Intussusception

What is it?

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.

Etiology

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

Occurrence/Epidemiology

Children less than 3 years old, can also occur in older children, teenagers, and adults.

· Intussusception occurs more often in boys than girls.

Clinical Presentation 

(subjective and physical examination)

Subjective: Pain, Sudden loud crying, Straining, Draw knees up, Irritable.

Objective: red mucus or jelly like stool, fever, lethargic, vomiting bile, diarrhea, sweating, dehydration, abdominal distention or lump.

Diagnostic Testing

X-Ray: may demonstrate an elongated soft tissue mass with a bowel obstruction proximal to it.

Ultrasound: ‘Target Sign’

also known as the doughnut sign or bull's eye sign. appearance is generated by concentric alternating echogenic and hypoechogenic bands.

Upper & Lower GI Series (Barium Swallow & Enema): giving the "coiled spring” appearance

3 Differential Diagnosis 

(include difference between each differential diagnosis & the main diagnosis)

Intussusception:

Pain, sudden crying, red mucus or jelly like stool, fever, lethargic, vomiting bile, diarrhea, sweating, dehydration, abdominal distention or lump.

Gastroenteritis: vomiting that are typically nonbilious, often with anorexia, fever, lethargy, and diarrhea.

No jelly like stool

Gastric Volvulus: Epigastric pain tenderness and distention, vomiting, bloody diarrhea

No jelly like stool

Appendicitis: abdominal pain that has migrated from a periumbilical position to the right lower quadrant.

No jelly like stool or masses.

Non-Pharmacologic Management

There are currently no nonpharmacological treatments.

Pharmacologic Management

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.

Follow Up

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.

References

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