PEDIATRIC SURGERY NOTES

Intussusception

Definition:

Telescoping of one portion of the intestine (intussusceptum) into an adjacent segment

(intussuscipiens), causing intestinal obstruction and sometimes intestinal ischemia.

Incidence:

Intussusception is the most common cause of intestinal obstruction in children before

age of 3 years. It occurs between 6 months & 3 years of age, with 65% of cases occurring
before age 1 & 90% occurring before age 2.

Causes:
 Primary Intussusception (Idiopathic 75% of cases).
 Secondary Intussusception occurs in 25% of cases, a
lead point (mass or intestinal abnormality) triggers the
telescoping. Examples include: polyps, lymphoma,
Meckel diverticulum, and immunoglobulin A-associated
vasculitis.

Symptoms & Signs:

The initial symptoms of intussusception are

sudden onset of severe, colicky abdominal pain
that recurs every 15 to 20 minutes. Between the
attacks of abdominal pain the child is calm.

Vomiting: early the vomiting is clear and it

may turn bile stained due to small intestinal
obstruction.

Passage of currant-jelly stool.

Signs
 On gentle abdominal examination a palpable abdominal mass (Sausage-shaped)
 Signs of peritonitis may be present if perforation happened with severe tenderness, guarding and rigidity.
 Pallor and tachycardia indicate shock.

Diagnosis:

Ultrasonography
 Ultrasound is available and is used for diagnosis and treatment.
 Ultrasound is diagnostic and shows the target sign.
 It is used widely in many centers to guide in hydrostatic reduction in early cases.
 Barium Enema

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 It is used in many centers and reveals the classic coiled-spring appearance around the intussusceptum.

Ultrasonography is the preferred method of diagnosis; it is easily done, relatively

inexpensive, available, and safe. The characteristic finding is termed (Target Sign)

22Target Sign

21Coiled-spring
Treatment:

Initially, naso-gastric suction, fluid resuscitation, and broad-spectrum antibiotics.

Surgical treatment.

 In early cases (clear vomiting, lax abdomen, & no signs of peritonitis)

 Hydrostatic reduction using warm saline enema guided by ultrasound
 Air enema reduction under C-arm
 Barium enema reduction
 In late cases (Bile stained vomiting, tender mass, & generalized abdominal tenderness) surgical treatment is
indicated.
 Abdominal exploration

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 Simple reduction
 If there is intestinal gangrene resection and anastomosis will be done.

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