IntussusceptioIntussusceptionn

• Telescoping of one segment of Telescoping of one segment of intestine into another, usually intestine into another, usually proximal into the immediately proximal into the immediately distal segment. distal segment.

• Commonest site : Terminal ileum Commonest site : Terminal ileum into right colon - ileocolic.into right colon - ileocolic.

PartsParts

• IntussusceptumIntussusceptum

• IntussuscepiensIntussuscepiens

• NeckNeck

• ApexApex

ClassificationClassification

•Primary: Primary: Idiopathic - 95% casesIdiopathic - 95% cases

Seen in infantsSeen in infants

•SecondarySecondary

PrimaryPrimary

• Factors :Factors :

i) Attack of gastroenteritis / i) Attack of gastroenteritis / Preceding viral infectionPreceding viral infection

ii) Relatively mobile ileum ii) Relatively mobile ileum opening into fixed caecumopening into fixed caecum

iii) Presence of Peyers patchesiii) Presence of Peyers patches

SecondarySecondary

Meckel’s diverticulumMeckel’s diverticulum

Intramural haematomaIntramural haematoma

Submucous hamartomaSubmucous hamartoma

PolypsPolyps

Intestinal lymphomaIntestinal lymphoma

PathophysiologyPathophysiology

Intestinal Obstruction

Lymphatic obstruction

Venous obstruction

Arterial obstruction

Clinical presentationClinical presentation

•Age : 4-10 months. Age : 4-10 months.

Can occur in older Can occur in older

childrenchildren

•Well fed babies during Well fed babies during

weaningweaning

•M:F 3:1M:F 3:1

SymptomsSymptoms

• Intermittent inconsolable cryIntermittent inconsolable cry

• Colicky abdominal pain, Colicky abdominal pain,

vomiting, abdominal distentionvomiting, abdominal distention

• RED CURRANT JELLY STOOLSRED CURRANT JELLY STOOLS

SignsSigns

• Dehydration / ShockDehydration / Shock

• Sausage shaped mass shifting in siteSausage shaped mass shifting in site

• Empty right iliac fossa-sign de danceEmpty right iliac fossa-sign de dance

• PR – Blood staining of fingerPR – Blood staining of finger

Mass per rectumMass per rectum

ULTRASOUNDULTRASOUND

DOUGHNUT SHAPED MASS

PSEUDOKIDNEY SIGN

BARIUM ENEMABARIUM ENEMA

CLAW/PINCER SIGN

SPRING COIL APPEARANCE

TreatmentTreatment

• RESUSCITATIONRESUSCITATION

• NON-OPERATIVENON-OPERATIVE

• OPERATIVEOPERATIVE

Non-OperativeNon-Operative• Indication – early presentation in Indication – early presentation in

infantsinfants

• MethodsMethods

Hydrostatic – USG guidedHydrostatic – USG guided

Pneumatic - Fluoroscopy guidedPneumatic - Fluoroscopy guided

Barium - Fluoroscopy guidedBarium - Fluoroscopy guided

OPERATIVEOPERATIVE

• Indications:Indications:

Failed reductionFailed reduction

Delayed presentationDelayed presentation

Signs of bowel ischemiaSigns of bowel ischemia

Child > 1yrChild > 1yr

RecurrenceRecurrence

Procedure:

Reduction by gentle pushing, look for

lead point.

Resection and anastamosis if

gangrene is present