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Intussusception
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What
is it?
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Intussusception
occurs when a portion of the intestine folds like a telescope, with one
segment slipping inside another segment. It can occur anywhere in the
intestines. This causes an obstruction, preventing the passage of food that
is being digested through the intestine.
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Etiology
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The cause of intussusception is not known. Though rare, an increased incidence of
developing intussusception may be seen in children:
·
Who
have abdominal or intestinal tumors or masses
·
Who
have appendicitis
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Occurrence/Epidemiology
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Children less than 3 years old, can also
occur in older children, teenagers, and adults.
·
Intussusception
occurs more often in boys than girls.
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Clinical
Presentation
(subjective
and physical examination)
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Subjective: Pain,
Sudden loud crying, Straining, Draw knees up, Irritable.
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Objective: red
mucus or jelly like stool, fever, lethargic, vomiting bile, diarrhea,
sweating, dehydration, abdominal distention or lump.
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Diagnostic
Testing
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X-Ray: may
demonstrate an elongated soft tissue mass with a bowel obstruction proximal
to it.
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Ultrasound:
‘Target Sign’
also known as
the doughnut sign or bull’s eye sign. appearance is generated by concentric
alternating echogenic and hypoechogenic bands.
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Upper &
Lower GI Series (Barium Swallow & Enema): giving the “coiled spring”
appearance
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3
Differential Diagnosis
(include
difference between each differential diagnosis & the main diagnosis)
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Intussusception:
Pain, sudden
crying, red mucus or jelly like stool, fever, lethargic, vomiting bile,
diarrhea, sweating, dehydration, abdominal distention or lump.
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Gastroenteritis: vomiting that are typically nonbilious,
often with anorexia, fever, lethargy, and diarrhea.
No jelly
like stool
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Gastric
Volvulus: Epigastric
pain tenderness and distention, vomiting, bloody diarrhea
No jelly like stool
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Appendicitis: abdominal pain that has migrated from a
periumbilical position to the right lower quadrant.
No jelly
like stool or masses.
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Non-Pharmacologic
Management
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There are
currently no nonpharmacological treatments.
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Pharmacologic
Management
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May fix itself
while being diagnosed with barium enema.
Air enema (aids in moving intestines back).
Antibiotics if
infection present
Surgery: push
the telescoped intestine back out. Rare cases a resection of intestines may
happen, and stoma created.
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Follow
Up
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With toleration
of diet, patients treated with nonoperative reduction are usually discharged
12-18 hours after the therapeutic enema. After operative reduction,
postoperative progress dictates the length of stay.
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References
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Blanco, F. C.,
Chahine, A. A., King, L., & Wilkes, G. (2017, July
3). Intussusception: Practice Essentials, Background, Etiology and
Pathophysiology. Retrieved from http://emedicine.medscape.com/article/930708-overview#a1
Crawford, E. (2015). NP-Family Specialty Review
and Study Guide: A Series from StatPearls. Retrieved from https://books.google.com/books?id=86ybCgAAQBAJ&dq=intussusception+np+questions&source=gbs_navlinks_s
Epocrates. (2017). Intussusception Differential
Diagnosis – Epocrates Online. Retrieved from https://online.epocrates.com/diseases/67935/Intussusception/Differential-Diagnosis
Shah, V.,
& Amini, B. (2017). Intussusception | Radiology Reference Article |
Radiopaedia.org. Retrieved from
https://radiopaedia.org/articles/intussusception
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