the baby and reveal that:

General condition: conscious, HR: 112 /min, RR: 32 /min, T: 37,2 ºC

Head: slight depress on fontanel
Dry lips
Thorax: Heart and Lung within normal limit.
Abdomen: slightly distended, no muscle rigidity and there is palpable mass around the
epigastrium. There is also increased bowel sound.

On digital rectal examination::

There is bloody–mucous stool at the glove, no portio like appearance.

Has this information changed your hypotheses

What more information do you need ?
 Page 3

The laboratory findings are:

Hemoglobin: 12,6 gr/dl

Leucocyt: 9.000 cell/mm3
Faeces: erythrocyte many, leucocyte 0-2, mucous +++,
Amebic cyst & trophozoit forms -

Imaging :

Plain Abdominal X- ray shows that the bowel gas distribution increase, air fluid level is
also seen and there’s soft tissue mass appearance across central abdomen .

Abdominal ultrasound reveals ‘doughnut’ or target sign

1. What have you learned so far?

2. If the diagnosis has been established what do you plan to do.
 Page 4

The surgeon in charge at surgical E.R diagnosed Intussusception and after giving initial
therapy, he decides that hydrostatic reduction shoud be undertaken and emergency
laparotomy should be performed if reduction is failed

What do you think about this decision? Describe any kind of reduction therapy you
know !

Describe all informed consent needed for the parents!.

 Page5

After three attempts of each three minute normal saline flushing by ultrasound guiding
hydrostatic technique, the procedure is considered to have failed and the baby is proceed
to have an emergency laparotomy.

During operation the surgeon find:

 Clear peritoneal fluid
 Ileo- colica intussusception

The surgeon successfully release the intussusception by milking technique. The bowel
which involved in intussusception is still vital.
 Page 6

Epilogue :

After surgery, the patient resumes her diet on the second postoperative day, and recovers
well.

By the end of the fourth post-operative day, the patient is discharged

Tutor guide :

Guiding questions

It is intended to help students focus on learning objectives and to be employed at tutor’s

discretion.

1. What is the definition of intussusception ?

2. What is the intussuscipien and intussusceptum?
3. What are the etiologic factors related to intussusception and how is the classification?
4. What is the age related incidence?
5. What are the leading points of intussusception?
6. How is the pathogenesis of intussusception?
7. What are the signs and symptoms of intussusception?
8. What is intussusception triad?
9. What kind of modality could be used in establishing diagnosis?
10. What is the typical finding of each diagnostic tools?
11. What are the steps of management for intussusception?
12. What kind of complication should happened in such patien? How is the
pathophysiology?
13. What are the initial therapy of intussusception patient?
14. When should Barium enema be undertaken?
15. What are treatment options for intussusception
16. What are the indications of Barium enema / hydrostatic reduction therapy.
17. What are the contra indications of hydrostatic reduction therapy
18. What are the surgical options for intussusception based on operative findings ?
19. What is informed consent?
20. What kind of informed consent should be given for such patien?
Kepustakaan :

1. Young D G : Intussusception , in : O’ Neill’s Pediatric surgery . 5 th ed., 1998,

Mosby yearbook publisher, St Louis Missoury, pp 1185-1194