Makindo Medical Notes

Related Subjects: |Encopresis in Children |Enuresis/Bedwetting in Children |Acute Glomerulonephritis in Children |Nephrotic Syndrome in Children |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Panayiotopoulos Syndrome in Children |Reflex anoxic attacks in Children

Introduction

• Intussusception causes intestinal obstruction when part of the small bowel telescopes into itself.
• This condition can affect patients of any age, but it is most common in infants
• Age of occurence typically between 5–12 months old, with a male-to-female ratio of approximately 3:1.

Clinical Presentation

• Intermittent, episodic, inconsolable crying, often accompanied by drawing the legs up to the abdomen (colicky pain).
• Vomiting may occur, and in some cases, blood may be present in the stools. The blood may resemble "red-currant jam" or just appear as small flecks, which is a late sign.
• A sausage-shaped abdominal mass may be palpable upon examination.
• In severe cases, the child may present in shock and appear moribund.
• Between episodes of pain, the child may appear well with no noticeable signs.

Diagnosis and Tests

• Ultrasound (US): The least invasive and most commonly used diagnostic tool. It can reveal the presence of intussusception and, in some cases, can be used for reduction (air enema).
• Air Enema: Preferred over barium for reduction of intussusception, as it is less invasive and has fewer risks.
• CT Scan: While CT may show a right lower quadrant opacity and possible perforation, it is less commonly used due to availability issues and potential complications.
• Plain Abdominal X-ray: May show an opacity in the right lower quadrant, and can help identify perforation, though this is less specific.

Management

• Non-surgical Reduction: If intussusception is diagnosed, the first-line treatment is to attempt reduction using an air enema. This approach is preferred over barium enema due to its safety profile.
• Surgical Intervention: If reduction via enema fails, surgical intervention via laparoscopy or laparotomy is necessary to reduce the intussusception and, if necessary, resect necrotic bowel tissue.
• Pre-operative Care: Resuscitation is crucial, including fluid replacement. Blood should be cross-matched in preparation for potential surgery, and a nasogastric tube should be placed to decompress the stomach.

Special Considerations

• Children Over 4 Years: Older children present differently from infants. Rectal bleeding is less common, and they may have a longer history of symptoms (e.g., >3 weeks). Conditions such as cystic fibrosis, Henoch–Schönlein purpura, Peutz–Jeghers syndrome, ascariasis, nephrotic syndrome, or lymphomas can contribute to intussusception in this age group.
• Obstructive Symptoms: In older children, obstructive symptoms caused by intussusception are often the first sign of underlying pathology, such as tumors or systemic diseases.

Recurrence and Prognosis

• Recurrence Rate: The recurrence rate of intussusception is approximately 5–15% in infants following initial successful reduction.
• Overall Prognosis: Most children recover well with appropriate treatment, but prompt diagnosis and management are critical to avoid complications like bowel perforation or necrosis.