INTUSSUSCEPTION Dr Elio Quesada Gonzalez Consultant Pediatrician Introduction

INTUSSUSCEPTION Dr. Elio Quesada Gonzalez Consultant Pediatrician

�Introduction �Etiology �Pathophysiology �Clinical manifestation �Diagnosis �Differential diagnosis �Treatment

INTRODUCTION �Intussception is a condition in which a part of the intestine folds into the section next to it or when a portion of the alimentary tract is telescoped into the adjacent segment. It is the most commom cause of intestinal obstruction between 3 months and 6 yrs of age and the most common abdominal emergency in children less 2 yrs.

ETIOLOGY AND EPIDERMIOLOGY About 90% cases of intussusception in children are idiopathic. Risk was seen in children less 1 yr after receiving a tetravalent rhesus-human reassortant rotavirus vaccine, however, this vaccine is no longer available and the current rotavirus vaccine has not been associated with intussusception. In 2 -8% of patients some lead points for the intussusception has been found

Risk Factors � Meckel diverticulum � Intestinal polyp � Neurofibroma � Hemangioma � lymphoma � cystic fibrosis

PATHOPHYSIOLOGY Intussusceptions are most often ileocolic less commonly cecocolic, and rarely exclusively ileal. Very rarely, the appendix forms the apex of an intussusception. Mostly occur when the intussusceptum invaginates the intussuscipien pulling its mesentery into the enveloping loop. Constriction of the mesentery obstructs venous return; engorgement of the intussusceptum follows with edema and bleeding from the mucosa which leads to bloody stool, which sometimes contains mucus. This presentation must be distinguished From rectal prolapse Most intussusceptions do not strangulate the bowel within the first 24 hrs but can result in intestinal gangrene and shock

CLINICAL MANIFESTATION �Paroxysmal colicky pain �Lethargy �Respiratory distress �Vomitting(sometimes contains bile) �Bloody stool in the early phase �Little or no stool flatus in the late phase �Sepsis or shock can occur �fever

DIAGNOSIS �History physical findings �Ultrasound �Radiograph �Rectal examination �Air enema

Intussusception in an infant. The obstruction is evident in the proximal transverse colon. Contrast material

DIFFERENTIAL DIAGNOSIS �Enterocolitis �Meckel diverticulum �Henoch-schonlein purpura �Rectal prolapse

TREATMENT �Laparoscopy �Surgical reduction resection �Barium or water soluble enema

PROGNOSIS If left untreated could be fatal, and recovery after reduction is best within the first 24 hrs, increased mortality is seen after the second day. There is also reccurance after resection and it can be reduced with corticosteroid.

Reference � Nelson textbook of pediatrics(19 th edition) �wikipedia