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- Intussusception is the invagination of a proximal segment of bowel into the distal bowel lumen.
- The commonest occurrence is a segment of ileum moving into the colon through the ileo-caecal valve.
- Any age but commonly occurs in the 2 month to 2 years (peak 5 to 9 months).
- Intermittent pain which is colicky, severe and may be associated with the child drawing up the legs.
- Episodes typically occur 2-3 times/hour and may increase over the next 12-24 hours
- During these episodes of crying the child may look pale.
- vomiting is usually a prominent feature, but bile stained vomiting is a late sign
- Bowel motions
- Blood and/or mucus
- Classic red currant jelly stool is a late sign
- Abdominal mass – sausage shaped mass RUQ or crossing midline in epigastrium or behind the umbilicus, palpable in about two thirds of children.
- Distended abdomen
- Stool: Bloody stool/occult blood positive
- absence of bowel in the right lower quadrant (Dance’s sign)
- Signs of an acute bowel obstruction
- Hypovolaemic shock is a late sign
- Plain abdominal X-ray – to exclude perforation or bowel obstruction
- visible abdominal mass, abnormal wind pattern, dilated bowel loops, air-fluid level
- Target sign – 2 concentric circular radiolucent lines usually in the right upper quadrant
- Crescent sign – a crescent-shaped lucency usually in the left upper quadrant with a soft tissue mass
- Gas insufflation enema (or contrast enema)
- Diagnostic investigation of choice if high level of suspicion
- This intervention is both diagnostic and therapeutic
- Ultrasound scan
- soft-tissue mass, ‘doughnut sign’, pseudokidney/sandwich appearance, ‘target sign’
- Routine blood tests
- Blood glucose
- Blood group and hold prior to theatre
- FBE and U&E may be useful if the child looks unwell
- Nil by Mouth
- Nasogastric tube to decompress the bowel
- Start IV rehydration
- Refer to pediatric surgeons
- Ischaemia, infarction and necrosis